Combo with "Mastery of the Environment: Evaluation & Intervention" and 2 others

National Registry of Rehabilitation Technology Suppliers

-helps to develop standards and measuring tools to ensure proper design, fabrication, prescription, and delivery of rehabilitation technology

Functional Impairments: Ideational apraxia?

- Breakdown in knowledge of what is to be done or how to perform - Lack of knowledge re: object use -neuronal model about the concept of how to perform is lost although the sensorimotor system may be intact

Psychoeducational group?

- Classroom format & principles of learning to provide info. to members and to teach skills - Teacher/student relationship exists - Use of Homework encouraged to facilitate skill development & generalization of learning

Program evaluation and quality improvement - Major types and terms: Peer review

-A system in which the quality of work of a group of health professionals is reviewed by their peers

Program evaluation and quality improvement - Major types and terms: Continuous quality improvement (CQI)

-A system-oriented approach that views limitations and problems proactively as opportunities to increase quality -Prevention is emphasized -Blame is not attributed to persons; problems are related to organizational improvement needs

Rigidity

-increased resistance to passive movement throughout the range -"cogwheel" (alternative contradiction/relation of muscles being stretched) -"lead pipe" (consistent contraction throughout range)

Parking spaces

-should have an adjacent 4 foot aisle to allow wheelchairs to maneuver

virtual context

-refers to the environment in which communication occurs by means of airways or computers and an absence of physical contact -for example: email, video conferencing, web-based social networking

What gross motor skills are developed at 3-4 months in standing?

1) bears some weight on legs 2) head in midline 3) pelvis and hips are behind shoulders 4) legs are apart

What are the gross motor skills of a 9 month old in prone?

1) begins to dislike prone position

What gross motor skills are developed at 10-14 months in walking?

1) walks 2) stoops and recovers

At what age are self-dressing skills of removes coat, shoes, pull down pants, finds are holes?

2 years

Acute Care Hospitals:

Admission is for medical or psychiatric diagnosis that cannot be treated on an outpatient basis.

A reminiscence group for Alzheimer patients is what type of intervention?

Maintenance

Interventions designed to support and preserve the individual's current functional level

Maintenance

Interventions designed to reduce or minimize disruptive behaviors that interfere with therapy

Management (anxiety)

Early Intervention and Education Acts

Mandates FAPE for all children regardless of ability or disability (3-21) in the LRE; mainstreaming, public school provide OT, OT as primary service, funding for family support svcs, recomm. for states to develop infant/toddler programs

State Regulatory Boards (SRBs)

Public bodies created by state legislatures to assure the health and safety of the citizens - Protect the public from potential harm that might be caused by incompetent or unqualified practitioners

What gross motor skills are developed at 11-24 months in sitting?

Rises from supine by rolling then pushing up into sitting

What type of teaching is acting out scenarios and assuming roles?

Role Play

What type of social play do 4-5 year olds participate in?

Role play Dress up Tell stories Pretend play with scripts

What extrinsic flexor muscles of the hand are innervated by the ulnar nerve?

Flexor digitorum profoundus

What righting reaction elicits increased extensor muscle tone when placed in supine?

Tonic labyrinthine supine Onset- 37 weeks gestation Integrates- 6 months Clinical use- facilitates total body extension

Assessment of Task performance: How are the TOA and SIS scores used?

Used as indicators of overall func. perf. and provide info. about person's cog., affective, social and perceptual motor skills

What are Correlational Statistics? - Include testing measures

Used to determine relationships between two variables. - Pearson used to correlate interval or ratio data - Spearman used to correlate ordinal data - Intraclass correlation coefficient (ICC): reliability coefficient based on an analysis of variance.

Task analysis

break down activity

Practice of motor learning: Variable conditions

practice of skills in various contexts to improve transfer of learning and retention

Reflex Testing for Motor Control: STNR

stimuli: flexion of the head followed by head extension response - flexion of head results in flexion of arms/extension of legs and extension of head results in extension of arms/flexion of legs

Reflex Testing for Motor Control: Body righting acting on the body

stimulus - head rotation to one side response - segmental rotation of the trunk

OTAs with one year of experience

can supervise an OTA level II fieldwork student

Cock-Up Splint

carpal tunnel, radial nerve palsy, wrist extensor tendonitis, colles' fracture, RA, RSD,

Screening tools include

chart reviews, brief interviews, structured observations, and checklists....

Dynamic MCP Flexion Splint

combined median/ulnar nerve injury

School Function Assessment (SFA)

focus: assesses and monitors functional performance in order to promote participation in school environment pop: not listed

Coping Inventory and Early Coping Inventory

focus: assesses coping habits pop: coping inventory: 15 yrs + early coping inventory: 4-36 mo

Test of Visual-Perceptual Skills (TVPS3)

focus: assesses visual-perceptual skills and differentiates from motor dysfunction pop: 4-19 yrs

What is an independent variable?

- the presumed cause of the dependent variable - the treatment you're using to make changes in the subjects/clients

Average w/c length

-42-43 inches -360 degree w/c turning space requires a clearance space of 60inchx60 inch

Pathways/Walkways

-48inches wide

What is the intervention of medina nerve lacerations?

1) Dorsal protection splint Low lesion- dorsal protection splint 30' wrist flexion High lesion- above and include 90' elbow flexion 2) 2wks post op- A/PROM of digits with wrist flexed 3) scar management 4) 4 wks- AROM 5) 9 wks- strengthening

Considerations in activity selection for a group?

-Degree of structure (inherent or imposed) -Types & degree of instruction provided -Degree of new learning required -Complexity of the activity -Length of time for completion -Nature& degree of skill required for engagement & completion -Degree of challenge to members' skills

Anticonvulsants

-Depakote, Tegretol, Neurontin -Side effects include dizziness, drowsiness, ataxia, weight gain, sedation

Diagnostic criteria for dysthymia

-Dysthymia is characterized by at least 2 years of a depressed mood, most days, with depressive symptoms that are not severe enough to meet the criteria for a major depressive episode

Global aphasia

-Involves all forms of aphasia

Visual-perceptual Driving Eval

-intact acuity, night vision, contrast sensitivity, peripheral field, scanning, spatial relations, and depth perception are needed to access essential visual 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

Intervention Strategies for aphasia?

-decrease external auditory stimuli -give them increased response time -use visual cues & gestures -use concise sentences -use of augmentative communication devices

reclining back w/c

-indicated for individuals who are unable to independently maintain an upright sitting position

What is the medical management of Osteogensis Imperfecta?

1) cast and brace 2) pain management 3) audiological consult 4) reduce act, that cause fx 5)

What gross motor skills are developed at 0-3 months in supine?

1) head held to one side 2) able to turn head side to side

What gross motor skills are developed at 6-14 months in rolling?

1) rolls segmentally initiating with head, shoulders or hips

What gross motor skills are developed at 18 months in walking?

1) seldom falls 2) runs stiffly with eyes on ground

What gross motor skills are developed at 5-10 months in sitting?

1) sits alone steadily 2) play with toys in sitting

Four basic steps of program development

1. Needs assessment 2. Program planning 3. Program implementation 4. Program evaluation

What are performance skills? 1. _____individuals use to participate in daily occupation

1. Observable, concrete, goal-directed actions individuals use to participate in daily occupation

What is an OT referral? 1. Request for _____

1. Request for OT service- orders or consultation ***Ability to act on a referral depends on specific state licensure laws and reimbursed

What social skills are developed at the ages 3-4 years?

Attempts challenging act, Group play vs parallel play Turn taking Social aspects of conversation Prefers same sex playmates

What is Osteogensis Imperfecta?

Autosomal dominant inherited disorder Signs and symptoms Fractures in utero Brittle bones Multiple fx as child grows Deformities of arms and legs Developmental growth problems Eye deformities- blue sclera & cataract Risk of hearing impaired

Clinical reasoning 1. Deals with how disability affects person, involves therapeutic relationships and facilitates effective tx

Interactive Reasoning

Management

Interventions designed to reduce or minimized disruptive or undesirable behavior that interfere with procedures needed to change areas of dysfunction: - modify/compensate/adapt - support ability and increase to engage

What is the difference between an intraarticular and extraarticular fracture?

Intraarticular fx- fx in the joint space Extraarticular fx- fx outside of joint space

What is Claw hand?

Flexion of index and middle finger

What wrist flexors are innervated by the median nerve?

Flexor carpi radialis Palmaris longus

Assessment that involves asking specific questions.

Interviews

What is the purpose of a budget?

It financially projects, for a specified time period, the costs of managing a program and the anticipated revenue from services.

What muscles are responsible for scapula downward rotation?

Levator scapulae- c3-c4 nerves Rhomboidal- dorsal scapula nerve Serratus anterior Latissimus dorsi

What are Kohlbergs stages of moral development? (psychsocial)

Level 1- up to age of 8 1) stage 1 punishment obedience 2) stage 2 moral choices bases on self benefit Level 2- 9-10 years 1) stage 1 social conformity 2) stage 2 law and order, social norms Level 3- age ranges vary some will not achieve 1) social contracts,influence decisions

How do you facilitate swallowing?

Lip closure Slight downward pressure to middle aspect of tongue

Primitive Reflex Testing for Oral Motor Eval: Bite reflex

Long tongue depressor is placed lightly between the upper and lower teeth Dys. is a reflexive bite

Sensory Integration principles & schizophrenia patients (psychosocial frame of reference)?

Lorna Jean King based on work of A. Jean Ayres worked w/ppl w/chronic schizophrenia&observed this: -Posture: limited ability of head to tip back, an S curve of spine & pattern of holding the arms & legs in a flexed, adducted, &internally rotated pattern -shuffling gait; poor balance -poor hand fx: adduction of thumb, atrophy of thenar eminence, ulnar deviation & weak hand grip strength -right & left dominance confusion -inability to hold arms over the head -decreased responsiveness to vestibular input -decreased like of movement -poor muscle tone

Bradykinesia

overall slowing of movement patterns

What is Zone V of the hand?

MCP

What are the hand antideformity positions following a brain injury?

MCP flexion 70' IP extension Thumb abduction

Expressive/creative arts therapist

May or may not be licensed or registered; includes art, dance/movement, music, horticulture and poetry therapists; facilitates self-expression, self-awareness, social skills, symp. reduction and management

General Assessments of Mental Status: Mini-Mental State Examination (Folstein Mini-Mental) (focus, method, scoring, population)?

widely used, Quick screening test of cog functioning. -Method: structured tasks in interview format; part 1 req. verbal responses to assess orientation, memory, attention; part 2 assesses abil. to write sentence, name objs, follow verbal&written directions, & copy complex polygon design -Scoring: point value of each item ranges 1-5, max score=30 (below 24 indicates cognitive impairment) - Pop.: indiv. w/cognitive or psychiatric dysfunction

Assessments of Cognition, Affect &/or Sensory Processing: Beck Depression Inventory (focus, method, scoring, population)?

Measurement of the presence and depth of depression (high score=high depression) - Method: admin. by interview or completed as questionnaire by indiv.; indiv. rates feelings relative to 21 char. associated w/depression - Scoring: items scored 0-3 (3 being most severe), score >21 indicates severe depression - Pop.: adolescent and adult

Validity

Measures assessment's accuracy to determine if the tool measures what it's intended to.

What are the classifications of burns?

Superficial Superficial partial thickness Deep partial thickness Full thickness Forth degree

managed care

Method of maintaining costs and services. Most common is HMO and PPO.

What muscles are responsible for shoulder abduction?

Middle deltoid Axillary nerve

What scapula muscles are responsible for scapula adduction?

Middle trapezius Rhomboid major

What gross motor skills are developed at 0-1 months in release?

No release

What releasing skills develop at 0-1 months?

No release present

Clinical reasoning Deals with individual occupational story and focuses on process of change needed. Determines priorities of intervention and outcomes that are valued by clt.

Narrative Reasoning

Occupational story, valued roles/activities prior to decline, client's priorities are examples of what type of reasoning?

Narrative reasoning

Spearman's rank correlation coefficient is used to correlate what type of data?

Ordinal (nonparametric test)

What prewriting skills develop at 1 to 1 1/2 years?

Palmar-supinate grasp- 1) fisted grasp 2) wrist slightly flexed 3) slightly supinated 4) whole arm movements

What fine motor skills are developed at 5 months in grasp?

Palmer grasp

What type of social play does a 2-3 year old participate in?

Parallel Play Cooperative play Increased interest in peers

Developmental Groups

Parallel, Project, Egocentric cooperative, Cooperative, and Mature.

What dorsal muscles of the forearm are innervated by the radial nerve?

Supinator

What SITS muscle is involved in shoulder abduction and flexion?

Supraspinatus- suprascapilar nerve

Beneficiary

The recipient of health care services. In a SNF, this is a "resident"

How is a frame of reference important when selecting an OT evaluation tool?

The tool should be compatible with the FOR selected for intervention plan.

What are the types of groups?

Thematic Topical Task-oriented Developmental Instrumental group

Part A Medicare

Pays for inpt hospital, SNF, home health and hospice care (automatically provided to all who are covered by SS system that meet above criteria); services have specific time limits and require deductible and coinsurance payments by beneficiary; req. svcs min. of 5 days/week

Management by Objective (MBO)

Complete system of management based upon a core set of goals to be accomplished by a program

What are two types pf nerve injury?

Compression Laceration

What are the 2 types of criterion validity?

Concurrent: compares results of 2 instruments given at about the same time. Predictive: compares the degree to which the assessment can predict performance on a future criterion.

What releasing skills develop at 9 months?

Release with full are extension

What is volition?

Thoughts and feelings that motivate people to act and is comprised of personal causation, values, interests

What gross motor skills are developed at 2-3 years?

Rides tricycle Catches large ball against chest Jumps from step Hop on one foot

What is Personnel Management? What does it include?

The oversight of OT practitioners and support personnel and the services they provide. Includes: 1. Design work roles and write job descriptions 2. Recruit, select, and orient personnel to perform the roles 3. Supervise and evaluate personnel to ensure adequate role performance and organization 4. Support ongoing professional development 5. Deal with personnel issues as they arise.

What are the axilla antideformity positions following a brain injury?

Shoulder abduction 90' External rotation

Group Decision Making

Unanimous, Consensus (agree to majority decision but retain right to reconsider), Majority rule, Compromise.

NDT/Bobath: Inhibition Techniques

Use inhibition techniques to decrease synergistic movement, hypertonicity, and asymmetrical posture

What is zone VII of hand?

Wrist and proximal

What deformities occur for radial nerve lesion?

Wrist drop

What splint is recommended for a dorsal burn of the hand?

Wrist extension 30-45' MCP joints 70-90' flexion IP joint flexion Thumb abduction and extension

Can the OTA assist with the evaluation?

Yes, once service competency is established and with OT supervision, the OT decides which assessments will be used

What are the age catagories of the elderly?

Young elderly 65-74 Old elderly 75-84 Old and frail elderly above 85

What is Zone I of the hand?

Zone I- the tip of the finger to the middle of middle phalanx. Its contains only flexor digitorum profundus. DIP Mallet finger deformity

What is zone III of the hand?

Zone III- extends from distal palmar crease to the distal edge of flexor carpal ligament. Boutonnière deformity PIP It is also called lumbrical zone because of the presence of lumbricals in this zone

wellness and prevention program

acceptance is most often by individuals self referral to meet a personal need or by an institution example parenting skill classes or pregnant teens in a schools

Functional Impairments: Agraphia?

acquired inability to write

Total Quality management

all employees contribute to environment of continuous improvement

Functional Impairments: Figure/ground dysfunction?

an inability to distinguish foreground from background

temporal balance and regulatiry

between work/productive activities, leisure/play, and rest

"reasonable accommodations"

biz with over 15 employees, allow employees to perform essential job functions unless they would impose "undue hardship" on the business

love and accepatance

from own characteristics not accomplishments...barriers can include aphasia and dyslexia

Occupation

goal-directed pursuits that have purpose, value and meaning to performer and involved multiple tasks: - different contexts - interdependent (work to play, play to work) - can be used as a "means" or "end or desired outcome"

Referral order can range from _____________ and ________________

highly specific (resting hand splint required) to very general (evaluation for developmental delay)

Functional Impairments: Right-left indiscrimination?

inability to discriminate between the right & left sides of the body or to apply the concepts of right & left to the environment

Akinesia

inability to initiate movements

Functional Impairments: Impaired problem solving?

inability to manipulate a fund of knowledge & apply this info to new or unfamiliar situations

Entry level OT

close supervision by all levels of OT, or intermediate advance OTA who is under supervision of OT. can supervise aide, volunteers, and technicians.

diagnosis code

code that describe's a patient's medical reason or condition that requires health service

Practice of motor learning: Mental practice

cognitive rehearsal of the skill without actual movement

Activity Synthesis

combine info from activity and person to ensure that it is a suitable match for needs/abiliites....may need to modify/adapt

Homebound status criteria

confinement, based on necessity of adaptive equipment for mobility, need for assistance from others, or "considerable and taxing effort" to leave home. May leave home for medical appt and non-medical infrequent appts (hair, church, etc)

OT hospice care

covered if terminally ill (<6 months to live)

Operating expense budgets

daily financial activity, salary, housekeeping, marketing, rent

Face validity

face value of the assessment tool; it appears to measure what it's supposed to measure.

Functional Impairments: Unilateral body neglect?

failure to respond to or report unilateral stimulus presented to the bodyside CONTRAlateral to the lesion

Kleinert/Duran Dorsal Protection Splint

flexor tendon injury

Sensory Profile (SP): Adolescent/Adult SP

focus: allows pts to id personal behavioral responses and develop strategies for enhanced participation pop: 11-65 yrs

Participation Scale (P-Scale)

focus: measure of restrictions in social participation related to comm mobility, access, reaction, social interactions pop: 15 yrs+ with physical disabilities

self-actualization

participate in activities for one's own self and personal satisifaction

OT is covered in SNFs if...

patient requires skilled therapy on a daily basis

co-insurance

percentage charged to a patient

Capital expense budgets

permanent/long term purchases such as kitchen, new facilities, usually above a fixed amount (500+)

Intervention for tongue thurst, tonic bite

press bowl of spoon down and hold on tongue; thick food for tongue thrust

Continuous Quality Improvement

prevention emphasized, blame attributed to program, not persons.

Practice of motor learning: Blocked practice

repeated performance of the same motor skill

Utilization review

review the resources, cost effectiveness, usually a part of CQI

intermediate level OT

routine to general supervision by OT and advance OTA. can supervise aide, volunteers, technicians and entry level OTA. and level one OT student and level one and two OTA student.

Heuristic.

Complete involvement of the researcher in the experience of the subjects to understand and interpret a phenomenon. - To understand human experience and its meaning. - Idea that meaning can only be understood if personally experienced.

Topical Group

Discuss specific activities that members are engaged in outside of group to allow them to be more effective and satisfy needs (ex: parenting skills group for parents of children with disabilities).

What is the purpose of documentation?

Legal, serial record of clt condition in eval, re-eval, intervention, response to tx and referral for d/c Reference for non-primary therapist Enhance healthcare communication Provide data for program evaluation, education and research

Gestational diabetes

-2-5% of all pregnancies (40% may go on later to develop Type 2 diabetes in later life) -Usually resolves after pregnancy -Occurs at greater frequency in people in race/ethnicity risk groups -Obesity is another risk factor

What scissor skills develop at 4-6 years?

1) cutting simple figure shapes

What are the areas of work?

1) employment interests- identifying work interests 2) employment seeking 3) job performance 4) retirement 5) volunteer exploration 6) volunteer participation

What is included in the occupational profile evaluation?

1) Who is the client 2) Why do they need services 3) What areas of occupation are there deficits and success 4) What are supports and barriers of an enviro or context 5) Clt. occupational hx 6) Clt. priorities

What type of hand splint is recommended for a volar surface of hand?

1) Wrist extension 0-30' 2) MCP joint in neutral and abduction IP joint in full extension Thumb abduction and extension

What are complications of a hip fx?

1) avascular necrosis 2) non-union 3) DJD 4) all of the above may result in total hip replacement

What are the type of hip fx?

1) femoral neck 2) intertrochanteric fx 3) subtrochanteric fx

Intradisciplinary team

One or more members of one discipline evaluate, plan and implement tx of the individual; other disciplines not involved; limited commun.

What releasing skills develop at 6-7 months?

One stage transfer- simultaneously taking with one hand and releasing with other hand

Type of medical tx that stabilizes fx by surgical nails, screws, plates or wires?

Open reduction internal fixation ORIF

fee for service

Payment system. The provider is paid the same rate per unit of service. Usually the payer pays 80%

What grasping skills develop at 8 months?

Pellet object Scissors grasp- between thumb and curled index finger Cube object Radial digital grasp- object held with opposed thumb and finger tips

Functional Impairments: Alexia?

acquired inability to read

residential programs

admission is for a developmental, medical or psychiatric condition that has resulted in functional deficits that impede independent living but are not severe enough to require hospitalization

Test of Playfullness (TOP)

focus: assesses a child's playfulness based on observations pop: 15 mo - 10 yrs

Assessment of Premature Infants' Behavior (APIB)

focus: assesses infant's pattern of developing behavioral organization in response to increasing sensory/environmental stimuli pop: premature infants

Play History

focus: assesses play behavior and opportunities pop: children, adolescents

Toddler and Infant Motor Evaluation (TIME)

focus: assesses quality of movement pop: 0-3 yrs 6 mo

Ataxia

-The irregularity or failure of muscle coordination upon movement

Impact of manic episode on function

-The lack of inhibition experienced during a manic phase may lead to excessive spending, impulsive travel, flamboyant an promiscuous dress and/or behavior, etc -Individuals may be euphoric in early phases, but may become labile, threatening, and assaultive -Individuals may have high, often undirected, energy levels and require little sleep -Poor judgement can lead to dangerous situations, poor self-care, problems in relationships, and decreased or irresponsible work performance -The incidence of substance abuse is increased

Echopraxia

-The meaningless imitation of another person's movement

Prospective payment system (PPS)

-The nationwide payment schedule that determines the Medicare payment for each inpatient stay of a Medicare beneficiary based on DRGs

Tangentiality

-The abrupt changing of focus to a loosely associated topic

What is the most common wrist fx?

Scaphoid fx Poor blood supply requires longer to heal

What is the OT evaluation for a school setting?

(1) Assess client factors, performance skills and patterns and areas of occupation, that impact on the educational and functional performance of the child within the school (2) Assess the child's functional and developmental level to contribute to the functional behavioral analysis

What gross motor skills are developed at 12 months in standing?

1) equilibrium reactions present in standing

What gross motor skills are developed at 2-3 months in standing?

1) legs may give way when held in standing

Physical/non-human environment

-everything that is non-human (buildings, objects, tools, devices, animals, trees)

Functional Impairments: Impaired attention?

-an inability to attend to or focus on specific stimuli -may result in distraction by irrelevant stimuli -includes difficulty w/ sustained attention & selective attention in addition to dividing & altering attention between two tasks

stander w/c

-designed to enable a person to independently change seat height and/or elevate to a standing position

stair-climbing w/c

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

Meeting health needs

...interventions designed to satisifty inherent, universal human needs (food, clothes, shelter) needs to automatically meet

Exploratory Play

0-2 yrs; develops body scheme; sensory integrative and motor skills developed with play; plays mostly with caregivers

What are the areas of temporal context that needs to be addressed with evaluation tools?

1) chronological & developmental age 2) duration of disability ( long term, short term, permanent) 3) stage of illness ( acute, chronic, exacerbation, terminal)

What are some comon vision declines as we age?

1) decrease ability to adapt to dark then bright light 2) sensitivity to glare 3) loss of color discrimination

What are the clinical implications affect the neurological system of the elderly population?

1) decrease cerebral blood flow 2) decrease speed and coordination 3) decrease reaction time 4)decrease motor planning 5) recruit aid from other senses to effectively process motor movements.

What are the type of group leaderships?

1) directive leadership 2) facilitative leadership 3) advisory leadership 4) co-leadership

What gross motor skills are developed at 6-11 months in sitting?

1) prone to sitting

What gross motor skills are developed at 10-12 months in sitting?

1) protective extension backwards 2) move in and out of sitting position

What gross motor skills are developed at 6-12 months in standing?

1) pulls to standing using furniture

What gross motor skills are developed at 9-13 months in standing?

1) pulls to standing using leg only 2) stands alone momentarily

What are the guidelines for OTA documentation?

1) qualified to write notes in chart 2) AOTA does not require co-sign, but maybe required at state level

What are the areas of intervention review?

1) reevaluate plan and target outcomes 2) need to continue, d/c or referral POC

What is included in an OT eval of a hip fx?

1) review precautions and weight bearing status 2) occupational roles 3) ADL- dressing, bathing, transfers 4) ROM and strength of UE 5) other assessments as warranted

What gross motor skills are developed at 9-18 months in sitting?

1) rises in supine by rolling in prone and pushing up on all 4s

What gross motor skills are developed at 5-6 months in rolling?

1) rolls from prone to supine 2) rolls supine to side with R and L leg moving independently 3) rolls supine to prone with R and L legs moving independently

What gross motor skills are developed at 8-9 months in standing?

1) rotates trunk over LE 2) increase LE muscle activation when pulling to standing 3) transitions to standing by kneeling, then half-kneeling

What are the areas of intervention implementation?

1) select type of intervention 2) monitor clt. response through assessment and reassessment

What are therapeutic group norms?

1) self-reflection 2) reinforce value 3) establish support and safety atmosphere 4) maintain confidence

What are the different types of development?

1) sensorimotor 2) reflex development & integration 3) motor development 4) cognitive development 5) self-care development 6) play development

What gross motor skills are developed at 8-10 months in sitting?

1) sits well without support 2) legs closer, upright position, knees straight 3) increase sitting positions, w sitting and side sitting 4) fine motor skills with wide base os support

What are environmental context areas to asses before selecting an evaluation tool?

1) social cultural- roles, values norms, supports. 2) physical environment Will they have to perform certain tasks assessed in evaluation tool upon discharge. If not assessment is not warranted.

What is the motor loss of a high median nerve laceration at the elbow?

1) lumbricals I&II (MCP flexion of digits II& III) 2) abductor pollicis brevis (thumb abduction) 3) opponens pollicis (opposition) 4) flexor pollicis brevis (flexion of thumb MCP) 5) flexor digititorum profundus 6) flexor pollicis longus 7) flexor carpi radialis

Americans w/ Disabilities Act (ADA)

Prohibits discrim. against qualified persons w/disabilities in employment, transportation, accommodations, telecomm, public svcs

Fair Housing Act

Prohibits discrim. on bases of disabil., religion, sex, color, etc.; req. owners of housing to make reasonable exceptions; allows tenants to make reasonable mods

Rehab Act of 1973

Prohibits discrim. on basis of disabil. in any program/activ. that receives federal assistance

What type of group develops the ability to perform a shared, short-term activity with another member in a comfortable, cooperative manner?

Project, developmental

What are the tx for prontator Teres syndrome?

Conservative tx 1) elbow splint at 90' and forearm in neutral 2) avoid act. with excessive pronation /supination Decompression surgery 1) AROM 2) nerve gliding 3) strengthening- 2wks post-op 4) sensory reeducation 5) work/act modification

What are the tx of CTS?

Conservative: 1) wrist splint in neutral at night and during repetitive activity 2) median nerve gliding exercises 3) activity modification: 0 wrist flexion, 0 wrist & finger flexion, 0 wrist flexion with grip 4) ergonomic evaluation Surgical intervention: carpal tunnel release (CTR) 1) edema control 2) AROM 3) nerve & tendon gliding 4) sensory reeducation 5) strengthening of thenar muscle 6) work/act. Modification

Total Quality Management (TQM)

Creation of an organizational culture that enables all employees to contribute to an environment of continuous improvement to meet or exceed consumer needs

What gross motor skills are developed at 10-11months in creeping?

Creeps on hands and feet

What gross motor skills are developed at 11-12 months in creeping?

Creeps well

What wrist flexors are innervated by the ulnar nerve?

Flexor carpi ulnaris

T or F? All interventions should be planned with consideration of the expected planned discharge environment?

T

What is Productivity?

The amount of direct care and reimbursable services each therapist must provide per day. *The more time you spend with a client you should have equal reimbursable services, or strive for that goal.

Those exempt from ADA employer guidelines are...

US gov't, religious groups and/or private tax exempt membership clubs, Indian Tribes

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)

focus: standardized test assesses and provides index of overall motor proficiency, fine and gross motor, including consideration of speed, duration, accuracy of performance, and hand/foot preferences pop: 4 yrs - 21 yrs

What is Skier's Thumb?

Rupture of collateral ligament of MCP of thumb OT tx- 1) thumb splint 2) AROM after 6 weeks 3) pinch strengthening 4) opposition with ADL tasks Post-op tx- 1) thumb splint 6 wks 2) AROM 3) PROM at 8 wks 4) strengthening 10 wks

OTPFW terms that alter context/demands of an activity to reduce distracting features

modify/compensation/adaptation

Dystonia

sustained distorted movement or posture involving contraction of groups of muscles

Reimbursement in SNF is dependent on

resource utilization groups, which allows for maintenance plan design and reeval, caregiver training is part of this, must demo competence in training vefore discharge from OT

Describe a Rehabilitation Hospital.

- Person is medically stable but has residual functional deficits requiring skilled rehabilitation. - LOS: week - months - Discharge to: SNF, community residence, home

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

Opponens Splint

median nerve injury

thumb post splint

median nerve injury

Productivity standards

"reimburseable" service each therapist is to provide each day

Isometric Exercises

-Contraindicated for Phase I & II Cardiac Rehab: causes rapid and sudden increase in BP.

What are the acceptance criteria for OT services in a school 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 eval

What is the OT intervention focus for a school setting?

(1) address the student's functional performance along with academic performance (2) Assistive technology and transition services, in accordance with the regulations of IDEA, are provided (3) Performance skill deficits and client factors are treated to improve the child's ability to participate in and perform education-related activities within a school setting (4) Skills for adult life post-school are developed in accordance with the student's transition plan

health maintenance organization

(HMO). Most common form of managed care, requires enrollees to see only doctors within the HMO network, and be referred to specialists by the PCP

preferred provider organization

(PPO). Another form of managed care, typically with more selection of providers, however the more choices, usually the more expensive the rates.

Tests of significance

- An estimation of true differences, not due to chance. - A rejection of the null hypothesis.

What is a Qualitative Design?

- A form of descriptive research that studies people, individually or collectively, in their natural social and cultural context. - To describe real life experiences and give them meaning. - Based on direct observation in naturalistic settings.

Describe a Skilled Nursing Facility.

- A medical or psychiatric diagnosis that is chronic and requires skilled care, but the illness is stable with no acute symptoms. - People admitted for medical care and rehabilitation as well. - LOS: 1 month - lifetime - Discharge to: home if stable and can safely access/maintain

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

What is FTE?

- Full-time equivalent, meaning the amount of time a full-time staffer works (8 hours/day, 5 days/week) - A budget formula to determine the # of personnel providing direct care.

Mild mental retardation

- IQ range of 55 to 69 -Focus is placed on the individual acquiring social and vocational skills to function adequately -Minimal support is required -Additional intermittent support may be required in special circumstances

Describe Acute Care.

- LOS: 1-7 days - Discharge to: Ongoing care -> subacute

Cognitive/Perceptual Intervention: Information Processing Approach?

- Provides info. on how indiv. approaches task - Looks at how performance changes w/cueing - Standardized cues given to determine effect on perf. - Cues/feedback are utilized to draw attention to relevant features of task - Investigative questions are used to provide insight to the underlying deficits

Errors. - standard error - type I - type II

- Standard error: the expected chance variation among the means; the result of a sampling error. - Type I error: null hypothesis rejected when it's true (means of scores concluded to be different when they are not) - Type II error: null hypothesis not rejected when it's false (means of score concluded to not be different when they actually are)

Explain operating expense budgets.

- The daily financial activity of a program/service. - direct expenses like salary, benefits, office supplies, tx equipment - indirect expenses like utilities, housekeeping

Ratio data.

- The highest level of measurement. Has all the characteristics of the previous levels and a true zero.

NBCOT

- The national credentialing agency for OTs. - NBCOT has jurisdiction over all NBCOT certified OTs as well as those eligible for NBCOT certification. - NBCOT has investigatory and disciplinary action procedures in place for incompetence, unethical behavior, and/or impairment.

Stages of motor learning: Skill retention stage (associated stage)

- practices movements, refines motor programs - spacial and temporal organization - decreases errors - decreased dependance on visual feedback, increase use of proprioceptive feedback - cognitive monitoring decreases Training strategies: - intervene when errors become consistent - emphasize proprioceptive feedback "feel the movement", to assist in establishing an internal reference for correctness - focus on variable practice to improve retention

Restricted or constricted affect

-Reduced, but less so than blunted affect

Etiologies and risk factors for Type 2 diabetes (non-insulin dependent)

-90-95% of all diabetes -Older age -Obesity -Family history - Prior history of gestational diabetes -Impaired glucose tolerance -Physical inactivity -Race/ethnicity: African-Americans, Hispanic/Latino Americans, American Indians, Asian-Americans (non-Japanese), Pacific Islanders

Specific phobia

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

Social phobia

-A clinically significant anxiety from certain types of social or performance situations leading to avoidance

Anxiety

-A feeling of apprehension or worry associated with anticipation of future danger

Assessment for components of motor control - reflex testing

-A response to stimulus is termed "positive" and no response to stimulus is "negative" -Therapist notes the highest level of reflex control achieved

Blunted affect

-A severe lack of affect

Trance

-A sleeplike state with minimal environmental awareness, followed by amnesia for the experience

Program evaluation and quality improvement - Major types and terms: Performance assessment and improvement (PAI)

-A systematic method to evaluate the appropriateness and quality of services -Utilization of an interdisciplinary systems focus -A client-centered approach which focuses on the rights, assessment, care, and education of the person -Organizational ethics, improved organizational performance, leadership and management are emphasized

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

Sensory Awareness group?

-Activities to promote sensory fxs &environ awareness

Rehabilitation to treat meningitis from Lyme disease

-Acute care: positioning, splinting, supportive care while hospitalized -Rehabilitation if there is recovery related sequelae Address present dysfunctional performance skills Neuro, motor, sensory, cognitive, functional (ADL/IADL)

Four stages of HIV infection

-Acute infection: flu-like response to initial contact with the virus -Asymptomatic disease: HIV replicates and affects the immune system, but no visible signs other than blood abnormalities are detectable -Symptomatic HIV: signs and symptoms appear -Advanced disease or AIDS: severely compromised immunity (CD4+ level drops to below 1000/mm3

Procedure codes

-Codes that describe specific services performed by health professionals

What are the 5 development areas that should be assessed for early intervention programs?

-Cognitive -Physical - Communication - Social-emotional - Adaptive

Third party payers

-Agencies and companies who are the primary reimbursers for health care in the US (eg. Blue Cross). HMOs and PPOs are also third party payers

Personnel management - Staff development steps

-Assess employees' development needs and interests -Assess organization's strategic plan to identify existing and new areas planned for OT service that may require staff training -Provide mentorship and supervision -Provide educational in-services, workshops, and practical on-site experiences -Support self-directed learning, such as journal reviews, self-study courses, on-line networking, teleconferencing, off-sire workshops, and/or post-professional education

Flight of ideas

-Refers to rapid shifts in thoughts from one idea to another

Assessment for glenohumeral joint subluxation

-Allow arm to dangle into gravity -Palpate the space underneath the acromion process with your index finger -Compare to the intact side and document the width of the space in terms of finger breadths

Impact of kidney disease on self-care

-Alteration in urination -Need for sanitary techniques with self dialysis -Strict restrictive diet -Alteration in sexuality (impotence; less desirable) -Need for use of adapted equipment (tub/toilet bench; build ups; reaching assist devices; fine motor assist devices [button hooks, etc]) -Energy conservation/work simplification-fatigue -Altered mobility (wheeled mobility, use of assistive devices to walk such as an ankle-foot orthosis, walker, cane)

Fear

-An anxiety that is focused on a real danger

Autonomic dysreflexia

-An extreme rise in blood pressure -This is a medical emergency if not reversed

Receptive aphasia (Wernicke's)

-An organic loss of the ability to comprehend what has been said

Anti-obsessional medications

-Anafranil, Paxil, Prozac, Zoloft, and Luvox -Reduce obsessional thinking -Side effects similar to that of selective serotonin reuptake inhibitors

Onset, prevalence, and prognosis for anorexia nervosa

-Anorexia most commonly begins in the mid-teens -It occurs in 0.5-1% of adolescent girls -It is 10-20 times more common in girls -The long term prognosis may not be good, with mortality rates from 5-18%

Medical management of mood disorders

-Antipsychotics -Mood stabilizing medications:lithium, anticonvulsants -Mood stabilizers are also used to prevent bipolar disorder

Test for GERD

-Barium swallow (observing below the pharynx). Visualize external to airway in profile via x-ray -Flexible endoscopy (observing at the pharynx and descending to the esophagus directly)

Focus of OT intervention for substance-related disorders

-Assist the individual in identification of the reasons for substance use -Develop the skills necessary to cope with life stressors without substance use -Develop the skills needed for a substance-free lifestyle: interpersonal relationships; socialization; vocation; leisure and time use -Assist with concrete practical services, such as obtaining social security, housing, and food stamps, as needed -Life-long patterns of denial, resistance, and other defensive behaviors can make treatment challenging and difficult -Refer to support groups, including Alcoholics Anonymous, Narcotics Anonymous and others

Treatment focus of medical management of substance-related disorders

-Assist the individual to refrain from substance use through medication -Provide psychotherapy

Program evaluation and quality improvement - Major types and terms: Retrospective review

-Audits of medical records after intervention were rendered -Method to ensure appropriate care was given -A UR tool for third party payers that can be time consuming and costly

Diagnostic classification for intellectual disorders

-Based on measurement of intelligence or IQ test. Those individuals who score more than two standard deviations below the norm, or below an IQ of 70, are considered to have mental retardation Classifications are mild mental retardation, moderate mental retardation, severe mental retardation, profound mental retardation -Multiple disabilities such as hearing and other sensory impairments, seizures, and other neurological abnormalities may be associated with various syndromes (eg. fetal alcohol syndrome)

Diminished esophageal motility causes...

-Bolus sits in the esophagus and can slowly either move toward the stomach or upward toward the pharynx -Person may feel that food is stuck in the esophagus -Person aspirates when food propels upward and he/she cannot swallow it

Wrapping in a Circular Manner

-Contraindicated for Amputee Care: wrapping a residual limb with an elastic bandage in this manner. -It causes a tourniquet effect and dangerously restricts limb's circulation.

Diagnostic criteria for cyclothymic disorder

-Characterized by at least 2 years with numerous periods of hypomanic and depressive symptoms that do not meet the criteria for a manic episode or major depressive episode

Obsessive-compulsive personality disorder

-Characterized by emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness -The essential feature is a pervasive patter of perfectionism and inflexibility -It should not be confused with obsessive-compulsive disorder

Catatonia

-Characterized by immobility or rigidity

Impact of disruptive behavior disorders on function

-Children with disruptive behavior disorders have difficulty at school and with the formation of health social and familial relationships -Difficulties within the family affect not only the child but all family members, impacting on their role performance

Diagnostic criteria for cognitive disorders

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

Procedures for developing a group?

-Conduct a needs assess to identify intervention needs -Develop the protocol -Present protocol to treatment team/program admins -Select potential members who would benefit from it -meet w/each potential member to explain the purpose & circumstances of the group -Hold introductory sessions of group& revise the protocol as needed

Generalized anxiety disorder

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

Nonspontaneous speech

-Consists of responses that are given only when spoken to directly

Stuttering

-Consists of the repetition or prolongation of sounds or syllables

Obsessions

-Constitute a persistent thought or feeling that cannot be eliminated by logical thought

Focus of OT intervention for psychotic disorders during long term hospitalization

-Continuation of assessment -Provision of a normalizing environment -Development of realistic and meaningful intervention discharge goals -Development of a plan for goal achievement -Development of the skills needed to function in the anticipated discharge environment -Contribution to the development of the discharge and aftercare plans

Perseveration in speech

-Continued repetition of a word or phrase

Prevention of scleroderma

-Control symptoms of Raynaud's phenomenon -Have screening echocardiograms to rule out pulmonary hypertension -Smoking cessation

Medical treatment of lupus

-Control symptoms to prevent complications -Treat with diuretics and drugs that prevent spillage of protein in the urine (angiotensin converting enzyme-ACE)

Interventions for impairment level problems for the rehabilitation for immunological system disorders

-Counsel people to be compliant with screening and treatment regimens -Set personal goals to invest behaviorally in one's health -Provide support to those dealing with immunological system disorders that are chronic illnesses (ie, AIDS) -Provide supportive counseling and social support for psychological disorders that can develop (eg. anxiety disorder, depression, and/or adjustment disorders) -Refer to physician for drug therapy and complementary medicine as indicated for accompanying physical and/or psychiatric disorders (eg. kidney disease, depression)

Managing hallucinations?

-Create an environ. free of distractions that trigger the thoughts & interfere w/ reality-based activity -Use highly structured, simple, concrete activities that holds the individual's attention -Attempt to redirect thoughts to reality-based thinking & actions

Personnel management - 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

THEMATIC Groups?

-Designed for learning of specific skills

Risk factors for Kidney Disease

-Diabetes: can contribute to development of nephrotic syndrome -Hypertension (HTN) -Systematic lupus erythematosus: can contribute to development of nephrotic syndrome

Cold

-Diabetic Neuropathy: decreased vascular circulation. -This is contraindicated as it negatively impacts vascular circulation and can cause pain and numbness of the affected areas. -Gentle heat is an appropriate alternative to promote pain relief and tissue elasticity.

Conduct disorder

-Disregard for the rights of others leading to aggression towards people and animals, destruction of property, deceitfulness, theft, or serious violation of rules -It is estimated that 6-16% of boys and 2-9% of girls under the age of 18 have a conduct disorder -Prognosis is related to the age of the onset and the severity of symptoms and behavior -Severe conduct disorder is often associated with the development of other disorders and substance abuse later in life -Assaultive behavior and parental criminality correlate highly with future incarceration

Disorganized type schizoprenia

-Distinguished by marked regression demonstrating primitive, disinhibited, and disorganized behavior

Medical treatment of acute renal failure

-Drug control of underlying medical contributory conditions -Emergent, acute dialysis

Selective norepinephrine, or serotonin and norephinephrine inhibitors

-Effexor, Desyrel, Serzone, Wellbutrin, and Remeron -Side effect vary but may include: hypertension, anxiety, dizziness, sedation, nervousness, weight gain, nausea, sweating

Tricyclics

-Elavil, Tofranil, Norpramin, and Pamelor -Side effects include: dry mouth, blurred vision, sedation, postural hypotension, and other anticholinergic effects

Focus of OT intervention for attention-deficit/hyperactivity disorders

-Environmental adaptations including structuring the child's environment in school and at home for more successful outcomes -Social skills training -Self-management training -Interventions to promote sensory modulation -Consultation to parents and teachers regarding strategies for the provision of structure and expectations in a manner that fosters the child's psychosocial adaptation -On going collaboration with team members and parents in child's occupational environments

Penetration of the bronchioles/bronchi by the bolus when aspiration occurs causes...

-Food enters the lung; true aspiration occurs -Bacteria can cause pneumonia (aspiration pneumonia) -If the person's immune system is functioning well, he/she may not experience pneumonia

Lithium

-Eskalith, Lithobid, and time released forms -Side effects include excessive thirst, tremors, excessive urination, weight gain, nausea, diarrhea, and cognitive impairment -Precautions include the monitoring of blood levels to maintain the narrow therapeutic window (high levels may cause nerve damage and death; early symptoms of toxicity include motoric disturbances)

Fiscal management - Budget terms and concepts - Productivity standards

-Establishes the amount of direct care and reimbursable service(s) each therapist is to provide per day -Managed care pressures have increased productivity expectations in some practice areas resulting in ethical dilemmas and/or ethical distress

Lyme disease (tick bite disease)

-Etiology and risk factors: disease from tick bites (tick attach to people as they brush by the object to which the tick is attached; tick attaches to hidden and hairy areas such as groin, armpits, and scalp

Hepatitis

-Etiology: a viral infection -Risk factors for Type A - contaminated seafood; protective immunization possible -Risk factors for Type B, C and other identified forms - body and blood borne exposure; protective immunization possible for type B -Healthcare workers are most susceptible to hepatitis B -Prevention: practice standard precautions with all persons to prevent contact with blood or body fluids -Sequelae: fever; fatigue; the above contribute to decreased tolerance for activity participation and lack of energy

Overview of OT evaluation and intervention for pervasive developmental disorders

-Evaluate developmental and functional levels -Develop sensorimotor, social interaction, vocational readiness, and community integration skills relevant to the child's level -Provide sensory integrative intervention, as indicated -If indicated, prescribe and train in technologically-based augmentive communication Provide adaptive and positioning equipment to facilitate function, eg. the stereotypical movements of licking, biting and slapping of 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 flexion -Collaborate with the family and interdisciplinary team to promote occupational performance and social participation

Diagnostic criteria for personality disorders

-Evidence of characteristics and patterns of inner experience and behavior that deviate markedly form the culturally accepted norms in cognition, affect, impulse control, and interpersonal relating -Behavior must be inflexible and maladaptive across a broad range of personal and social situations -There must be evidence of onset in late childhood or adolescence

Hypervigilance

-Excessive attention and alertness that guards against potential danger

Psychomotor agitation

-Excessive motor and cognitive activity, usually nonproductive and in response to inner tension

Stage 3 cancer

-Extensive evidence of a primary tumor that has spread to other organs in the body -Tumor can be surgically debulked, but some cells may remain behind -Deeper spread of the tumor cells in the lymphatics -Widespread cancer- multiple organs of the body -Mean 5 year survival rate is 20% plus or minus 5%

Hallucinations

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

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 -Hypoglycemia: 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: 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

Intervention Strategies for impaired alertness or arousal?

-increase environmental stimuli -use gross motor activities -increase sensory stimuli

What are conservative OT interventions of Adhesive Capsulitis?

1) active use through ADL 2) PROM 3) modalities

Community reintegration group?

-Focus: identification & use of resources -may be in a modular &/or psycho-educational format

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

OT evaluation for manic episode

-Focuses on current skills and functional performance, safety and judgement issues, and treatment history

Cognitive/Perceptual Intervention: Remedial/Restorative/ Transfer of Training Approach?

-Focuses on restoration of components to increase skill - Deficit specific - Targets cause of symptoms - Emphasizes performance components (result in inc. skill) -Assumes improvements in performance components will result in increased skill -Assumes cerebral cortex is malleable& can re-org. -utilizes *Tabletop & computer activities as tx modalities* (i.e., memory drills, block designs, parquetry, etc.)

Aggression

-Forceful, angry or destructive speech or behavior

Risk factors for scleroderma

-Genetic -Environment

Program evaluation and quality improvement - Major types and terms: Professional review organization (PRO)

-Groups of peers who evaluate the appropriateness of services and quality of care under reimbursement and/or state licensure requirements

Frequent complaints of people with GERD

-Heartburn/indigestion -Swallowing problems -Sensation of feeling that something is getting stuck in their "throat" -Chest pressure or pain -Regurgitation after swallowing

Types, signs and symptoms of heat syndromes/hyperthermia

-Heat cramps are characterized by a normal body temperature, nausea, diaphoresis (increased sweating), muscle twitching or spasms, weakness, and/or severe muscle cramps -Heat exhaustion is characterized by a rapid pulse, decreased blood pressure, headache, nausea, vomiting, cool pallid skin, mental confusion -Heat stroke is characterized by hot, dry red skin; a body temperature higher than 104 degrees; slow, deep respiration;; tachycardia (increased heart rate); dilated pupils (increased ANS); confusion; progressing to seizures and possibly loss of consciousness

Risk factors for cancer

-Heredity: some tumors seem to have a high hereditary risk (breast cancer, prostate cancer, skin cancer, colon cancer) -Environmental: chemical polution -Habit or lifestyle related: tobacco can contribute to lung cancer and head and neck cancer; drinking alcohol contributes to some head and neck cancers; obesity/high fat diets may be linked to an increased risk of some cancers

Aggressive PROM, Heat, Splinting

-Heterotrophic Ossification: a calcium deposit that may occur in or near a joint after burns. -Circumferential burns are most susceptible to this condition. -Symptoms include decreased joint excursion, a stiff endpoint, and increased pain.

Prevocational groups?

-I'D of skills, limitations, interests, work behaviors&job hunting skills (general skills that apply to most jobs)

Managing lack of initiation/participation?

-Identify w/indiv. the reasons for lack of participation (e.g. lack of skill, irrelevance of activity, attention deficits, embarrassment, depression, etc.) - Motivational hints: more likely to particip in activities that address issues that are of interest or concern to them; more ownership have of activity=more likely to participate; success is motivating; fun is motivating; (+) feedback & rewards are motivating; everyone has own motivators- important to i'd them; curiosity can be used to motivate; food can be motivating

Modified barium swallow (MBS)

-In diagnostic radiology suite -Done with swallowing team and radiologist: person seated at uprighted edge of radiology table; person must have adequate sitting balance; person must be supervised at all times -Person administered trial boluses laced with barium: person should be given boluses mixed with food consistencies, purees, thick liquids, solids, and thin liquids; if the person aspirates the test ceases -Video records moving x-ray of swallow. A copy of the video is kept as part of the record -Still x-ray shots are taken if aspiration is observed

Prevention of heat syndromes/hyperthermia

-In hot weather, wear light-weight, loose fitting clothing -Avoid hot places; seek shade, use fans, and air conditioners -Rest frequently -Increase fluid intake

Praxis/motor planning deficits causes...

-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

Impact of attention-deficit/hyperactivity disorders on function

-Infants are over-active, difficult to soothe when crying, and demonstrate poor sleeping habits -Defensiveness to environmental stimuli, frequent irritability, emotional lability, and fluctuating and unpredictable performance -Difficulty with delayed gratification in the school and home environment -Deficits in academic and/or social functioning -Deficits in perceptual motor tasks with disorders in reading, mathematics, written expression, and general coordination resulting -Disorders of memory, thinking, speech, and hearing -Depression secondary to frustration and difficulty learning (this often leads to low self-esteem and conduct disorders) -Individuals with symptoms remaining in adolescence and adulthood are prone to antisocial personality disorders, and are at risk for substance-related disorders

Stage 4 cancer

-Inoperable primary lesion -Survival dependent on depth and extent of the tumor spread as well as the ability to have the tumor respond to therapy (mean 5 year survival rate is <5%) -Multiple metastases

Mandated Medicaid services

-Inpatient and hospital services -Outpatient (eg. laboratory work, x-rays, skill nursing) and physician's 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

Intervention for stress incontinence

-Kegel exercises to strengthen pelvic floor -Timed routines for emptying bladder before it is full enough to cause spillage -Lifestyle adjustments to use incontinence supporting garments, for a socially acceptable solution and to decrease public attention to the incontinence -Medications may be used when the physician feels the client can tolerate the side effects of drug therapy support -Electric stimulation may be used if the client fits the parameters of recovery for the condition

Labile affect

-Labile affect is rapid and abrupt changes in affective signs of emotion

Poverty of speech

-Limited in amount and content

Types of scleroderma

-Limited: skin involvement (with good prognosis); linear scleroderma (bands of thicker skin, with good prognosis) -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; sclerodactyl of fingers and toes; telagiectasis or red spots covering the hands, feet, forearms, face and hips); general morphea

Structures involved in Gastric Esophageal Reflux Disease (GERD)

-Lower esophageal sphincter and gastric sphincter: food enters stomach and mixes with stomach acid/digestive juices; lower esophageal sphincter inefficiently closes => stomach contraction propels acid/acidic bolus back into the esophagus -Person reports heartburn sensation, indigestion or dull chest pain -Positional elevation of the head above the stomach, when the person is reclined, may discourage upward retropulsion of the bolus from the stomach

Focus of OT intervention for cognitive disorders

-Management of the symptoms -Maintenance of quality of life through activity adaptation and environmental modification -Family education to understand the nature of the person's disorder and improve the management of its symptoms and functional effects

Anxiolytic medications

-Xanax, Valium, Librium, Ativan, Klonopin, and BuSpar -Side effects include: drowsiness, ataxia, headache, nausea, depression, and dependence

Intervention guidelines for limb and postural control impairments

-Massed practice and shaping of the affected limb during repetitive functional activities -Less affected UE is constrained via a splint, sling, or glove -Practicing of functional tasks or close simulations that have been identified as important by participants is used to find effective and efficient strategies for performance -Opportunities for practice outside of therapy time (eg. homework assignments, circuit training, etc) are provided -Adaptions to the environment, task modifications, assistive technology, and/or a reduction in the effects of gravity are used to enhance performance

Illusions

-Misperceptions or misinterpretations of real sensory event

Monamine Oxidase Inhibitors (MAOIs)

-Nardil and Parnate -Side effects include: weight gain, hypotension, insomnia, liver damage, etc -Precautions include dietary restrictions for individuals taking MAOIs -Foods that contain the amino acid tyramine must be avoided -Tyramine increases blood pressure and may lead to stroke or other cardiac reactions -Headache is the first sign of a problem

Interventions for participation problems for the rehabilitation for immunological system disorders

-Needs assessment to determine individual issues the person has with mobility, social, or political access to their personal, home or community environments -Identification and facilitation of procurement of system changes to allow person access and ability to participate as a contributing member of society

Schools (criteria, ot focus, scope)

-OT is a related service -Criteria: child requires special ed and OT will enable the child to benefit from special ed --OT will faciliate the child's participation in ed and improve functional performance --School reviews referral and recs OT eval -length determined by child's ability to benefit -IEP annually -Educational model, but includes functional performance -corrective and compensatory methods -ADL, play and school domains addressed -addresses skills for adult life too, transition needs

Obsessive-compulsive disorder

-Obsessions are recurrent and persistent thoughts, images, or impulses that are disturbing, intrusive, and inappropriate -Compulsions are repetitive behaviors that the person is driven to perform to reduce anxiety or prevent a dreaded event or situation -The obsessions or compulsions are time-consuming and distressing despite the individuals awareness of their irrationality

Diagnostic criteria for major depressive disorder

-One or more depressive episodes -May be a single episode or recurrent episodes

Diagnostic criteria for bipolar II disorder

-One or more major depressive episodes -There must be at least one hypomanic episode

Structures involved in dysphagia and swallowing disorders

-Oral facial musculature -Pharyngeal and laryngeal structures -Piriform sinuses -Vocal folds -Bronchioles/bronchi -Lungs -Esophagus

Subtypes of schizophrenia

-Paranoid type -Disorganized type -Catatonic type -Undifferentiated type -Residual type

Personality disorders not otherwise specified (NOS)

-Passive-aggressive -Depressive -Sadomasochistic -Sadistic

Reisburg's stages for dementia - Stage 7

-Person can be in a vegetative state. He/she is usually bedbound and unable to respond verbally or non-verbally to questions or commands

Dementia Stage III

-beginning signs and deficits noted -forgets important information -experiences difficulty completing complex tasks -experiences difficulty negotiating directions to new location

Principles of the Contemporary Task-Oriented Approach

-Practice with varied strategies to find optimal solutions for motor problems and develop skill in performance -Functional tasks help organize motor behavior -Therapist determines which systems (personal, environmental, etc) have positive or negative influences on motor behavior -Evaluation using top-down approach -Interventions: 1) Help adjust to role and task limitations 2) Practice functional tasks or close simulations to find effective and efficient strategies for performance 3) Minimize inefficient or ineffective movement patterns 4) Adapt the environment 5) Modify the task 6) Use AE

Pre-operative rehabilitation for cancer

-Pre-operative functional assessments and preparation of the client for post-operative phase and care -Client and caregiver education concerning recover and follow up care/functional expectations and client engagement

Treatment for renal disease

-Prevention, early intervention, and control of hypertension through diet, medication, exercise, stress reduction and smoking cessation -Prevention, early intervention and control of diabetes

TASK-ORIENTED GROUPS?

-Purpose: to assist the members in becoming aware of their needs, values, ideas &feelings thru performance of a shared task

Pediatric seating and positioning systems

-Purposes a. allow for contractures and deformities b. allow for function at home and in school setting c. facilitate eye contact and parent/teacher/sibling/peer interactions d. general positioning goals -Types a. usually custom molded created systems b. standers provide WB experience which maintains hips, knees, ankles, and trunk in optimal position, facilitate formation of acetabulum and long bone development, and aid in bowel and bladder function 1. prone standers decrease effect of tonic labyrinthine reflex (TLR) 2. supine standers provide more support posteriorly c. sidelyers decrease effects of TLR and put hands in visual field d. triwall construction for infants and toddlers e. abductor pads at hips to decrease scissoring extensor pattern

INSTRUMENTAL Groups?

-concerned w/ meeting health needs & maintaining function

Functional Impairments: Impaired alertness or arousal?

-person has a decreased response to environmental stimuli

Acute stress disorder

-Similar to post-traumatic stress disorder; however, it immediately follows the event -The symptoms do not persist beyond one month

Circumstantiality

-Speech that is delayed in reaching the point and contains excessive or irrelevant details

Reisburg's stages for dementia - Stage 1 and 2

-Stage 1: no disability is noted -Stage 2: the person complains about forgetting normal age-related information (location of objects: keys, wallet,etc)

Funding for Environmental Modifications

-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 play for home and work modifications, if the modifications enable a person to go to work or school. -Private companies will fund modifications to ensure ADA compliance -Private insurance, medicare, medicaid, and works compensation will possibly reimburse for certain devices/adaptations

Thought blocking

-The interruption of a thought process before it is carried through to completion

Medical treatment of cancer

-Surgery: lumpectomy; en bloc resection; reconstruction; amputation -Chemotherapy: intravenous; shunt (ommaya reservoir to brain); oral -Radiation: external beam (wide beam; cone down); brachytherapy (seed implantation, flexible rods) -Immunotherapy: interferon; monoclonal antibodies -Hormonal therapy -Transplantation: bone marrow

Hypomanic episode

-Symptoms are the same as for a manic episode; however, they are not severe enough to cause marked impairment in social or occupational function or to require hospitalization

Prevention of autonomic dysreflexia

-Teach person/caregiver frequent pressure relief principles -Ensure compliance with intermittent catheterization -Practice well-balance diet habits -Ensure medication compliance -Educate person with condition and caregivers or family members: recognition of the cause, signs, symptoms (ie. sweating, headache); first aid procedures to deal effectively with the occurrence; prevention methods for this condition

Stereotypy

-The repetition of fixed patterns of movement and speech (eg. echolalia)

Current diagnostic information

-The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) is the primar source -The DSM-IV-TR uses a multiaxial format for diagnosing mental disorders -DSM-IV-TR diagnoses are made when the following criteria are met: 1) the behavior is not caused by other medical conditions, substance abuse, or medications 2) the symptoms cause significant distress and impairments in function 3) the symptoms cannot be better accounted for by another diagnosis

Program evaluation and quality improvement - Major types and terms: 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

Personnel management - Retention and motivation of staff

-The process of identifying understanding, and meeting employees' needs, expectations, and desired rewards

Akathisia

-The state of restlessness characterized by an urgent need for movement, usually as a side effect of medication

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

Onset, prevalence and prognosis for bulimia nervosa

-The usual age of onset of bulimia is later than that of anorexia -It begins in adolescence or in early adulthood -It is present in 1-3% of women -It is significantly more common in women -The prognosis is better than for anorexia, with 80% of individuals not meeting the criteria for diagnosis after 10 years

Diagnostic criteria for substance abuse

-There must be continued use despite serious consequences

Medical treatment of nephrotic syndrome

-Treat with diuretics and drugs that prevent spillage of protein in the urine -Drug control of fluid overload and/or spillage of protein into the urine (proteinuria) -Encourage compliance with drug therapy, dietary and exercise recommendations

Functional Impairments: Anosognosia?

-Unawareness of motor deficit -may be related to a lack of insight regarding disability

Interventions for home care rehabilitation for immunological system disorders

-Use of a collaborative assessment (eg. Canadian Occupational Performance Measure [COPM] to set client goals) -Evaluation and restoration of functional ability -Restoration of activity/exercise tolerance -Community mobility: to inner and outer boundaries of home environment; into the street./block; further ability to venture out into the community (ie. marketing, use of transportation, medical/business appointments, leisure access)

Undifferentiated type schizophrenia

-Used to classify those patients who do not clearly fit into one of the other categories

Visual Foundation Skills: these skills must be evaluated to differentiate perceptual dysfunction & visual System Deficits?

-Visual Acuity: clarity fo vision both near & far -Visual fields: available vision to the right, left, superior & inferior; an ex. of field loss is homonymous hemianopsia (*left temporal field* & *right nasal field* are affected) -Oculomotor function: control of eye movements -Scanning: ability to systematically observe & locate items in the environment

Sensory environment

-Visual: lighting, colors, clutter -auditory: loudness of radios, loudspeakers, classroom noise -tactile: room temperature, seating textures -olfactory: pleasant or offensive odors -gustatory: pleasant or offensive tastes

Americans 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 accomodations

pop-over or seated sitting

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

Cognition?

-ability of the brain to process, store, retrieve & manipulate info. it involves the skills of understanding & knowing, ability to judge & make decisions & overall environmental awareness

light-touch keyboard

-activation systems for persons with decreased strength and/or mobility (eg individuals with muscular dystrophy)

delayed touch keyboard

-activation systems for persons with poor motor control (eg individuals with athetoid movements)

What are the precautions of a hip fx?

1) weight bearing status 2) ROM of affected joint 3) timeframe of OT per MD

Assisstive Technology Devices (ATD)

-any piece of equipment or product...used to increase, maintain, and improve functional capabilities of individuals with disabilities"

Mini-mental state examination (MMSE) or Folstein Test

-brief 30-point questionnaire test that is used to screen for cognitive impairment -Commonly used in medicine to screen for dementia

chair lifts

-chairs with power control to allow elevation from surface for individuals who may otherwise not be able to transfer independently

W/C transfers safely

-clear areas involved in transfers of any clutter -ask for help or standby assist if questioning ability to transfer safely -use gait belt -stabilize/lock brakes -swing away legrests and flip up footplates -remove armrest if individual is unable to assist, is too heavy to bring to a standing position, or if the individual has a weight bearing precaution

Documentation-ATDs

-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 -Re-evaluation guidelines 1. assess for change in status of the individual with a disability 2. determine efficiency and efficacy of use of assistive devices 3. check parts of the device for durability

Whirlpool

-edema of extremity, lethargy, unresponsiveness, maceration, UE infection, febrile conditions, compromised cardiovascular or pulmonary function, acute phlebitis, renal failure, dry gangrene, incontinence of urine or feces if in full body tank.

Contoured and/or custom-contoured seating

-ergonomically supports the individual -provides excellent support -enhances postural alignment -decreases abnormal posturing -provides pressure relief -may be difficult for independent transfers if decreased UE muscle strength -good for individuals with mod to severe CNS dysfunction or neurological dx

Armrests: w/c componets

-fixed: minimal benefit but may be seen in older wheelchairs and/or in rentals -detached: helpful for transfers -height adjustable: allows for ease in transfers and better support of a 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 the overall width of the chair by 1"

TOPICAL Groups?

-focus on discussion of activities & issues outside of the group that are current or anticipated

eye gaze

-for individuals with severe mobility impairments -eg: ALS

sliding board

-for those who are not able to stand to transfer (SCI, amputations) -board is placed under individuals gluteal region during a weight shift, while the other end of board is placed on surface being transferred to -individual then uses UEs to push buttocks up and "slide" over to transfer surface -if individual uses a tenodesis grasp or splint for functional activities, the person should weight bear on clenched fists with wrists extended

ACL IV

-goal-directed actions -carry simple tasks through to completion -visual cues -ex. sorting laundry by type/ color

Functional Impairments: Executive dysfunction or dysexecutive syndrome?

-impairments related to multiple specific functions; such as, decision making, problem solving, planning, task switching, modifying behavior in the light of the new info., self-correction, generating strategies, formulating goals & sequencing complex actions

Cognitive-Perceptual Driving Eval

-intact orientation, alertness, memory, ability to shift attention, problem solving, response time, topographical orientation, sign recognition, and knowledge of "rules 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

Perception?

-integration/interpretation of sensory impressions received from the environment into psychologically meaningful information

Functional Impairments: Short Term memory loss?

-lack of registration & temporary storing of info received by various sensory modalities

Functional Impairments: Long term memory loss?

-lack of storage, consolidation & retention of info that has passed through the working memory -includes the inability to retrieve this information

Individuals with Disabilities Education Act (IDEA)

-mandates that children w/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 a child for independent living and employment environments

back height

-measurement is based on need for postural stability, UE movements, and potential for independent w/c propulsion -take measurement from seat surface (including the cushion) upward to one of the following depending on trunk control, activity level, strength, and size of person with disability a. mid-back under scapula: 1-2 " below b. mid-scapula or axilla c. top of the shoulder -lower back height can increase functional mobility as in sports chairs a. lower back height can increase back strain -higher back height may be needed if poor trunk stability a. if back height of chair is extended, potential problems must be recognized 1. added back height may prevent the individual from locking onto the push handle for stabilization and/or weight bearing 2. added back height may increase difficulty of fitting chair into car or van

Psychosocial Intervention: One-to One versus group intervention- Indicators for Group Intervention?

-more cost effective -effective at assisting members to learn to live in social environments -takes advantage of group dynamics & therapeutic milieu: are facilitated in a therapeutic manner by an OT are inherently curative

Dementia Stage I

-no disability noted

Dementia Stage VII

-person can be in vegetative state -usually bed-bound -unresponsive verbally or non-verbally

Dementia Stage V

-person cannot function independently -can perform ADL -unable to safely drive -poor judgment -forgets to take care of hygiene

Dementia Stage VI

-person cannot perform ADL without cues -can perform components of familiar tasks -follow demo/ hand-over-hand cues -becomes incontinent of bowel and bladder

Dementia Stage II

-person complains about forgetting normal age-related information (location of objects, etc)

Contextual Assessment: W/C prescription

-physical environment a. areas of travel and w/c use b.surfaces and terrains that will be traveled on indoors (eg floor surfaces) and outdoors (eg sidewalks) -building characteristics of school, work, leisure, and/or worship a. doorways b. hallways c. restrooms d. workspace design e. parking f. other specifics as described in the home evaluation

ACL VI

-planned actions -absence of disability

ACL II

-postural actions -movement associated with comfort -ex. min exercise with demo

Purposes of wheelchair seating and positioning

-promote comfort during upright ADL -promote functional posture by provision of appropriate back, trunk and/or leg supports -provide physiological maintenance and tissue protection through prevention of shearing -promote sensory readiness through provision of proper eye and head position -facilitate upper limb function which occurs with proper trunk support -promote social acceptance by allowing eye contact -decrease progression of deformity through customized seating as needed -decrease pain through provision of proper support to all limbs -facilitate mobility with what means the person with a disability has available -increase self-esteem through provision of a wheelchair wich meets the persons needs and facilitates mastery of the environment

Intervention-ATDs

-select and use several devices on a 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 -provide multiple training sessions

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 a. fluid 1. facilitates pelvic and LE alignment 2. provides pressure relief without changing support 3. good for individuals who need increased stability b. air 1. minimal postural support offered 2. provides pressure relief 3. good trunk control is needed -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 w/c at hip level keep hips stable -lateral supports extend up the side of the chair to just below persons armpits to provide trunk supports

Wheelchair characteristics considered in assessment

-transportability/portability -ride quality -wheelchair types available a. control mechanism (eg type or brakes use, use of anti-tippers) b. features (eg use of lap tray, cushion, backpack to hold personal items and/or medical equipment, racing model for more athletic individuals) c. propulsion method (eg one arm drive, use of hand rim projections, motorized, use of LE to propel)

para-transit

-transportation systems specifically developed to meet the community mobility needs of persons with disabilites

Normal Distribution with averages.

...

At what age are self-dressing skills of cooperating with dressing by holding out arms! Pushing through sleves?

1 year

What is a hypertrophic scar?

1) Appears 6-8 weeks after wound closure 2) most common with 2nd and 3rd degree burns 3) wear compression garments 4) matures for 1-2 years

What is prosthetic training of anamputation?

1) Fxn training 2) donning and doffing prothesis 3) tolerance wearing 4) physical and psych adjustment

What are the 3 types of prevention intervention? 1) _____- reduce _____ of disease or disorder in population (parenting skills for teenagers) 2) _____- early _____ in population at risk to reduce or minimize effects (screening premature infants for developmental delays) 3) _____- eliminate or _____ of dysfunction (community integration)

1) Primary, incident or occurrence 2) Secondary, detection of problems 3) Tertiary, reduce impact

What is Piaget's process of cognitive development?

1) adaptation- respond to environmental challenges 2) mental schemes- organize experiences into concepts 3) operations- organize schemes & experiences into subsequent actions 4) cognitive competence 5) equilibrium- balance of what is known and what environment provides 6) assimilation- match new situation and to past experiences to achieve generalization 7) accommodation- development of new scheme in response to new situation

What is the criteria for selecting appropriate standardized and non-standardized? 1. Pertains to _____ 2. considers client ____ and _____ 3. _____ of setting 4. Has client _____ and _____

1) pertains to goal planning 2) clt baseline fxn & concerns 3) context of setting (outpatient vs long-term care) (available resource) 4) Clt. Current & projected context 5) Temporal context of clt & disability

What are the gross motor skills of a 7-8 month old in prone?

1) pivots in prone 2) moves from prone position to sitting

What are Medicare indicators for group membership?

1) willingly engage 2) attend to group guidelines 3) participate in group 4) benefit from leadership input 5) benefit from peer input 6) respond appropriate through group process 7) incorporate feedback 8) complete act. Towards goals 9) benefit from group vs 1:1

What is required in an OT screen? 1. Understand 2. Review the _____ 3. Conduct _____ , _____ and/or _____

1. Clt performance abilities 2. Chart/medical review 3. Checklists, Structured observation, Brief interview

What are the 6 main types of Quality Improvement?

1. Continuous Quality Improvement (CQI) 2. Total Quality Management (TQM) 3. Performance Assessment and Improvement (PAI) 4. Utilization Review 5. Professional Review Organization (PRO) 6. Risk Management

What are the 14 Community-Based Practice Settings?

1. Early Intervention 2. Schools 3. Supportive Education 4. Prevocational Programs 5. Vocational Programs 6. Residential Programs 7. Partial hospitalization/day hospital programs 8. Clubhouse 9. Adult day care 10. Outpatient/Ambulatory care 11. Home Health Care 12. Hospice 13. Case management programs 14. Wellness and prevention programs

Brunnstrom's six stages of motor recovery following the onset of *hemiplegia*

1. Flaccidity 2. Developing synergies 3. Beginning voluntary movement within synergy path 4. Initial movements that deviate from synergy 5. Independence from the basic synergies 6. Isolated, near normal movement with minimal spasticity

NDT/Bobath technique: Intervention

1. Handling is essential. The therapist's hands are used to attain intervention goals. 2. Utilize key points of control 3. Utilize inhibition techniques 4. Utilize techniques to normalize tone 5. Establish ability to weightshift *Apply all of this in ADLs and mobility skills to integrate both sides of the body while limiting abnormal responses.

Discuss how to Analyze Market Opportunities.

1. Identify if you can offer what is needed 2. Analyze consumer demand 3. Identify potential competitors and identify areas not being met 4. Assess politics, economics, sociocultural factors that can impact on service/product

Explain Program Implementation.

1. Initiate program. 2. Document activities, procedures, use 3. Communicate with other related systems 4. Promote program to ensure it reaches targeted population

OT Interventions in adult day care:

1. Maintaining healthy, functional aspects of the person and facilitate adaptation to impairments 2. Engagement in purposeful activities that provide stimulation, reflect interests, develop new interests, foster sense of community 3. Caregiver education, support groups, home visits, consultations, referrals to community resources 4. Modify day care center and person's home environment to maximize their comfort, mastery, and control of the environments.

What are the 4 the purposes of a program evaluation?

1. Measure program effectiveness 2. Use information in findings to improve program 3. Identify program problems/limitations and resolve them 4. Address accreditation requirements of JCAHO, Medicare Certification, etc.

What are the 3 Models of Practice?

1. Medical Model 2. Education Model 3. Community Model

List the types of Qualitative design.

1. Phenomenological 2. Ethnographic 3. Heuristic 4. Case study

5 P's of marketing

1. Product 2. Price 3. Place (distribution method to get to target market) 4. Promotion 5. Position (the place the product or svc holds in relation to similar products or svcs avail. in the marketplace)

What 3 areas do the administrative functions of management include?

1. Program Development 2. Program Evaluation and Quality Improvement 3. Fiscal and Personnel Management *Marketing/Promotion is also an important part of management.

What is Prevention intervention? 1. To _____ wellness, _____ disabilities and illness and _____ health 2. Has how many types?

1. Promote, prevent, maintain 2. 3 types (Primary, Secondary and Tertiary)

What must occur before an initial OT evaluation? 1. Get a _____ 2. Conduct a _____

1. Referral 2. Screening

What is important to use purposeful occupations in intervention? 1. uses components of deficit areas in daily tasks 2. developing new and successfully habits in occupations 3. what people value and want from an occupation. 4. choice to perform occupations of own interests. 5. develops patterns in occupation 6. instant feedback on performance of occupation. 7. success of skills and accomplishments 8. use of groups and social interaction during occupations.

1. Remediate and Restore 2. Establish 3. Inherently motivating 4. Values and interests 5. Practice 6. Feedback 7. Mastery 8. Participation

What are the areas of rest and sleep? 1. quiet and effortless actions 2. going to sleep, staying asleep, and ensuring health 3. routines to prepare for sleep. 4. cessation of activity, napping, dreaming, night time care of toileting

1. Rest 2. Sleep 3. Sleep prep 4. Sleep participation

What is Maintenance interventions? 1. Interventions designed to _____

1. Support and preserve the individual's current functional level.

What is an instrumental group? 1. Purpose? 2. Type of client? 3. Therapist role? 4. Type of Activities?

1. a supportive structured environment that provides activities to prevent regression and maintain function. 2. members who can not meet mental health needs independently due to cog. psych, perceptual-motor or social deficits 3. select and design activities while providing support and structure 4. interesting, non-demanding activities that promote socialization and maintaining function

What is a Change Process intervention? 1. Interventions designed to achieve _____ 2. AOTA practice FM terms _____ are used for pt change 3. An example of this is _____ 4. this the most _____

1. achieve behavioral changes and functional outcomes 2. Establish/ restore/ remediate/ restoration 3. Establishing skills never developed or restoring skills lost due to disability 4. Most used intervention in OT

What is an OT screen? 1. Acquiring information if _____ and to _____

1. an evaluation is warranted, obtain a basic understanding of the Clients Needs Clients Limitations Clients Assets Clients Resources

Developmental groups What is a mature group? 1. To enable to members to _____ 2. To reinforce _____ 3. Leadership roles?

1. assume all functional socio-emotional and task roles in group 2. behaviors needed to complete task. 3. leaders act as a peer/equal only assisting only to reinforce behavior or maintain balance ****Activity- number of people working together to complete activity in a set time

Developmental groups What is a project group? 1. Group members share _____ 2. Develop _____ 3. Members _____ and _____ 4. Leadership roles?

1. common activity goals with other members in a comfortable and cooperative manner. 2. social interaction beyond activity 3. give and seek assistance 4. directive role of selecting activity to encourage member cooperation while promoting members to give and seek assistance ****Activity- two or more members participate in short-term activity that requires interaction to complete ****Focus on group interaction vs project completion

What are communication and social skills? 1. Actions or behaviors of a person uses to _____

1. communicate and interact with others to interact with environment

Model of Human Occupation (MOHO) (frame of reference)? 1. Principles: occupation is ______. Personal occupational choices& engagement in occupation ______. 2. Three elements inherent to humans _____ 3. Environmental impact through opportunities, demands, resources, constraints: _____

1. dynamic & context-dependent; shape the individual 2. volition, habituation (organized, recurring patterns of bx & is comprised of roles & habits), performance capacity (physical&mental skills needed for performance & subjective experience of engaging in occupation) 3. environment is divided into physical & social components; each component is influence by the culture it takes place at

Home Health Care Intervention

1. engagement of client, family, and caregivers in treatment planning, implementation, and re-evaluation. 2. functional improvement in areas of occupation and role functioning w/in home. 3. remediate skill deficits and compensate for factors affecting performance in home. 4. educate family, caregivers, and/or home health aides 5. environmental modifications and activity adaptations to maintain optimal functioning / improve quality of life. 6. increase ability to resume occupational roles outside the home. 7. prevent hospitalization / avoidance or delay of residential institutional placement (SNF).

What is an OT reevaluation? 1. The process to determine if an individual's performance has _____, _____ or _____ after intervention.

1. improved, remained the same, declined

What are activity demands? 1. Specific features of activity that _____

1. influence the type and effort required to perform activity. Specific objects, properties, social demands, sequencing or timing and physical space requirements.

What is an OT evaluation? 1. Process of _____ and _____ the data necessary to tx the clt, system or situation

1. obtaining, interpreting

What are cognitive performance skills? 1. Action or behaviors of client uses to _____

1. plan and manage the performance of activity

What is Management intervention? 1. Interventions designed to _____

1. reduce or minimize disruptive behaviors that interfere with occupations.

Developmental groups What is an egocentric group? 1. To enable to members to _____ 2. Members identify and meet ____ 3. Leadership roles?

1. select and complete long-range activity requiring group interactions. 2. needs of self and others 3. less directive role who facilitates leadership in members by providing guidelines. Role model leadership role ****Activity- 5-10 people working together on member selected activity that will take two or more meetings

What is the purpose of program development?

1. to meet a perceived need of a specific population 2. to increase visibility and use of available services (i.e. outpatient cardiac rehab program more visible than individual referrals = increased recognition and use of this service

Developmental groups What is a parallel group? 1. To enable members to _____ 2. Minimal _____ 3. Develops basic level of _____ 4. Leadership roles?

1. to perform individual tasks in the presence of others. 2. verbal/non-verbal interaction 3. awareness of trust and comfort with others 4. develop trust, reinforce behaviors, provide structure, facilitate interaction ***Activity- perform activities independently without interaction

Developmental group 1. Type of group that _____ to develop _____. 2. how many different types of groups? 3. Clints with? 4. Therapist role?

1. uses an continuum of groups ( //, project, egocentric-cooperative, cooperative, mature groups), interpersonal skills 2. The use of 5 groups to develop social skills 3. Clt- individuals with social skills dysfunction 4. appropriate placement with correct group level, goal orientation, decrease leadership role as group progresses to each level.

What are the person client factors? 1. principles, standards, qualities of an individual 2. cognitive content held true 3. personal quest to understand the meaning of life 4. physiological Fxn of body systems 5. anatomical parts of the body

1. values 2. beliefs 3. spirituality 4. body function 5. body structures

What are organizational client factors? 1. vision statements, code of ethics, value statements 2. planning, organizing, coordinating, products and services, productivity 3. department relationship, leadership, and management, performance measures and job titles

1. values and beliefs 2. functions 3. structures

When does rotary chewing develop?

12 months

At what age are feeding skills of dipping spoon in food, bringing to mouth but spills food?

12-14 months

At what age are feeding skills of scooping food on spoon and placing in mouth?

15-18 months

Type 1 and Type 2 error

1: null hypothesis is rejected by researcher when it is true 2: null hypothesis not rejected by researcher when it is false

At what age are toileting skills of indicating discomfort when wet?

1year

At what age are self-dressing skills of removes pants, pulling socks on, front buttons and unbuttons?

2 1/2 years

At what age are toileting skills of regular toileting with occasional daytime accidents, verbalized toileting needs, continues to require reminders, require assistance?

2 1/2 years

Galant

2 mo: tapping along spine in prone results in lateral trunk flexion twoards stimulated side

Symbolic Play

2-4 yrs; play experiences where child formulates, tests, classifies; language development; manageable objects preferred; parallel play

When does the ability to chew meats and raw veggies develop?

24 months

average wheelchair width

24-26 inches

At what age are feeding skills of new interest in fork and is proficient with spoon?

24-30 months

At what age are feeding skills of holds and attempts to eat cracker but gums the cracker?

6-9 months

Rooting

3 mo integration

At what age are self-dressing skills of min A don pull over shirt, put on shoes & socks, doff pants, zips and unzipps?

3 years

At what age are toileting skills of sits self on toilet, assistance with wiping, assistance with fasteners?

3 years

What are the wrist antideformity positions following a brain injury?

30-45' extension

Provider has ...days to respond to request for medical records

30-60

When do jaw and tongue become strong enough to allow for feeding?

35 weeks of gestation

What is the typical gestation period?

38 to 42 weeks

At what age are self-dressing skills of buckles shoes, don socks correctly, assistance tying shoes, ID front and back of garment?

4 years

Oral development

4-5 mo: muching (phasic bite/release) 6 mo: strong downward and upward tongue movement 7-8 mo: begin mastication of soft/mashed food with diagonal jaw movement 9 mo: lateral tongue movement, drink from cup but jaw not firm 12 mo: firm jaw, rotary chewing (hard cookie) 24 mo: chew most meats and raw veggies (phasic bite/release - vertical tongue movement - diagnoal jaw movement - lateral tongue movement - rotary chewing)

When does a phasic bite and release develop?

4-5 months

At what age are toileting skills of independently toileting( paper, flushing, wash hands, clothing management?

4-5 years

Palmar grasp

4-6 mo

Asymmetric tonic neck

4-6 mo: fully rotate head for 5 seconds; extension of extremities on face side; flexion on skull side

Moro

4-6 mo: rapidly drop head backward - abd arms, brings arms in, cries

When is fine motor coordination typically start developing?

4-6 months

When do rooting, gag and cough reflex begin and persist to?

40 weeks gestation to 4 months

At what age are self-dressing skills of ties and unites shoes and dresses unsupervised?

5 years

At what age is laterality typically developed?

5 years of age, but dominance preference is seen earlier.

At what age are feeding skills of taking ceral from spoon?

5-7 month

At what age are feeding skills of holding bottle but will not retrieve if dropped?

6-8 months

Tonic labyrinthe - prone

6 mo: place in prone = increased flexor tone

Tonic labyrinthe - supine

6 mo: place in supine = increased extensor tone

When does an up and down movement of tongue develop?

6 months

Episode

60-day unit of payment for services

When do children begging playing structured games with rules?

7-12 years

Games

7-12 yrs; play with rules, competition, social interaction; cooperative peer groups; friends become more important

When does mastication and diagonal jaw movements develop?

7-8 months

Dysdiadochokinesia

impaired ability to perform rapid alternating movements

Plantar grasp

9 mo

When do lateral tongue movements and ability to drink from cup develop?

9 months

What is the rule of nines?

9%- each arm and head 36%- trunk 19%- each leg 1%- genital area

Crossing midline and bilateral integration begin at...

9-12 mo

When is bilateral integration typically developed?

9-12 months Clinical- coordinating 2 sides of the body is developed by increased movement and neuro system development

When does crossing midline typically occur?

9-12 months Clinical- increase mobility and movement against gravity leads to crossing midline.

At what age are feeding skills of finger-feeding emerging?

9-13 months

Cognitive Disabilities Model: Level 5?

: Exploratory Actions -Overt trial & error problem solving; new learning occurs; this may be the usual level of functioning for about 20% of the population

Cognitive Disabilities Model: Level 4?

: Goal Directed Actions -Ability to carry out simple tasks through to completion; indiv. relies heavily on visual cues; he/she may be able to perform estab. routines but cannot cope w/unexpected events

Cognitive Disabilities Model: Level 3?

: Manual Actions -Begins w/use of hands to manipulate objects; indiv. may be able to perform limited number of tasks w/long-term repetitive training

Cognitive Disabilities Model: Level 6?

: Planned Actions Absence of disability; person can think of hypothetical situations & do mental trial- &- error problem solving

Cognitive Disabilities Model: Level 2?

: Postural Actions -Movement that is assoc. w/comfort; some awareness of large objects in environ. and indiv. may assist the caregiver w/simple tasks

What is Management by Objective (MBO)?

A complete system of management based on a core set of goals to be accomplished by a program. 1. mission and goals established 2. measurable objectives quantified 3. specific time frames for accomplishing objectives established 4. staff training needs and deterrents to progress identified 5. program evaluation instituted.

What is a partial hospitalization or day hospital program?

A person with medical or psychiatric condition that is stabilized enough to d/c home or to community residence comes back for treatment (no longer inpatient hospitalization). Treatment is up to 5 days/week with multiple interventions throughout the day.

What is a Utilization Review?

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

Explain Risk Management and give examples.

A process that evaluates and resolves risk activities - Used to decrease actual or potential losses Examples: 1. client/employee injury 2. property loss or damage 3. maintain safe treatment environment 4. staff education/training (i.e. annual BBP, CPR, etc)

Case study.

A single subject or a group of subjects investigated in an in-depth manner. - Purpose can be description, interpretation, or evaluation

What is fantasy play?

A type of symbolic play Object fantasy- objects used in new unreal purpose (box becomes house) Person fantasy- people qualities given to object Announced fantasy- announce fantasy, then items are found to reinact fantasy

Outpatient/ambulatory care:

An individual who does not require hospitalization but has functional deficits requiring eval and intervention may receive OT services on an outpatient basis in private clinics, medical offices, and/or hospital satellite centers.

What must occur if the OT and clt do not fluently speak the same language?

An interpreter must be used Ensures validity of information and success of therapeutic process

What intrinsic muscles are innervated by the median nerve?

Abductor pollicis brevis Opponens pollicis Flexor pollicis brevis Lumbricals (radial side)

What are client factors? 1. _____, _____ or _____ of an individual that affect _____ in areas of occupation. 2. What are the 3 area of client factors?

Abilities, characteristics or beliefs, performance Physical or social environments 2. personal, organizational, population, performance

What is a above elbow amputation!

AE amputation Humeral neck- 30% of humerus Short AE- 50% of humerus Standard AE- 90% of humerus

What intrinsic muscles are innervated by the ulnar nerve?

Abductor digiti minimi Opponens digiti minimi Flexor digiti minimi Lumbricals (ulnar side) Palmar interossei Dorsal interossei

Assessment for components of motor control - Evaluating Abnormal Tone

Abnormal tone evaluated by eliciting stretch reflexes -Limb is quickly stretched in a direction opposite the pull of the muscle group being tested. -Objectively measured by Modified Ashworth scale 0 = no increase in muscle tone 1 = slight catch and release at end range 1+ = catch with min resistance thru rest of movement <50% 2 = marked increase in tone most of ROM but part moves easily 3= considerable increase in tone with passive mvmt difficult 4 = the affected part is rigid in flexion or extension)

In a school setting, what are the 5 areas that assessment information must relate to for OT?

Academic, mobility, psyhcosocial, self-care and behavioral. MUST be educationally relevant

National Committee on Quality Assurance (NCQA)

Accredits HMOs, PPOs and managed behavioral health care orgs

Commission on Accreditation of Rehabilitation Facilities (CARF)

Accredits free-standing rehab facilities and rehab programs of larger hospital systems in the areas of behavioral health, employment and community support services and medical rehab

Joint Commission on the Accreditation of Health Care Organizations (JCAHO)

Accredits health care facilities according to JCAHO established standards and conditions

National League for Nursing/American Public Health Association (NLN/APHA)

Accredits home health and community nursing agencies that offer nursing and other health services outside of hospitals, ECFs and SNFs

Accreditation Council for Services for Mentally Retarded and Other Developmentally Disabled Persons (AC-MRDD)

Accredits programs or agencies that serve persons with devel. disabilities

Forensic Setting:

Admission is d/t engagement in criminal activity by a person. The person can be remanded to a variety of settings depending on the nature of the crime and if he/she has a psychiatric diagnosis.

Rehabilitation hospitals:

Admission is for a disability that is medically stable but which has residual functional deficits requiring skilled rehab services.

rehabilitation hospital

Admission is for a disability that is medically stable but which has residual functional deficits requiring skilled rehabilitation services LOS is determined by presenting deficits and rehabilitation potencial can range from week to months

Sub-acute care/Intermediate care facilities (ICFs):

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.

SNFs/Extended care facilities (ECFs):

Admission is for a medical or psychiatric diagnosis that is chronic and requires skilled care, but the individual's illness is stable with no acute symptoms.

Interdisciplinary team

All disciplines relevant to the case at hand agree to collaborate for decision making; members directed toward common goal and not bound by discipline line-specific roles and functions

Degrees of freedom.

Allows the determination of level of significance based on consulting appropriate tables for each statistical test.

Freedom to Work Act

Amended SS Act to enable Americans receiving retirement SS benefits to be able to work without affecting their SS income

Deductible definition

Amount a pt must pay to a provider before the insurance benefits will pay

What is a below-elbow amputation?

Amputation below the elbow at any point of forearm Very short BE- 0-35% of forearm Short BE- 35-55% Long BE- 55-100%

What is a elbow disarticulation amputation?

Amputation of the UE distal to the elbow jt 100% of humerus

Standard error of measurement.

An estimate of expected errors in an individual's score: a measure of response stability or reliability

Response to Intervention (Rtl):

An evidence-based, structured intervention approach that uses Early Intervention Services (EIS) to address academic difficulties and Positive Behavioral Supports (PBS) to address behavioral problems early in a child's education

What does Marketing/Promotion entail?

Analyzing consumer needs, planning and designing a service or product meet identified needs, implement strategies and actions to promote consumer use of the service/product

What are the required body structures of activity demands?

Anatomical parts of body required to perform activity Organs Limbs

What muscles are involved in shoulder flexion?

Anterior deltoid- Axillary nerve Coracobrachialis- Musculo nerve Supraspinatus- suprascapula nerve

What is shoulder dislocation?

Anterior dislocation is the most common Etiology: trauma & overuse OT Focus: 1) Regain ROM - avoid abduction/ ER 2) pain free ADL 3) strengthen rotator cuff

What are performance patterns? 1. automatic behaviors 2. sequences of occupations 3. behaviors expected by society

Are habits, routine, roles, and rituals to engage in occupation. Habits- automatic behaviors Routine- sequences of occupations Roles- behaviors expected by society

What is the leading cause of disability in the elderly population?

Arthritis Hypertension Hearing impaired Heart impairment Cataracts Orthopedic impairment Diabetes Visual impairments 60-80% report more than one disability

Type of medical tx that stabilizes fx through fusion?

Arthrodesis

Type of medical tx to stabilize fx by joint replacement?

Arthroplasty

What are surgical interventions for adhesive capsulitis?

Arthroscopy Manipulation

What are the types of surgery for rotator cuff tendonitis?

Arthroscopy Open repair for: small, medium, large, massive tear

Evaluation Group

Assesses client skills, assets, and limitations regarding group interaction. Using tasks that can be completed in one session and require interaction.

Social worker

Assesses clients, families and caregivers with accessing social support services and obtaining needed reimbursement/funding; provides individual, couple and family counseling/crisis intervention ; contributes to d/c plan

Assessment of Task performance: Bay Area Functional Performance Evaluation (BAFPE) (focus, method, scoring, population)?

Assesses cog., affective, perf. and social interaction skills req. to perform ADL. - Method: brief interview prior to assessment to collect basic demographic data and clinical info and to familiarize indiv. w/the eval then uses Task Oriented Assessment (TOA) and Social Interaction Scale (SIS) - Scoring: TOA and SIS scores are NOT combined for total BAFPE score - Population: adult indiv. w/psychiatric, neuro, developmental diagnoses

C-Bar splint

median nerve injury (prevents web space contractures with night wear)

What righting reaction is elicits backward arm extension, when quickly tapped off-balance backwards?

Backward parachute or protective extension backward Onset- 9-10months Integrates- persists Clinical use- prevents fall and unilateral spinal rotation

What sensorimotor development occurs at 2 to 3 years?

Balance and posture- due to refinement of vestibular, proprioceptive, and visual systems 2) fine motor skills- due to increased tactile discrimination and localization 3) praxis ideation 4) motor planning

In elbow flexion, what elbow muscles are innervated by the musculocutaneous nerve?

Biceps Brachialis

Assessment of Task performance: Occupational Case Analysis Interview Rating Scale (OCAIRS) (focus, method, scoring, population)?

Based on MOHO; explores personal causation, values, goals, interests, roles, habits, skills, other areas related to environ./systems dynamics - Method: semi-structured interview - Scoring: items scored 1-5; data analyzed from 4 perspectives: dynamic (interaction b/t various elements), historical (impact of indiv's exper. over time), contextual (indiv.'s interaction w/environ.), system trajectory (where person is headed) - Pop.: originally for adult-elder w/psych diagnosis but currently used in broader context

What type of play do 5-6 year olds engage in?

Board games Competitive play Cooperative games Sports Organize group play

Inhibitory/Tone Normalizing Orthoses

Bobath Finger Spreader (abduction splint) Rood Cone Orthokinetic splint Spasticity Reduction splint

What righting reaction elicits segmental rolling of upper trunk to maintain alignment, when in supine hip and knees are flexed?

Body on body righting Onset- 4-6 months Integration- 5 years Clinical use facilitates trunk and spinal rotations

Functional Impairments: Asomatoagnosia?

Body scheme disorder that results in diminished awareness of body structure & a failure to recog. body parts as one's own

In elbow flexion what muscles are innervated by the radial nerve?

Brachioradialis

What is zone VI of the hand?

CMC to MCP

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling SPATIAL NEGLECT & intervention?

Cannot find food (usually) L side of plate, phone on the usually L side of the desk or cannot balance check book (e.g., the # 1,550.00 may be perceived as 50.00), gets lost easily during ambulation or WC mobility due to only responding to one side of environment, etc. - I: graded scanning activ., grade from simple to complex, use anchoring activ. to compensate (yellow tape on sink), manipulative tasks in conjunction w/scanning activ., external cues (colored markers, written directions)

What peripheral nerve injury is a median nerve injury causing numbness and tingling to the thumb, index, middle, and radial half of ring finger?

Carpel tunnel syndrome CTS Etiology: repetition, awkward postures, vibration, pregnancy Symptoms: 1) parasthesias occurs at night 2) dropping things 3) advance stages results in muscle atrophy of thenar eminence

What are the areas of IADL's?

Care of others Care of pets Child rearing Communication management Community mobility Financial management Health management Home management Meal prep Religious observance Safety and emergency maintenance Shopping

Primitive Reflex Testing for Oral Motor Eval: Jaw jerk

Center of the mandible is firmly tapped 1-2 times Normal response is no reaction Dys. is a reflexive jaw closure/opening response

Assessment that uses a predetermined list of items against which a person's performance is checked.

Checklist

Nominal data.

Classifying observations into mutually exclusive categories. - measuring gender as female or male

What is the etiology of an amputation!

Congenital Peripheral vascular Trauma Cancer Infection

hot packs, paraffin, and PROM

Contraindications for Complex regional pain syndrome (CRPS) type I as they may be too painful in initial stages if the affected limb demonstrates elevated temp. -this activity is also not tolerated due to severe pain and hypersensitivity to touch.

Rood: Interventions

Controlled sensory input through: 1. Facilitation 2. Inhibition

What social skills develop at 2-3 years?

Cooperative play Interest in peers Takes turns Shy with strangers Dialog with few words

What type of group enables members to engage in a group activity which facilitates free expression of ideas and feelings?

Cooperative, developmental

What are the leading causes of death in the elderly population?

Coronary heart disease Cancer CVA COPD

What are the pros and cons of a hand voluntary opening terminal device?

Cosmesis: appealing Pinch force: stronger than VO hook Prehension pattern: cylindrical grasp Weight: heavy Durability: less durable Reliability: more service Feedback: some proprioceptive

Discuss school programs. - Criteria for OT services

Criteria: - Child requires special ed and OT will enable child to benefit from special ed - OT will facilitate participation in educational activities and enhance functional performance. - Referrals from previous agency that provided early intervention - School reviews referrals and decides if OT warranted.

What gross motor skills are developed at 8 months in walking?

Cruises sideways

What peripheral nerve injury causes numbness and tingling along the ulnar aspect of the forearm and hand?

Cubital Tunnel Syndrome Ulnar nerve Etiology: 2nd most common elbow nerve compression 1) pressure on elbow 2) extreme elbow flexion Symptoms: 1) pain in elbow especially in elbow flexion 2) weakness of power grip 3) atrophy of flexor carpi , ulnaris, flexor digiti pollicis,, ulnar nerve intrinsic muscles

What fine motor performance skills are developing at ages 5-6?

Cuts with scissors Prints name Copies triangle Completes 20 piece puzzle Manipulates tiny objects

What are inferential statistics? - List the types

Determine how likely the results of the study of a sample can be generalized to the whole population. - Standard error of measurement - Tests of significance (alpha level, degrees of freedom, errors) - Parametric statistics - Nonparametric statistics - Correlational statistics

When are primitive reflexes developed and integrate?

Develop- at or just after birth Integrate- after first year

Child Abuse Prevention and Tx Act

Defines child abuse and neglect and mandates professionals to report abuse and neglect to law enforcement officials

What is lateral epicondylitis?

Degeneration of wrist extension tendons at origin of lateral epicondyle. 1) extensor carpi radialis brevis Tennis elbow Tx- 1) Immobilization by elbow strap or wrist splint 2) ice 3) deep friction massage 4) stretching 5) as pain decrease begin strengthening

What is medial epicondylitis?

Degeneration of wrist flexors tendons at origin Golfer's elbow Tx same as lateral epicondylitis

What is Osteoathritis?

Degenerative joint disease 1) wear and tear 2) not systematic 3) affects large weight bearing joints Etiology: 1) genetic 2) trauma 3) inflammation 4) cumulative trauma 5) endocrine/ metabolic disease

BENEFICENCE

Demonstrating a concern for the safety and well-being of recipients of OT services (patients, clients). E.g. -Fair and equitable services addressing the cultural aspects of the person. - Fees are fair and reasonable.

What type of teaching occurs when a clt. imitates task performed by OTR?

Demonstration and performance teaching

What are dx codes?

Describe condition or medical reason for OT services ICD-9 codes Each service, procedure, supply, or equipment must re Ate to medical dx code

Project Group

Developmental Group. Develops ability to perform a shared, short-term activity with another member in a comfortable, cooperative manner. Task is shareable and requires two or more people to complete.

What is diabetic retinopathy ?

Damage to retina by abnormal capillary growth, hemorrhage that lead to retina scaring 1) central vision impairment 2) vision is blurred

Thumb Spica Splint

DeQuervain's, RA, Skier's Thumb, CMC Arthritis

Functional Impairments: Topographical disorientation?

Difficulty finding one's way in space secondary to memory dysfunction or an inability to interpret sensory stimuli

What prewriting skills develop at 2-3 years?

Digital-pronate grasp- 1) held with fingers 2) wrist neutral or ulnar deviation 3) forearm pronated 4) arm moves as unit

Intervention for oral motor dysfunctions: Direct Therapy

Direct therapy: techniques that utilize a bolus -Modification of consistency, amount, and pacing of solids and liquids -Postural interventions to increase swallowing efficiency during meals (chin tuck, head tilt, head turn) -Specific swallowing adaptations: 1) Supraglottic swallow technique to voluntarily close/protect the airway during food intake 2) Medlesohn's maneuver (voluntarily prolonging the rise of the larynx by prolonging tongue contraction)

Parallel/project groups need what type of leader?

Directive

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling BODY NEGLECT & intervention?

Does not dress (usually) L side of body/shave L side of face, etc., does not incorporate involved limbs in activities such as bed mobility or sandwich making - I: bilateral activities, guide affected side through activity, inc. sensory stim to affected side

Hipaa does/does not require a guarantee of 100% confidentiality

Does not, just requires reasonable and vigilant safeguards

What righting reaction elicits extension of LE when infant is rapidly lowered toward surface while vertically suspended?

Downward Parachute or protective extension downward Onset- 4 months Integration- persists Clinical use- reaction to anticipated surface

How do you prevent tonic bite reflex?

Downward pressure on middle aspect of tongue

What sensorimotor development occurs at 3 to 7 years?

Driven to challenge sensorimotor by: 1) roughhouse play 2) playground activities 3) games 4) sports 5) music 6) dance 7) arts and crafts 8) household tasks 9) school tasks

What type of group enables patient and OT to assess skills and function, is appropriate for all patients who will be in groups or lack group skills, therapist's role is the observer, and tasks should be completed in one session and require interaction?

Evaluation group

What flexor tendon mobilization program uses passive flexion and extension of digits?

Duran Protocol 1) 0-4 weeks. Dorsal blocking splint (prevents extension) Passive flexion of PIP, DIP 10 x every hour 2) 4-6 weeks- active flexion and extension in splint as allowed 3) 6-8 weeks- tendon gliding and scar management 4) 8-12 weeks- strengthening

What prewriting skills develop at 4 to 6 years?

Dynamic Tripod posture 1) thumb opposition 2) digit flexion 3) palmar arch 4) wrist extended 5) MCP stabilization 6) PIP movement

Individual Roles

Dysfunctional roles that serve an individual purpose and interfere with successful group function.

What is a superficial burn?

Epidermis only Minimal pain, edema No blister Heals in 3-7 days

Ecology of Human Performance (EHP) Model: Evaluation & Intervention ?

EVALUATION: -utilizes checklists that were designed along w/ this model-for person, environ, tasks analysis & priorities -The sensory profile comes out of this model INTERVENTION:fall into 5 strategies to help the person, context, task or all 3. These interventions are: 1)Establish & restore: enhancing person's abilities by teaching skills lost b/c illness or disability or never learned 2)Alter: assessing a person's context to determine which is best match for person's abilities 3)Alter/Modify: changing context or task in some way so that it leads person to successful performance 4)Create: assisting the person by promoting enriching&complex performances in person's context

Test-retest Reliability

Establishes that the same results will be obtained twice by the same administrator.

Lack of opportunity to do activities perceived as worthwhile to others requires what type of intervention?

Esteem; facilitate recognized contributions

Clinical reasoning What type of clinical reasoning requires weighing the risks and benefits of intervention approach or strategies?

Ethical Reasoning

EPSDT

Early Periodic Screening, Diagnosis and treatment for children under 21. This includes hearing, vision, dental, periodic physical and developmental examinations

Secondary Prevention

Early detection of problems in an at risk population.

In a school/education setting what should all assessments be related to?

Educational Performance 1) Academic 2) mobility 3) psychosocial 4) behavioral 5) self-care

What type of group enables members to select and implement a long-range activity which requires group interaction to complete?

Egocentric-cooperative, developmental

Title I ADA

Employment. - Prohibits discrim. in all aspects of employment - Reasonable accommodations

What psychosocial development has 8 stages of resolving personal conflict?

Ericsson 1) trust-mistrust- survival needs will be met (0-18 months) 2) autonomy- doubt- self control of body (2-4 years) 3) initiative-guilt- social skills and gender role identity (pre-school) 4) industry- inferiority- security through peers and mastery of activities (elementary) 5) self-identity-role diffusion- make choices about adult roles (teenage years) 6) intimacy-solidarity- isolation- intimate relations with partner and family (young adulthood) 7) generavity- self-absorption- security in profession ( middle adulthood) 8) integrity- despair- reflection on values, and share wisdom (maturity)

Medicare Title 18-PL 89-97

Estab. Medicare and Supplemental Security Income (SSI); enables person w/disabil. to receive monthly income enabling them to live in community

Work Investment Act

Estab. a federally sponsored national employment and voc training system. - "One-stop" delivery system for adults 18+ seeking access to employment and training svcs

NDT/Bobath: Weight shifting

Establish the ability to weightshift symmetrically in various positions in all directions.

Face Validity

Establishes how well the assessment appears to measure it purpose.

Inter-rater Reliability

Establishes that different raters will achieve the same results.

Content Validity

Establishes that the content included in the eval is representative of the content that should be measured.

What peripheral nerve injury demonstrates numbness, tingling, and weakness on the ulnar side of hand?

Etiology: compression at Guyon's Canal due to pressure or fascia thickening Symptoms: 1) numbness, tingling, weakness on ulnar side of hand 2) atrophy of the hand muscles on ulnar side

What is the OT eval and intervention strategies of Osteogensis Imperfecta?

Eval 1) identify safe act of interest 2) identify enviro risk factors Intervention 1) act adaptation 2) enviro modification 3) positioning and splinting 4) weight bearing act to promote bone growth 5) Ed. On proper handling, positioning, enviro modification

Discuss early intervention programs. - Eval and Intervention process

Evaluation: assess cognitive, physical, communication, social-emotional, adaptive. Determine effects of current development on play and ADLs. Intervention: develop cognitive, psychosocial, communication, interaction, sensorimotor skills, play, ADL skills. Family education, advocacy/training, transition planning.

What type of teaching is when a clt. is given a verbal explanation of task and to plan or review components of activity?

Explanation discussion teaching

What type of teaching is when a clt. chooses between a diversity of activities?

Exploration and diversity teaching

What type if play develops skills of body scheme, sensory integration, motor development due to cause and effect of actions or objects?

Exploratory Play 0-2 years

What is exploratory play?

Explore surrounding using cause and effect Ages birth to1 Ages2-4 classify objects and develop purpose to action

Encourager, compromiser are what type of group role and is it functional or dysfunctional

Expressive; functional

What are the Elbow antideformity positions following a brain injury?

Extension

What wrist extensors are innervated by the radial nerve?

Extensor carpi radialis brevis Extensor carpi radialis longus Extensor carpi ulnaris

What are the extrinsic extensor muscles of the hand innervated by the radial nerve?

Extensor digitorum communis Extensor digiti minimi Extensor indicis proprius Extensor pollicis longus Extensor pollicis brevis Abductor pollicis longus

Type of medical tx that uses external hardware to stabilize fx?

External fixation

Ego-centric/cooperative groups need what type of leader?

Facilitative

What type of leadership requires the OTR to share responsibilities with group members?

Facilitative leadership Leader roles to have members acquire skills through experience

Negligence

Failure to do what other reasonable practitioners would have done under similar circumstances, the end result was harm. Supervisors assume liability if they provided faulty supervision. The institution assumes liability if the individual was harmed as a result of an environmental problem (i.e. slippery floors, lack of grab bars).

Center for Medicare and Medicaid Services (CMS)

Federal agency which develops rules and regulations pertaining to federal laws, in particular Medicare and Medicaid programs

What grasping skills develop at 12 months?

Fine pincer grasp- between fingertips and distal thumb joint flexed

What manipulating skills develop at 12-15 months?

Finger to palm transition 1) linear movement of object 2) finger to palm 3) picking up coin

What extrinsic flexor muscles of the hand are innervated by the median nerve?

Flexor digitorum superficialis Flexor digitorum profoundus Flexor pollicis longus

Modular group?

Focus of each sessions rotated in way that indiv. can join at any time & still cover each topic (e.g. Independent Living Skills group that addresses nutrition 1st session, money manage. 2nd session, transportation 3rd, then cycle begins again)

Instrumental Roles

Functional roles that help the group select, plan, and complete a task.

Expressive Roles

Functional roles that provide support and maintain the overall group members' needs.

Assessment of Task performance: Occupational Performance History Interview (OPHI-II) (focus, method, scoring, population)?

Gathers info re: indiv's life history, past and present occu. perf., and the impact of disability - Method: using a semistructured interview covering 5 areas addressing org. of daily routines: occupational roles, occupation/activity choices, critical life choices, and occupational behavior settings - Scoring: OT rates the identity, competence, and the impact of occ. behavioral settings from 1 (extreme dysfx) to 4 (competent) ratings used to identify indiv's life hx pattern (then narrative written) - Pop.: variety (adolescent to elders)

No Child Left Behind Act (NCLB)

General edu. law which emphasizes standards- based edu.; req. schools to provide accommodations, if needed by students, for mandated tests

What gross motor skills are developed at 5-6 months in release?

Grasp item before releasing hand to let go

Stigma and symptoms due to mental health can prevent regular interactions with a group and require what type of intervention?

Group association; social interaction skills and community supports

What types of play do 4-5 year olds participate in?

Group games with simple rules Organize play with roles Organize gross motor games

Cock-up splints

Hand/wrist based splint that can be dorsal or volar Supports the wrist in 10-20 degrees of extension to prevent contractures Allows the digits to function (ex: to support flaccid wrist)

Opponens splints

Hand/wrist based splint that can be dorsal or volar; May be short or long Designed to support the thumb in a position of abduction and opposition Utilized during functional activities to compensate for weakness patterns

HIPAA stands for...and ensures...

Health Insurance Portability and Accountability Act, ensures individual's right to continuity in healthcare coverage, privacy and security of records

What is Presbycusis?

Hearing loss associated with middle and old age 1) bilateral hearing loss 2) high frequency lost first 3) poor auditory discrimination Especially background noise

What are the different types of bone spurs in OA?

Heberden's nodes- @ DIP Bouchard's nodes- @ PIP

Instrumental Group

Helps members function at their highest level possible for as long as possible. Member are unable to change or progress (ex: reminiscence group for dementia patients).

What sensory loss occurs with radial nerve lacerations?

High level lesion- medial aspect of dorsal forearm, dorsal palm, thumb and index, middle, radial half of ring finger

Directive groups (purpose and 5 parts)?

Highly structured, designed to assist LOW functioning pt.s in developing BASIC SKILLS. Kathy Kaplan. - Each session divided into 5 parts, followed by 15 min. review of session by leaders - Part 1: orientation to purpose/goals - Part 2: review of names& intro of new members - Part 3: warm-up activities to make members comfortable & engage them in group - Part 4: one or more activ. designed to address the goals of the group and needs of members - Part 5: activities designed to give meaning to activities and closure to group

What is a terminal device and the type?

Hook or hand that is interchangeable with prosthesis Voluntary open- hook remains closed until cable is activated Voluntary closed- hook remains open until tension cable is activated Cosmetic device- minimal Fxn, stabilization Selection of TD depends on clt roles and preferences

What gross motor performance skills are developed at ages 5-6?

Hops long distances Skips with good balance Catches ball with 2 hands Kicks with accuracy Stands on one foot 8-10 sec

Individualized Family Service Plan

IFSP, for parents of children aged 0-2 years, OT is a primary early intervention service.

Assessment of Task performance: Canadian Occupational Performance Measure (COPM) (focus, method, scoring, population)?

Identified indiv.'s perception of satisfaction w/perf. and changes over time in areas of self-care, productivity and leisure - Method: semi-structured interview re: the 3 areas, prob. areas identified, identified problems rated by indiv. as to perf. and satisfaction, reassess at approp. intervals - Scoring: items rated 1-10 (highest), total scores for perf. and satisfaction used to identify tx focus, tx outcomes and indiv. satisfaction - Pop.: indiv. over age 7 or parents of small children

What is constructive play?

Identifies outcomes Ages 3-4

National Adult Day Services Association (NADSA)

In affiliation w/CARF, accredits adult day services for persons with functional and cog. impairments

Functional Impairments: Impaired organization/sequencing?

Inability to organize thoughts w/ activity steps properly sequenced

What is Glacoma?

Increase intraocular pressure that degenerates optic disc and atrophy of optic nerve 1) loss of peripheral vision

Task-Oriented Group

Increases clients' awareness of their needs, values, ideas, feelings, and behaviors. Focus on problems which emerge in the process of choosing, planning, and implementing a group activity.

Quasi-experimental design

Indep. variable is manipulated to determine its effect on a dependent variable but there is a lesser degree of control and/or no randomization (often used in hc, used to study intact groups created by events or natural processes)

What is correct hand placement while facilitating jaw movements?

Index finger under lip Middle finger under jaw Thumb lateral end of mandible

Intervention for oral motor dysfunctions: Indirect Therapy

Indirect therapy: procedures that do not include use of a bolus -Thermal (cold) stimulation via a chilled dental examination mirror to elicit a swallow reflex -Reflex facilitation -Strengthening, facilitation and coordination of oral movements -Airway adduction procedures -Positioning to maintain the trunk/head in correct postures

What is the difference between group and individual intervention?

Individual- 1) learning capacity of person 2) individual attention to persons body structure and function 3) need for privacy 4) needed control of context 5) difficulty of occupation and activity demands 6) persons behavior Group- 1) developing interpersonal skills 2) engaging in socialization 3) receiving feedback 4) motivated by peer role models 5) learning from others 6) perspective of one's condition 7) developing group normative behavior.

Aggressor, blocker are what type of group role and is it functional or dysfunctional

Individual; dysfunctional

What grasping skills develop at 9 months?

Inferior Pincer Grasp- Between thumb and index finger with increased thumb opposition

What grasping skills develop at 7 months?

Inferior-scissoring grasp- raking objects into palm with 1) adducted and flexed thumbs 2) flexed fingers

What SITS muscle is involved in shoulder external rotation ?

Infraspinatus- suprascapula nerve Teres minor- Axillary nerve

Mandated medicaid services

Inpatient, outpatient, home health, Early Periodic Screening Diagnosis and Treatment (EPSDT) for children under 21, services identified under EPSDT

What type of group is designed to help members function at their highest possible level for as long as possible, includes patients that have demonstrated in treatment and inability to change or progress, therapist's role is to provided unconditional positive regard, and suitable task can be completed with structure and assistance?

Instrumental group

Initiator, organizer are what type of group role and is it functional or dysfunctional

Instrumental; functional

What type of reliability measures tester to another tester?

Inter-rater reliability

What is Zone IV of the hand?

It is the zone under the carpal ligament MCP to PIP

What type of gross motor play does a 2-3 year old participate in?

Jumping, rough and tumble,

What gross motor performance skills are developing at age 3-4?

Jumps, climbs, runs Skipping or hopping Static standing on one foot Alternates feet walking up stairs

largest single payer for OT services?

Medicare

Interventions to satisfy inherent, universal human needs

Meeting health needs

What reflex elicits first arm extension/abduction and hand opening, second arm flexion and addiction, when head is dropped backwards?

Moro reflex Onset- 28 weeks Integration- 4-6 weeks Clinical- facilitates ability to depart dominant flexor posture and protective response

HMO

Most common form managed care; enrollees see docs only in network and must obtain referrals before seeking specialty or ancillary care

Dynamic Splint

Moving parts included; splints that have a resilient component (elastic bands or spring) and are utilized to increase passive motion, assist weak motions, or substitute for lost motion

What are requirements of Medicare in intervention documentation?

Must show level of complexity and need for intervention requiring OT judgement, knowledge, skill of therapist 2) Tx must match dx code 3) Tx unique to OT 4) home care due to Fxn limitations

What gross motor skills are developed at 4 months in release?

Mutual fingering in midline

What is included in background information of documentation?

Name Age Sex Date of admission Tx diagnosis Referral source Referral reason Chief complaint and OT relevance History: PLOF Support systems Medical hx Developmental, education, socioeconomic, and vocational Precautions, risk factors, contraindications, medications, surgery dates

Prospective payment system (PPS)

Nationwide payment schedule that determines Medicare payment for each inpt stay of a Medicare beneficiary based on DRGs

What righting reaction elicits log rolling of entire body to maintain alignment with head, when head is turned to one side?

Neck on body righting Onset- 4-6 months Integration- 5 years Clinical use- initiates rolling

What are the neck antideformity positions following a brain injury?

Neutral to slight flexion

What are the forearm antideformity positions following a brain injury?

Neutral to supination

What grasping skills develop at natal?

No grasp or visual attention to objects

Non-experimental/correlational design

No manipulation of independent variable; randomization and researcher control not possible; used to study the potential relationship b/t 2+ existing variables

What are the levels of measurement/data?

Nominal data Ordinal data Interval data Ratio data

Chi square test

Nonparametric test of sig. used to compare data in the form of frequency counts occurring in two or more mutually exclusive categories

Assessments that produce scores that compare the individual's performance to a set of population's performance.

Norm referenced

Age, gender, and diagnostic grouping are examples of what type of data?

Normative data

What type of data is used for comparative analysis of an individual's score?

Norms

What is symbolic play?

Not real life, pretends 2-5 years

Multidisciplinary team

Number of professionals from different disciplines conduct assessments and interventions independent from one another; members' primary allegiance is to his/her discipline; limited commun.

Who can score the assessment?

OT and/ore OTA

Principle 4: Duty

OT personnel shall achieve and continually maintain high standards of competence. - hold approp. national and state credentials - conform to AOTA standards of practice and official documents - maintaining and documenting competence in practice, edu., research by participating in CE - be competent in all topic areas in which they provide instruction - keep current w/emerging knowledge - provide approp. supervision - refer or consult w/ other services whenever

SOCIAL JUSTICE

Occupational therapy personnel shall provide services in a fair and equitable manner.

Group Development Phases

Origin --> Orientation -->Intermediate --> Conflict --> Cohesion -->Maturation --> Termination

Overhead suspension sling

Orthotic device incorporates an arm support that is supported by a sling and suspended by an overhead rod Patient presenting with proximal weakness (ALS, Guillian-Barre syndrome, muscular dystrophy) with muscle grades in the 1/5 to 3/5 range are appropriate candidates

What assessment must be completed to verify a person's eligibility for Medicare home health benefits?

Outcome and Assessment Information Set (OASIS)

prospective payment system

PPS. Nationwide payment schedule that determines the medicare payment for each inpatient stay based on DRG.

What is post-op intervention for adhesive capsulitis?

PROM immediately after surgery Pain relief ADL

What are the symptoms of RA?

Pain Stiffness Limited ROM Fatigue Weight loss Swelling Deformities

What are the symptoms of OA?

Pain Stiffness Limited ROM bone spurs

What are the required action and performance skills of activity demands?

Performance skills used to carry out activity Sensory Perception Motor Praxis Emotional Cognitive Communication Social skills Performance skills correlate with other activity demands

Assessments that involve structured guidelines and/or standard procedures.

Performance tests

What are the space demands of activity demands? Environmental....

Physical environment Enviro size Enviro arrangement Enviro surface Enviro lighting Enviro temperature Enviro noise

What are the required body functions of activity demands?

Physiological functions required to perform activity

What grasping skills develop at 10 months?

Pincer grasp- distal pad of thumb and index finger with thumb opposed

How do you facilitate chewing?

Place food between gum and teeth

What reflex elicits toe flexion, when pressure is applied to ball of foot?

Plantar grasp Onset- 28 weeks Integration- 9 months Clinical- increases tactile input of foot

What is cooperative play/ reciprocal play?

Play directed toward common goal and peer social interaction Middle childhood

What are the areas of play?

Play exploration- exploration play, practice play, pretend play, games and rules, constructive play, symbolic play Play participation- maintaining balance of play with other occupations

What special test can be performed to indentify pronator teres syndrome?

Positive Tinel's at forearm

What muscle is responsible for shoulder horizontal abduction?

Posterior deltoid Axillary nerve

What muscle is involved with shoulder extension?

Posterior deltoid Latissimus dorsi Teres major

What are the 5 P's?

Product Price - cost of doing business Place - access to the service Promotion - advertising Position - where it stands against similar services/products

Clinical reasoning What type of reasoning requires identification of context and environment to promote occupations?

Pragmatic Reasoning Barriers, time constraints, financial resources, limited space or assistance

Context of treatment setting and how it shapes treatment considerations is what type of reasoning?

Pragmatic reasoning

What gross motor skills are developed at 12-15 months in release?

Precise, control release into small container with wrist extended

What is reflex development and integration?

Predictable motor response elicited by stimulation of: 1) tactile system 2) proprioceptive system 3) vestibular system

Prevention

Promotes wellness, prevent disabilities and illness, and maintain health.

What volar muscles are innervated by the median nerve?

Pronator teres Pronator quadratus

What righting reaction elicits curving of the spine towards raised side and abduction/ extension of arms and legs, when positioned in prone and raising or tilting to one side?

Prone tilting Onset- 5 months Integration- persists Clinical- maintains equilibrium without arm support Facilitates postural adjustments in all positions

Resting Hand Splint

RA, Crush injuries, burns, spasticity due to upper motor neuron lesions, flaccidity

NDT/Bobath: Handling

Provide external stability Normalize movement patterns Facilitate or inhibit specific muscle groups Inhibit abnormal patterns of control Provide sensory input Increase ROM Dissociate body segments (scapular mobilization) Normalize tone

Institutionalized orphans confined to cribs require sensorimotor interventions to counter environmental deprivation is what type of intervention?

Psychophysical

Title III ADA

Public Accommodations and Services operated by public entities. - Places of accommodation (hospitals, hc providers' offices, schools, etc.) may not discrim. against persons w/disabil.

What peripheral nerve injury causes weakness or paralysis of the wrist extensors, MCP extensors, and thumb?

Radial Nerve Palsy Saturday night palsy Radial nerve compression Etiology: compression to radial nerve at the upper arm due to 1) extended pressure (sleeping on it) 2) humeral fx causing nerve impingement

What fine motor skills are developed at 8 months in grasp?

Radial digital grasp

Dynamic Wrist Finger Thumb Extension Splint

Radial nerve palsy

What fine motor skills are developed at 6 months in grasp?

Radial-Palmar grasp

What fine motor skills are developed at 6 months in fine pincer grasp?

Raking and contacting item

Ordinal data.

Ranking. Numerical value that assigns an order to a set of observations. i.e. Ranking income into categories (1=poor, 2=lower income, 3=middle income, 4=upper income). We can say that middle is higher than lower, but not the extent to which the rankings differ.

Assessment that requires the patient or therapist to rate reactions, performance, or set criterion.

Rating scale

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling PERSEVERATION & intervention?

Repeats same motor act (continuing to wash one arm or continuing to pull up a sock that already covers the foot); difficulty terminating a hand to mouth pattern when the plate or bowl is empty, repeats same task (ex. dress, undress, dress, undress) - I: bring to conscious level & train person to inhibit bx, redirect attn., tasks that req. repetitive action (knitting?)

What are risk factors of cumulative trauma disorders?

Repetition Static position Posture Arthritis

What type of teaching uses repetition of task to increase speed and accuracy?

Repetition and practice

Telecommunications Act of 1996

Req. providers of telecommunications systems and manufacturers of telecomm. equip. to make scvs and equip. usable by and accessible to indiv. w/disabil.

What is the difference between righting reactions and primitive reflexes?

Righting Reactions- develop at or shortly after birth in response to the new environment of gravity. They are most distinguishable at 10-12 months old and remain active throughout life, providing integrated movement between the head and trunk, and the body and gravity Primitive Reflexes-are stereotypical movement patterns in response to specific stimuli. In other words, each time a stimulus is provided, the same movement pattern is elicited with no or limited variation for typically healthy development. PR- integrate by 4-6 months of age although a few remain as reflexes throughout life. Integration is accomplished when equal and opposite reflexes modulate each other for more variable and mature movements.

What are the components of STG and LTG's? SMART 1) of areas of deficit or performance areas (button 2/4 buttons vs increase self-cares) 2) give an quantifiable amount (50% of time) 3) realistic outcomes ( with supervision vs 100% accuracy) 4) to roles and environment 5) relevant to setting and length of stay LOS 6. LTG's must _____

SMART 1) Specific- of areas of deficit or performance areas (button 2/4 buttons vs increase self-cares) 2) Measurable- give an quantifiable amount (50% of time) 3) Attainable- realistic outcomes ( with supervision vs 100% accuracy) 4)Relevant- to roles and environment 5) time-limited- relevant to setting and length of stay LOS 6. indicate final outcome before d/c

Living in a chaotic and abusive home requires what type of intervention?

Safety

What is the tx of ulnar nerve laceration?

Same as median nerve laceration Splinting MCP flexion block

Screening pre-term infants for developmental delays and starting sensory programs is what type of intervention?

Secondary prevention

Assessment that requires the individual to disclose personal information in an organize manner.

Self-report

What muscles are responsible for scapular abduction?

Serratus anterior

Biomedical engineer

Serves as a technical expert to recommend commercial products, adapt available devices and/or modify existing environments; develops, designs and fabricates customized equip., devices and techniques

What manipulating skills develop at 3 to 3 1/2 years?

Shift- 1) linear movement 2) repositioning object by repositioning fingers 3) separating papers with fingers

What righting reaction elicits arm extension and abduction when tipped off balance to side while in sitting?

Sideward Parachute or Protective Extension Sidewards Onset- 7 months Integrates- persists Clinical use- prevents lateral fall

PPO

Similar to HMO but more choice of providers (but as choice inc., % of payment dec.)

What type of teaching is acting out an activity performance by simulating a task?

Simulation

What are praxis performance skills?

Skilled purposeful movement Sequential motor movements Learned motor activity Visual-spatial construction Ocular and oral-motor Organization temporal sequence

What performanc skills are developed by 2-3 years?

Snips with scissors Traces forms like crosses Colors large forms Draws circles Builds cube towers Completes 4-5 piece puzzle

What are the social demands of activity demands?

Social environment Cultural context

What SITS muscle is responsible for internal rotation?

Subscapularis- subscapular nerve

What is laterality motor development?

Specific hemispheric preference for one side. Can occur in hands, feet and cerebral hemispheres

What are procedure codes?

Specific services delivered by healthcare provider HCPCS and CPT codes Service codes should relate to services provided

How is grip strength assessed for arthritis?

Sphygmomanometer Dynometer- contraindicated secondary to excessive joint stress and ROM

Brunnstrom's levels of motor recovery

Stage 1 = *flaccidity*, no voluntary or reflexive activity Stage 2 = minimal voluntary movement, components of the synergies are elicited as reflex reactions. Spasticity begins to develop Stage 3 = *marked spasticity*, synergies are performed voluntarily Stage 4 = movements that begin to deviate from synergy can be accomplished on a volitional basis Stage 5 = movements which differ greatly from the basic synergies are utilized Stage 6 = *spasticity essentially absent*; isolated muscle actions freely performed Stage 7 = *normal* motor function

insurers are regulated by

States in which they provide

Correlational Statistics: strength of relationships

Strength of relationships: - Positive correlation: 0 to +1, as x increases, so does y - Negative correlation: -1 to 0, as x increases, y decreases - High correlation: .70 to +1 - Moderate: .35 to .69 - Low: 0 to .34 ***0 means NO RELATIONSHIP between variables

What type of play uses pretend ideas, pretend objects, or imaginary friends?

Symbolic play 2-4 years Associated with language development Mostly involved with parallel play

What reflex elicits flexion of hip and knees, when infant is placed in crawling position and head extended?

Symmetrical Tonic Neck reflex Onset- 4-6 months Integration- 8-12 months Clinical- breaks up extensor posture Facilitates static quadruped

Continuous Quality Improvement (CQI)

System-oriented approach that views limitations and problems proactively as opportunities to increase quality (prevention emphasized, blame not attributed to persons)

What is Rheumatiod Arthritis?

Systematic and symmetrical inflammation affecting many joints 1) most commonly attacks hands 2) remission and exacerbations 3) acute phase is an inflammation process of synovial fluid Etiology: 1) infection theory 2) autoimmune theory

Performance assessment and improvement (PAI)

Systematic method to evaluate appropriateness and quality of svcs (interdisciplinary systems focus, client-centered approach)

What type of group increases one's awareness of needs, values, ideas, feelings, and behaviors, patients involved have cognitive and/or socioemotional due to psychological or physical trauma, therapist's role is active to facilitate task reinforce new behavior, and activities are selected, planned, and implemented by group members?

Task-oriented group

Title IV ADA

Telecommunications. - All televisions must have closed captioning - Relay svcs 24 hr/day, 7 days/wk

What are Parametric Statistics? - List the types

Testing based on population parameters - T Test: test of significance to compare two group means and identify a difference at a selected probability level (i.e. p=.05) - ANOVA: compare two or more treatment groups or conditions at a selected probability level - ANCOVA: compare two or more treatment groups or conditions while also controlling for the effects of intervening variables (i.e. two groups compared on UE reach with two types of assistive devices but one group has longer arms than other group so need to control for this)

Who is responsible for reevaluation and modification of plan?

The OT with collaboration of COTA

Who can interpret the assessment?

The OT, but the OTA can collaborate with the OT to integrate referral, screening and diagnostic information

Who is responsible for intervention implemention?

The OTA with the supervision of the OT

Interventions designed to achieved behavioral change

The change process

Explain Total Quality Management (TQM).

The creation of an institutional "culture" where all members participate in continuous improvement to meet or exceed needs of "customers"

Explain the difference between IV and DV.

The dependent variable DEPENDS on the independent variable. i.e. changes in ROM (dependent variable) due to treatment (independent variable) of PROM, AAROM, HEP.

Co- insurance definition

The monetary amount to be paid by a patient, usually expressed as % of total charge

What is Dupuytren's disease?

Thick and contracted fascia of palm and digits Conservative tx not effective Tx- surgical release 1) z plasty 2) aponeurotomy 3) McCash proceedure (open palm) OT tx- 1) wound care 2) edema management 3) extension splint 4) A/PROM 5) scar management

FIDELITY

To treat colleagues and other professionals with fairness, discretion, and dignity.

What type of group discusses specific activities that members engage in outside of the group?

Topical group 2 types- concurrent (act. already happened) or anticipatory (act. anticipated to happen) 1) improves ability to engage in act. outside of group by discussing problem.areas, solutions, appropriate behaviors 2) clt.- share similar problems, ego-centric cooperative group skill level Verbal and cog. levels Therapist roles- facilitate discussion, problem solving, reinforce skills, acts as role model

What reflex elicits flexing of UE, when grasping infants arm in pull to sit position?

Traction reflex Onset- 28 weeks Integrated- 2-5 months Clinical use- enhances momentary reflexive grasp

What gross motor skills are developed at 4-8 months in release?

Transfers objects hand to hand

What is the difference between transverse vs spiral vs oblique?

Transverse fx- complete break that is perpendicular Spiral fx- caused by torque resulting in a twisting break Oblique fx- breaking of bone in a diagonal pattern

What muscles are responsible for scapula elevation?

Trapezius upper Levator scapulae

In elbow extension, what muscles are innervated by the radial nerve?

Triceps Anconeus

What fine motor performance skills are developing at ages 3-4 years?

Tripod grasp Colors within lines Copies simple shapes Begins to copy letters Cuts simple shapes 3-D block construction 3 block bridge

True or false? In school/educational settings, medically necessary and educationally relevant OT must be separate?

True

What releasing skills develop at 5-6 months?

Two stage transfer - grasp with both hands before release

Prevention Intervention: promote wellness, prevent disabilities and illnesses, and maintain health

Two types * Primary Prevention: reduce incidence or occurence of disease or disorder in high-risk area (parenting for teens to prevent child abuse) *Secondary Prevention: early detection, reduce duration or disorder/disease and/or minimize affects through early detection/diagnosis (premature babies for developmental delays)

Bobath finger spreader (abduction splint)

Type of inhibitory/tone normalizing orthoses Based on Bobath's principle of reflex inhibiting patterns This soft splint positions the digits and thumb in abduction in an effort to reduce tone

Rood cone

Type of inhibitory/tone normalizing orthoses Based on Rood's inhibitory principles of sustained deep pressure This cone-shaped splint is utilized to reduce flexor spasticity in the hand

What gross motor skills are developed at 8 months in release?

Uses wrist flexion to release above a surface

Discuss how to Analyze a Target Market

Validate perceived needs and desires by RESEARCH

What measures the assessments accuracy?

Validity

Educational Model:

Views the individual with a disability as lacking knowledge or skills.

Community Model:

Views the individual with a disability as lacking skills, resources, and supports for community participation.

What reaching skills develop at newborn?

Visual regard Swiping and batting Shoulder abduction

What releasing skills develop at 7-9 months?

Voluntary Release

Pro Bono

Working for a free or reduced rate, paid for by therapist

Disciplinary Actions: Censure

a public statement of the respective agency's disapproval of a practitioner's conduct.

AT interviews

asking specific questions

Evaluation group

assess client's skills, assets and limitations in group setting

Thematic group

assist members in learning skills, knowledge and/or attitudes needed to perform a specific activity in a group

dynamic PIP extension splint

boutonniere deformity

Oval-8 Finger Splint

boutonniere deformity, swan neck deformity, combined median/ulnar injury

Ulnar Gutter Splint

boxer's fracture (5th metacarpal)

Functional Impairments: Wernicke's Aphasia?

deficit in auditory comprehension that affects semantic speech performance, manifested in paraphasia or nonsensical syllables

diagnostic related grops

descriptive category set forth by CMS that determines the level of payment at a per case rate.

pleasure

do things just for fun...important for children on strict rehab and intervention therapy

Purposeful activities

doing processes that are directed toward a desired and intended outcome and require energy and thought to engage in and complete

Athetosis

dyskinetic condition that includes inadequate timing, force, and accuracy of movements in the trunk/limbs; movements are writhing and worm-like

safety

enviro free from hazards or threats

OTPFW terms for change a person in some manner

establish/restore/remediation/restoration

Erhardt Developmental Prehension Assessment (EDPA) Revised and Short Screening Form (EDPA-S)

focus: observation checklist based on performance which assesses three clustered areas including involuntary arm-hand patters, voluntary movements approach, prewriting skills pop: children of all ages and cognitive levels with neurodevleopmental disorders

task-orient group

increase awareness of needs, values, ideas and feeling and behaviors as they are engaged in a group task

rating scales

individual or OT/COTA rate reactions, performance or set criteria according to an established scale

Self-report AT

individuals discloses info in an organized manner, such as a questionnaire

acute care hospital

initial onset of a new illness or major health problem acute exacerbation of a chronic illness LOS can be limited to 1-7 days

Traction

integrates 2-5 mo; pull to sit, complete flexion of UEs

Chorea

involuntary movements of the face and extremities which are spasmodic and of short duration

Resting tremor

involuntary tremor noted in resting postures

Functional Impairments: Disorientation?

lack of knowledge of person, place & time

Functional Impairments: Broca's aphasia?

loss of expressive language indicated by a loss of speech production

Ataxia

loss of motor control including tremors, dysdiadochokinesia, dyssynergia, visual nystagmus

psychophysical

need for adequate shelter, food, material goods, sensory stimulation, physical activity and rest (children confined to crib needs sensorimotor intervention to counter enviromental deprivation)

group association

need to feel connected....counter, mental illness

esteem

need to recognized for one's own accomplishments

checklists

predetermined listing of items against which a person's performance is checked to determine an absence/presence of these items (sensory profile)

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling IMPAIRED ATTENTION?

not being able to attend to long conversations, instructions, class lessons, TV shows or movies (impaired sustained attention), not being able to study outside w/ the noise of traffic & children playing (impaired selective attention), not being able to make toast & tea at the same time (impaired divided attention), having difficulty switching your attention from typing a paper to answering the phone & then back to typing (impaired attentional switching)

Landau

onset 3-4 mo, integrates 12-24 mo: horizontal prone position, when head comes up, feet come up; when head goes down, feet go down

Downward parachute

onset 4 mo; rapidly lower infant toward ground = extension of lower extremities

Symmetric tonic neck

onset 4-6 mo, integrates 8-12 mo: place in crawling position and extend head = flexion of hips/knees

Forward parachute

onset 6-9 mo; extension of upper extremities

Practice of motor learning: Random (variable) practice

practice of several tasks that are presented in a random order encouraging reformulation of the solution to the presented motor problem

norm-referenced assessments

produce scores that compare the individuals performance to a set-populations performance

Home health agencies are reimbursed under...type of payment system

prospective payment system

criterion-referenced assessment

provide scores that compare performance to a pre-established criterion.

Overhead Suspension Sling

proximal weakness, muscle grades 1/5-3/5

"Disabled" criteria

significant physical or mental impairment that significantly limits one or more major life activities, with a record of impairment. does NOT include substance users, gamblers, kleptos, pyros, sexual deviants

Cone Splint

spasticity (also called spasticity splint)

Vocational programs

specific voc skills, Person has good tasks skills but requires specific training to perform a job, OT focus on remediation, advocacy, ADA accommodations, referral to state offices

Serial splints

splints that are utilized to achieve a slow, progressive increase in motion by progressive remolding

clinical/critical pathway

standardized recommended intervention protocol for a specific diagnosis

performance tests

structured guidelines and/or standarized procedures for engaging individual in performing an activity and for scoring the activity

mastery

successfully complete an activity or difficult goal b/c it is interesting and challenging

supervision of aide

supervisor OT or OTA must be within auditory and/or visual contact i nte immdiate area of the aide during the aide's task performance

Maintenance

support/preserve current functional level; no improvement is planned, just stopping regression due to disorder/disease (alzheimers)....major part of OT due to chronic/progressive disorders, but not often reimbursed by 3rd party payers

Developmental group

teach skills, subgroups are: parallel - do a task with min interaction with others as they are doing the same task (school), project - work together, egocentric-cooperative - long range activity with others, cooperative - work with others, and mature group

Functional Impairments: Perseveration?

the continuation or repetition of a motor act or task

Disciplinary Actions: Suspension

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

Home health OT is covered if

the patient is determined to be homebound

Disciplinary Actions: Revocation

the permanent loss of membership, certification, or licensure.

Disciplinary Actions: Reprimand

the private communication of the respective agency's disapproval of a practitioner's conduct.

Individualize educational plan IEP

this plan should be done annually. OT address the goals and objectives documented in the IEP usinf corrective and compensatory methods.

Ulnar Drift Splint

ulnar drift (common with RA)

Dynamic/Static Splint with MPs in flexion

ulnar nerve injury

Dysmetria

undershooting (hypometria) or overshooting (hypermetria) of a target

Hemiballismus

unilateral chorea characterized by violent, forceful movements of the proximal muscles (usu. after CVA)

Intention tremor

worsening of action tremor as the limb approaches a target in space

What is the OT intervention focus for long-term acute care hospital (LTAC):

• For all client's eval and intervention is concerned with palliative care and the prevention and treatment of complications • For individuals who are cognitively intact, the focus of eval and intervention is mastery of the environment and the attainment of client-centered goals.

What is the OT intervention focus for SNFs/extended care facilities?

• For individuals with rehab potential, the focus of intervention and eval is the same as identified under Rehab Hospitals. • For individuals without rehab potential, eval and intervention is more concerned with palliative care and the maintenance of quality of life.

What is the OT intervention focus for long-term hospitals?

• Functional improvements in performance skills and patterns and areas of occupation • Development of compensatory strategies for residual deficits and client factors. • Maintenance of quality of life. • Development of skills for d/c to the least restrictive environment.

What is the OT intervention focus for Acute Care Hospitals?

• Stabilization of client's status • 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. • Discharge planning and after-care referrals • Family, caregiver, and consumer education

Hypnotic medications

-Restoril, Dalmane, Ambien, and Bendaryl -Side effects are similar to those of the anxiolytics

What is the difference between closed and open fracture?

Closed fx- does not break skin Open fx- breaks skin

Type of medical tx that stabilzes fx through cast, splinting, sling or brace?

Closed reduction

What is the acceptance criteria for an early intervention eval?

"at risk" status of the infant or toddler who is under the age of 3 and have one of the following: -Birth complications -Suspected delays in development -Failure to thrive - Maternal substance abuse during pregnancy -Birth to an adolescent/teen mother -Established disability/diagnosis

Expressive aphasia (Broca's)

-A disturbance in which the individual knows what he/she wants to say but cannot say it

Hypoactivity

-Decreased or slowed motor and cognitive activity

Normal Distribution.

...

Tenodesis Splint

C6 to C7 SCI

Reliability

Consistency ans stability of the evaluation.

Origin Phase

Leader composes group, protocol, and planning.

Orientation Phase

Members learn what group is about and develop initial connections and commitment.

Optional Medicaid services

OT, PT, SLP

What is parallel play?

Plays around other peers with similar toy, but does not interact 2years

What is social play?

Play with interactions with others Birth to ........

What type of group assists members to acquire knowledge, skills needed to perform specific activity?

Thematic Activity related group vs interrelationship Assumptions- act. taught in group will carryover outside of group. Clt.- similar goals and concerns and have minimal level of parallel group skills. Role of therapist- directive leadership of selecting, structure and grades act.

What type of group assists members in acquiring skills to perform a specific activity, group goals are determined by group members and members must meet min skills to participate, therapist's role is to select, grades, and adapts task to reinforce skill development?

Thematic group

What special tests can identify Cubital Tunnel Syndrome?

Tinel's - positive at elbow

Overriding goal of OT

engagement in occupation to support the individual's participation in environment(s) of choice

Etiologies and risk factors for Type 1 diabetes (insulin dependent)

- 5-10% of all diagnosed cases of diabetes -Autoimmune -Genetic -Environmental factors

Eligibility for Medicare

- 65 yrs. + - Indiv. w/permanent kidney failure, black lung disease and/or other long-term dis. specified by law - Persons who have been on some SS prog. for 24 mo.

Cognitive Disabilities Model principles?

- Claudia Allen -based on stages of cog develop as described by Piaget & neurobiological sciences - Cog. abil. is determined by biological factors & the potential to improve dictated by those factors - Once max. level achieved, compensations must be made (bio/psychologically and environmentally) -Cognitive performance is placed on a continuum divided into 6 levels

Explain Performance Assessment and Improvement (PAI).

- Client centered approach - Focus is on individual rights, assessment, care, and education of client

To Test for Significance:

- It doesn't matter what type of statistic you're calculating (T-test, chi-square, F-statistic, etc.), the produce is the same: 1. Decided on the alpha level you will use (error you are willing to accept) 2. Conduct the research 3. Calculate the statistic 4. Compare the statistic to a critical value obtained from a table

Describe Sub-Acute Care / Intermediate Care Facilities.

- LOS: 5-30 days - Discharge to: Ongoing care -> rehab facility/home

Assessments of Cognition, Affect &/or Sensory Processing: Elder Depression Scale (method and scoring)?

- Method: completion of 30 item checklist which looks at presence of char. assoc. w/depression - Scoring: items scored yes or no, score of 10-11 is threshold most often used to indicate depression

Change Process

- Most common and most reimbursable - often the only form of intervention used/discussed - identified by terms "establish/restore/remediation/restoration" - goal to achieve behavioral changes and functional outcomes - establish skill that person never had or restore/remidate one they lost due to impairment

Describe a non-experimental/correlational design.

- No manipulation of Independent var; randomization and researcher control not possible. - To study potential relationships between two or more variables - Cannot establish cause and effect - Correlational coefficient (-1.00 to +1.00)

What are capital expense budgets?

- Permanent or long term purchases (ADL kitchen, new wing for work hardening) - Anything above a fixed amount is capital

Describe a true-experimental design.

- Random selection and assignment into groups that either receive treatment or a control group that receives no treatment. - The levels of treatment = IV - The outcome that might be influenced by tx = DV

Observation Skills

- during actual performace is critical - in both structured/unstructured and in different contexts - structured tool to note observations increases relability - observations must be ongoing to assess nuances and subtle changes - be aware of own socioculture background/bias - interpretations made with collaboration of OT and must be validated by individual and/or caregiver

What is a dependent variable?

- the phenomenon you seek to understand, explain, or predict. - the assessments you are using to measure the effects of the treatment (ROM, MMT, other)

Impact of kidney disease on leisure/sports activities

-Ability to participate -Ability to pace self/self regulate -Choice of activities that allow participation with minimum risk -Awareness of precautions for participation -Access to sports facilities that have adaptive possibilities or sources for adaptations

Selective inattention

-Blocking out those activities, objects, or concepts that produce anxiety

Subtypes of attention-deficit/hyperactivity disorder

-DSM-IV-TR delineates three subtypes: 1) predominantly inattentive type 2) predominately hyperactive-impulsive type 3) combined type

Intervention strategies for aphasia?

-Decrease external auditory stimuli -give indiv. increased response time -use visual cues & gestures &concise sentences, -investigate use of augmentative communication devices

Intervention for heat syndromes/hyperthermia

-Heat stroke is a medical emergency and hospitalization is required immediately: immediately call emergency medical services; lower person's body temperature by getting the person to a cooler area, placing ice packs on arterial pressure points and/or spraying the body with a cool mist; IV infusions and medications are necessary -Heat cramps and heat exhaustion usually do not require hospitalization: loosen clothing and have the person lie in a cool place; replace fluid and electrolytes with fruit juice or a balanced electrolyte drink (if these are not available, give fluids and seek additional medical attention); massage muscle if cramps are severe; IV infusions and oxygen may be indicated if symptoms are severe

Dependent personality disorder

-Persons with this disorder subordinate their own needs to those of others and need others to assume responsibility for major areas of their lives -Individuals with dependent personality disorder lack self-confidence -They may experience discomfort when alone for more than a brief period

Mood

-Pervasive and sustained emotion manifested by thoughts and actions (eg. elation, anger depression) -Physiological disturbances associated with mood are frequently autonomic in nature

Selective serotonin reuptake inhibitors

-Prozac, Zoloft, Paxil, Celexa, and Luvox -Side effects include: nausea, headache, sexual dysfunction, and insomnia

Medical management of anxiety disorders

-Psychotherapy to explore psychodynamic issues -Several types of medications may be helpful depending on the specific disorder: anxiolytic medications, antidepressant medications, anti-obsessional medications -In some cases hypnotic medication to induce sleep may be used briefly -

Human immunodeficiency virus (HIV) infection

-Retrovirus: the RNA of the virus combines with recombinant RNA of human cells; the new DNA has 1 strand of normal RNA/1 strand of virus; 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); the T-cells (also known as CD4+ cells) attack the cells of the body including central nervous system cells, gastrointestinal tract cells, uterine/cervical cells

Managing offensive behavior (physical or verbal)?

-Set limits& IMMEDIATELY address bx during a session -Reasons bx is not acceptable should be clearly presented in non-confrontational/judgmental manner - Consequences of continued offensive bx should be clearly communicated -It is required that staff protects all pts from threat of harm or abuse by another pt. Needs of the entire unit& group membership must be kept in mind

Shortened forms of the Mental Status Examination

-The Folstein Mini-Mental -The Short Portable Mental -OT's often use the above shortened forms of the mental status examination as a screening tool to assess cognitive functioning

Rehabilitation to treat pain from Lyme disease

-Use of physical agent modalities to reduce pain -Use of stress management (complementary care) techniques to control the intensity of the pain and to increase coping ability -Use neutral warmth to decrease intensity of pain -Use of adapted techniques to avoid triggering of movements that exacerbate pain during activity (eg. sit on higher seat to decrease stress load in sit or stand)

Executive Function Performance Test

-assesses function deficits during the performance of real world tasks (cooking oatmeal, making a phone call, managing medications & paying a bill) -uses a structured cueing & scoring system to assess initiation, organization, safety, & task completion & develop cuing strategies

Restraint Reduction

-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 -intervention to address contributing factors/correct underlying problems

ACL I

-automatic actions

Massaging the legs

-contraindicated for Deep Vein Thrombosis -indicated: elevate the legs -medical emergency

Dementia Stage IV

-deficits noted in IADL -can follow simple verbal and demonstrational cues -becomes increasingly forgetful -cannot follow written cues -experiences difficulty in word finding -cannot manage at home without assist

prevocational programs

-develop skills that are prereq to work, d/c usually to voc program, OT focus on task skills, social skills, work habits

Functional Impairments: Spatial relations impairment?

-difficulty relating objs to each other or to the self secondary to a loss of spatial concepts (up/down, front/back, under/over, etc.)

Edema

-direct applications of heat -aggressive ROM exercises.

Assessments of Occupational Performance & Occupational Role: Activity Card Sort (ACS)?

-focus: the identification of a persons AMOUNT and DEGREE of involvement in instrumental, leisure, and social activities **How involved they are- not about interest -89 cards of real-life activities -scoring: Global Scores for Current Activity, Previous Activity, and Percent Retained -can be used to help assist clients in building (or re-building) routines comprised of meaningful/healthy activities

ACL III

-manual actions -use hands to manipulate objects -repetitive training -ex. sanding wooden blocks

Intervention Strategies for body neglect?

-provide bilateral activities -guide the affected side through the activity -increase sensory stimulation to the affected side

Psychosocial Driving Eval

-the presence of impulsive and/or agitated behaviors, and/or psychiatric sysmptoms such as suicical intentions, delusions, and hallucinations can affect an individuals ability to drive safely

Heat and Ultrasound

-there are contraindicated for Cancer as they can accelerate spread of the tumor cells.

Cognistat Neurobehavioral Cognitive Status Examination?

-usually takes less than 45 mins to take -test explores, quantifies & describes performance in central areas of brain-behavior relations: level of consciousness, orientation, attention, language, constructional ability, memory, calculations & reasoning

Shoulder Sling

-wearing for prolonged periods as long-term use can result in soft-tissue contractures, edema, and dev't of pain syndromes. -can be used to support a flaccid shoulder for SHORT and controlled periods of time.

Phenomenological qualitative research

A study of one or more persons and how they make sense of their experience - meaning ascribed by participants only (not researcher)

What are the gross motor skills of a 5-8 month old on prone?

Airplane posturing in prone Chest and thighs off surface

What is Response to Intervention (RtI)?

An evidence-based, structured intervention approach. It works on addressing behavioral problems early in a child's education.

What happens when Risk Management fails?

An incident report must be completed.

Psychodynamic/Psychoanalytic (frame of reference)

Based on work of S. Freud, A. Freud, Jung, Sullivan - Principle developers: Gail Fidler and Ann Mosey - Rarely used today. proper use of this approach requires further specialized training - Indiv. may protect themselves from anxiety through use of "defense mechanisms" (some healthy, some not) -Understanding fx of defensive mechanisms is useful in therapeutic relationship -Defense mechanisms are grouped into a hierarchy according to the phase of maturity assoc w/ them - Projective & functional tasks used to promote self-awareness & identification of intrapsychic content

Referral

Basic request for OT services; can be made by: family/individuals/caregiver/social worker/PT/insurance companies/teachers/physicians, etc...

What gross motor skills are developed at 0-3 months in standing?

Bears minimal weight in legs when held in standing

What are the requirements of Medicare in prescription documentation?

Certification: 1) MD signature at bottom of note 2) MD signature 700 or 701 form 3) MD note certifying tx Dx acute not chronic 1) rephrase dx for MD if needed 2) use onset days with in 60 days ( acute exacerbation of RA as of 6/15/2012

What type of group leadership requires sharing roles with more than one therapist?

Co-leadership

Types of Hand/Wrist based splints

Cock-up splints Resting hand splint Opponens splint

Mature Group

Developmental Group. Enables member to assume all functional socio-emotional and task roles within a group. Number of people required to work together. Requires end product or time limit for completion.

Occupational Safety and Health Administration (OSHA)

Standards related to safety - Structural standards/building codes - Safety of employees and consumers (handling infectious materials and blood borne products, controlling BBP, operating machinery, handling hazardous substances)

What righting reaction elicits curving of the spine towards raised side and extension and abduction of legs and arms when supporting surface is tilted in standing position?

Standing tilting Onset-12-21months Integrates persists Clinical- maintain equilibrium and facilitate postural adjustments

What are the special test for CTS?

Tinel's: positive sign @ wrist Phalen's

What gross motor skills are developed at 7-9 months in release?

Voluntary release

What is zone II of the hand?

Zone II- the middle of the middle phalanx to distal palmar crease. It contains both flexor tendon superficialis and flexor tendon profundus Both the tendons are interwoven and surrounded by a number of pulleys in this zone

sexual

acknowledge and fulfill (institute rules)

examples of reasonable accommodations

acquire or modify equipment/devices, modifications or adjustments to training materials, provision of ancillary aids, modified schedule, improvement of existing facilities

Functional Impairments: Acalculia?

acquired inability to perform calculations

Revised Knox Preschool Play Scale (RKPPS)

focus: observations of play skills to differentiate developmental play abilities, strengths, weaknesses, interest areas pop: 0-6 yrs

Motor-Free Visual Perception Test (MVPT-3)

focus: quick, standardized eval to assess visual perception (excludes motor) in 5 areas pop: 4-95 yrs

instrumental group

function at highest possible level for those who cannot change or progress or can't independently meet their mental health needs

Disciplinary Actions: Probation

the requirement that a practitioner meet certain conditions to retain membership, certification, or licensure by the respective agency.

Assessment Tools (AT) Observation

visual assessment of individual and his/her behavior and enviromental contexts

Low tech

-inexpensive household and/or catalog items that are readily available for use (eg: jar opener, shoehorn, and sock aid)

Managing delusions?

- Redirect thoughts to reality-based thinking&actions -AVOID discussions & other exper. that focus on & validate or reinforce that material

Community model focus/frames of reference

- Focus: placed on identifying and develop. skills needed for one's expected environ. - FOR: promote devel. of perf. components and/or perf. areas w/in the indiv. perf. contexts ( life-style perf., occupation adaptation)

Education model focus/frames of reference

- Focus: placed on learning and making the bx changes needed to interact successfully in the environ. - FOR: based on learning theories to facilitate adaptation in the environ. (role acquisition, cog. remediation)

Rood's Inhibition techniques

- *Gentle rocking*: in a chair or in the therapist's arms to elicit a generalized relaxation response - *Slow stroking*: over the posterior rami of the spine will have a generalized inhibitory effect - *Slow rolling*: from supine to side lying and back in rhythmical pattern will produce generalized calming effect - *Tendinous pressure*: over the muscle insertion with the therapist's hands will inhibit the specific muscle - *Maintained stretch*: to an overactive muscle group will inhibit spastic muscles - *Neutral warmth*: wrapping the person (or a specific body part) in a blanket will result in a relaxation response - *Prolonged icing*: over a muscle group will be inhibitory

ANOVA and ANCOVA

- ANOVA: parametric test used to compare two or more tx groups or conditions at a selected prob. level - ANCOVA: parametric test used to compare two or more tx groups or conditions while also controlling for the effects of intervening variables

Arnadottir Occupational Therapy Neurobehavioral Evaluation (A-ONE)?

- Adult pop. presenting w/cognitive/perceptual (neurobehavioral) deficits - Structured obs. of BADL & mobility skills performed to detect underlying neurobehavioral dysfunction -system of error analysis is utilized to document the underlying performance components (neglect, spatial dysfunction, body scheme disorder, apraxia, etc) that have a direct impact on daily living tasks Scoring: - Functional Independence Scale: 0=unable to perform; 4=independent - Neurobx Specific Impairment Scale: 0=no neurobx impairment observed; 4=unable to perform secondary to neurobx dysfunction

Discuss hospice

- Criteria: terminal illness that has a life expectancy of 6 months or less. - Services provided most often in home (may be done in SNF or hospital as needed) - Evaluation: determining person's occupational functioning and physical, psychosocial, spiritual, and environmental needs most important to person. - Intervention: 1. maintenance of control over his/her life. 2. facilitate engagement in meaningful occupations / purposeful activities 3. reduce or remove distressing symptoms and pain 4. environmental modification / activity adaptations that maintain optimal functioning and improve QoL. 5. caregiver / family education and support for optimal functioning and improved QoL for all.

Reauthorization and Amendment of IDEA

- Emphasize IEP is to address child's unique needs and how they can be served - Clarifies IEP can incl. consideration of AT and bx interventions - States that edu. student receives should prepare him/her for indep. living and employment in adult life

If your statistic is LOWER than the critical value from the table:

- Finding NOT significant - Fail to reject the null - Probability is high that the difference/relationship happened by chance, and p is greater than the alpha level (p>alpha)

Describe a Quasi-experimental design.

- IV manipulated to determine its effect on DV, but there is a lesser degree of researcher control and/or no randomization. - *Used in health care when its unethical to control/withhold treatment.*

Interval data.

- Indicates how much categories differ. Uses equal spacing between categories. - Absence of a true zero. i.e. Fahrenheit and Celsius scales, IQ scales. There are no true zeros, but equal distance between categories.

Discuss wellness and prevention programs.

- Individual self referral to meet a personal need or an institution's provision of a program to its members or employees. - Programs for at-risk populations - Can be held in offices, residences, community sites. - LOS determined by individual desired outcome (smoking cessation), program length (i.e. 6 week joint protection program). - Intervention 1. disease prevention and health promotion 2. range from traditional OT (home safety and environmental modifications) to contemporary areas of concern (stress management, life coaching) 3. Refer to primary, secondary, and tertiary prevention notecards.

Occupational Adaptation (frame of reference)?

- Janette Schkade and Sally Schultz - Concerned w/processes that indiv. goes through to adapt to his/her environment - 3 elements: person, occupation environment, outcome of interaction b/t person&environ=occupational response - Two assumptions: (1) occupation provides the means by which humans adapt to changing needs&conditions (2)is a normative process that is most pronounced in periods of transition, both large & small. The greater the adaptive transitional needs, the greater the importance of the process -Eval: focuses on occupational environment, role expectation & person's potential for adaptation & best means for adaptation to occur -Intervention: increasing skills needed for adaptation. It addresses both the individual & the environment

Descriptive statistics include:

- Measures of central tendency - Measures of variability

Transitional planning and services

- Planning: beings at 14 to help student plan course of study that will lead to post-school goals - Services: beings at 16 to provide student w/coord. set of svcs to attain post-school goals (mandates Individual Family Service Plan for children 0-2 yrs age)

Allen Cognitive Level Test?

- Populations: psychiatric disorders acquired brain injury, dementia - used as a *SCREENING tool* to estimate indiv's cog. level - Individual performs 3 leather lacing stitches progressing in complexity - Six level scale of cog. function (Level 1=automatic actions to Level 6=planned actions)

Specific PNF techniques directed at the agonist

- Repeated contractions of agonists to increase the range and endurance in weaker components - *Rhythmic initiation*: involves passive rhythmic movement followed by active participation in the same pattern to improve movement initiation

Criteria for coverage of DME

- Repeated use can be withstood - Primarily and customarily used for a medical purpose - Generally not useful in the absence of injury or illness

Cognitive/Perceptual Intervention: Compensatory/Adaptive/Functional Approach?

- Repetitive practice of functional tasks - Emphasizes modification/environ. adaptation/ compensatory strategies when task too difficult -activity choice driven by tasks the person needs or wants to perform - Emphasizes intact skill training - Treats symptoms NOT cause - Treatment is *task specific, utilizes functional tasks* (ADL, work, leisure, etc.) that individual desires or is required to perform at discharge as the basis of treatment

Explain the Community Model.

- Views individual with disability as lacking skills, resources, and supports for community integration. - Focus on identifying and developing skills for one's expected environment. - OT frames of reference promote development within the individual's performance contexts (life-style performance, occupation adaptation).

Explain the Medical Model.

- Views person with disability as someone who has a physiological insult resulting in reduced functional capacity. - Treatment addresses the disease or dysfunction. - OT frames of reference address the pathological process (biomechanical, neurodevelopmental).

Explain the Education Model.

- Views the individual with a disability as lacking knowledge or skills. - Focus on learning, behavioral change for interacting successfully in environment. -OT frames of reference based on learning theories to facilitate adaptation in the environment (role acquisition, cognitive remediation).

Stages of motor learning: Skill acquisition stage (cognitive stage)

- develops understanding of task - assesses abilities and task demands - selects response - structures motor program Training strategies: - focus on errors as they become consistent (do not cue on large number of random errors) - focus on success of movement outcome - stress controlled movement to minimize errors - provide adequate rest periods - manual guidance to assist as needed - blocked practice of same task to improve performance - variable practice to increase cognitive processing and retention - mental practice to improve performance and decrease anxiety - reduce extraneous environmental stimuli

Stages of motor learning: Skill transfer stage (autonomous stage)

- involves demonstrating skill in new context - continues to refine motor responses - spacial and temporal highly organized - largely error free movements - minimal cognitive monitoring Training strategies: - provide occasional feedback when errors are evident - variations of tasks (open skills) - high levels of practice (masses practice) - vary environments

interviewing guidelines

- questions should be relevant, significant and consistent with stated purpose - build rapport - organized and formal - observe non-formal communication - personal questions asked to interviewer indicte: - general polite interest - increase therapeutic relationship - indirectly introduce a personal concern answer then immediately redirect to purpose of interview - OT interprets verbal/non-verbal to formulate hypotheses about interviewee's situations - OT/COTA develop plan - further eval/info - intervention (with client) - can use interview to formulate plan can prevent interviewing for sake of interview

What is meeting health needs intervention? Interventions designed to _____ 1. needs of shelter, food, material goods, sensory stimulation. 2. balance between work, leisure, play 3. environment free of hazards or threats 4. connected to others with similar goals 5. successfully complete activity 6. recognition of ones accomplish,wants 7. need to do things just for fun 8. engage in activities just for one's self

- satsify inherent universal human needs. 1. Psychophysical 2. Temporal 3. Safety 4. Group association 5. Mastery 6. Esteem 7. Pleasure 8. Self-actulaization

orthotic devices

-(sometimes referred to as braces) are used to prevent contractures and provide stability to joints involved 1. AFO: ankle-foot orthosis 2. KAFO: knee-ankle-foot orthosis 3. HKAFO: hip-knee-ankle-foot orthosis

Etiologies and risk factors for other types of diabetes

-1-2% of all cases of diabetes -Genetic syndromes -Surgery -Drugs (eg. steroids) -Malnutrition -Infections

Medical management of intellectual disorders

-Dependent upon presenting symptoms and complications -Psychological, hearing and speech evaluation and interventions may be indicated -Intermittent support may be required in special circumstances

Agoraphobia associated with panic attacks

-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

Etiology, diagnostic characteristics and sequelae for Rett's syndrome

-Etiology: a genetic disorder in which deterioration occurs after a period of normal development -Receptive and expressive communication skills and social skills deteriorate -Muscle wasting can make these children prone to scoliosis and eventually may necessitate the use of a wheelchair -Stereotypical movements of licking, biting, and slapping of the hands may result in deterioration of the integrity of the skin

Neurogenic Bowel

-Etiology: sympathetic nerve impairment, generally occurring in persons who have spinal cord injury above the (thoracic) T-6 level -- loss of control of anal sphincter; sensory loss resulting in a lack of awareness of feces in the bowel; motor loss, decreased or lost ability to self-initiate or control a bowel movement -Flaccidity of muscles results in incontinence

Delusions

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

Leisure Groups?

-May include i'd of interests, develop of activity specific skills, i'd of resources& recognition of importance of healthy use of unstructured time

Cognitive-Perceptual Deficits?

-Occur as a result of multiple pathologies including CVA, TBI, neoplasms, acquired diseases psychiatric disorders, &/or developmental disabilities

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

Behavioral Inattention Test?

-Pop: Adults presenting w/*unilateral neglect* - Examines presence of neglect & impact on functional task performance -9 activity-based subtests: picture scanning, menu reading, map navigation, address/sentence copying, card sorting, article reading, telephone dialing, coin sorting, telling/setting time) -6 pen/paper subtests: line crossing, star cancellation, letter cancellation, figure & shape copying, line bisection

Panic disorder

-Recurrent panic attacks followed at least once by concern for recurrence

Prevention of diabetes

-Regular physical activity may reduce the risk of type 2 diabetes -Maintaining normal body weight may be preventitive

Remote memory

-The ability to recall events of the distant past

Vendor/supplier

-The entity which supplies services

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

Cognitive Behavioral FOR/ Cognitive Behavioral Therapy (CBT)- Dialectical Behavior Therapy (DBT)?

-addresses suicidal thoughts -commonly used with people who have borderline personality disorder -used also for MD, SA, and eating disorders -Evaluation: begins with DSM-IV-TR diagnosis -Intervention: *teaches assertiveness, coping, and interpersonal skills *a STRONG therapist-client relationship is essential (Rapport is used for validation as well as CONFRONTATION)

Physical considerations

-arrangement of furniture -accessibility of items needed for desired activities and for safety -ease of use -housing/workplace design -neighborhood characteristics: a. availability and use of transportation b. overall accessibility

expanded keyboards

-provide large keys for persons with limited motor accuracy and control (eg individuals with ataxia)

What are extensor tendon early mobilization programs of zones V,VI and VII?

0-2 weeks volar wrist splint 1) 30 degrees wrist ext. 2) MCP 0-10 degrees flexion, 3) IP full extension 2-3 weeks shorten splint with flexion/extension of IP 4weeks remove splint for active MCP flexion/extension 5weeks active wrist ROM & splint donned outside of exercises 6 week d/c splint

What are the parts of an OT evaluation? 1) Obtain _____ of client & _____ 2) Select appropriate _____ 3) Administer, score and interpret _____ 4) collaborate with _____ 5) develop _____ by prioritizing identified problems 6) document and _____ 7) refer to _____

1) HX of clt & PLOF 2) Select appropriate non/standardized evaluation tool 3) assessment 4) clt, family, caregiver, other team members 5) intervention plan 6) communicate plan 7) other health professionals

What reaching skills develop at 4 months?

1) Hands come to midline 2) Bilateral reach with shoulders abducted, pronation, and finger extension

What scissor skills develop at 2-3 years?

1) Interest in scissors 2) holds scissors 3) snips with scissors 4) controlled ability to open and close scissors

What are group dynamics?

1) Nature of group and interrelationships of members and outcomes 2) examined by structure, content, and process

What is included in a superficial partial-thickness and deep partial -thickness burn evaluation?

1) Occupational hx 2) ROM post-op 72 hrs 3) sensation when wounds are healed 4) strength when wounds are healed 5) ADL as-soon as possible

What are the types of documentation formats?

1) POMR- Problem Oriented Medical Records- system of writing a progress note based on a list of problems. 2) SOAP notes- subject objective, assessment and plan 3) consultation reports- meeting or conversations with other healthcare providers 4) Critical Incident Report- significant , out of norm event that occurs during intervention

What is the post op intervention of rotator cuff tendonitis?

1) PROM (0-6 wks) 2) ice then progress to heat 3) strengthening (6 wks) isometric to isotonic below shoulder level 4) leisure/work act after 8-12 weeks

What manipulating skills develop at 2- 2 1/2 years?

1) Palm to finger translation- 1) stabilization 2) linear movement 3) palm to finger 4) placing coin in slot 2) Simple Rotation 1) turning object 90 degrees 2) using finger pads 3) unscrewing bottle cap

What observations should be completed in an oral-motor/ feeding eval?

1) Postural control 2) Oral sensitivity 3) Jaw, lip, tongue, and cheek motor Control 4) endurance

What are the stages of group development? 1) leaders develop protocol and planning of group 2) members learn what group is about 3) members develop bonds, norms, roles, through goal directed activity 4) members challenge group structure, purpose and process 5) regrouping after conflict 6) members use skills to be productive and achieve goals 7) dissolution of group due to lack of engagement or conflict

1) origin 2) orientation 3) intermediate 4) conflict 5) cohesion 6) maturation 7) termination

What are the outcomes of a OT screen? 1. Information about client _____ (5) 2. Know if there is a need for _____

1,Clt factors, Areas of occupation, Performance skills, Performance patterns, Context 2. Need for further evaluation

Rood's 4 Phases of Motor Control

1. *Reciprocal inhibition/innervation*: early mobility pattern 2. *Co-contraction*: 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*: mobility superimposed on stability; proximal muscles contract and move and the distal segments are fixed 4. *Skill*: combines stability and mobility; stabilized proximal segment with distal segment movement

What are the 8 types of Institutional Practice Settings?

1. Acute care hospitals 2. Sub-acute care/intermediate care facilities (ICFs) 3. Long-term acute care (LTAC). 4. Rehabilitation hospitals 5. Long-term hospitals 6. Skilled nursing facilities (SNFs) 7. Forensic settings 8. Outpatient/ambulatory care

Explain program planning.

1. Define a focus for the program based on needs assessment results. 2. Establish mission statement and philosophy (adopt FOR) 3. Establish objectives related to the primary focus of the program 4. Determine how objectives will be evaluated to determine program effectiveness 5. Consider the impact of your program on the existing system (potential barriers? how can you minimize them?) 6. Develop a referral system - Determine specific service needed within the program - Criteria for program admission - Criteria for discharge 7. Determine fiscal implications - Projected volume or demand to estimate revenue - Identify projected expenses - Compare the two to determine the financial viability of the program

Explain a needs assessment.

1. Differentiate expressed needs and real needs via sample survey, focus groups, key informants (people knowledgeable about the target population needs) 2. Determine unmet, priority needs 3. Identify resources which include fiscal, physical, community

Identify the steps of program development.

1. Needs Assessment 2. Program Planning 3. Program Implementation 4. Summative Program Evaluation

What are the basic differences between OT and OTA?

1. The occupational therapist is responsible for directing the entire treatment process (evaluation, treatment, outcome, discharge). The OT does not need supervision. 2. The OTA's primary role is to implement treatment. The OTA requires supervision by the OT. The supervision may vary depending on setting and experience of OTA. 3. OTA's cannot independently do evaluations but can contribute under the direction of the OT, and must wait until the evaluation is complete before initiating treatment.

What are sensory-perceptual performance skills? 1. Actions or behaviors used to _____

1. locate, identify, and respond to sensation

At what age are toileting skills of urinating regularly?

2 years

What are measures of variability? - Include the types.

A determination of the spread of a group of scores. - Range: different between highest and lowest score. - SD: determination of variability of scores (difference) from the mean - Normal distribution: symmetrical bell-shaped curve indicating the distribution of scores (mean, median, mode are all similar) *68% scores fall w/in +1 or -1 SD - Percentiles: data divided in 100 equal parts and position of score determined. - Quartiles: data divided into 4 equal parts and position of score determined.

sub-acute

Admission is for medical or psychiatric diagnosis that ahas progressed from an acute stage but has not stabilized sufficiently to be treated on an outpatient basis LOS can range from 5 - 30 days

long-term hospital

Admission is for medical or psyquiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis

Long-term hospitals:

Admission is for a medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis.

Long-term acute care hospital (LTAC):

Admission is for chronic or catastrophic illnesses or disabilities that require extensive medical care and/or dependency on life support or ventilators.

What are motor performance skills?

Actions and behaviors used to move and interact with tasks, objects, context and environments Involves Planning Sequencing Executing new movements

What type of group leadership requires the OTR is a resource for the group members?

Advisory leadership OTR role is to have members understand and self direct the group process.

Omnibus Budget Reconciliation Act )OBRA) of 1981

Affirmed application of Section 504 of Rehab Act of 1973 which prohib. discrim. in federally funded programs; provided Medicaid financing for community-based svcs for people w/ devel. dis. when svcs were less exp. than institutional care

Omnibus Budget Reconciliation Act (OBRA) of 1990

Applied to all nursing homes that receive federal money for Medicare/caid pts - Emphasized attending to resident rights, autonomy, providing qual of care, etc. - Mandated Minimal Data Set assessment system (coord. by RN) - Restraint reduction

What deformities occur with median nerve laceration?

Ape Hand- flattening of thenar eminence Claw Hand- flexion of index and middle finger (low lesson) Benediction sign- flexion of digits 4 & 5

What is the difference between an Anterolateral and Posterolateral Hip replacement?

Antero- anterior approach that does not require compliance of standard hip precaution Posterior- follow strict hop precautions per MD recommendations and timeframe

Psychosocial Assessment: Areas addressed & assessment methods?

Areas Addressed: -performance skills (cognitive, perceptual, psychological, & social)&their impact on performance in areas of occupation; history of behavior patterns; person's goals, values, interests & attitudes -client factors &physical conditions/limitations that impact functional bxs&performance in areas of occup. -the impact of the person's social, clultural, spiritual, & physical contexts -i'd of roles &bxs that are required of person either by society or for achievement in their desired goals -precautions & safety issue:suicidal&/or aggressive bx -Use:interviews(structured & unstructured: Occupational Profile); standardized tests; clinical obs & rating scales; questionnaires; self-report inventories

Assessment of Task performance: The Role Checklist (focus, method, scoring, population)

Assesses self-reported role participation and value of specific roles to indiv. - Method: checklist completed by indiv. or alone w/th. (part one identifies roles, part 2 identifies degree to which indiv. values each role) - Scoring: no score, data used to address goal identification and tx planning, QOL, d/c planning - Pop.: adolescent-elder w/physical or psychosocial dysfunction

Assessment of Task performance: Adolescent Role Assessment (focus, method, scoring, population)?

Assesses the development of internalized roles w/in family, school and social settings. - Method: semi-structured interview that follows interview guide to generate discussion in areas of family, school perf., peer interactions, occu. choice and work - Scoring: indicates bx that is approp., marginal or inapprop. - Pop.: adolescents 13-17

What type of teaching uses slides, videos, and audio materials?

Audiovisual aids

Cognitive Disabilities Model: Level 1?

Automatic Actions -Automatic motor responses & changes in the ANS; conscious response to the external environment is minimal

NON-MALEFICENCE

Avoid imposing or inflicting harm upon the recipient of OT services. E.g. - No pt. exploitation via physical, emotional, sexual, financial, etc. - Avoid relationships that interfere with judgement/objectivity - Bring unprofessional concerns of colleagues to appropriate authority.

What injury occurs due to a high injury of the median nerve?

Benediction sign

Heuristic qualitative research

Complete involvement of the researcher in the experience of the subjects to understand and interpret a phenomenon

What is DeQuervain's?

CTD of stenosis of abductor pollicis longus and extensor pollicis brevis Symptoms- pain and swelling over radial styloid Special test- Finkelstien's Test Conservative tx- 1) thumb spica splint 2) ice massage 3) gentle AROM of wrist and thumb Post op tx- 1) thumb spica splint & AROM 0-2 weeks 2) strengthening 2-6 weeks

What are words that do not reflect clt progress?

Chronic Status quo Maintaining Little change Plateau Slow progress Stable Uncooperative Confused Inability to follow directions Pt refused Unmotivated General weakness

True-experimental design

Classic two-group design, random selection and assignment into exp. group that receives tx or a ctrl group that receives no tx

What deformities occur with ulnar nerve lacerations?

Claw hand Flatten Metacarpal arch

What are the types of medical management for a hip fx?

Closed reduction- min. displacement Open reduction internal fixation ORIF Joint replacement

What is cataracts?

Clouding of the lens due to excess lens protein 1) gradual loss of vision 2) central loss, then peripheral 3) problems with glare 4) darkening of vision 5) loss of acuity

What gross motor skills are developed at 10-14 months in release?

Clumsy release in small container with hand resting on edge

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling MOTOR/ IDEOMOTOR/ APRAXIA & intervention?

Clumsy, diff. crossing midline, diff. w/manipulation activ. (i.e., manipulating coins), use awkward grasp pattern to answer phone, diff. w/bilateral activ. (i.e., folding a sheet) - I: general verbal cues (not specific), dec. manipulation demands, hand-over-hand, visual cues

What are the pros and cons of a myoelectrically controlled terminal device?

Comesis: appealing Pinch force: strong variety of pinches Prehension pattern: cylindrical grasp Weight: medium wt Durability: less durable Reliability: most services Feedback: some feedback

Criterion validity

Compares the assessment to another one with already established validity

Criterion Validity

Compares the assessment tool to another one with already established validity.

Predictive Validity

Compares the degree to which an instrument can predict performance.

Concurrent Validity

Compares the results of two instruments given at the same time.

Explain Summative Program Evaluation

Complete Quality Assurance to ensure program is effective, resolve any problems/limitations, and address accreditation requirements.

What is the difference between complete and incomplete fracture?

Complete fx- the bone is broken completely Incomplete- the bone is not broken completely

Clinical reasoning What type of reasoning requires multidimensional thinking to integrate all forms of clinical reasoning?

Conditional Reasoning Understanding the clt., context, occupations, clt. priorities, and selection of optimal intervention

Ongoing revision of treatment, integration of all reasoning describe what type of reasoning?

Conditional reasoning

What are the tx of Radial Nerve Palsy?

Conservative 1) dynamic extension splint 2) work/act modification 3) strengthening wrist and finger extensor muscles when motor Fxn returns Surgical: decompression 1) ROM 2) nerve gliding 3) strengthening after 6-8 weeks

What are the txs of Cubital Tunnel Syndrome?

Conservative 1) elbow splint blocking elbow flexion (especially at night) 2) elbow pad to decrease compression 3) act/work modifications Surgical- decompression or transposition 1) edema control 2) scar management 3) AROM (2wks post-op) 4) nerve gliding (2wks post-op) 5) strengthening (4wks post-op) 6) MCP flexion splint if clawing

What is the tx for Guyon's Canal syndrome?

Conservative 1) wrist splint in neutral 2) work/act modification Post-op tx 1) edema control 2) AROM 3) nerve gliding 4) strengthening in 2 wks post op 5) sensory reeducation

Content validity

Content included meets content measured

What are the pros and cons if a voluntary closure grip terminal device?

Cosmesis: poor Pinch force: excellent strong grasp, 50 lb force Prehension pattern: fine pinch Weight: heavier than VO hook Durability: durable Reliability: little service Feedback: better proprioceptive feedback

Discuss residental programs. - Criteria - LOS

Criteria - Developmental, medical, or psychiatric condition that resulted in functional deficits that impede independent living but not severe enough to require hospitalization. LOS: - Transitional living determined by agency's funding - Long-term/permanent housing funded by person's social security benefits.

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling SPATIAL RELATIONS DYSFUNCTION & intervention?

Diff. w/dressing such as orienting shirt to body (e.g., the shirt is put on backwards or upside down), undershooting or overshooting (reaching for glasses, spilling milk when pouring into a glass), difficulty aligning/moving body in space during a transfer - I: activ. that challenge underlying spatial skills, tasks that req. discrimination of R/L

What type of leadership requires the OTR to be responsible for planning and structuring the group?

Directive leadership Leader's role is achieve task accomplishment

IDEA

Directly addresses student's FUNCTIONAL perf. along w/academic perf., provides for piloting of multi-year IEP to allow for long-term planning, flexibility in IEP meetings, recomm. be made based on peer-reviewed research, screening done by specialist NOT EQUIV. to eval. for eligibility for IDEA svcs, students assessed in compliance with No Child Left Behind Act, clarifies purpose of IDEA to prepare children w/disabil. for further edu., employ., and indep. living; allows each state to define dev. delay criteria to determine if infant/toddler eligible for EI, req. IFSP to be done, req. state to estab. procedures for referral of victims of abuse/neglect to EI svcs

Termination Phase

Dissolution of group due to task accomplishment, goal attainment, lack of engagement, inability to resolve conflict, or administrative constraints.

What is the cause of Ape Hand?

Distal median nerve compression or laceration

What is a Colle's fx?

Distal radius Dorsal displacement

What is a Smith's fx?

Distal radius fx Volar displacement

What is a wrist disarticulation amputation?

Distal to wrist joint Wrist disarticulation Transcarpal Transmetacarpal

What fine motor performance skills are developing at 4-5 years?

Dynamic tripod Copies simple shapes 10 piece puzzle Cuts squares and simple shapes Colors in lines No Bilateral integration to use both hands Draws stick figures Copies name String 1/4 in beads

Discuss vocational programs. - Evaluation - Intervention

Eval/Intervention: 1. remediate skill deficits and compensation for client factors affecting work performance. 2. Develop general work abilities and specific job skills. 3. Consult with / supervise vocational direct care staff. 4. Identify and implement reasonable accommodations according to ADA. 5. Referral to state offices of vocational and educational services (One Stop Centers) for persons with disabilities needing further evaluation/education/training.

Discuss school programs. - Evaluation - Intervention

Evaluation - Assess all areas that impact educational and functional performance of child within the school (including behavioral). - Findings contribute to IEP and functional goals are made to address educational needs Intervention: - Addressing IEP goals (educational and functional performance) - Includes AT and transition services - Can include behavioral intervention plans (Response to Intervention RtI, Early Intervening Services, Positive Behavioral Supports)

What are the main aspects of the OT process Service Delivery? 1. Conducting _____ 2. Providing _____ 3. Evaluating _____

Evaluation Intervention Outcomes

Discuss early intervention programs. - Evaluation Criteria - Intervention Criteria - LOS

Evaluation Criteria - based on at-risk status of child under age of 3: - Birth complications, suspected delays in development, failure to thrive, maternal substance abuse during pregnancy, birth to teen mother, established disability/diagnosis. Intervention Criteria 1. The extent of the developmental delay (typically 33% delay in one area or 25% in two areas) 2. An established diagnosis/disability LOS: create infant family service plan. 6 month reviews submitted to determine if services should continue.

How do you decrease tactile sensitivity prior to feeding?

Firm pressure Sucking and chewing on cloth, rub gums, palate and tongue Oral exploration toys Graded intro to varieties of food textures

Medicaid

For persons who have income that is below an established threshold

Overview of constraint induced movement therapy

For those who present with control of the wrist and digit -Motor control inclusion criteria for the affected side: 1) 20 degrees of extension of the wrist and 10 degrees of extension of each finger or 2) 10 degrees of extension of the wrist, 10 degrees abduction of the thumb, and 10 degrees extension of any two other digits or 3) able to lift a wash rag off a table top using any type of prehension and then release it

What righting reaction elicits extension of UE, open hand and neck extension when suddenly tipped forward vertically to surface?

Forward Parachute or Protective Extension Forward Onset- 6-9 months Integration- persists Clinical use- use of UE to prevent fall

What is a comminuted fracture?

Fx causing splintering or fragments of bone

What is a Boxer's fx?

Fx of 5th metacarpal Tx- ulnar gutter splint

What reflex elicits lateral trunk flexion and wrinkling of skin on stimulated side, when tapped along side of spine?

Galant reflex Onset- 32 weeks Integrated- 2 months Clinical- facilitates lateral trunk movement needed for trunk stability

What type of play do 6-10 year olds participate in?

Games with rules Board games Cooperative play Competitive play

Professional review organization (PRO)

Groups of peers who eval. the appropriateness of svcs and quality of care under reimbursement and/or state licensure requirements

Fee for service

Payment system under which the provider is paid the same type of rate per unit of service (traditionally, payer pays 80% and pt or provider pays 20%)

Personal Care Assistants/Home Health Aides

Indiv. who provide primary care to enable a person w/a disability to remain in his or her own home. - Personal care, home management, supervision of home programs

Pearson product-moment coefficient (r) is used to correlate what type of data?

Interval or ratio

What gross motor skills are developed at 1-4 months in release?

Involuntary release

What releasing skills develop at 1-4 months?

Involuntary release

What righting reaction occurs when an infant reacts with neck and LE extension when placed in prone suspension?

Landau reaction Onset- 3-4 months Integrates- 12-24 months Clinical use- breaks up flexor dominance

What early mobilization flexor tendon program uses active extension of digits and passive flexion through traction using rubber bands.

Kleinert Protocol 1) Dorsal block splint 0-4 weeks (passive flexion/ active extension) 2) wristlets 4-6 weeks & scar management 3) AROM & tendon gliding & D/C splint 6-8 weeks 4) strengthening 8-12 weeks

Discuss school programs. - LOS

LOS - If OT can improve child's abilities to participate in education activities and allow full access to the general ed curriculum, services can be continued. - Annual review of services and progress made toward IEP.

What righting reaction elicits upright head position when tilted 45' right or left and forward or backwards?

Labyrinthine reaction- vision occluded Optical- vision present Onset- birth to 2 months Integration- persists Clinical use- orients head in space

What is a forequarter amputation of the UE?

Loss of Scapula Clavicle Entire UE

Functional Impairments: Anomia?

Loss of ability to name objects or retrieve names of people

Functional Impairments: Agnosia?

Loss of ability to recognize objects, persons, sound, shapes or smells while the specific sense is not defective nor is there any sig. memory loss

What is Macular Degeneration?

Loss of central vision by decreased blood supply to retina 1) sensitive to glare 2) difficulty adjusting to light 3) loss of central vision

What is a shoulder disarticulation amputation?

Loss of entire UE

Ticket to Work and Work Incentive Improvement Act (TWIIA)

Makes it more realistic and easier for person w/disabil. to work; removes major disincentive to work by allowing indiv. w/disabil. to maintain Medicare or Medicaid hc benefits

Deficits in performance require what type of intervention?

Mastery to acquire or compensate

What type of group enables members to assume all functional socio-emotional and task roles within a group?

Mature, developmental

Presenting characteristics of oral motor dysfunction

May result in speech impairments (dysarthria), swallowing impairments (dysphagia), or psychosocial stresses related to facial asymmetry and/or drooling

Conflict Phase

Members challenge group structure, purposes, or processes. Characterized by disagreements among members.

Intermediate Phase

Members develop group norms, roles, and develop bonds.

Cohesion Phase

Members regroup after conflict with clearer sense of purpose and affirmation of group norms and values, leading to group stability.

Transdisciplinary team

Members support and enhance the activities and programs of other disciplines to provide quality, efficient, cost-effective service; role blurring accepted

Maturation Phase

Members use their energy and skills to be productive and to achieve group goals.

Balanced forearm orthoses

Mobile arm supports or ball-bearing forearm orthoses Consists of an arm trough, proximal and distal arms, and a support brackets Allows a patient with weak proximal musculature to utilize available control of the trunk and shoulder to engage in functional tasks

Static Splint

No moving parts; splint utilized for external support, prevention of motion, stretching of contractures, aligning joints for healing, resting joints, or reducing pain

What type of group enables members to perform individual tasks in the presence of others?

Parallel, developmental

Intervention Planning: who's responsibility?

OT's, with collaboration with COTA

T test

Parametric test of significance used to compare two group means and identify a difference at a selected probability level

The Ethics Commission

Part of AOTA, responsible for the Code of Ethics and the Standards of Practice. The Ethics Commission is responsible for informing and educating members about current issues, upholding practice and education standards, monitoring behavior of members, and reviewing allegations of unethical conduct.

Assessment of Task performance: Social Interaction Scale (SIS) (What does it measure and how is it scored?)?

Part of BAFPE. - Assesses general abil. to relate approp. to other people w/in the environ. through obs of the indiv. in 5 situations (1 to 1, mealtime, unstruc. group, struc. activ. group, struc. verbal group) - Scoring: 7 areas of social functioning measured via obs in 5 social situations

Assessment of Task performance: Task Oriented Assessment (TOA) (What does it measure and how is it scored?)?

Part of BAFPE. - Measures cogition, performance, affect, qualitative signs and referral indicators through completion of 5 standardized, time tasks (sorting shells, bank deposit slip, house floor plan, block design, draw a person); evaluator observes and rate task perf. but does not provide guidelines for task completion - Scoring: utilizes 5 tasks in which 12 functional parameters in cog., perf. and affective areas are rated; norms presented for comparison w/specific adult psychiatric populations

Ethnographic qualitative research

Patterns and characteristics of a cultural group, including values, roles, beliefs and normative practices (extensive field obs., interviews, etc.)

Ethnographic.

Patterns and characteristics of a cultural group, including values, roles, beliefs, and normative practices are intensely studied. - Extensive field observations, interviews, participant observation, examination of literature and materials, cultural immersion. - Used in health care to understand an insider's perspective to develop meaningful services

Capitation definition

Payment system under which provider is paid prospectively a set fee for each member of a specific pop. regardless if no covered health care is delivered or extensive care is delivered - The healthier the enrollees, the more the provider retains of the total payment

What is role play?

Play to learn about social systems and cultural norms Functional roles- doctor, firefighter, teacher, Relationship role- mom, dad, Character role- tv characters, movies

What is solitary play?

Plays alone not aware of other 2-3 years

What gross motor skills are developed at 7-10 months in release?

Presses down to on surface to release

Interventions to promote wellness

Prevention

Types of Intervention

Prevention, Meet health needs, Change process (behavior or functional outcome), Management (ex: anxiety), Maintenance.

Why is it important for early intervention of mobilization after tendon repair?

Prevents adhesion formation Facilitates wound and tendon healing

Parenting classes for teens to decrease child neglect/abuse is what type of intervention?

Primary prevention

What fine motor skills are developed at 4 months in grasp?

Primitive squeeze grasp

Largest source of insurance payment in U.S.

Private Pay

Intermediaries

Private insurance companies that contract with Medicare. Determine if services provided are within Medicare guidelines

What type of teaching is analyzing a situation, defining a problem, identifying solution and evaluating outcome?

Problem solving

Clinical reasoning 1. Involves identifying OT problems, goal setting, and tx planning

Procedural reasoning

Identify OT problems, goal setting, and treatment planning, the "doing" of practice are examples of what type of reasoning

Procedural reasoning

What is sequencing and timing of activity demands?

Process to carry out activity- Steps Sequence Timing requirements

What peripheral nerve injury has pain in proximal forearm due to compression of median nerve between the two heads of a forearm muscle?

Pronator Teres Syndrome (proximal volar forearm) Etiology: repetitive pronation and supination Symptoms: 1) pain in proximal forearm 2) no night symptoms

Title II ADA

Public Services. - No discrim. persons w/disabil. to participate in or benefit from svcs, programs, activ. of public entities: transporation, public edu., employment, recreation, social svcs, hc, courts, voting, etc.

What righting reaction elicits curving spine towards raised side and abduction/ extension of arms and legs, when positioning infant on all fours and slowly raise surface to one side?

Quadruped Tilting Onset- 9-12 months Integration- persists Clinical- maintain equilibrium and facilitate postural adjustments

Use RADAR Approach to screen for & respond to domestic abuse, what is it?

R=Routinely ask. Inquiring about potential ___ when interviewing all clients-shows that it is not an acceptable secret & can be 1st step in intervention A=Affirm & Ask: support person who discloses abuse, determine any possible risk factors-Ask direct ?s D=Document objective findings: (person has multiple bruises) & record client statements in quotes A=Assess & Address person's safety: (become more violent over time? are there weapons in the house?) R=Review options & referrals: Refer to domestic violence hotlines, shelters& safe houses which have staff trained in family violence & safety planning

What is the reason for discharge planning process? 1) Individual's goals _____ 2) Individual has a functional _____ 3) Exacerbation of _____ 4) Length of stay in setting has _____

Reason 1) have been met 2) plateau 3) illness or medical status. 4) expired.

What gross motor skills are developed at 7-10 months in creeping?

Reciprocal creep

Primary Prevention

Reduction of occurrence of disease within a population that is well or potentially at risk.

Tertiary Prevention

Reduction of the impact of dysfunction.

What are the 3 main aspects of service delivery?

Referral Screening Evaluation

What gross motor skills are developed at 9-10 months in release?

Releases into a container with wrist straight Increase motor control does not use tenodsis to release

What measures the consistency?

Reliability; scores are the same time-to-time, place-to-place, and evaluation-to-evaluation

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling impaired ALERTNESS/ AROUSAL; & intervention?

Req. sensory cues to maintain arousal (loud voice, tactile stim., vestib. input, appears lethargic, falls asleep during ADL) - I: increase environ./sensory stimuli, GM activities

What are residential programs?

Residential programs are on a continuum from 24 hour supervision quarter way housing, halfway houses, or group homes, to supportive apartments with weekly/biweekly check-in.

Mature groups need what type of leader?

Resource

State Regulatory Boards (SRBs)

Responsible for protecting the public from potential harm that might be caused by incompetent or unqualified practitioners. SRBs discipline members of a profession if the public is determined to be at risk due to malpractice. They limit their review of complaints to those involving illegal acts directly connected with professional practice (fraud, misappropriation of funds).

What is frozen shoulder/ adhesive capsulitis?

Restricted PROM- ER greatest, abduction, IR, and flexion Due to adhesion of humeral jt capsule or ligament Etiology: immobilization or inflammation Diabetes Parkinson's

What area specific areas of a fx evaluation?

Results of x-ray, MRI Edema Pain AROM do not perform PROM Sensation

What reflex is elicits movement of tongue, mouth, and turning head toward stimulus, when the corner of mouth is stroked?

Rooting Onset- 28 weeks gestational Integrated- 3 months Clinical use- locating feeding source

Forced leisure due to unemployment requires what type of intervention?

Temporal balance and regularity

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling SEQUENCING & ORGANIZATION DEFICITS & intervention?

Steps of task not in logical order (e.g., putting on shoes & socks before pants) or steps of the activity are left out (e.g., washing dishes without soap) - I: external cues (written directions, daily planner), grade tasks that are increasingly complex in terms of # steps req.

Medicaid is operated by...

States, however they receive 50% of their funding from the federal govt

Types of orthoses/splints

Static Dynamic Serial

What prewriting skills develop at 3 1/2 to 4 years?

Static tripod posture 1) slight flexion of digits 2) proximal grasp on writing tool 3) adjustment using other hand 4) hand moves as unit

What is unoccupied play?

Stationary, random movements, without purpose Birth to 6 months

Phenomenological qualitative research

Study of one or more persons and how they make sense of their experience

What are the rotator cuff muscles?

Subscapularis Infraspinatus Teres minor Supraspinatus

What reflex elicits strong, rhythmical sucking, when index finger is place in mouth and infants head is in midline?

Suck-swallow reflex Onset- 28 weeks Integration- 2-5 months Clinical use- ingestion of nourishment

What are the areas of d/c planning?

Summary of eval and tx Compare initial and d/c status Number of sessions Goals achieved Functional outcomes Reason for d/c Goals attained home programs Clt/ caregiver Ed Equipment provided Follow up plan Referral

What righting reaction elicits curving of the spine towards raised side and abduction/extension of arms and legs when positioned in supine or sitting and raising one side of surface?

Supine or Sitting tilting Onset- 7-8 months Integrates- persists Clinical- maintain equilibrium without arm support Facilitates postural adjustments

Why type of group increases awareness of individual needs, values, ideas, feelings, and behaviors by choosing, planning, and implementing group activity?

Task-oriented group Activities allow members to explore, and experience thoughts, feelings, self-awareness and behaviors Clt- cog. and socioemotional dysfunction with fair verbal skills and interaction skills Therapist role- defines group goals and structure, activity selection, facilitate discussion, provides feedback, explore relationships,

What is trigger finger?

Tenosynovitis of the finger flexors at the pulleys. Typically the A1 pulley Cause- repetition and use of tools that are placed too far Conservative tx- 1) trigger finger splint - MCP extended and IP jts free 2) scar massage 3) edema control 4) tendon gliding 5) activity modifications

Complex rehabilitation programs to maximize community reintegration is what type of intervention?

Tertiary prevention

What type of reliability measures same tester to multiple administrations?

Test-retest reliability

Primitive Reflex Testing for Oral Motor Eval: Rooting reflex

Tested by lightly stroking from the corner of the mouth along the cheek in a direction toward the ear Normal response is no reaction Dys. includes head turning and tongue protrusion toward the direction of the stimulus

NDT/Bobath: Key Points of Control

Use key points of control when handling to control quality of movement. - Neck, shoulder girdles, trunk, pelvis, trunk, and hands and feet

Assessment of Task performance: Barth Time Construction (BTC) (focus, method, scoring, population)?

Time usage, roles and underlying skills and habits. - Method: person constructs color-coded chart indiv. or w/group which depicts way time spent during typical week - Scoring: not scored; percentages of time calculated according to main groupings, discuss w/indiv. - Pop.: adolescent through elder

What is the OTA's primary role?

To implement treatment.

VERACITY

To provide accurate information about services. E.g. - Accurately represent credentials, education, experience, training, competence - Disclose any potential conflict of interest

AUTONOMY, CONFIDENTIALITY

To respect the rights of the recipients. E.g. - Collaborating in setting goals - Pt. fully informed of nature/risks/outcomes of intervention - Respect the right of refusal for services - Protecting all privileged confidential information.

What righting reaction elicits increased flexor muscle tone when placed in prone?

Tonic labyrinthine prone Onset- 37 weeks gestation Integration- 6 months Clinical use- facilitate total body flexing

What type of group discusses specific tasks performed outside group to engage in tasks more effectively, patients involved share similar functional issues, therapist's role is to facilitate group discussion, and the activity is verbal discussion to work through issues?

Topical group

What are the chest antideformity positions following a brain injury?

Trunk extension Scapula retraction

Spasticity reduction splint

Type of inhibitory/tone normalizing orthoses Places the spastic distal extremity on submaximal stretch to reduce spasticity

Orthokinetic splints

Type of inhibitory/tone normalizing orthoses Utilizes tactile input (ex: via elastic bandages) to facilitate and/or inhibit appropriate muscle groups

usual and customary rate

UCR. Average cost of specific service and procedure in a geographic area .Max amount the insurer will pay for a service.

What areas of sensory loss occur in a ulnar nerve laceration?

Ulnar aspect of palmar and dorsal surfaces 1/2 of ring and little finger

What is the functional loss of a radial nerve lesion?

Unable to extend digits to release objects Difficulty ,manipulating objects

Non-standardized Screening Methods for Cognitive & Perceptual Impairments during Daily Activities: signaling IDEATIONAL APRAXIA & intervention?

Uses objects incorrectly (i.e., uses a hairbrush as a toothbrush), cannot sequence steps of task (can't sequence steps of meal preparation), & does not engage in task - I: step-by-step instructions, hand-over-hand, opportunities for motor planning/execution

Shoulder slings

Utilized to support a flaccid arm after neurologic insult for short and controlled periods of time Long term use may be detrimental in terms of soft-tissue contracture, edema, and the development of pain syndromes

What is Complex Regional Pain Syndrome? CRPS

Vasomotor dysfunction that results in abnormal reflex that can be localized pain or spread to other parts Etiology- unknown cause but usually results after trauma or surgery Symptoms- severe pain, edema, discoloration, OT tx- 1) modalities for pain 2) AROM of involved joints 3) stress loading- (weight bearing, distraction, desensitization, carrying act) 4) splinting reduce contracture risk Contraindications - PROM, passive stretching, joint mobs, dynamic splinting, casting.

What gross motor skills are developed at 8-18 months in walking?

Walks with 2 hands held

Cognitive Disabilities Model: Cognitive Performance Test?

Was designed to assess the func. perf. of indiv.'s w/Alzheimer's disease; the focus is on the identification of effects that particular deficits have on ADL performance

flail arm splint

brachial plexus injury (holds arm close to body)

Dyssynergia

breakdown in movement resulting in joints being moved separately to reach a desired target as opposed to moving in a smooth trajectory; decomposition of movement

Airplane Splint

burns, especially axilla

supervision of a level I OT

can be done by a intermediate or advance level OTA

Topical group

discuss activities to increase effective participation in that activity: concurrent group - they are already engaged in activity, and anticipatory - they will be engaged in the future

Hawaii Early Learning Profile (HELP)

focus: non-standardized scale of developmental levels; educational curriculum-referenced test taht assesses 6 areas of function: cognitive, language, gross motor, fine motor, social-emotional, self-help pop: children ages 0-3 with developmental delay, disabilities, or at risk, HELP for preschoolers available for 3-6 yrs without delays

Neurological Assessment of Pre-term and Full-term Newborn Infant

focus: rating scale consisting of brief neuro exam incorporated into routine assessment pop: pre-term, full-term newborns

Pediatric Evalation of Disability Inventory (PEDI)

focus: standardized behavior checklist and rating scale that assesses capabilities and detects functional deficits to determine developmental level, monitor progress, complete program eval pop: 6 mo - 7 yr

Preschool Visual Motor Integration Assessment (PVMIA)

focus: standardized norm referenced assessment which evaluates visual motor integration and visual perceptual skills of preschoolers pop: preschoolers ages 3.5-5.5 yrs

Peabody Develpomental Motor Scales (PDMS-2)

focus: standardized rating scales of gross and fine motor development pop: children ages birth to 6 yrs with motor, speech-language, hearing disorders

Bayley Scales of Infant Develoment (BSID-III)

focus: standardized rating scales that assess multiople areas of development to attain a baseline for intervention and to monitor progress pop: 1 -42 mo

Denver Developmental Screening Test II

focus: standardized task performance and observation screening tool for earld id of children at risk for developmental delays in 4 areas: personal-social, fine motor-adaptive, language, gross motor pop: 1 mo - 6 yrs

Pattern analysis of diagonal patterns - D1 flexion (UE)

fruit on tree, across body, and put in basket (PNF) -Scapula: abducted and upwardly rotated -Shoulder: flexed, adducted, externally rotated -Elbow: slightly flexed -Forearm: supinated -Wrist: flexed towards radial side -Fingers: flexed, adducted -Thumb: flexed, adducted

Screening

gathering of information to determine need for a more in-depth evaluation...usually brief and easy, OTA can collect screening date and report info to OT, who will determine if further evaluations is needed

Advance-level OT

general supervision by OT

Suck-swallow

integrates 2-5 mo; strong sucking of finger when placed in mouth with head in midline

What is the focus of the Medical Model?

o Focus is placed on identifying the disease or dysfunction. o Treatment addresses the disease or dysfunction (performance components) contributing to decreased functional skills o OT frame of reference address the pathological process of the disease or dysfunctions (e.g. biomechanical, neurodevelopmental).

What is the focus of the Community Model?

o Focus is placed on indentifying and developing the skills needed for one's expected environment. o If skills cannot be developed, community resources and supports are identified and developed to enable functioning within one's chosen environment. o OT frames of reference promote development of performance skills and/or areas of occupation within the individual's performance contexts (e.g., lifestyle performance, occupation adaptation).

What is the OT intervention focus for Outpatient/ambulatory care?

o Focus of outpatient care is diagnostic eval, interventions to increase functional performance, consumer education, and prevention.

Durable Medical Equipment coverage by Medicare

repeated use can be withstood, primarily used for a medical purpose (w/c or walker) self help items not reimbursable

Reflex Testing for Motor Control: Optical Righting

stimulus - alter body position in all directions response - head orients to vertical with mouth horizontal

Reflex Testing for Motor Control: Positive Supporting Reaction

stimulus - contact to ball of foot in an upright position response - extension of the legs

Reflex Testing for Motor Control: Equilibrium Reactions

stimulus - displace center of gravity by tipping support surface response - righting of head/trunk/limbs

Reflex Testing for Motor Control: Protective Extension

stimulus - displace center of gravity outside the base of support response - arms and legs respond to protect against falling

Reflex Testing for Motor Control: Flexor Withdrawal

stimulus - stimuli to sole of foot response - flexion of stimulated leg

Disciplinary Actions: Ineligibility

the removal of eligibility for membership, certification, or licensure by the respective agency for an indefinite or specific time period.

What is the OT intervention focus for sub-acute care/intermediate care facilities (ICFs)?

• Functional improvements in performance skills and areas of occupation. • Active engagement of the client in the treatment planning, implementation, and re-evaluation process. • Discharge planning to expected environment.

What is onlooker play?

Observe others but does not interact 1year

What type of teaching identifies behaviors required to develop appropriate social skills?

Behavioral management

short and long term goals written SMART manner

Specific, Measurable, Attainable, Relevant, and time-limited.

Weakness of the elevation of the pharynx during swallow causes...

-Incomplete triggering (diminished neural stimulation) of the pharyngeal phase of swallowing

Inappropriate affect

-Inconsistent with the accompanying idea, thought or speech

cultural context

-includes customs, beliefs, activity patterns, behavior standards, and expectations accepted by the society of which the client is a member

What are extensor tendon early mobilization programs of zone III and IV?

0-4weeks PIP-extension splint (DIP free) AROM of DIP 4-6 weeks AROM of DIP and flexion of digits to DCP

Immediate memory

-The ability to recall material within seconds or minutes

What are the causes of hip fx?

Trauma Osteoporosis Pathological fx- cancer

PNF relaxation techniques

- *Contract-relax*: isometric contraction of the antagonist, relaxation, then passive movement of agonistic pattern by the therapist, with the goal of increasing range of motion - *Hold-relax*: isometric contraction of the antagonist, relaxation, then active movement of the agonist by the individual, with the goal of increasing mobility - *Rhythmic rotation*: utilized when a restriction is felt during range of motion. therapist repeats rotation of all components of the pattern at the point of restriction, slowly and gently. as the relaxation response occurs, the movement is continued throughout a larger range

Cognitive Disabilities Model intervention?

- Activities used to elicit indiv.'s highest cog. level - Therapy focus to maintain highest level of func. - Compensation through environ. changes & activ. adaptation to allow greatest degree of independence - OT meets w/family or caregivers to develop understanding of indiv.'s abil./deficits/care needs - OT and team develop approp. d/c plan

Describe Forensic settings.

- Admitted due to criminal activity. *Jail (sentences less than 1 year) *Prison (sentences greater than 1 year) *Psychiatric hospital (mentally ill or not guilty by reason of insanity) -LOS: determined by court

Cognitive/Perceptual Intervention: Dynamic Interactional Approach (Multicontextual Approach)?

- Emphasizes *transfer of info. from one situation to the next* - Utilizes varying treatment environments -practice of a targeted strategy w/ varied tasks & sits - Emphasizes metacognitive skills (self-awarenes of strengths&deficits) as basis& generalization of learning -Transfer of learning doesn't occur automatically - *Transfer of learning occurs through graded series of tasks that decrease in similarity* (e.g., training scanning strategies for a person w/ a visual neglect to find items fridge for milk to a less similar task like scanning to cross street) - Therapist utilizes *awareness questioning* ("how do you know this is right?") to help indiv. detect errors, estimate task diff. & predict outcomes; self-monitoring techniques

If your statistic is HIGHER than the critical value from the table:

- Finding is significant - Reject the null hypothesis - Probability is small that the difference/relationship happened by chance, and p is less than the alpha level (p<alpha)

Describe Outpatient / Ambulatory Care.

- Focus: diagnostic evaluations, interventions to increase functional performance, consumer education, prevention.

Medical model focus/frames of reference

- Focus: identify dis. or dysf. - FOR: address the pathological process of the disease or dysfunctions (biomechanical, neurodevelopmental)

Ethics Commission

- Responsible for Code of Ethics and the Standards of Practice of the profession - Responsible for informing and educating members about current ethical issues, upholding the practice and education standards of the profession, monitoring bx of members and reviewing allegations of unethical conduct

Managing manic or monopolizing behavior?

- Select/design highly structured activ. that hold attn. & require a shift of focus from pt to pt -Thank the indiv. for participation & redirect attn. to another group member AND refer to limit setting

Specific PNF techniques to promote reversals of antagonists

- Slow reversals: to gain range of motion. alternating isotonic contraction of antagonists - *Rhythmic stabilization*: simultaneous isometric contraction of antagonists, results in cocontraction, promoting stability

Disorientation

-A disturbance of orientation to person, place, or time. Situation is sometimes used as a fourth consideration

Diagnostic criteria for major depressive episode

-A two week period of depressed mood or loss of interest or pleasure -Five or more of the following symptoms: 1) depressed mood most of the day 2) markedly diminished interest or pleasure 3) weight loss/gain, increase/decrease in appetite 4) insomnia/hypersomnia 5) psychomotor retardation/agitation 6) fatigue, loss of energy 7) feelings of worthlessness or guilt 8) diminished ability to concentrate/make decisions 9) recurrent thoughts of death/suicide (with or without a plan), suicide attempt -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) there may be an increased use of medical services

Managing escalating behavior?

-AVOID what can be perceived as challenging bx (eye contact, standing directly in front of person) -Maintain comfortable distance; actively listen; use a calm tone (not patronizing); speak simply, clearly& directly; do not judge indiv. thoughts/feelings/bx; clearly present what you would like person to do; avoid positions where you or the pt. feel trapped; -If cont to escalate & is non-responsive to above, need to ensure safety by: REMOVE other patients from area AND get/send for other staff

Early Intervention Programs (criteria, review frequency, OT role)

-Acceptance criteria "at risk" status: birth comp, suspected DD, failure to thrive, maternal subs abuse, teen mom, est. disability -DD criteria typically 33% delay in 1 cat, 25% in 2+cats -6 month reviews to determine continued service -OT eval: cog, phys, soc-emot, adaptive, communication -Evals written in strength-oriented, family friendly lang.

Basic task skills group?

-Activ. designed to develop the basic cog. skills necessary for the completion of simple tasks -uses a skill acquisition approach which differs from psychodynamic approach used in task-oriented group described by Fidler & Mosey

Reversible causes of mental confusion

-Age-related losses in hearing, vision, touch, etc -Unavailable or inadequate prostheses such as hearing aids, glasses, dentures, etc -Sensory overload; too much, too long, too fast -Sensory deprivation; too little stimulation, isolation, restraints -Loss of cues to aid orientation and memory such as clocks, magazines, calendars, and strict adherence to routines and rituals -Depression -Drug interactions, side effects, and build-up from longer absorption and elimination times -Over-the-counter cold, sleeping, and pain remedies; often taken without the physician's knowledge and which react with prescribed drugs -Viral or bacterial infections; may be accompanied by fever -Urinary tract infections, pneumonia, etc -Gallbladder disease -Metabolic problems cause by liver or kidney disease; thyroid disorders (hyperthyroidism, hypothyroidism); dehydration from diuretics, low fluid intake, hot weather; poorly controlled diabetes -

Fiscal management - Budget terms and concepts - Break-even analysis

-Also called cost-volume-profit analysis -Determines the volume of services needed to be provided for revenues to equal cost and profits to equal zero

Paranoid type schizophrenia

-Characterized by preoccupation with one or more delusions of persecution or grandeur -Auditory hallucinations are frequently present -Individuals with paranoid type schizophrenia tend to exhibit fewer of the negative symptoms

Catatonic type schizophrenia

-Characterized by severe disturbances in motor behavior involving stupor, negativism, rigidity, excitement, or posturing

Medical management for major depressive episode

-Antidepressant medications: selective serotonin reuptake inhibitors, tricyclics, selective norephinephrine, or serotonin and norepinepherine inhibitors, monoamine oxidase inhibitors (MAOIs) -The most effective treatment involves antidepressant medication combined with psychotherapy -Cognitive approaches are helpful for those who demonstrate self-awareness, intact cognitive skills, and the ability to actively participate in the treatment process -Electroconvulsive therapy (ECT) is very effective, although how it works is not fully understood (it often produces some memory loss for the period surrounding treatment) -Individuals must be closely monitored for self-destructive and/or suicidal behavior -The most dangerous time may be when the depression begins to lift and the person becomes mobilized

Anxiety disorders

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

Onset, prevalence and prognosis of anxiety disorders

-Anxiety disorders often begin in childhood but may develop at any time -Post-traumatic stress disorder and acute stress disorder follow the stressful event -Prevalence and prognosis vary with the specific disorder

Panic attacks

-Are not coded diagnoses -Discrete periods of intense fear or discomfort, in which four or more symptoms develop abruptly and reach a peak within 10 minutes: 1) palpitations or accelerated heart rate 2) sweating 3) trembling or shaking 4) sensations of shortness of breath or smothering 5) feelings of choking 6) chest pain or discomfort 7) nausea or abdominal stress 8) feeling dizzy, unsteady, lightheaded or faint 9) derealization or depersonalization 10) fear of losing control or going crazy 11) fear of dying 12) paresthesias 13) chills or hot flashes

Focus of OT intervention for personality disorders

-Assistance to the individual in identification of issues may increase commitment to treatment and the pursuit of behavioral change -Cognitive behavioral approaches and an increase in functional and coping skills may decrease symptomatic behavior

DSM-IV-TR multiaxial format for diagnosis

-Axis I identifies the clinical disorders and other conditions that may be a focus of clinical attention -Axis II includes personality disorders and mental retardation -Axis III identifies general medical conditions -Axis IV lists psychosocial and environmental problems: problems with primary support group; problems related to the social environment; educational problems; occupational problems; housing problems; economic problems; problems with access to health care services; problems related to interaction with the legal system/crime; other psychosocial and environmental problems -Axis V provides a global assessment of functioning (code 0-100)

Cognitive/Perceptual Intervention: Quadraphonic Approach?

-Based on remediation -Integrated model-use of several theories: info. processing, teaching/learning eval., neurodevl. eval, biomechanical eval. - Micro-perspective: eval of management of performance component sub skills: attn., memory, motor planning, postural ctrl, & prob. solving - Macro-perspective: eval includes use of narratives, interview, real-life occupations (shopping, cooking, etc.) -one of the pops it is used for is TBI pt.s

Reisburg's stages for dementia - Stage 3

-Beginning signs and deficits are noted in this stage -Person's strengths: remains independent in IADL; can recognize challenging situations to avoid, in order to minimalize manifested deficits; can utilize compensation as an adaptive mechanism -Person's weaknesses: forgets important information for first time in one's life; experiences difficulty completing complex tasks; experiences difficulty negotiating directions to new location

Motor behavior

-Behavioral and motoric expressions of impulses, drives, wishes, motivations and cravings -Disturbances of motor behavior: echopraxia, catatonia, stereotypy, psychomotor agitation, hyperactivity, hypoactivity, aggression, acting out, akathisia, ataxia

Medical management of disruptive behavior disorders

-Behavioral techniques are often the most effective forms of intervention with adolescents -The identification and treatment of other disorders, (attention-deficit/hyperactivity disorder, learning disorders, substance use, depression, etc) is important -The use of medications such as antipsychotics, antidepressants, anxiolytics, and mood stabilizers may be helpful -A consistent approach from all team members is essential

Close, routine, general or minimal supervision

-Close: daily, direct contact at work site - Routine: at least every 2 wks. at work site, interim sup. by other methods (phone, written communication) - General: at least monthly direct contact w/super. PRN by other methods - Minimal: PRN basis, may be < monthly

Atypical antipsychotic medication

-Clozaril, Rsperdal, Zyprexa, Seroquel, Geodon -Side effects vary with individual medications -Complications of Clozaril may include agranulocytosis, which is decrease in certain white blood cells that requires weekly blood count monitoring

High-Grade Joint Mobilization

-Contraindicated for Diabetes: provides too much stress on the joints and the limitations in ROM of the shoulders

resistive exercise programs

-Contraindication for Osteoarthritis (OA) -Herberden's nodes and Bouchard's nodes are types of bone spurs that can result.

Focus of OT intervention for disruptive behavior disorders

-Contributing disorders need to be addressed in treatment -The development and improvement of self-esteem/self-efficacy -Development of the skills needed for competence in ADL, social, leisure, school, and vocational behaviors -Skill development may improve emotional adjustment -Behavioral approaches must be consistent throughout all programming -The therapist should assist the parents, other family members, teachers, and other school personnel to understand the nature of the child's condition and to develop strategies for behavior management

Schizophrenia diagnostic criteria

-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 -Positive symptoms are the excesses or distortions of normal function as found in criterion A -Negative symptoms represent a loss or absence of function: restricted emotion; decreased thought and speech; lack of motivation and initiative; inability to relate to others

Diagnosis and medical treatment of Lyme disease

-Diagnosis: presence of symptoms and signs; history of exposure to ticks, especially in geographic areas where Lyme disease is known to occur; blood titer to determine whether antibodies for Lyme disease are present -Medical treatment: antibiotics (oral or intravenous); management of joint-related symptoms from the accompanying arthritis

Medical treatment of end stage renal disease (ESRD)

-Dialysis required to stay alive: hemodialysis; peritoneal dialysis (inpatient treatment, continuous ambulatory peritoneal dialysis [CAPD]) -Transplantation: cadaver; living related; living unrelated

Medical management of cognitive disorders

-Differential diagnosis to ensure that symptoms are not pseudodementia due to a reversible cause -Medication treatment involves resolution of the causes of the disorder if possible -There are a limited number of newer medications that appear to maintain or slow the decline of cognitive function (eg. Aricept, Cognex)

Amnesic disorders

-Difficulty with memory only, but sufficient to cause functional difficulty -Causes and types: 1) cerebrovascular accident 2) multiple sclerosis 3) Korsakoff's syndrome 4) alcoholic blackouts 5) electroconvulsive therapy 6) traumatic brain injury 7) transient global amnesia

Diagnostic characteristics for Asperger's disorder

-Difficulty with social interaction -Restricted interests and behaviors -Characterized by clumsiness -Delayed developmental motor milestones -Differentiated from autism by adequate language and the level of social interaction and engagement in activities with others

Etiology, onset, prevalence and prognosis for Asperger's disorder

-Etiology is unknown; however, studies indicate a strong relation to autism. It is hypothesized to be due to genetic, metabolic, infectious, or perinatal causes -Little is known, and course and prognosis are variable -Those individuals with a normal IQ and high level of social skills appear to have a good prognosis, although they tend to be socially uncomfortable and demonstrate illogical thinking

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

Stress incontinence

-Etiology: local damage to bladder sphincter associated with aftereffects of bearing children, morbid obesity, weakening of accessory musculature associate with normal aging

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

Overview of OT evaluation and intervention for intellectual disorders

-Evaluate developmental and functional levels -Assess performance skills and occupational performance -Support and assistance may be required to address performance skills and patterns in areas of occupation -Develop community integration and participation skills -Collaborate with the interdisciplinary team and family to promote participation in areas of occupation -Collaborate with the educational team to contribute to a comprehensive educational program if individual is of school age

OT intervention for manic episodes

-Focus of initial treatment -Management of all behaviors that threaten the safety and well being of the individual as well as that of others on the unit -Limit-setting to reduce the individual's fears of losing control, increase participation in the treatment process, and promote safety -Engagement in activities that provide for release of excess energy in a positive and therapeutic manner -Activities should be brief and promote reality-based thinking -Periods between episodes should be used to educate the individual and the family on symptom management

Focus of OT evaluation for disruptive behavior disorders

-Functional and dysfunctional behaviors -Contributing disorders (attention deficit/hyperactivity disorders, mood disorders, learning disorders, etc) and their effect on performance components and occupational performance area -Child's goals, stressors, and family and social relationships

Focus of OT evaluation for eating disorders

-Functional performance assets and deficits -Coping skills -Interpersonal relationship skills and limitations

Focus of OT evaluation for personality disorders

-Functional problems associated with symptomatology -Ability and willingness to engage in treatment -Cognitive skills -Coping skills

Clinical aspiration

-Food enters the airway -Person can clear airway by coughing (reflex intact) -Person silently aspirates -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

Sign and symptoms of diabetes

-Frequent urination -Excessive thirst -Unexplained weight loss -Extreme hunger -Visual changes -Sensory changes (tingling/numbness) in the hands or feet -Fatigue -Very dry skin -Slow healing wounds -Increased rate of infections

Mental status examination

-General description of the individual: appearance, behavior and psychomotor activity, attitude toward examiner -Mood and affect: mood (pervasive, sustained emotion), affect (observable expression of mood), appropriateness of mood and affect -Speech -Perceptual disturbances -Thought: process or form of thought, content of thought -Sensorium and cognition: alertness and 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 -Impulse control -Judgement and insight -Reliability

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: cognitive impairment (eg. safety issues, communication and expression impairments, alteration of personality, decreased ability to engage as before in interpersonal relationships); affective changes; sensory changes (associated with dementia); 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.); myelopathy (spinal cord pathology); peripheral neuropathy; visual impairment (ie. peripheral: cytomegaloviral (CMV) infection, retinopathy, central: neurobehavioral loss/impairment)

Etiology of intellectual disorders

-Genetic conditions such as chromosomal abnormalities (eg. Down syndrome, Fragile X syndrome, Prader-Wili syndrome, and Klinefelter's syndrome) -Metabolic conditions such as phenylkeonuria, hypothyroidism, and Tay-Sachs disease -Prenatal infections such as rubella, toxoplasmosis, AIDS -Maternal substance abuse -Perinatal factors such as trauma and prematurity -Acquired conditions including infections such as encephalitis, meningitis -Head trauma sustained in motor vehicle accidents, falls, child abuse, etc.

Etiology and risk factors of heat syndromes/hyperthermia

-Heat production increases with infection, exercise, and/or drugs -Heat loss decreases with high humidity and/or temperature, excess clothing, obesity, cardiovascular disease, dehydration, sweat gland dysfunction, lack of acclimatization, and/or drugs -When an individual's heat loss is not sufficient to offset his/her heat production, his/her body will retain heat and a heat syndrome can develop -Individuals who are elderly, obese or taking drugs are at increased risk

Profound mental retardation

-IQ of 25 or below -Assistance and ongoing supervision are required for basic survival skills -Significant impairments in motor functioning and physical development are typical -Supervised living is required

Severe mental retardation

-IQ range of 25 to 39 -Focus is usually placed on the individual acquiring communication skills and some basic health habits -Assistance is 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

Moderate mental retardation

-IQ range of 40 to 54 -Focus is usually placed on the individual acquiring independence in routine daily skills and skills necessary to work in a sheltered workshop -Limited support and assistance may be required in specific occupational performance areas on a daily basis -Supervised living is required

Traditional antipsychotic medication

-Include Mellaril, Thorazine, Prolixin, Stelazine, Trilafon, Haldol, and Navane -Long-acting injections are available for Haldol (once a month) and Prolixin (once every two weeks) -Side effects may include: dry mouth, blurry vision, photosensitivity, constipation, orthostatic hypotension, Parkinsonism, dystonias (ie. impaired tonicity), akathisias (ie. restless, anxiety provoking need for movement), tardive dyskinesia (slow, rhythmic, automatic, stereotyped movements), and cardiovascular disorders -Complication may be include Neuropleptic Malignant Syndrome, an autonomic emergency leading to increased blood pressure, tachycardia, sweating, convulsions, and coma

General principles/assumptions of the Contemporary Task-Oriented Approaches to Motor Control Training

-Include remediation of performance components and environmental modifications to improve task performance -Movement is controlled by the integration and interaction of multiple systems including environment, sensorimotor factors, musculoskeletal factors, regulatory functions, and behavioral/emotional goals

Facial paralysis causes...

-Incomplete closure of the mouth -Loss of the bolus out of the front of the oral cavity

Impact of major depressive episode on function

-Individuals are often tearful, brooding and isolative -Anxiety leads to excessive concerns about physical health, complaints of pain, and alcohol abuse -Hoplessness, lack of energy, and slow thought processing lead to limited interest in activity and difficulty performing tasks in all occupational performance ares including self care, social interaction, and productivity

Irritants in autonomic dysreflexia

-Irritants that would normally cause pain to the areas below the spinal injury specific to the bowel: bowel irritation or over-distention; constipation/impaction; distention during bowel program (digital stimulation); hemorrhoids; infection or irritation (appendicitis) -Bladder infection or over distention: urinary tract infection (UTI); urinary retention; blocked catheter; overfilled urine collection bag; non-compliance with intermittent catheterization program -Skin-related disorders: any skin irritation below area of injury; decubitus ulcers; ingrown toenails; burns; tight or restrictive clothing or pressure to skin from clothing restrictions or wrinkles -Sexual activity: over-stimulation during sex (stimuli to the pelvic region that would be felt as pain if sensation were intact); menstrual cramps; labor and delivery -Other: heterotopic ossification/myositis ossificans; skeletal fracture

Sensory impairment of the oral cavity causes...

-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

Stage 2 cancer

-Localized spread of the tumor -Lesion is operable and can be removed with margins -Spread is limited and usually responds well to treatment (chemo/radiation/immunotherapy) -Mean 5 year survival rate is 50% plus or minus 5%

Stage 1 cancer

-Localized-Tumor present, no perceived spread of disease -Lesion operable -Prognosis good (70-90% mean survival at 5 years) -No spread of disease to the lymph nodes -No metastatic lesions

Functional Impairments: body scheme disorders?

-Loss of awareness of body parts as well as the relationship of the body parts to each other & objects. -Includes body neglect and asomatognosia

Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)?

-Pop: TBI, CVA, tumor - Measure basic cog. functions that are prereq. for managing everyday tasks - 20 subtests in 5 areas: orientation, visual, spatial perception, visualmotor org., thinking operations -Abilities scored from 1=low ability to 4=high ability

Rehabilitation to treat Bell's palsy from 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 ear piece [similar to eyeglass ear rim]) -Use electric 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 alteration in body image, since the individual is coping with a facial deformity

Impact of kidney disease on performance components/skills/client factors

-Motor dysfunction: fatigue; muscle pain; edema limiting mobility; weakness -Sensory system function: neuropathy/vision loss (diabetes/drug related) -Cognitive dysfunction: alteration of body image due to dialysis (tied to equipment/schedule) or post transplant (foreign tissue); delusions due to sepsis or toxicity; dementia, multi-infarct or metabolic -Perceptual/neurobehavioral dysfunction: dementia/infarct related;stroke related -Psychological/emotional dysfunction: mood/adjustment disorder; poor management of pyschosocial disorders can increase the risk of cardiac arrest; supportive counseling and social support are indicated; drug therapy and complementary medicine

Impact of personality disorders on function

-Personality disorders are grouped in clusters according to their impact on behavior -Cluster A: (paranoid, schizoid, and schizotypal) individuals with these disorders are often perceived as odd and eccentric -Cluster B: (antisocial, borderline, histrionic, and narcissistic) individuals with these disorders are often perceived as dramatic, emotional, and erratic -Cluster C: (avoidant, dependent, obsessive-compulsive and those not otherwise specified) individuals with these disorders are often perceived as anxious or fearful -The type and degree of impact on relationships and daily function depend on the severity and type of disorder

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

Program evaluation and quality improvement - Major types and terms: Statistical utilization review

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

Hyperactivity

-Restless, sometimes aggressive or destructive activity, often associated with brain pathology

Focus of OT intervention for anxiety disorders

-Skills training and cognitive behavioral approaches may reduce avoidant behavior -Development of relaxation and stress management skills may decrease the incidence and severity of symptoms -Graded activities designed to promote self-efficacy may increase self-confidence, motivation, and participation in treatment

Intervention for GERD

-Sleeping with more than one pillow (elevating the head to discourage regurgitation associated with body posture) -Drug therapy -Diet modification: less spice; small meals on more frequent basis -Stress management

Clinical exams and functional findings for dysphagia and swallowing disorders

-Staff report questioning swallowing dysfunction: person coughs during or after drinking water or other thin liquid -The person's face changes color during or after eating: flushed/reddened color, ashen appearance for persons with darker skin; blanches -Person gasps for breath, but has a partial or complete airway obstruction: to clear the obstruction and raise the bolus that has been aspirated, the Heimlich maneuver is used as long as the person is awake and responsive; if the person loses consciousness, basic life support procedures are used to continue to try to reestablish airway -- this includes abdominal thrusts and back blows, plus periodically looking in the oral cavity to try to visualize the object, if visualized, it may be possible to remove the object and restore respiratory function -Bedside swallowing assessment: assessment of level of alertness, ability to follow directions, level of awareness of impairment, orientation to activity; assessment of sensory and motor components of swallowing; assessment of ability to manage own secretions -- auscultation of neck to hear elongation of the oropharyngeal structures and to listen for wetness/gurgling which could be a sign of insufficient swallowing; clinical observation of person; assessment of swallowing function using trial boluses: suggestion of diet modification, as indicated; recommendations for further testing

Funding for ATDs and EADLs

-State Vocational and Educational Services for Individuals with Disabilities (VESID), Offices for Vocational Rehabilitation (OVRs), and Divisions of Vocational Rehabilitation (DVRs) 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 workers compensation will possibly reimburse for certain devices

Recent memory

-The ability to recall events of the past few days

Flat affect

-The absence of any affective signs of emotion

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

Antisocial personality disorder

-This disorder is characterized by continual antisocial or criminal acts, but is not synonymous with criminality -It is an inability to conform to social norms that involves many aspects of the individual's adolescent and adult development -Persons with antisocial personality disorder have no regard for the safety or feelings of others and the lack remorse

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

Program evaluation and quality improvement - Purposes of program evaluation

-To measure the effectiveness of a program; that is, were program goals 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

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

Motor Driving Eval

-adequate ROM, 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 breaking

Residential programs

-adm d/t fnal deficits that impede (I) living, but not severe enough for hospitalization -continuum: 24 hour, halfway house, group home, supportive apartments w/ weekly check-in

Intervention Strategies for perseveration?

-bring to conscious level & train person to inhibit it -redirect attention -engage person in tasks that require repetitive action

Isometric Exercises

-contraindicated for Hypertention: (i.e. contract-relax exercise, muscle contractions and holds). -indicated: isotonic exercises to increase muscle strength

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

ACL V

-exploratory actions -trial and error problem solving -new learning occurs -ex. plan a three course meal

Functional Impairments: Astereognosis (tactile agnosia)?

-inability to recognize objects, forms, shapes & size by touch alone -failure of tactile recognition although sensory testing (tactile & proprioceptive) is intact

Functional Impairments: Unilateral spatial neglect?

-inattention to or neglect of stimuli presented in the extra-personal space CONTRAlateral to the lesion -may occur independently of visual deficits

Intervention Strategies for ideational apraxia?

-provide step by step directions -hand over hand -opportunities for motor planning and motor execution

Psychosocial Intervention: One-to One versus group intervention- Indicators for One-To-one intervention?

-refusal to attend groups -inability to tolerate group interaction -presence of bxs that would be disruptive to the goals of the group -issues that must be addressed are specific to that pt/ client only

Functional Impairments: Global aphasia?

-symptoms are those of severe Broca's aphasia & Wernicke's aphasia combined. -Almost total reduction of all aspects of spoken & written language in expression as well as comprehension

Bariatric considerations for W/C prescription

-wheelchair users who are obese must be prescribed wheelchairs that are rated for their obesity category a. selection based on patient characteristics, safety, and function -the bariatric client has a center of body mass that is positioned several inches forward in comparison with the non-obese person a. in order to ensure w/c stability, the rear axle is displaced forward in comparison w/the standard w/c b. this forward position allows for a more efficient arm push (full arm stroke with less wrist extension) -Bariatric w/c can be ordered with special adaptations a. hard tires versus pneumatic tires for increased durability b. adjustable backrest to accommodate excessive posterior bulk c. reclining w/c to accommodate excessive anterior bulk, cardiorespiratory compromise (eg orthostatic hypotension) d. power application attached to a heavy duty w/c to accommodate excessive fatigue

What are the general principles of a dischage? 1) d/c planning begins _____ and developing _____ 2) collaboration with _____ 3) selection of appropriate _____ 4) _____ of d/ c setting to ensure safe discharge. 5) include _____ and _____ gains.

1) at initial eval, and developing 2) individual, family and caregivers, other professionals 3) setting and environment (home, transfer to SNF) 4) home assessment 5) community integration, functional maintenance

What is included in an OT intervention for a full thickness burn?

1) 72 hrs dressing change 2) 5-7 days post op begin AROM, light ADL, 3) 7 days PROM 4) massage when wound heals 5) compression garments

What are the principles of how motor development progresses?

1) Cephalocaudal / proximal to distal 2) gross to fine movements 3) stability to controlled mobility

In prone, what are skills of a 0-2 month old?

1) turns head side to side 2) lifts head momentarily 3) bends hips with pelvis in air 4) lifts head and sustains midline 5) rotates head when up 6) bear weight on forearm 7) tuck chin and gaze at hands in forearm prop 8) shoulder collapse when shifting weight on forearms

What type of deformities are a result of RA?

1) ulnar deviation of wrist and MCP subluxation 2) boutonnière- flexion PIP, hyper extension DIP 3) swan neck- hyperextension PIP, flexion DIP

What is required of an OT while interperting assessment results? 1. Use of _____ 2. Relate to _____ 3. Use caution with _____ 4. Identify _____

1) use of universal terminology 2) relate to function abilities 3) use caution with self report data 4) identify fxn deficits

What are population client factors? 1. emotional, purposive, and traditional perspective 2. economic, political, social, and cultural capital 3. similarities of constituents ( genetics, gender, conditions)

1) values & beliefs 2) function 3) structure

What are the clinical implications affect the sensory system of the elderly population?

1) vision decline due to natural age and pathology 2) hearing 3) vestibular/ balance 4) somatosensory - touch, proprioceptive

What gross motor skills are developed at 11 months in walking?

1) walks with one hand held 2) reaches for furniture out of reach 3) cruises in either direction

What is the hierarchy of Piaget's cognitive development?

1)Sensorimotor (0-2 years) Integration of reflexes and senses to develop learning 2) Pre-operational- (2-7 years) imitation, symbolic relations,and use of perception to develop learning 3) Concrete operation- (7-11 years) reversibility, rules, inductive reasoning, to develop learning 4) Formal operations- (11 years to teens) Hypothesize, deductive thinking, to develop learning

Rood: Motor Patterns

1. *Supine withdrawal* (total flexion while supine to gain trunk stability) 2. *Rollover* (arm/leg on same side flex as trunk rotates, to elicit lateral trunk responses) 3. *Prone extension* (prone w/upper trunk/head in extension) 4. *Neck co-contraction* (prone, lift head into extension, to develop head control) 5. *Prone on elbows* (inhibit tonic neck reflexes, provide trunk and proximal limb stability) 6. *Quadruped* (on all fours, to develop limb and trunk cocontraction) 7. *Standing* (first static then active weight shifting) 8. *Walking* (gait patterns integrated into functional activities)

What are the 4 steps in a Marketing/Promotion Program?

1. Analyze Market Opportunities 2. Analyze Target Market 3. Develop Marking Strategies using the "5 P's" 4. Implement and Evaluate

What is the most important aspects of the OT process? 1. Client _____ 2. Should be _____ 3. always adapting to clt. or situation/environment

1. Client centered 2. Interactive 3. Dynamic

Discuss the 2 types of case management programs

1. Clinical Case management: individualized support and intervention to client with serious illness that limits ability to access and/or engage in existing community services / therapeutic programs, ensuring the person can remain in community and not be re-hospitalized. - Includes 1:1 counseling, family education, ADL training, community re-entry, etc. 2. Administrative case management: connects person with serious illness to appropriate and needed community services and/or therapeutic programs, overseeing to ensure quality of care in cost-effective manner is achieved. - Referral-based.

Explain the role of the OTA

1. Delivers OT services under the supervision of and in partnership with the OT. 2. Implements delegated assessments, provides verbal and written reports of observations and client capacities to the OT 3. Collaborates with OT and client to develop intervention plan 4. Communicating with OT about client's responses to and communications during intervention. 5. Selects, implements, and makes modifications to therapeutic activities and interventions consistent with demonstrated competency levels, goals, and requirements of the practice setting. 6. The OTA can implement outcome measurements as given by the OT and provide needed client discharge resources. 7. The OTA can supervise an OT aide 8. OTA's can be activities directors in nursing homes.

Interventions for PNF

1. Diagonal patterns or mass movement patterns utilized during functional activities (Two pairs of diagonals to each body segment, flexion or extension is major component, all patterns cross midline) 2. Assisted diagonal patterns using techniques of "chop" and "lift" 3. Total patterns of movement during tx utilize a developmental approach 4. PNF techniques superimposed on postures and movement patterns - manual contact, placement of therapist's hands over agonist to facilitate response; quick stretch of muscle to elicit contraction; traction of joint to stimulate joint receptors and promote movement; manual compression of joint to stimulate joint receptors 5. Specific techniques directed at the agonist and techniques to promote reversals of antagonists 6. Relaxation techniques

NDT/Bobath technique: Concepts

1. Normalize tone 2. Develop movement patterns 3. Symmetrical posture and bilateral integration 4. weight bear and weight shift 5. Integrate or inhibit primitive reflexes 6. Normal righting and equilibrium reactions 7. Prevent movements and stimuli that increase tone 8. Inhibit abnormal postures

Evaluation for oral motor dysfunctions

1. Range of motion, strength, and tone of the lips, cheeks and tongue 2. Extra- and intra-oral sensation 3. Dentition (ex: integrity of teeth, denture fit, etc) 4. Oral control of bolus includes the following abilities: contain the bolus in the oral cavity, form a cohesive bolus, propel the bolus posteriorly into the pharynx 5. Presence of a swallow reflex: - laryngeal elevation- larynx rises to approximate the epiglottis and protect the airway - soft-palate elevation- soft palate rises to close off the naso-pharynx to prevent food/liquid from entering the nasal cavity - pharyngeal peristalsis- peristaltic "waves" of muscle contraction propel food through the pharynx 6. Airway protection via the following mechanisms: - gag reflex- which expels a bolus that is too large from entering the pharynx - volitional and spontaneous cough- utilized to clear the pharynx of residual material - vocal fold adduction- closes off the airway and prevents food from entering the larynx - reflexive inhibition of respiration- prevents inhalation of food into the airway 7. Relaxation of the esophageal sphincter 8. Primitive reflexes 9. Cranial nerve testing 10. Objective testing; ie.Modified Barium Swallow/Videofluoroscopy, FEES (fiberoptic endoscopic evaluation of swallowing)

List the types Quantitative Designs.

1. True-experimental 2. Quasi-experimental 3. Non-experimental / coorelational

Brunnstrom's movement therapy: Basic Concepts

1. Use of reflexes and primitive movements to facilitate recovery of voluntary movement 2. Progression from reflex to voluntary to purposeful 3. Movement is elicited by use of associated reactions and tactile stimulation *Brunnstrom techniques rarely used now bc not based on current understanding of the motor system.

Developmental groups What is a cooperative group? 1. To enable to members to _____ 2. To develop _____ 3. Members identify and meet ____ 4. Leadership roles?

1. engage in activity that facilitates free expression of ideas and feelings 2. trust, love and belonging and cohesion 3. socio-emotional needs 4. leader acts as advisor and members give feedback, identify and meet needs, and reinforce behaviors. ****Activity- allow expression of idea and may not produce an end product.

Evaluation

A comprehensive process of obtaining and interpreting the necessary data to understand the person, system, or situation...

NDT/Bobath: Normalize tone

Weight bearing Trunk rotation Scapula mobilization Pelvis alignment and weightshifts Slow and controlled movements Proper positioning

What is the Forment's sign?

Assesses thumb addiction with lateral pinch Ulnar nerve damage

What are areas of eval and re-eval documentation?

Assessments administered Summary of assessment findings 1) baseline findings 2) re-eval comparison 3) indication of change Occupational problem list Recommendations Clt understanding of CLOF and problem areas Clt interests

Thematic Group

Assists members in acquiring the knowledge, skills, and attitudes needed to perform a specific activity (ex: cooking group to learn to cook).

What reflex elicits extension on face side and flexion of skull side, when head is rotated for 5 sec?

Asymmetrical Tonic Onset- 37 weeks Integrates- 4-6 months Clinical- promotes visual hand regard

What is associative play?

Interact with peers by exchanging toys and communicating ones behavior, but engages in play separately 2 years

What are the areas of ADL's?

Bathing Bowel and bladder Dressing Eating Feeding Fxn mobility Personal device care Personal hygiene Sexual activity Toilet hygiene

Understanding how the disease/disability affects the person; therapeutic relationship b/t therapist and client/caregiver are examples of what type of reasoning?

Interactive reasoning

What type of play uses drawing and puzzles?

Constructional Play 2-3 years simple puzzle 4 years increase spatial awareness to build block design 5 years 3-D design construction

What type of teaching formally presents information of increase knowledge of disease, maintenance of roles and methods of prevention?

Consumer/family/caregiver education.

When persistence or reemergence of primitive refexes occurs what system is being affected?

Central nervous system

Egocentric Cooperative Group

Developmental Group. Enables members to select and implement a long-range activity which requires group interaction to complete. 5-10 people work together.

Cooperative Group

Developmental Group. Members engage in a group activity which facilitates free expression of ideas and feelings. May not produce end product.

General Assessments of Mental Status: Short Portable Mental Status Questionnaire (focus, method, scoring, population)?

Focus=intellectual function(scores on basis of ERRORS) -Method: short questionnaire: 9 ?'s (day, president, etc.), subtraction task -Scoring:each item gets point if inaccurate, one point added for edu beyond high school, one subtracted if edu does not go beyond grade school; number of errors totaled w/potential error score of 10 *Higher score=lower fx/ more intellectually impaired -8-10 is severe intellectual impairment -5-7 is moderate intellectual impairment -3-4 is mild intellectual impairment -0-2 is intact intellectual function - Pop.: indiv. w/cognitive or psychiatric dysfunction

Technology Related Assistance for Indiv. w/ Disabilities Act

Funded the devel. of technology and technologic aids for persons w/disabil.

What is a Professional Review Organization (PRO)?

Groups of peer professionals who evaluate appropriateness of services and quality of care set forth by reimbursement agency requirements.

Resting hand splint

Hand/wrist based splint that can be dorsal or volar Utilized for persons who need to have their wrist, digits, and thumb supported in a functional position for prolonged periods (ex: when developing contracture of the long flexors)

What is the functional loss of a median nerve injury?

Loss of thumb opposition Pinch weakness

Barriers due to aphasia and ataxia require interventions to ensure_______?

Love and acceptance; support

Principle 5: Procedural justice

OT personnel shall comply with laws and Association policies guiding the profession of OT. - understand/abide by applicable Association policies (local/state/federal/national/international) - be familiar with revisions in the laws/policies - adhere to Code and encourage those they supervise to adhere - ensure employers are aware of OT's ethical obligations - record/report in timely manner all info. related to professional activities

Principle 1: Beneficence

OT personnel shall demonstrate a concern for the safety and well-being of the recipients of their services. - provide services in fair, equitable manner - ensure fees are fair and reasonable - advocate for recipients to obtain needed services - promote public health, safety and well-being of indiv., groups and/or communities

Principle 6: Veracity

OT personnel shall provide accurate information when representing the profession. - represent credentials, qualifications, education, etc. accurately - disclose anything that may pose a conflict of interest - refrain from using or participating in the use of any form of communication that contains false/deceptive/unfair statements - disclose errors that compromise safety - accept responsibility for professional actions

Principle 3: Autonomy/Confidentiality

OT personnel shall respect the recipients to assure their rights. - collaborate w/clients (family, caregivers) in setting goals and priorities - obtain informed consent from participants involved in research activities - respect indiv.'s right to refuse services - protect all confidential forms

Principle 2: Nonmaleficence

OT personnel shall take reasonable precautions to avoid imposing or inflicting harm upon the recipient of services or to his or her property. - maintain relationships that do not exploit recipient of services/avoid relationships that interfere w/professional judgment/objectivity - exercise professional judgment - identify personal prob. that may impact prof. judgment/duties - bring concerns to attn. of approp. authority

Principle 7: Fidelity

OT personnel shall treat colleagues and other professionals with respect, fairness, discretion and integrity. - preserve, respect and safeguard info. about colleagues/staff - represent qualifications, views, contributions and findings of colleagues - discourage, prevent, expose any breaches of Code and report to approp. authority - use conflict resolution - familiarize w/ established policies and proced. for handling concerns with the Code

Criteria for coverage of partial hospitalization (PHP)

OT services covered under general medicare guidelines, and the beneficiary would have otherwise required inpatient psychiatric care, active and individualized, multidisciplinary treamtnet must be provided

What is in an intervention plan?

Objective and measurable goals 2) selection of theory and evidence based intervention 3) mechanisms of service delivery 4) d/c planning needs 5) select outcome measures 6) recommendations and referral

What are the objects and properties of activity demands?

Objects used to carry out activities Tools Materials Equipment

Visual assessment of client's behavior and environmental contexts.

Observation

Capitation

Payment system. Provider is paid prospectively a specific amount for each member of a health plan regardless of services provided. (e.g. on a monthly basis). PMPM=per member, per month

What muscle is involved with shoulder horizontal adduction?

Pectoralis major- lateral pectoral nerve

What are Non-Parametric Statistics?

Testing not based on population parameters. Used when parametric assumptions cannot be met. Less powerful than parametric tests. - Chi-Square Test: test of significance to compare data in the form of frequency counts occurring in two or more mutually exclusive categories (subjects rate treatment preferences)

Assessments of Occupational Performance & Occupational Roles: Activities Health Assessment (focus, method, scoring, population)?

Time usage, patterns and configurations of activities, roles and underlying skills and habits. - Method: (1) person completes Idiosyncratic Activities Configuration Schedule (color-coded chart depicting how he/she spends time during typical week) (2) completes Idiosyncratic Activities Configuration Questionnaire (3) th. interviews person - Scoring: not scored; determination of person's activities health made by person and th. based on schedule, questionnaire and interview; sig. placed on person's interp. of level of balance, satisfaction and comfort to which each activity contributes - Population: adults through elders

DUTY

To achieve and continually maintain high standards of competence. - Holding all appropriate credentials - Protect pts. by ensuring duties by personnel match competencies - Consult with other service providers / referring when appropriate.

Procedural JUSTICE

To comply with laws and Association policies of OT. E.g. - Abide by local, state, and federal laws - Abide by institutional rules - Make employers aware of ethical obligations - Reporting and documenting all info accurately and in a timely manner (part of laws).

Long term acute hospital

admission for chronic or catastrophic illnesses or disabilities that required extensive medical care or life support. LOs is greater than 25 days to maintain medicare certification

forensic setting

admission is due to engagement in criminal activity by a person. this is a specialized hospital or unit within a hospital which provides inpatient psyquiatric care for individuals convicted of a crime and found guilty but mentally ill or not guilty by reason of insanity. LOS is determine by the court

Pattern analysis of diagonal patterns - D1 extension (UE)

bow and "ta da" (PNF) -Scapula: adducted, downwardly rotated -Shoulder: extended, abducted, internally rotated -Elbow: extended -Forearm: pronated -Wrist: extended towards ulnar side -Fingers: extended, abducted -Thumb: extended, abducted

Beery-Buktenica Developmental Test of Visual Motor Integration (Beery VMI-5)

focus: assesses visual motor integration pop: shot form for children ages 2-7 yrs, full form for 2-18 yrs

Developmental Test of Visual Perception (DTVP-2) and Developmental Test of Visual Perception - Adolescent adn Adult (DTVP-A)

focus: assesses visual perceptual skills and visual motor integration for levels of performance and for designing interventions and monitoring progress pop: children 4-10 yrs for DTVP-2; 11-74 yrs for DTVP-A

Erhardt Developmental Vision Assessment (EDVA) and Short Screening Form (EDVA-S)

focus: behavior rating scale to determine visuomotor development, assesses involuntary visual patterns (ie: eyelid reflexes) pop: 0-6 mo, EDVA-S can be used for older children

First STEP Screening Test for Evaluating Preschoolers

focus: checklist and rating scale which ids preschool students at risk in need of more comprehensive eval pop: 2 yrs 9 mo - 6 yrs 2 mo

Childhood Autism Rating Scale (CARS)

focus: determines severity of autism pop: 2+ yrs with mild, mod, severe autism

forearm orthosis

mounts to wc, must have shoulder/trunk movement, ALS, SCI, Guillan Barrebalanced

Home health assessment

outcome and assessment information set, which can be performed by an OT and places the patient into a home health resource group. Determines need for services. Must be completed within 48 hours of referral/return home

Reflex Testing for Motor Control: neck righting

stimulus - head rotation to one side response - body rotates as a whole to align with head

Reflex Testing for Motor Control: Crossed extension

stimulus - passively flex extended leg while opposite leg is flexed response - extension of opposite leg with adduction and internal rotation

Reflex Testing for Motor Control: Grasp

stimulus - pressure to palm of hand response - finger flexion that resists object removal

Reflex Testing for Motor Control: Tonic Labyrinthine Reflex (TLR)

stimulus - prone position followed by supine position response - prone results in flexor posturing of arms/legs and supine results in extensor posturing of arms/legs

Reflex Testing for Motor Control: Associated Reactions

stimulus - resisted voluntary movement of the less involved limb response - involuntary movement of the contralateral resting limb (ie. "overflow")

Reflex Testing for Motor Control: ATNR

stimulus - rotate head 90 degrees response - limb extension on face side, flexion dominated on skull side

Hand based finger splint for immobilizing MCP in extension with IP joint free

trigger finger

A pre-discharge home evaluation must be completed to ensure the person will be safe and to identify home adaptions

true

What is the OT intervention process for early intervention program?

• Development of cognitive/process, psychosocial/communication/interaction, and sensorimotor skills • Development of play and ADL skills • Provision of family education • Provision of advocacy and advocacy training • Transition planning from early intervention to preschool is essential.

stand-pivot

-individual stands and turns to transfer surface

programmable keyboards

-allow for customized overlays (eg enlarged letters and numbers for persons with low vision; graphics and symbols for individuals with cognitive impairments)

bariatric w/c

-heavy-duty, extra-wide w/c designed to assist mobility for individuals who are obese

Omnibus Budget Reconciliation Act (OBRA)

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

What gross motor skills are developed at 6-7 months in release?

One-stage- simultaneously taking hand and releasing hand

Types of Supportive Orthoses

Overhead suspension sling Balanced forearm orthoses Shoulder slings Supports may be used on a w/c to position a flaccid arm (lapboards, arm troughs)

Part B Medicare

Pays for hospital outpt physician and other prof. services incl. OT provided by independent practitioners; considered Supplemental Medical Insurance Program (must be purchased by beneficiary), no time limit and require 20% co payment; typically covers 3 days/wk outpt svcs

Cognitive Behavioral FOR/ Cognitive Behavioral Therapy (CBT)- Beck's cognitive triad?

1) negative self evaluation 2) pessimistic world view 3) hopelessness regarding the future

Rood's Facilitation techniques

- *Fast brushing*: applied via a battery operated brush to provide sensory input to the skin over the muscle being facilitated - *Stretch/tendon tapping*: quick manual tapping with the therapist's hands to apply a quick stretch to the desired muscle - *High frequency vibration* (100-300 cycles per second) - *Quick icing*: applied over a muscle group in an effort to stimulate - *Heavy joint compression*: applied manually through a joint in a weightbearing position - *Resistance*: utilizing gravity or via the therapist's hand to stimulate muscle recruitment

Assessment of Motor and Process Skills (AMPS)?

- 3 yrs.+ regardless of diagnosis - Examines person's func. competence in 2 or 3 familiar & chosen BADL or IADL tasks (indiv. chooses from list of over 80 standardized tasks) - Therapist observes/documents motor & process skills that interfere w/task performance -16 motor & 20 process skills are scored for each task performed: Skills scored from 1=deficit to 4=competent; final scores account for task difficulty & therapist's rater severity -A test of occupational performance that is appropriate for those living w/ a variety of impairment: including cognitive & perceptual impairments

What is adult day care?

- A day treatment program aimed at adults and elders with chronic physical and/or psychosocial impairments, and/or individuals who are frail but semi-independent. - Treatment occurs in a group setting. - Individual schedules vary, as flexibility allows time to address daily caregiver needs and time for rest. - Schedules of individual persons can very from one afternoon per week to 5 full days. LOS: indefinite. Services are provided to people who might otherwise be institutionalized or are frail and need ongoing support (cooked meals, socialization opportunities).

Describe a long-term hospital.

- A medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis. - LOS: month - years - Discharge to: state run long-term hospital, SNF, home, supportive residence

Role Acquisition (frame of reference)

- Ann Mosey - Interv. focused on acquis. of specific skills an indiv. needs to function in his/her environ.; employs tasks & social skills to meet demands of personally desired & necessary roles - Perf. addressed through func/dysfunc in 7 categories: task skills, interpersonal skills, family interaction, ADL, school, work, play/leisure/rec. -considers temporal adaptation -Temporal adaptation addresses the individual's temporal orientation & ability to organize use of time in a need satisfying manner -Eval: focuses on gathering data indicative of fx/dysfunction in above categories -Intervention: Principles of learning used to promote skill devel.; general postulates for change are provided to guide the treatment process -specific postulates provided for each of continuums -**Any treatment activities or strategies that employ the teaching-learning principles are acceptable *

General level criteria for scoring of Allen Cognitive Level Test

- Level 2: unable to imitate running stitch - Level 3: able to imitate running stitch, 3 stitches - Level 4: able to imitates whip stitch, 3 stitches - Level 5: able to imitate single cordovan stitch using overt (physical) trial and error methods, 3 stitches - Level 6: able to imitate single cordovan stitch using covert (mental) trial and error methods, 3 stitches

Impact of kidney disease on instrumental activities

- Lighter work load and housekeeping assistance; altered role in the family) -adapted vehicles; access to handicapped transit passes or parking spaces; special planning for long distance travel -training to change usual habits to cook appropriately for dietary limitations; planning to budget and purchase appropriate supplies; safety in cooking -ability to do banking; ability to budget funds; ability to prioritize goals; ability to achieve goals or problem solve solutions.

Functional Impairments: Motor apraxia/ideomotor apraxia?

- Loss of kinesthetic memory, so that purposeful mvmt cannot be achieved due to ineffective motor planning although sensation, mvmt & coord. are intact

Who are Occupational Therapy Practitioners?

- Occupational Therapist OT - Occupational Therapy Assistant OTA OT Aides are NOT considered OT practitioners

Alpha level (p value).

- Pre-selected level of statistical significance. - What you as the researcher are willing to accept as the expected difference due to chance (the percentage of error) - Usually .05 or .01 - .05 = only 5 times out of 100 or a 5% chance of error

Life-Style Performance Model (frame of reference)?

- Proposes method to look at match b/t environ. and individual's needs - Four hypothesis: 1) there is greater mastery& competence in activities valued by society 2) a total activity & each of its elements have symbolic as well as reality-bsed meanings that affect one's experiences & motivation 3) mastery & competence are more readily achieved & sense of person pleasure & intrinsic gratification is more intense in those activities that are most closely matched to one's neurobiology & psychological structure 4) focus on the END PRODUCT or outcome of an activity for competency&achievement -Performance& QOL can be enhanced by envir. that provides for 10 fundamental human needs:autonomy, individuality, affiliation, volition, consensual validation, predictability, self-efficacy, adventure, accommodation, reflection - Performance measured in quality of functioning in 4 domains: self-care&maintenance, intrinsic gratification, service to others, reciprocal relationships -Evaluation focuses on obtaining an activity hx & life-style performance profile related to the four skills domains. Environmental factors are explored -Intervention: addresses 5 main questions that identify the focus: what does the person need to be able to do? What is the person able to do? What is the person unable to do? What interventions are needed & in what order? What are characteristics & patterns of activity& of environment that will enhance person's QOL? -Any interventions or activities that promote the performance in the 4 domains are acceptable

Treatment foundations of neurophysiologic frames of reference

- Sensory input regulates motor output and is necessary for movement to occur -Normal movements are governed by hierarchical centralized motor programs that determine muscle activation patterns - Damage to higher control centers release 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 brainstem reflexes occurs by eliciting higher level righting and equilibrium responses - Controlled sensory input can influence motor responses -"facilitation" and "inhibition" techniques can improve motor performance

What are Clubhouse programs?

- Services are provided by staff and members with responsibilities of operating the clubhouse shared equally by staff and members. - Clubhouses open at least 5 days/week (many open 7 days/week). - The schedule is organized around a "work-ordered" day, which parallels typical working hours. Evening and weekends are focused on other interests /recreation.

Cognitive/Perceptual Intervention: Neurofunctional Approach?

- Specifically used for indiv. w/acquired neuro impairments - Based on learning theory - Focuses on retraining real world skills rather than cog-percep processes - Uses overall adaptive approach, but incorporates some remediation components -*Treatment focus on training specific functional skills in true contexts*

Explain Continuous Quality Improvement (CQI).

- Using a proactive or preventative approach: limitations and problems are viewed as opportunities to increase quality - Blame is not attributed to persons; problems are related to organizational improvement needs.

max height for countertops

-31 inches

minimal clearance width for doorways/halls

-32 inch doorway width minimum -ideal is 36 inches -additional 26 inches is needed beside the door to allow for door swing -removing doorstops can add 3/4 inch in width -replacing existing hinges with offset hinges can add 1.5-2 inches -hallways should be 36 inch wide

Delirium

-A disoriented reaction with restlessness and confusion. It may be associated with fear and hallucinations

Reminiscence group?

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

Diagnostic criteria for manic episode

-A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week -During this period, three or more of the following symptoms have persisted: 1) inflated self-esteem or grandiosity 2) decreased need for sleep 3) more talkative than usual or pressured to keep talking 4) flight of ideas or feeling that thoughts are racing 5) distractibility 6) increase in goal-directed activity or psychomotor agitation 7) excessive involvement in pleasurable activities that have high potential for painful consequences -Behaviors often associated with a manic episode: treatment-resistance resulting from failure to recognize illness; suggestive or flamboyant dress; gambling, promiscuity, excessive spending or giving things away; irritable, assaultive, or suicidal behavior

Delirium

-A disturbance of consciousness (awareness of environment) with a decreased ability to attend -There is a change from previous cognition and/or perception -It covers a short period of time (hours to days) and tends to fluctuate -There are many causes: brain dysfunction, medication, endocrine disorders, cardiac disorders, fever, liver function disorders

Personnel management - Motivating job characteristics

-A fair and competitive salary and benefits package -Job security, realistic performance expectations, and fair employment policies -A good working environment with a relaxed, friendly atmosphere, adequate physical space, and sufficient current equipment and supplies -Challenging, satisfying work and diverse caseloads -Competent supervision with adequate feedback on job performance -Active mentorship and support for professional development -Tuition reimbursement and financial support for conferences, workshops, and /or post-professional education

Emotion

-A feeling state associated with affect and mood that consists of psychological and physical components (eg. fear, anger, joy) -Affect is the observable component of emotions -Appropriate affect is consistent with the accompanying idea, thought, or speech -Disturbances of affect: inappropriate affect, blunted affect, restricted or constricted affect, flat affect, labile affect

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

Thinking

-A goal-oriented reasoned flow of ideas and associations -When thinking follows a logical sequence, it is considered normal -Disturbances in form of thought: circumstantiality, tangentiality, perseveration, flight of idea, thought blocking -Disturbances in content of thought: delusions, compulsions, obsessions, poverty of content, phobias, and hypochondria

Compulsions

-A need to act on specific impulses to relieve associated anxiety

Per diem

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

Perseveration

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

Free-floating anxiety

-A pervasive anxiety that does not have a specific focus

Program evaluation and quality improvement - Major types and terms: Utilization review

-A plan to review the use of resources within a facility -Determination of medical necessity and cost efficiency -Often a component of a CQI or PAI system

Program evaluation and quality improvement - Major types and terms: Risk management

-A 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 -Potential risks are client or employee injury and property loss or damage with resulting liability and financial loss -OTs are responsible to ensure proper maintenance of equipment and a safe treatment environment -Staff education and training (eg. annual certification/recertification in CPR) is required -Effective communication with consumers (eg. informed consent) and with team members is required -Risk management is an integral part of program evaluation -If risk management fails and an incident occurs, completion of an incident report according to setting's standards is required

Consciousness

-A state of awareness -Disturbances of consciousness: disorientation, delirium, confusion, sundowning -These disturbances are usually a result of brain pathology

Personnel management - Job description

-A statement of the job's expectations, duties, and purpose and its supervisory relationships. It should include: -Position's title and department -Skilled and non-skilled requirements of the job including education, physical demands, and licensure requirements -Specific responsibilities, duties, and performance standards in detail -Supervisor(s) and supervisory relationships: decision making authority and degree of autonomy

Depersonalization

-A subjective sense of being unreal or inanimate

Derealization

-A subjective sense of being unreal or inanimate

Self-Awareness group?

-Activities as values clarification, awareness of own assets, limitations & bxs & person's impact on others

Managing akathisia?

-Allow person to move around as needed if it can be done w/out causing disruption to goals of the group -Keep in mind that participation on many levels & in many forms can be beneficial to the individual -If possible, select GM activities instead of FM/sedentary ones

What are the types of intervention?

1) prevention 2) meeting health needs 3) change process 4) management 5) maintenance

Active Flexion

-CONTRAINDICATED: post-sx b/c the tendon repair can rupture (0-4 weeks)

Reisburg's stages for dementia - Stage 4

-Deficits are noted in all IADL -Person's strengths: can still perform simple, repetitive ADL independently; can live at home with support; can follow simple verbal and demonstrational cues -Person's weaknesses: becomes increasingly forgetful; becomes unable to follow and sequence written cues; becomes unable to perform familiar, challenging activities; experiences difficulty in word finding; cannot manage at home without assistance

Onset, prevalence, and prognosis for cognitive disorders

-Delirium occurs in 10-25% of hospitalized individuals depending on the related medical condition -Delirium may resolve quickly or take several days -Delirium is more severe with advanced age -Delirium may indicate a poor prognosis over time -Dementia is present in 5% of those over 65 and increase with age -With dementia there may be periods of plateauing with a gradual decline over time -The prevalence of and prognosis for amnesic disorders varies with the cause -It is most often associated with alcohol use disorders and head injury

Methods of supervision

-Direct: face-to-face contact between supervisor and supervisee (includes co-treatment, observation, instruction, modeling, and discussion) -Indirect: non face-to-face contact between supervisor and supervisee (includes electronic, written and telephone communications)

Pervasive developmental disorder, unspecified

-Disorders that are similar with impairments see in autism, Asperger's disorder and Rett's syndrome (pervasive development disorders) -Impairments in social interaction, communication skills, stereotyped behavior, interests, and activities; however, cannot be classified as pervasive development disorder as not all criteria

Relationship of swallowing dysfunction to occupation

-Disruption of role relative to family unit, ability to comfortably eat at the dinner table: modified diet could be infantalizing; tube feeding may preempt person's ability to partake in the family meal in cultural/social context -Disruption of ability/comfort level for eating out in public: person may chose not to dine in a public social context; if business lunches or dinners are part of a vocational role, the person may not be able to resume his/her vocation without modification of expectations regarding how participation in social meals relates to vocational performance -Alteration of self-concept concerning life roles and appearances: if person is tube fed, how does that alter how he/she perceives self? -- sex appeal can be questions; self image as it impacts on life roles (eg. jet-setter or fashion plate) can be altered;; if tube fed, how does that alter how others perceive him/her? --accepted, feared, or pitied by children, grandchildren, family and friends

Brief psychotic disorder

-The individual experiences at least one day but less than one month with one or more criterion A symptoms of schizophrenia which result from severe psychosocial stress

Dementia

-Disturbances of memory and multiple cognitive deficits (aphasia, apraxia, agnosia, disturbance of executive function [i.e. planning, organization, sequencing]) -Dementia often includes personality changes -Dementia must lead to functional problems -It represents a decline in the person's previous level of cognitive skill -Alzheimer's type and vascular dementia account for 75% of all cases -Other causes include AIDS, Pick's disease, Huntington's chorea, Parkinson's disease, and alcoholism Although symptoms of Alzheimer's and vascular dementia are the same, vascular dementia requires evidence of a vascular cause -Mental confusion due to reversible causes must be ruled out (sensory changes and problems; depression; drug use and misuse; infections/inflammation; metabolic problems caused by other disorders)

Interventions for inpatient rehabilitation for immunological system disorders

-Evaluation and restoration of functional abilities: self-care; instrumental ADLs; energy conservation and work simplification; 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: access to environment; participation issues

Qualitative descriptions of motor control

-Evaluation of motor control should include observations of the quality of movements during performance of functional tasks -Examples of motor control issues resulting in observable poor quality of movement: intention tremor; dysmetria; dyssnergia; dysdiadochokinesia; ataxia; resting tremor; rigidity; bradykinesia; akinesia; athetosis; dystonia; chorea; hemiballismus

Program evaluation and quality improvement - Major types and terms: Concurrent review

-Evaluation of ongoing intervention program during hospitalization, outpatient, or home care treatment -Method to ensure appropriate care is being delivered -Often a component of a CQI or PAI system

Program evaluation and quality improvement - Major types and terms: Prospective review

-Evaluation of proposed intervention plan that specifies how and why care will be provided -Used by third party payers to approve proposed occupational therapy intervention program

Mildred Ross' Five Stage groups (purpose and 5 stages)?

-Expanded on work of Lorna Jean King (w/ chronic schizophrenia-proposed using non-cortical, alerting, stimulating,& pleasurable activities would normalize movement & increase strength&flexiblity& facilitate adaptive bxs) -extended use of sensorimotor approaches to other chronic pop. (ID, Alz, neurological impairment, etc) -5 stages of group follows a clear structure to attain a specific aim: 1: orienting members to session and each other 2: Mvmt uses a variety of vigorous GM activ. that are stimulating & alerting 3Perceptual-motor:brief activities w/perceptual-motor skills designed to be calming & to incr ability to focus 4. Cognitive: activities to provide cognitive stimulation to promote organized thinking 5:Closure: brief discussions to promote a sense of satisfaction & closure

Principles of collaboration

-Factors that influence effective team functioning -Member skill and knowledge -Membership stability -Commitment to team goals -Good communication -Membership composition -A common language -Effective leadership

Monamine oxidase inhibitor (MAOI) diet

-Foods and beverages to be avoided -Pickled herring -Liver -Dry sausages -Broad bean pods (fava) -Sauerkraut -Cheese (cottage cheese and cream cheese allowed) -Yogurt -Beer and wine including alcohol-free and alcohol-reduced -Yeast and meat extract -Smoke food products -Excessive amounts of chocolate and caffeine -Any improperly stored, handled, or refigerated products -Also avoid -Cold and cough preparations -Decongestants -Hay-fever medications -Sinus medications -Asthma inhalants -Anti-appetite and weight-reducing preparations -"Pep" pills -L-tryptophan -Certain prescription drugs

Etiology, onset, prevalence and prognosis for autism

-Organic brain pathology -May or may not be seen with other disorders -May occur from birth up to 3 years of age -Occurs in 4 times as many boys than girls, and two to five cases per 10,000 live births -The prognosis for functional independence is poor with 70% of children needing a supervised living setting (although the life expectancy is normal)

Focus of OT intervention for psychotic disorders in community settings

-Provision of services that assist in the maintenance of existing skills -Assistance with the continued development of skills needed for independent living -Monitoring of the individual for changing clinical and social needs

Focus of OT evaluation for cognitive disorders

-Identification of cognitive skills and limitations -Goals -Values and interests -Treatment history -Support systems -Environmental factors

Focus of OT evaluation for psychotic disorders

-Identification of cognitive, perceptual and social deficits and their impact on function -Determination of roles and realistic goals

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])

Focus of OT evaluation for anxiety disorders

-Impact on function and life style -Identification of specific skills -Identification of coping strategies

Focus of OT evaluation for attention-deficit/hyperactivity disorders

-Impact on school, home, play/leisure, and social participation -Analysis of performance skills, performance patterns, context(s), activity demands and client factors

Diagnostic characteristics of autism

-Impaired social interactions and in most cases cognitive disabilities -Difficulty relating to others and forming relationships. Exhibited by lack of or diminished eye contact and facial expressions -Difficulty with communication (echolalia, muttering, and lack of initiation , reflection, or development of speech) -If speech is developed, difficulty engaging in conversation -Repetitive and stereotyped behaviors and movements such as flicking and wiggling of fingers; head banging; rocking of the head and/or body (ritualistic nonfunctional routines, preoccupation) -Restriction in the appropriate use of objects, characterized by twirling, spinning, and flicking of objects -Difficulty with sensory processing and perception of various sensory stimuli; difficulty in modulation of stimuli of various levels of the continuum eg. hyper- or hypo-responsiveness

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

Medical management of eating disorders

-Individual psychotherapy -Family counseling -Behavioral and/or cognitive therapies -The use of antidepressant medications may be used in anorexia nervosa, but they are more effective for individuals with bulimia -Treatment of any of the resulting medical complications such as cardiac disturbances, reduced thyroid metabolism, osteoporosis, seizures, etc may also be necessary -Treatment most often takes place in outpatient or day care programs -Hospitalization (less likely with bulimia) may be necessary if the individual has medical difficulties, is suicidal, cannot care for him/her self, or needs to be removed from his/her home environment -Behavioral programs designed around a privileging system are often used -Consistency among staff is crucial for program effectiveness

Borderline personality disorder

-Individuals with borderline personality disorder experience extraordinarily unstable affect, mood, behavior, relationships, and self-image -Fear of real of imagined abandonment leads to frantic efforts to avoid it -Recurrent self-destructive or self-mutilating behavior may be threatened or carried out

Vocal cord paralysis causes...

-Inefficient closure of the vocal folds during the pharyngeal phase of swallow -Vocal cords are in paramedian position; swallow may be safe -vocal cords fail to meet/close to protect airway; aspiration may occur

Weakness of the tongue/base of tongue structures causes...

-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 cricopharyngeal junction - sub-optimal propulsion of the bolus; interference with the normal timing of the swallow sequence; failure to trigger closure of the vocal folds during swallowing; aspiration

Medical management for personality disorders

-Psychotherapy and certain medications may reduce symptomatology for some patients -Monitoring, supervision, and hospitalization may be required during periods of increased symptomatology, and/or aggressive or self-destructive behavior

Post-operative rehabilitation for cancer

-Intervention planning based on a client's medical status and blood value guidelines that can affect safety during activity (platelets, hemoglobin, etc) -Post-operative precautions related to structural changes from surgery: dependent on the location of the tumor and the procedure done (eg. if joint is replaced with an en bloc resection and shoulder indwelling prosthetic; abdominal precautions when the tumor is in the abdominal cavity; regional precautions when there is an incision near a joint, etc)

Confusion

-Involves inappropriate reactions to environmental stimuli, manifested by a disordered orientation in relation to person, place, and time.

Dissociative identity 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 person's psychic activity -It may involve separating an idea from its emotional tone

Cognitive/Perceptual Intervention: Allen Cognitive Disabilities Model?

-Originally developed for used w/ ppl who have psychosocial dysfunction, currently also being utilized w/ persons w/ neurological dysfunction & dementia -*Describes cog. function on continuum from level 1 (profoundly impaired) to level 6 (normal)* - Each level describes extent of person's disability & difficulty in performing occupations - After level has been established, routine tasks are presented that person can perform or that have been adapted so he/she can perform them -*Focus placed on adaptive approaches and strengthening residual abilities*

Managing effects of Alzheimer's disease?

-Make eye contact to show interest in the person: Value & validate what is day by the person -Positive& friendly facial expressions & tone of voice during all communications (don't give orders; use short, simple words & sent; do not argue or criticize) - Do not speak about indiv. as if he/she not there -Use non-verbal communication -Create routine that uses familiar&enjoyable activ. (activities that demonstrate & promote personal interests & indepen; do not introduce infantilizing activities; analyze & grade carefully; do not rush activities (it is process of engaging that is important, task completion is NOT needed)) -Note effects of time of day on bx &activ. performance - Attend to safety issues at all times

Prevention, early intervention and control for cancer

-Mammograms are recommended for women beginning at age 40, yearly after age 50 -Prostate and testicular exams are indicated for all adult males -Skin checks should be done regularly for people who have a family history of skin cancer or those who have a high exposure potential to the sun (construction workers, fishermen, etc) -Those with a family history of colon cancer should have screening and follow-up colonoscopies throughout adulthood and interventional colonoscopy if they are symptomatic -Women should have regular pap smears to detect vaginal/cervical/uterine cancer -Women who have a risk for ovarian cancer should be screened by blood test and abdominal ultrasound -Protecting/monitoring the environment -Avoiding contributory habits (health care professionals should coach people who want to quit or change habits)

Impact if psychotic disorders on function

-Many individuals with psychotic disorders demonstrate deficits in cognitive-perceptual and social interaction skills that affect all areas of function -The deficits in the processing of sensory information that is experienced by some individuals makes 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 relationships -Deficits in cognitive function due to thought disorders and difficulties with the performance of basic skills interfere with all occupational performance areas from self-care and use of leisure time to vocational pursuits -It is important to assess and continue to monitor the degree of assistance and structure needed to maintain optimum independence in all performance areas

Flexible endoscopic esophageal swallow (FEES)

-May be done at bedside or in an office setting -Food consistencies are laced with green food coloring -A flexible endoscopic catheter containing a miniature video camera is passed through the nasal cavity into the pharyngeal cavity -The person is given a variety of consistencies to swallow and observation is made to determine whether the swallow is intact or impaired -Sensation for light touch in the pharyngeal cavity can be tested by forcing air through the endoscopic tube generating a light touch stimulus

Mood disorders

-Mood disorders are diagnosed based on the incidence of manic, hypomanic, major depressive, and mixed episodes -Mood disorders are not coded diagnoses in and of themselves -Treatment addresses the symptoms of the episode experienced by the patient (it will vary with shifts in mood)

Oppositional defiant disorder

-Negativistic, hostile, and defiant behaviors that result in functional impairment -Oppositional, negative behavior begins in early childhood and may be seen in 16-22% of school-age children -The course and prognosis depends on the severity of behaviors, the presence of other disorders, and the intactness of the family -It is most likely to progress into a conduct disorder if aggression is prominent

Onset, prevalence, and prognosis for Rett's syndrome

-Occurs almost exclusively in girls, 6-7 cases per 100,000 girls -Motor and social skills are age appropriate from 6 months to 2 years of development when the onset of progressive excephalopathy develops -Deterioration occurs and is characterized by loss of purposeful hand movements, with development of stereotypical movements such as hand wringing and licking, biting, and slapping of fingers -Muscle tone becomes hypotonic, then progresses to spasticity and then rigidity, resulting in ataxia, and an uncoordinated and stiff gait -Breathing patterns become irregular, marked by hyperventilation, apnea, and holding of breath -Deterioration of language and social skills may plateau at a 6 month to 1 year developmental level -Regression in cognition and praxis -EEGs are abnormal and seizures common -Development of physical growth and head circumference plateau resulting in progressive encephalopathy -A child may live for over ten years following the onset

Sundowning

-Occurs in the late afternoon and at night in older people -Characterized by drowsiness, confusion, ataxia, and falling -It is associated with sedation, dementia, and changes in orienting cues such as light, and familiar people and objects

Diagnostic criteria for bipolar I disorder

-One or more manic episodes -May be combined with depressive episodes

Reisburg's stages for dementia - Stage 5

-Person cannot function independently -Person's strengths: can perform ADL and some IADL with correct cues and assistance; can respond to encouragement; becomes unable to safely drive an automobile -Person's weaknesses: demonstrates poor judgement; experiences difficulty with all decision making; forgets to take care of hygiene

Reisburg's stages for dementia - Stage 6

-Person cannot perform ADL without cues -Person's strengths: can perform components of familiar tasks; can follow demonstration/hand over hand cues -Person's weaknesses: demonstrates significant deficits in following 2 steps of a task; cannot sequence steps of ADL tasks; cannot speak in full sentences; becomes incontinent of bowel and bladder

Carr and Shepherd's Motor Relearning Program (MRP)

-Person is active participant whose goal is to relearn effective strategies for performing functional movement -Postural adjustments and limb movements are linked together in the learning process -Successful task relearning has occurred when activities are performed automatically and efficiently -Learning of skills does not follow a developmental sequence -Continued practice of compensatory strategies limits functional recovery -Intervention is not focused on learning specific movements but instead on learning general strategies for solving motor problems -Obstacles to efficient movement include loss of soft tissue extensibility, balance loss, fixation patterns due to postural insecurity, and muscle weakness

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

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 great desire for companionship but consider themselves inept or unworthy -Individuals with avoidant personality disorder need unusually strong and repeated guarantees of uncritical acceptance

Rehabilitations issues of small bowel obstruction

-Self-care aspects of stoma care must be addressed for persons with decreased fine motor skills (eg. individuals with peripheral neuropathy secondary to chemotherapy treatment) -Decrease mobility of gross movements that cause traction on the healing scar: bending, stooping, foot/lower leg related self-care (dressing, bathing, nail and foot care) -Altered appetite in post-operative phase

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 -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

Rivermead Perceptual Assessment Battery?

-Pop: 16 yrs.+ w/ visual perceptual deficits after head injury or CVA - 16 performance test that assess: form & color constancy, obj completion, figure-ground, body image, inattention, & spatial awareness -Utilizes deficit-specific tasks in isolation from ADL tasks - Scoring: accuracy of task completion & time taken to complete each task

Rivermead Behavioral Memory Test?

-Pop: For Persons w/memory dysfunction - Offers initial eval. of indiv.'s memory function -Indicates appropriate treatment areas - Monitors memory skills throughout rehab program - 11 categories w/9 subtests: each subtest presents series of items that the person is req. to *memorize & recall in later assessment* - Scoring: 0-9=severe impaired memory, 10-16 mod. impair. memory, 17-21= poor mem., 22-24=normal

Criteria for coverage of occupational therapy services by Medicare

-Prescribed by a physician or furnished according to a physician-approved plan of care -Performed by a qualified OT or an OTA under the general supervision of an OT -Service is reasonable and necessary for treatment of individual's 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 person's level of functioning within a reasonable period of time

Medical management of attention-deficity/hyperactivity disorders

-Prescribed medication depend on presenting sypmtoms -Stimulants most commonly used include dextroamphetamine for children 3 years and older, and methylphenidate for children 6 years and older -Side effects of stimulants include loss of appetite, weight loss, loss of appetite, disturbed sleep patterns, and slow growth -Antidepressants used are Imipramine, desipramine, and nortriptyline (used when stimulants are unable to be used) -Careful monitoring of cardiac functioning is required for those on antidepressants -Clonidine -Monitoring of medication and its impact on cognitive and psychosocial function, eg. learning and self-esteem -Psychotherapy, behavior modification, parent and individual counseling may be indicated

Medical management of pervasive development disorder

-Prescribed medications depending on presenting symptoms -Seizure medication -Medication for muscle deterioration and/or complications due to abnormal tone -Medications to increase alertness -Medications to modulate behaviors

Astereognosis

-The inability to identify objects through touch

Nominal aphasia (anomial or amnestic)

-The inability to name objects

Etiology and risk factors of decubitus ulcers

-Pressure that interrupts normal circulation causing localized areas of cellular necrosis: greatest risk is over bony prominences (eg. ischial tuberosity); intensity and duration of the pressure determines the severity of the decubiti -Conditions that predispose an individual to the formation of decubitus ulcers include immobility or altered mobility, weight loss, edema, incontinence, obesity, pathological conditions, and/or changes in skin condition due to aging -The presence of substance abuse, cognitive deficits, and/or psychological impairments can jeopardize the individual's ability to understand and complete the required daily decubitus prevention regimen

Purposes of orthoses/splints for neuromotor dysfunction

-Prevent/correct deformity via prolonged stretch and proper alignment -Control spasticity by aligning joints and providing prolonged stretch to spastic muscles - Prevent/decrease/accommodate contractures of the joint or soft tissue -Correct biomechanical malalignment by external force -Position the hand in a functional posture to promote engagement in activities -Compensate for weakness to allow intact muscle groups to function -Provide proximal support -Support a painful joint -Promote distal mobility -Enhance a specific activity (ex: fabrication of a typing or writing splint or utilization of a cock-up splint for feeding) -Immobilize joints and soft tissues to promote healing -Prevent or reduce scarring via prolonged pressure and appropriate stretch

Intervention for decubitus ulcers

-Prevention is the most effective intervention -Use wheelchair cushions, floatation pads, and pressure-relief bed aids to distribute pressure over a larger skin surface -Train the individual and/or caregivers in positioning and weight-shifting techniques and schedules and in proper skin care: full push-ups, lateral leans, forward leans, or wheelchair tilt/recline options are common techniques used depending upon the abilities of the individual; weight shifts should occur every 30 minutes for 30 seconds or every 60 minutes for 60 seconds; integrate weight-shifting into daily activities (eg. lean forward to pick up the phone, lean sideways when reading the mail) -Train in proper skin care: keep skin free of excessive moisture, dryness and heat; check skin at least two 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 the scapula, elbows, ischia, sacrum/coccyx, trochanters, heels, ankles, and knees) -Encourage adequate intake of fluids and food to maintain nutrition, promote healing, and achieve a recommended body weight -Medical management including occlusive dressings, debridement, surgery and/or grafting may be needed depending upon the severity of the decubitus ulcer -Encourage participation in meaningful and productive activities: individuals who pursue active lifestyles have fewer decubiti

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

Ecology of Human Performance (EHP) Model?

-Principles: emphasizes the role of context (person's cultural, physical & social environ) & how environ impacts a person & their task performance -Model is applicable to ppl across the lifespan -The 4 main constructs: 1)person, 2)tasks, 3)context, 4)personal-context-task transaction -11 assumptions: ecology refers to interaction btwn a person & environ; person's performance is understood by looking at relationship btwn person, context & task; performance occurs when a person acts to engage in tasks within a context; each person is a unique imdivid w/ sensorimotor, cognitive & psychosocial skills & abilities; range of a person's performance is based on the transaction btwn person & context; skills that a person possesses can be increased or decreased due to illness &/or stress, a person's interests & life expers lead to continually changing variables; contexts are dynamic rather than static, there is a reciprocal relationship btwn a person & their context where one influences the other; roles that a person has in life is made up of tasks, the transactional relationship btwn person, task & context makes up occupation & roles; there is a difference btwn a person's performance in natural contexts & simulated exp; in OT process ppl are empowered by increasing their self-determination; this model defines independence as using supports in a person's context to meet his/her needs & wants

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)

Rehabilitation to treat joint pain and swelling from Lyme disease

-Provide education regarding acute arthritic flares: rest; anti-inflammatory medicine compliance; splinting or wrapping to protect inflamed joints and prevent overstretching of large joints; teach energy conservation and work simplification -Following flare in sub-acute phase, provide gradual re-introduction of normal performance of daily tasks and activities

Intervention for dysphagia and swallowing disorders

-Provide family-centered intervention to determine an acceptable dinner table alternative to interaction -Work with person toward developing new roles and occupations to transition from old role (ie. head of table) -Provide ongoing education and information to family regarding person's feeding/nutrition

Adiadochokinesia

-The inability to perform rapidly alternating movements

DEVELOPMENTAL GROUPS?

-Purpose: assist members to acquire&develop group interaction skills; offer 5 Levels of Interaction: 1) Parallel groups-individ tasks w/minimal interaction 2) Project groups-conisist of common, short term activities requiring some interaction & cooperation 3)Egocentric cooperative groups-req joint interaction on long-term tasks,BUT completion of task isn't focus, members JUST BEGINNING to express their needs & wants & address those of others 4)Cooperative groups-learn to work cooperatively, not specifically to complete a task but to enjoy each others company & meet emotional needs 5)Mature groups-responsive to all members needs & carry out a variety of tasks. Good balance btwn carrying out task & meeting members needs

EVALUATION GROUPS ?

-Purpose:to gather info about individual's task & group interaction skills that can be used to establish goals & plan intervention -In addition, often therapeutic thru process or content

Pressured speech

-Rapid and increased in amount. It may be difficult to interrupt

Intervention for scleroderma

-Raynaud's phenomenon: : keep fingers and toes warm; dress in layers; drug therapy, biofeedback -Pulmonary artery problems: drug therapy; oxygen (nasal) -Gastrointestinal problems: soft diet, avoidance of alcoholic beverages and spicy foods); treatment of infection with drug therapy -Fibrosis of the skin: protective gloves (cotton, insulated, mildly compressive) and drug therapy -Myositis (inflammatory muscle disease): cessation of exercise and drug therapy -Fibrosis of the lungs: drug therapy

Focus of OT intervention for psychotic disorders during periods of acute hospitalization

-Reality testing -Stabilization of behavior -Engagement of the person in the treatment process -The gathering and sharing of assessment information -Assistance with discharge planning -When working with persons with psychotic disorders, the presence of disordered thinking requires the therapist to communicate simply, clearly, and concretely -External structure to organize the individual's thinking, environment, and daily activities is often required

Diagnostic criteria and behavioral characteristics of bulimia nervosa

-Recurrent episodes of binge eating defined as a lack of control over discrete periods of excessive eating -Recurrent, inappropriate compensatory behavior in order to prevent weight gain (vomiting, use of laxatives, fasting, excessive exercising) -Binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months -Self-evaluation is unduly influenced by body shape and weight -The disturbance does not occur exclusively during episodes of anorexia nervosa -Individuals are often obsessed with their appearance and attractiveness to the opposite sex -They are likely to be sexually active and maintain a normal weight

Diagnostic criteria and behavioral characteristics of anorexia nervosa

-Refusal to maintain body weight at or above normal weight for age and height, or failure to make expected weight gain during a period of growth leading to a body weight less than 85% of that expected -Intense fear of gaining weight or becoming fat, even though underweight -Disturbance in the way in which one's body weight or shape is experienced -Undue influence of body weight or shape on self-evaluation -Denial of the seriousness of the current low body weight even when hospitalized or gravely ill -In postmenarchical females, amenorrhea, the absence of at least 3 consecutive menstrual cycles -Anorexia may or may not include binge eating/purging behavior -Individuals often exhibit obsessive/compulsive behavior, depression, anxiety, rigidity, perfectionism, and poor sexual adjustment

Amnesia

-The inability to recall past experiences or personal identity -It may be caused by organic or emotional dysfunction -Retrograde amnesia is the inability to remember events that occurred prior to the precipitating event

Visual agnosia

-The inability to recognize people and objects

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: liminality (self recognition of vulnerability and self sense of mortality); occupational role and body image adjustment; 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)

Scleroderma

-Rheumatic, connective tissue disease associated with impaired immune system -Etiology: unknown -Main components: 1) vascular (Raynaud's phenomenon; constant recurrent constriction of small blood vessels leading to pulmonary hypertension; 2) decreased esophageal motility); 3) fibrotic (scar tissue resulting from excess collagen (protein) causing thickness of skin and a burning sensation in the skin; 4) fibrosis of the lungs causing restrictive lung disease); autoimmunity (B cell-produced antibodies [anti-centromere, anti-topisomerase I antibodies])

PROM, isotonic exercises (high resistance activs), crouching, MMT, heat

-Rheumatoid Arthritis (RA) -activities that use AROM are indicated for tx both in the acute and chronic phases. -Use of this type of exercise is controversial with RA. strengthening should be limited to functional activities that are low in resistance to protect the affected joints. -this movt is contraindicated for pts w/ RA due to the pain and stress on the hips and knees. use a reacher instead, or an alternate bending technique to pick up items that does not provide excess stress on the joints -this type of eval contraindicated due to the potential to invoke pain and damage delicate joint tissues that are destroyed as part of the disease. -this modality is CA for RA where signs of acute inflammation are present in the affected joints.

Rehabilitation to treat numbness from Lyme disease

-Safety assessment and interventions to preserve safety and prevent injury -Management of aesthesias that are perceived as painful -Occupation-based interventions to encourage and preserve function and to cope with chronic pain condition

Pattern analysis of diagonal patterns - D2 extension (UE)

-Scapula: abducted and downwardly rotated -Shoulder: extended, adducted, internally rotated -Elbow: towards flexion -Forearm: pronated -Wrist: flexed towards ulnar side -Fingers: flexed, adducted -Thumb: flexed, adducted, opposed

Pattern analysis of diagonal patterns - D2 flexion (UE)

-Scapula: adducted and upwardly rotated -Shoulder: flexed, adducted, externally rotated -Elbow: extended -Forearm: supinated -Wrist: extended towards radial side -Fingers: extended, abducted -Thumb: extended, abducted

Interventions for community-based care rehabilitation for immunological system disorders

-School related: transition from home schooling back to school for child returning; transition of having student return to class for the classmates -Work related: participatory as per Americans with Disabilities Act (ADA) -Population-related intervention: coalition-related and grant initiatives for prevention and outreach programs

Interventions for activity level problems for the rehabilitation for immunological system disorders

-Self care: adaptations and training to do self care tasks with greatest ease while conserving energy (for example for an individual with scleroderma alter grasp and pinch patterns and level of demand and upper extremity demand; alter size of feeding utensils and tooth brushes to accommodate decreased ability to open mouth; prevent shearing forces on skin during specific personal activities of daily living tasks) -Work: work capacity evaluations; modification to work site to allow participation in component task and activities; counseling and intervention for transition to disability status when work is no longer possible -Leisure/sport: modify specific tasks and activities (eg. to protect body parts involved by sclerodermic changes); evaluate interests and skills to introduce new leisure or sports activities of interest to the person to transition to less physically demanding tasks as a disease progresses -Rest: monitor and intervene to maximize the ability to be well positioned during sleep; monitor sleep habits and patterns and intervene when strategies are needed to relax and unwind or to schedule time and opportunity for relaxation

Agnosia

-The inability to understand and interpret the significance of sensory input

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

Evaluation of Performance Skills & Client Factors

-Sensory skills: tactile to assess sensation to determine if there is an impairment with discrimination that could influence safety in the manipulation of devices -Visual-perceptual processing skills: (eg: Minnesota Rate of Manipulation Test, a standardized test to assess visual motor perception to assess for potential difficulties with computer use) -Musculoskeletal skills: (eg: ROM, strength, endurance, to assess if the person will be able to physically use the devices to optimal capability) -Neuromuscular skills: (eg: tone, coordination, to assess the persons ability to utilize all limbs rhythmically in mobility and environmental manipulation) -Cognitive skills: (eg: following directions and judgment to assess if a person is aware of limitations and able to follow and recall directions regarding operation of assistive technology and wheelchairs and the safe use of devices) -Psychosocial skills: (eg: social support, 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)

Types, signs and symptoms of decubitus ulcers

-Stage I: redness, edema, superficial epidermis and dermis involved. -Stage II: redness, edema, blistering and hardening (induration) of tissue, skin is open and inflammation extends to the fat layer with superficial necrosis in advanced Stage II lesions -Stages I and II are considered partial thickness ulcers -Stage III: a full thickness skin lesion extending down to the muscle, the ulcer margin is thickened -Stage IV: ulcer extends down to the bone and includes bone destruction -Decubiti are often called pressure sores or bed-sores by lay persons

Funding for driver rehabilitation

-State Vocational and Educational Services for Individuals with Disabilities (VESID), Offices 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

Substance-related disorders

-Substance-related disorders are diagnosed based upon the taking of a drug of abuse (including alcohol and prescription medications), the side effects of medication(s), and/or exposure to toxins (inhalant, lead) -Substance-related disorders are categorized into two groups: 1)substance use disorders include dependence and abuse 2) substance-induced disorders include a multitude of diagnoses including intoxication, withdrawal, and substance-induced anxiety, affective, and psychotic disorders

End of life care (hospice) for cancer

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

Onset, prevalence, and prognosis for attention-deficit/hyperactivity disorders

-Symptoms are often noted during the toddler years, usually by the age of three -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 -Occurs in 3-5% of elementary school children -Incidence in boys to girls is a 3 to 1 ratio, most common in firstborn boys -Partial remission may occur between the ages of 12 and 20, allowing for a productive adolescence and adulthood -Although hyperactivity may disappear, distractibility and impulsivity can persist -Symptoms persist into adulthood in 15-20% of cases

Onset, prevalence and prognosis for personality disorders

-Symptoms of personality disorders usually begin in childhood or early adolescence -The prevalence of personality disorders varies with the specific disorder from rare to approximately 3% -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 disorders -There is some evidence that the symptoms of avoidant, borderline, and antisocial personality disorders may decrease with age

Rehabilitation to treat heart irregularities from Lyme disease

-Telemetry during daily performance of tasks and activities that support role performance -Pulse oximetry measurements, if oxygenation is poor during performance of daily tasks and activities -Work simplification, adaptation, and modification to prevent further complications associated with arrythmia

Recent past memory

-The ability to recall events of the past few months

Attention

-The ability to remain focused on an activity or experience or the ability to concentrate -Disturbance of attention: distractibility, selective inattention, hypervigilance, trance

Memory

-The ability to store and retrieve information related to past experiences -Levels of memory: immediate memory, recent memory, recent past memory, remote memory -Disturbances of memory: amnesia

Fiscal management - Budget terms and concepts - Full-time equivalent (FTE)

-The amount of time a full-time staff employee works; in the US, 8 hours/day, 5 days/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

Fiscal management - Budget terms and concepts - Accounts receivable

-The assets within a budget -Indicates payments that are owed to the program, setting, or institution (eg. consultation fees)

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

Focus of OT intervention for eating disorders

-The building of trust is essential to effective intervention due to the anger, resistance, and ego fragility often associated with the stages of recovery -The OT practitioner must be honest, supportive, and gently confrontational when indicated -Identification and pursuit of non-food related areas of interest -Activities to promote a reality-based body image -Education and management of nutritional food management -Exploration of the importance of healthy relationships -Activities to improve communication skills and self-expression -Development of healthy use of leisure time -Activities to develop skills necessary for pursuit of vocational goals and interest -Development of a discharge plan that supports a healthy life style

Mixed episode

-The criteria are met for both a manic episode and a major depressive episode for at least one week

Fiscal management - Budget terms and concepts - Accounts payable

-The debts within a budget -Indicates payments that are due for purchases or services rendered (eg. to an equipment supplier, a landlord)

Impact of cognitive disorders on function

-The degree of impact varies according to the nature and severity of the symptoms -The individual may require interventions varying from education in compensatory strategies to the need for total care -Reisburg's stages of mental confusion describe the progressive impact of dementia on functional abilities

Impact of anxiety disorders on function

-The degree of impact varies with the severity and type of anxiety disorder -Reactions may vary from temporary discomfort to severely avoidant and paralyzing behavior

Impact of intellectual disorders on development

-The developmental impact of mental retardation can vary greatly -The impact is greatest in children with severe and profound mental retardation -Slower learning ability -Shorter attention span -Difficulty with problem-solving and critical thinking -Difficulty generalizing information and mastering abstract thinking -Increased distractiblity -Slower motor development with the attainment of physical milestones occurring at a later age than typical -Uncoordinated appearance and movements -Low muscle tone -Diminished sensory modulation abilities -Hyper- or hypo-sensitivity to all sensory stimuli -Decreased ability in recalling and retrieving words secondary to cognitive deficits (eg. inattention and impaired memory) -Difficulty grasping and expressing concepts secondary to cognitive deficits (eg. impaired abstract thinking) -Difficulty with the motor aspects of creating language secondary to motor deficits (eg. low tone) -Impaired ability to respond to social cues can result in a number of behavioral outcomes. These include: excessive shyness, aggressiveness -Hyperactivity and distractibility can also impede psychosocial development

Provider

-The entity responsible for the delivery and quality of services. Providers bill Medicare, HMOs, and PPOs for services rendered

Speech

-The expression of ideas, thoughts, and feelings through language -Disturbances in speech: pressured speech, poverty of speech, nonspontaneous speech, stuttering, perseveration of speech -Disturbances in language output: expressive aphasia (Broca's), receptive aphasia, nominal aphasia, global aphasia

Impact of substance-related disorders on function

-The impact that 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 upon it -Disinterest and inability to care for self -Difficulty with and loss of personal relationships -Inability to be productive and/or hold a job -Involvement of the legal system -Prolonged use may lead to severe physical, cognitive, and psychiatric problems and can result in death

Apraxia

-The inability to carry out specific motor tasks in the absence of sensory or motor impairment

Distractibility

-The inability to concentrate one's attention without attention being drawn to unimportant or irrelevant stimuli

Impact of eating disorders on function

-The individual is often functional in ADLs except in areas related to food management -Work skills can be intact unless medical problems interfere with work performance or prevocational/vocational skill development -Focus on weight control may interfere with pursuit of vocational goals and/or the development of prerequisite skills -Leisure skills can be intact unless affected by medical complications -Activities may focus mainly on appearance -Exercise activities previously done for fun (eg. running, swimming, cycling) may now be done excessively without enjoyment to decrease weight -Social skills are more likely to be intact in the person with bulimia. Individuals with anorexia nervosa may be isolative and have more severe difficulties with others, especially their parents

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

Private payment

-The individual receiving services is responsible for payment

Delusional disorder

-The individual's predominant symptoms are non-bizzare delusions with the absence of other criterion A symptoms 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

Onset, prevalence and prognosis for mood disorders

-The mean age of onset for major depressive disorder is about 40, with 50% having an onset between ages 20 and 50 -The onset of bipolar I disorder may range from childhood to age 50 or older, with a mean age of 30 -The lifetime prevalence of depressive disorders is 10-25% in women and 5-12% in men -Bipolar disorders have a lifetime prevalence of 0.4-1.6% -The prognosis for recurrences of mood disorders is poor; however, the effectiveness of medications has increased the number of individuals who are able to maintain satisfying life styles, resulting in a more favorable overall prognosis

Onset, prevalence, and prognosis of substance-related disorders

-The onset of abuse is becoming earlier and earlier. While it often begins in adolescence, it may begin anytime from childhood through seniority -Recent statistics reveal the prevalence for substance abuse or dependence: 16.7% for individuals over 18 and 6.1% for those age 12 or older with use during childhood increasing -10% of women and 20% of men have met the criteria for alcohol abuse in their lifetime -Prognosis varies depending on several factors including motivation, substance used, and degree and type of support

Onset, prevalence and prognosis of schizophrenia

-The onset of schizophrenia is usually between early adolescence and the mid thirties with a life time prevalence of 0.6 -1.9% -10-20% of diagnosed cases have been found to sustain a good outcome -20-30% are able to lead somewhat normal lives -The prognosis is poor for over 50% of the individuals with schizophrenia, resulting in repeated hospitalizations, periods of exacerbation and episodes of major mood disorders

Post-traumatic stress disorder

-The persistent re-experiencing (for more than one month) of an extremely traumatic event that produces symptoms of increased arousal -Results in avoidance of stimuli associated with the traumatic event

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 symptoms that meet criterion A symptoms for schizophrenia

Acting out

-The physical expression of thoughts and impulses

Diagnostic criteria for attention-deficit/hyperactivity disorders

-The presence of six or more symptoms in the inattention domain, the hyperactivity-impulsivity domain, or both -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; avoidance of tasks that require sustained attention; tendency to lose things; distractibility; and forgetfulness -Symptoms of 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 fully stated, difficulty with turn taking, and interrupting the conversations or activities of others -Visual-perceptual, auditory-perceptual, language, and/or cognitive problems may be present -Some of the symptoms that result in impairment were evident before 7 years of age -Symptoms that result in impairment are present in two settings, such as school, home and/or work -A detailed developmental history to confirm behavior patterns and the meeting of six or more symptoms of inattention or hyperactivity-impulsivity of the DSM-IV-TR

Personnel management - Performance evaluation/appraisal

-The process of evaluating staff performance according to established performance expectations -Steps in performance appraisal: 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

Personnel management - Disciplinary action

-The process of informing an employee that his/her job performance is unacceptable, the organization's procedures for an administrative review of disciplinary actions and the organization's 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 employee's behavior until the employee achieves satisfactory job performance, resigns voluntarily, or is terminated

What are the categories of performance skills?

1) motor and praxis skills 2) sensory-perception skills 3) emotional regulation skills 4) cognitive skills 5) communication social skills

Perception

-The process of interpreting sensory information received from the environment -Disturbances of perception: hallucinations, illusions -Disturbances associated with a cognitive disorder: agnosia, astereognosis, visual agnosia, apraxia, adiadochokinesia -Disturbances associated with conversion and dissociative 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 identity disorder, dissociation

Diagnostic criteria for substance dependence

-There must be evidence of tolerance and withdrawal -Tolerance to a substance results in diminished side effects from taking the same amount of a substance and the need to use increasing amounts to experience the desired effect -Withdrawal refers to the symptoms (specific to the substance) that occur with decrease or discontinuation ( the substance is then used not for pleasure, but to prevent or relieve the withdrawal symptoms) -Individual continues to use the substance despite serious consequences

Prevention of Lyme disease

-Ticks are usually found on animals, on the tips of grasses and shrubs, in woody areas, and on the fringes of gardens, especially those surrounding new homes that were built in formerly wooded areas -Avoid tick-infested areas especially in May, June and July -Wear light colored clothing so ticks can be easily seen -Tuck pants legs into socks or boots and shirt into pants -Tape the area where pants and socks meet -Spray insect repellent containing DEET on clothes and exposed skin, excluding the face -Use permethrin (kills ticks on contact) on clothes -Wear a hat and long -shirt -Walk in the center of trails and avoid contact with grass and brush -After being outdoors change clothes and inspect skin for the presence of ticks -Remove any ticks with tweezers, grasping the tick as close as possible and pull straight back -Save the live tick (if retrieved) in a plastic container and take it to a local health department for identification

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

Medical management of psychotic disorders

-Treatment consists primarily of the use of antipsychotic medications and the provision of a structured supportive environment -Neuromuscular side-effects of antypsychotics may be treated by Cogentin, Artane, Benadryl, Symmetrel, and Vitamin E (side effects include dry mouth, blurry vision, sedation, dizziness, hypotension, insomnia, and confusion

Etiology of attention-deficit/hyperactivity disorders

-Unknown, however, there are suggested contributing factors -Genetic factors include higher occurrence in monozygotic twins than in dizygotic twins, and twice the occurrence in siblings of hyperactive children -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/or trauma during early childhood -Neurochemical dysfunction related to neurotransmitters in the adrenergic and the dopminergic system -Psychosocial factors include stress, anxiety, or predisposing factors such as temperament

W/C mobility training

-assess cognition to determine the individuals ability to learn mobility -instruct in proper sitting posture -instruct in pressure relief (eg push ups, weight shifts leaning to one side, then the other) -instruct in purpose and use of additional devices (cushion, lap board) -provide time schedule for weight shifts -instruct in w/c propulsion -instruct in safety concerns -w/c mobility in community

Residual type schizophrenia

-Used when there is continued evidence of schizophrenic behavior in the absence of a complete set of diagnostic criteria

Focus of OT evaluation for substance-related disorders

-Volitional factors -Cognitive skills and deficits -Functional performance -Safety and judgement issues -Coping skills -Support systems -Due to the presence of learned "survival skills" the individual's abilities and potential may be overestimated -The OT can apprise the team of the person's actual skills and deficits -The OT assists the team in identifying realistic expectactions and discharge plans -Values and goals must be identified and explored

Splinting considerations

-Wearing schedules prescribed to enhance function of the splint (Splints to decrease spasticity/reverse contractures need longer wearing times) -Splints must be monitored for pressure over bony prominences -Donning/doffing procedures should be reviewed with individual and caregiver and be documented -Appropriate material must be chosen by the inclusion of necessary characteristics including: resistance to stretch, memory, conformability/drape, rigidity/flexibility, and self-adherence

Personal Assessment: W/C prescription

-age and developmental status -education and work history -leisure interests and pursuits (eg special sports chair can enable the individual to pursue past or new interests) -daily routines and habits -goals and desired occupations

General Assessment and Prescription Considerations-Wheelchair

-assess the ability of the wheelchair to interact/interface with other assistive devices -determine the individuals medical status, including prognosis (is condition temporary, stable or progressive?) and functional level/needs -collaborate with the consumer, caregiver, and interdisciplinary team members

Angled Foam Cushion

-contraindicated for SCI C7. -it would position the pt in a manner that would increases weight on the ischial tuberosity putting at risk for skin breakdown.

Percussion and donning/doffing prosthesis

-contraindicated for neuromas: nerve endings that are adhered to scar tissue after imputation. -can be very painful.

Progressive Resistance Exercises

-contraindicated for pt who is terminaly ill and at the end-stage of the illness. -These exercises can increase exhaustion.

Performing tasks in sitting

-contraindicated for pts with THA posterolateral appraoch. -it is more stressful on the hip joint than doing them in standing.

What gross motor skills are developed at 5-6 months in sitting?

1) momentarily sits alone 2) increase extension of back 3) sits propping on arms 4) wide base of support, legs bent 5) protective response when filling

Intervention Strategies for spatial neglect?

-provide graded scanning activities -gade activities from simple to complex -use anchoring techniques to compensate -use manipulative tasks in conjunction w/ scanning activities -use external cues (colored markers & written directions)

Community mobility

-the ability to move around one's community to engage in desired occupations and pursue meaningful activities -includes ability to access and use public and/or private transportation systems (ie buses, subways, trains, taxi cabs, or other community based transportation systems) -also includes the ability to drive, walk, and/or bicycle

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 -individuals telephone answering machine should be evaluated to see if it permits ATDs to be attached -the technological and 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 and/or other supports are not present -warranty information should be obtained and the consumer educated about these terms and conditions

on the road evaluation

-there are 2 levels of driving that must be considered when evaluating a persons 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 be assessed to increase safety and prevent discomfort -Include: 1. seat position in relation to visibility of car's end-points 2. positioning of 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 persons ability to manage automotive emergencies and obtain assistance should also be assessed

Hot Packs

-these are contraindicated for Guillain Barre Syndrome due to the potential for burns from altered sensation.

PROM

-this kind of ROM is contraindicated for pts with DJD

Social Interaction Groups?

-to develop communication skills, socially acceptable bx & interpersonal relationship skills -may be in a modular &/or psychoeducational format

Partial hospitalizations

-up to 5 days/week, with ongoing symptom treatment that does not require hospitalization, usually d/c to halfway or supported home setting

Intervention Strategies for spatial relations dysfunction?

-use activities that challenge underlying spatial skills -use tasks that require discrimination of right/left

Intervention Strategies for sequencing and organization deficits?

-use external cues (daily planner, written directions) -grade tasks that are increasingly complex in terms of number of steps required

Intervention Strategies for motor/ideomotor apraxia?

-use general verbal cues as opposed to specific -decrease manipulation demands -provide hand over hand tactile kinesthetic input -utilize visual cues

Intervention Strategies for memory loss?

-use rehearsal strategies -"chunk" information -use memory aids like alarm watches, timers, etc. -use temporal tags- focusing on when the event to be remembered occured

What are extensor tendon early mobilization programs of Zone I and II?

0-6 weeks DIP extension splint

At what age are toileting skills of sits on toilet when placed and suoervised?

1 1/2 years

What are the areas of occupation? 1) caring for one's body 1A. basic activities of daily living 1B. personal activities of daily living) 2) activities of daily life in home and community 3) activities that relate to restorative sleep 4) activities needed to learn and participate in environment 5) activities needed for employment or volunteering. 6) spontaneous or organizes activity for enjoyment or amusement 7) activities that are nonobligatory that are intrinsically motivating. 8) organized patterns of behavior expected by an individual in a social system.

1) ADLs- caring for one's body 1A. BADL 2B. PALD 2) IADL's 3) Rest and sleep 4) Education 5) Work 6) Play 7) Leisure 8) Social Participation

What manipulating skills develop at 6-7 years?

1) Complete rotation- rotating object 360 degrees Turning pencil to use eraser 2) In-hand manipulation with stabilization- stabilize several objects in palm while manipulating one object Picking up coins while storing mult coins in palm.

What gross motor skills are developed at 9-10 months in walking?

1) Cruises around furniture 2) Turns slightly in intended direction

What is a deep partial thickness burn?

1) Deep second degree 2) epidermis, deep dermis, hair follicle, sweat glands 3) red, white, elastic 4) sensation impaired 5) may convert to full thickness due to infection 6) heals 21-35 days

What are the types of clinical reasoning?

1) Procedural/ scientific 2) Interactive Reasoning 3) Narrative reasoning 4) Pragmatic Reasoning 5) Conditional Reasoning

What are the different forms of OT intervention?

1) Purposeful activities 2) Enviro modification and adaptation 3) Promotion of engagement of occupations 4) adaptive equipment, assistive tech, ortho devices 5) PAM (physical agent modalities 6) ergonomics 7) standard precautions 8) transition bases precautions 9) individual, group and population intervention

What is a superficial partial thickness burn?

1) Second degree burn 2) Epidermis and upper part of dermis 3) red, blister, wet 4) painful 5) no grafting 6) heals in 7-21 days

What is a full thickness burn?

1) Third degree burn 2) epidermis and dermis hair follicles, sweat gland, and nerve 3) white, waxy, leathery 4) pain free 5) hypertrophic scar 6) heals in months

What is Presbyopia?

1) Visual loss in middle to old age 2) inability to focus properly 3) due to loss of accommodation 4) loss of near vision 5) due to inability to focus lens on near objects.

What are the Medicare criteria for group leadership?

1) active leadership 2) instruct members 3) monitors and doc. individual response and participation 4) provides guidance and feedback 5) doc. progress toward goals

What are the areas of intervention implementation documentation?

1) activities, procedures and modalities 2) clt response 3) goal modifications 4) change to anticipated time and justification of change of goals 5) participation 6) missed tx 7) AE, orthoses, prostheses 8) clt conference or communication with other healthcare providers 9) home programs 10) d/c

What are conservative OT interventions for rotator cuff tendonitis?

1) activity modification- above 90' until pain subsides 2) avoid overhead or addicted/IR of shoulder while sleeping 3) decrease pain- positioning, modalities, and rest 4) strengthening below shoulder level

What are the areas of content of documentation?

1) background info 2) eval and re-eval 3) intervention plan 4) STG and LTG 5) intervention implementation 6) d/c planning 7) home programs 8) clt and family education 9) equipment provided 10) follow up plans and recommendations 11) referrals

What is involved in OT intervention of a hip fx?

1) bed mob 2) Fxn ambulation and transfers 3) UE strength 4) AE 5) practice role act IADL'S

What are the sensorimotor developments in neonatal stage?

1) body scheme development begins with tactile, proprioceptive, and vestibular input 2) vestibular system is refining 3) visual system develops identifying high contrast and items 10 inches from face. 4) auditory system is immature

What are the clinical implications affect the skeletal system of the elderly population?

1) cartilage change- decrease water content 2) loss of bone mass 3) postural changes- kyphosis, lumbar spine flattening 4) need for increase weight bearing 5) increase risk for fx due to weaker bone mass

What is the sensory loss of a median nerve injury?

1) central palm -thumb to 1/2 of ring finger 2) palmar surface- thumb to 1/2 of ring finger 3) dorsal surface- index, middle, 1/2 ring finger

What is preprosthetic tx?

1) change dominance 2) ROM of uninvolved joints 3) desensitization 4) prepare limb for prothesis 5) stump wrapping- distal to proximal with decrease tension proximal 6) ADL training and stump care

Why is clinical reasoning important in the role of OT?

1) clinical decision-making 2) explain rationale of decision 3) increase awareness of complexity of OT practice

What are areas of social participation?

1) community- successful interaction at comm. level ( neighborhood, organization, work, school) 2) family- successful interaction in daily roles 3) peer- engage act. at different levels of intimacy.

What gross motor skills are developed at 7 months in creeping?

1) crawls forward on belly

What are the different approaches in OT intervention? 1) does not assume disabilities but enhances performance in natural context 2) change and establish skills that have not developed 3) provide and preserve performance skills to meet occupational needs 4) compensatory methods that or adaptations to meet occupational demands or environmental demands 5) addresses clt. with or without disabilities who are at risk for occupational performance problems

1) create and promote 2) establish and restore 3) maintain 4) modify 5) prevent

What scissor skills develop at 6-7 years?

1) cutting complex figure shapes

What reaching skills develop at 6 months?

1) disassociation of body sides 2) unilateral reaching 3) decrease abduction 4) hand more open

What intervention is recommended for radial nerve lacerations?

1) dynamic extension splint 2) ROM 3) sensory reduction 4) activity modification

What gross motor skills are developed at 7-8 months in supine?

1) equilibrium reactions are present

What gross motor skills are developed at 7-8 months in sitting?

1) equilibrium reactions are present 2) rotate UB while LB stationary 3) protective response present when falling

What motor loss occurs with a low radial nerve lesion?

1) extensor carpi ulnaris- wrist extension 2) extensor digitorum communis Extensor digiti minimi (MCP extension) 3) extensor pollicis brevis Extensor pollicis longus Abductor pollicis longus (thumb extension)

What motor loss occurs with a high radial lesion?

1) extensor carpi ulnaris- wrist extension 2) extensor digitorum communis Extensor digiti minimi (MCP extension) 3) extensor pollicis brevis Extensor pollicis longus Abductor pollicis longus (thumb extension) 4) extensor carpi radialis brevis Extensor carpi radialis longus Brachioradialis 5) at axilla level triceps are affected

What are developmental considerations in an OT eval?

1) family and caregiver interview 2) consider appropriate developmental levels prior to formal eval 3) observe symmetries and asymmetries of movements 4) observe transitional movements 5) assess quality of movements 6) assess fine motor coordination 7) positioning and AE 8) assess cognition 9) assess psychosocial skills 10) assess visual & auditory status 11) use ped. Assessments

What sensorimotor development occurs at 13 to 24 months?

1) fine motor skills- due to increase tactile discrimination and location 2) motor planning- increase integration of all system allows more complex movement patterns 3) conceptualize- ideation occurs due to symbolic gesturing & vocalization 4) mastering environment- due to motor planning and self concept

What is the OT evaluation standards for arthritis?

1) focus on AROM 2) PROM avoided especially in inflammation stage 3) note deformities 4) MMT avoided unless written by MD 5) strength described in function 6) grip strength 7) ADL. Fxn and deficits 8) pain using pain scale 9) edema

What are the areas of education?

1) formal education- academics, nonacademics ( recess, lunch, hallway), extracurricular ( sports, band), vocational 2) interest exploration 3) personal education

What is intervention planning? 1. Formulate a _____ 2. _____ with _____, _____ and _____ 3. Prioritize _____ 4. What is the content of intervention plan?

1) formulate a plan 2) collaborate with individual, family and caregivers 3) problem areas to be addressed 4) POC: LTG, STG, intervention methods, duration and frequency, recommendations, clinical reasoning.

What scissor skills develop at 3-4 years?

1) forward motion of scissor 2) lateral direction of cutting 3) straight lines 4) simple geometrical shapes 5) starts cutting circles

What sensorimotor development occurs from the ages of 6 to 12 months?

1) mobility- due to increased vestibular, visual, and somatosensory development 2) fine motor & motor planning- due to tactile and proprioceptive development 3) midline & crossing midline- tactile and proprioceptive skills 4) purposeful communication- due to auditory, oral motor and proprioceptive development 5) primitive self-feeding- due to tactile, proprioceptive, gustatory and olfactory integration.

What is the typical development process of upper extremity function?

1) head and trunk control 2) eye-hand interaction and sensory-perceptual interaction 3) shoulder ( scapula) stability then mobility 4) numeral control 5) elbow control 6) forearm control 7) wrist control 8) thumb opposition and stability 9) palmar arches of hand 10) isolate finger control

What gross motor skills are developed at 0-3 months in held sitting?

1) head bobs 2) back is rounded 3) hips are apart, turned out and bent 4) chin tuck able to gaze at floor 5) sits with less support 6) shoulders are in front of hips

What gross motor skills are developed at 4-5 months in supine?

1) head lag is gone when pulling up to sitting 2) hands are together in space

What gross motor skills are developed at 3 to 4 months in supine?

1) holds head in midline 2) chin is tucked and neck lengthens in back 3) legs come together 4) lower back flattens against the floor

What is the process of activity analysis?

1) identify activity 2) identify procedures, materials, and tools 3) analyze task in ordinary circumstances 4) consider clt. factors, performance skills, and patterns 5) select frame of reference

What gross motor skills are developed at 5-6 months in standing?

1) increase ability to bear wt. 2) decreased support when held by arms 3) legs continue to spread apart 4) bounces in sitting position

What are OT tx goals after tendon repair?

1) increase tendon excursion 2) improve strength 3) increase jt ROM 4) prevent adhesions 5) Regain Fxn in occupations

What are group roles?

1) instrumental roles- assumed roles to select, plan and complete group tasks. Organizer 2) expressive roles- support and maintain group to meet members' needs. Encouragers 3) individual roles- individual purpose and interferes with group success. Aggressor/blocker 4)

What are areas of leisure?

1) leisure exploration- identifying interests, skills, opportunities, and appropriate leisure act. 2) leisure participation- planning and participation in leisure act.

What gross motor skills are developed at 5-6 months in supine?

1) lifts head independently 2) brings feet to mouth 3) brings hands to feet 4) reach for toy with one or two hands 5) hands are predominantly open

What is the motor loss of a low median nerve laceration at the wrist?

1) lumbricals I&II (MCP flexion of digits II& III) 2) abductor pollicis brevis (thumb abduction) 3) opponens pollicis (opposition) 4) flexor pollicis brevis (flexion of thumb MCP)

What are complications of amputations?

1) neuromas- hypersensitivity due to nerve endings attaching to scar tissue 2) skin breakdown 3) phantom limb sensation 4) phantom limb pain 5) infection 6) psych impairments 7) contractures

What are the types of OT interventions? 1) occupation matches goals 2) activities that promote skills to enhance occupations 3) prepare the clt. to perform in occupations 4) use of skilled OT knowledge to identify problems, solutions, adaptations to promote effectiveness in occupations 5) providing knowledge about occupations, health, and performance of occupations 6) promoting justice and empowering clt. to perform occupations

1) occupational-based 2) purposeful activity 3) preparatory methods 4) consultation 5) education process 6) advocacy

What are the areas of intervention plan documentation?

1) organize and prioritize problem list 2) goals related to problem list related to function and outcomes 3) goal statement- individual, desired function, underlying factors, context/environment, degree of behavior (measurable outcomes) 4) STG- 5) LTG 6) activities/ tx procedures/ methods of stated problems 7) type, amount and frequency to meet goals 8) clt. Understanding of tx plan

What are the outcomes of the OT process?

1) outcomes based on supporting health and participating in occupations 2) select outcome measures 3) measure outcomes

What motor loss occurs in low lesion of the ulnar nerve at the wrist?

1) palmar and dorsal interossei (ab/adduction of MCP joint) 2) lumbricals III & IV ( MCP flexion of digits 4 & 5) 3) flexor pollicis brevis (flexion and addiction of thumb) 4) ADM, ODM, FDM,(abduction, opposition, flexion of 5 digit)

What motor loss occurs in a high lesion of the ulnar nerve above the wrist!

1) palmar and dorsal interossei (ab/adduction of MCP joint) 2) lumbricals III & IV ( MCP flexion of digits 4 & 5) 3) flexor pollicis brevis (flexion and addiction of thumb) 4) ADM, ODM, FDM,(abduction, opposition, flexion of 5 digit) 5) flexor carpi ulnaris 6) flexor digitorum profundus

What are good observation skills of an OT?

1) performance of actual occupations 2) in a variety of context 3) physical and social support 4) use of structured tools 5) ongoing process through POC 6) no personal bias, from cultural background or influences 7) OT interpretation.

What sensorimotor development occurs in the first 6 months?

1) postural control- vestibular, proprioceptive, and visual systems become more integrated 2) visual fields- increase due to increase postural control 3) somatosensory skills- due to increase tactile and proprioceptive development 4) eye-hand coordination- due to development of visual and tactile systems allowing child to reach 5) profess from reflex to voluntary to goal-directed movement patterns

What is the purpose of therapeutic use of self?

1) provide reassurance 2) give advise 3) alleviate anxiety 4) obtain needed info 4) improve and maintain Fxn 6) promote growth and development 7) increase coping skills

What are good interviewing skills of an OT?

1) purpose of interview 2) establish rapport 3) ask questions in organized manner. 4) use assessments to structure interview. 5) observe non-verbal communication 6) use appropriate questions Open ended to facilitate discussion Close ended should be avoided inlets dx warrants. (CVA)

What are the causes of rotator cuff tendonitis?

1) repetitive use 2) curve or hook a acromion 3) weakness of rotator cuff 4) ligament or capsule tightness 5) trauma

What sensorimotor develops at prenatal period?

1) responds to first tactile stimuli 2) reflex development 3) innate tactile, proprioceptive and vestibular reactions

What gross motor skills are developed at 3-4 months in rolling?

1) rolls from prone to supine accidentally 2) rolls from supine to side

What are the gross motor skills of a 5-6 month old in prone?

1) shifts wt. on arms and reaches 2) bears and shifts wt. on extended arm 3) legs closer together and thighs roll inward for natural alignment 4) hips flat on surface 5) equilibrium reactions are present

What are the clinical implications that affect the muscular system of the elderly population?

1) slower movements 2) increase fatigue 3) denser & stiffer connective tissue 4) decrease functional mobility 5) unsteady gait, balance, strength, 6) increase risk for falls

What is OT intervention of arthritis?

1) splinting in acute phase 2) joint protection 3) energy conservation 4) AROM- pain free 5) strengthening avoiding positioning of deformity 6) ADL 7) AE

What gross motor skills are developed at 5-10 months in standing?

1) stands while holding furniture

What are the basic concepts of Maslow's psychosocial development?

1) survival- basic needs 2) safety-physical/physiologic 3) belonging- emotional support 4) self-esteem- valuable member of society 5) self-actualization- achieve personal goals

What is the analysis of Occupational Performance?

1) synthesize occupational profile 2) observe clt. occupational performance 3) identify patterns and performance of occupation 4) select appropriate assessment 5) interpret assessment 6) develope hypothesis on occupational strengths and deficits 7) collaborate with clt. to develop goals 7) intervention development with evidence and best practice.

What gross motor skills are developed at 9-17 months in walking?

1) takes independent steps but falls

What is the purpose of activity analysis?

1) to teach an activity 2) determine if clt. able to perform act. 3) adapt activity 4) grade an activity

What are the types of total hip replacements?

1) total hip joint implant- replaces acetabulum and femoral head 2) Austin Moore- partial replacement of femoral head

What gross motor skills are developed at 11-12 months in sitting?

1) trunk control and equilibrium responses 2) increased variety of a variety of sitting positions

What reaching skills develop at 9 months?

1) trunk stability 2) shoulder flexion & ex. rotation 3) wrist extension begins

What type of interventions are recommended for a superficial partial and deep partial thickness burn?

1) wound care / debridement 2) whirlpool 3) gentle AROM and PROM 4) edema 5) splinting if needed

Explain the OT's role.

1. Responsible for all aspects of service delivery and accountable for the safety and effectiveness of the OT service delivery process (which includes evaluation, intervention planning, intervention implementation, intervention review, and outcome evaluation). 2. Directs the evaluation process (must complete the evaluation herself, but can delegate certain aspects i.e. assessments to the OTA). 3. Overall responsibility for the development and implementation of the intervention plan. 4. Responsible for determining the need for continuing, modifying, or discontinuing OT services. 5. Selecting, measuring, and interpreting outcomes that are related to the client's ability to engage in occupations. 6. Responsible for supervision of the OTA (depending on setting and OTA experience the supervision may vary, i.e. direct to minimal supervision). 7. Responsible for the overall use and actions of the OT aide. Trained by the OT or OTA to perform specifically delegated tasks (which could be client and non-client tasks).

What are the purposes of fiscal management?

1. To ensure cost-effective services 2. To meet demands of a managed health care system 3. To remain competitive in a market-driven practice environment

Creative Play

4-7 yrs; play to refine relevant skills; explores combo of actions on multiple objects; begins to master skills taht promote performance of school/work activities; cooperative peer groups

At what age are feeding skills of grabs at spoon but bangs it or sucks on either end of spoon?

6-9 months

What are measures of central tendency? - Include the types.

A determination of average or typical scores. - Mean: the arithmetic average of all scores. - Median: the midpoint of scores - Mode: the most frequently occurring score

To determine the proper assessments to use in an evaluation the OT must consider....

Baseline functional level. Environmental context (length of stay, primary focus of setting, legal guidelines - i.e., in a school can not bill for medical reasons - and facility's resources) Environmental context of individual - roles, values, norms, support physical environment - 3rd floor building temporal context - chronological and developmental age, duration of disability, chronic illness, stage of illness IMPORTANT - eval's tool compatibility with FOR selected for intervention - existing evidence to support eval's use - ethical concerns/conflicts

Discuss Prevocational Programs. - Criteria - LOS

Criteria: adolescents/adults who require intervention to develop skills prerequisite to work (may never have had these skills or lost them due to illness/disability) LOS: determined by agency's funding/person's attainment of goals (d/c to vocational program or even work setting - if abilities developed) Eval/Intervention: working on task skills, social interaction, work habits, interests, and aptitudes.

What are the pros and cons of a voluntary opening terminal device?

Cosmesis: poor does not look like hand Pinch force: requires a lot of rubber band and added force Prehension pattern: precise Weight: light Durability: very durable Reliability: little service required Feedback: some proprioceptive feedback

Discuss supported education programs. - Criteria - LOS

Criteria - Adolescents or adults who require intervention to develop skills needed to succeed in secondary and/or post-secondary education (person may never have developed these skills or lost them due to psychiatric / mental health problems) LOS: determined by agency's funding and person's attainment of goals. Discharge is upon entry to or completion of an educational program or attaining a GED.

Discuss vocational programs. - Criteria - LOS

Criteria: 1. Person has prerequisite abilities to work (good task skills/work habits) but requires training for specific job/ongoing structure, support, or supervision to maintain employment. 2. Person has to develop his work capacities to a level acceptable for competitive employment (strength, endurance). LOS: 1. Rehabilitation workshops: d/c might not be a goal 2. Transitional Employment Programs (TEPs): time limited 3-6 months with d/c to employment/rehab workshops 3. Employee Assistance Programs (EAPs): provide ongoing support, intervention, referrals as needed to a company's employees to enable them to maintain their employment.

What is outpatient/ambulatory care in a community setting?

Criteria: medical or psychiatric condition not serious enough to warrant hospitalization, or for a condition that has sufficient stabilized to enable the person to be d/c but remaining symptoms require treatment. Tx: 30-60 min 1Xday up to 5 days/week. LOS: depends on diagnosis, symptoms, response to tx, insurance coverage/ability to pay. Evaluation and Intervention: same as in medical setting.

Discuss partial hospitalization/day hospital programs. - Criteria - LOS - Evaluation / Intervention

Criteria: medical or psychiatric condition that is sufficiently stabilized to enable a person d/c home or to a community residence (person still has some symptoms that require treatment) LOS: 1 week to 6 months. D/c usually to less intensive community day program. Evaluation/Intervention: attaining skills required in current and expected environments (community supports for community integration, remediating skills and deficits and compensating for factors affecting performance)

What is the criteria for entering a clubhouse program? What is the LOS? What is OT's role in the clubhouse model?

Criteria: open to adults and elders with current mental illness or history of mental illness. - All members have equal access to all clubhouse functions and opportunities regardless of functional level or diagnosis. - Those who pose a significant threat to the safety of clubhouse community are the only ones excluded from clubhouse. LOS: indefinite, members can come and go at will. OT is integrated into the clubhouse model. Acts as a generalists that contributes to the development and enrichment of members' abilities (no formal evaluation and intervention)

Discuss home health care. - Criteria - Treatment duration - LOS

Criteria: presence of medical/psychiatric condition not serious enough for hospitalization, or for condition sufficiently stabilized for d/c from hospital, but remaining symptoms require treatment. TX: 60 minute sessions, 1Xday, up to 5 days/week. LOS: depends on diagnosis, symptoms, response to tx, insurance/ability to pay

Assessments provide scores that compare the individual's performance to a pre-established criterion.

Criterion-referenced

What grasping skills develop at 5 months?

Cube Palmer grasp- 1) fingers on top of object 2) press object in center of palm 3) thumb adducted

What grasping skills develop at 4 months?

Cube Primitive Squeeze grasp- 1) visually attends 2) approach 1in from object 3) contacts with hand pulling object 4) squeeze against other hand or body

Parallel Group

Developmental Group. Enables members to perform task in presence of others, using similar activities or utilizing common materials to facilitate interaction.

Discuss residential programs. - Evaluation - Intervention

Evaluation: assessing skills for living in community (including social, environmental resources and supports to maintain current living environment) Intervention 1. Consult / supervise residential program staff. 2. Remediate skill deficits and compensation for client factors affecting independent living skills. 3. ADL training, activity adaptation, environmental modifications. 4. Referral to residential services as functional level improves. 5. Education person on ADA, Fair Housing Act, Section 8 Housing.

Discuss supported education programs. - Evaluation - Intervention

Evaluation: client factors, performance skills, patterns that impact role of student. Intervention: - Improve performance skills and patterns needed to be a student (time management, task prioritization) - Education/training in compensatory strategies (studying in quiet room) - Exploring educational interests and aptitudes to ensure self-determined engagement in education.

Cognitive Disabilities Model evaluation?

Focus is on identifying indiv.'s current cog. abilities& their implications for perf., indep.&need for assistance; potential for improv is considered; observation during functional task emphasized -several evaluation tools have been developed to assist w/ i'd of individual's cognitive level: Allen Cognitive Level Screen-5 (Leather Lacing Task), Routine Task Inventory (gathers data about ADL performance from an informed caregiver) & Cognitive Performance Test

What are emotional regulation performance skills?

Identify, manage, and express feelings while engaging in activity or social interaction

Assessments of Cognition, Affect &/or Sensory Processing: Hamilton Depression Rating Scale (focus, method, scoring, population)?

Measures severity of illness and changes over time in indiv. DIAGNOSED w/depressive illness. - Method: info. gathered through interview and consult w/family, staff, etc.; clinician rates info. relative to 17 symptoms characteristics - Scoring: rated 0-2 (0=absent, 1=trivial, 2=present) or 0-4 (absent, trivial, mild, mod, severe); scores for items 1-17 totaled; significance of total score NOT MADE- change in status is focus - Pop.: indiv. w/diagnosis of mood d/o

Assessment of Task performance: Comprehensive Occupational Therapy Evaluation Scale (COTE Scale) (focus, method, scoring, population)?

Observing and rating bx and bx changes in areas of general (e.g., appearance, punctuality, activ. level), interpersonal (e.g., cooperation, sociability, attention-getting bx) and task skills (e.g., concentration, following directions, prob-solving) - Method: indiv. behavior is observed during therapeutic session as indiv. completes a task; bx rated by th. according to specific criteria for each item; tasks used are selected/designed by th. - Scoring: each item rated 0 (normal)- 4 (severe); results may be used to plan tx and d/c - Pop.: adults w/acute psychiatric diagnoses

What grasping skills develop at 3 months?

Pellet 1) visually attends to object 2) no attempt to grasp Cube 1) visually attends 2) swipe object 3) voluntary grasp only upon contact

What grasping skills develop at 6 months?

Pellet object 1) raking objects 2) containing objects Cube object Radial Palmar grasp- 1) fingers on far side of object 2) press against opposed thumb and radial side of palm

What muscles are responsible for scapula upward rotation?

Trapezius- spinal accessory nerve Serratus anterior- long thoracic nerve

Primary difference between part A and B

Treatment schedule. Part A coverage requires minimum 5 days/week, Part B typically covers 3 days/week

tertiary prevention

elimination or reduction of the impact of dysfunction on an individual (rehab to get back to the community)

Motor Free Visual Perception Test- Vertical (MVPT-V)

focus: eval of pts with spatial deficits, due to hemi-field visual neglect or abnormal visual saccades pop: children and adults with field cuts or impairments, brain injury

Test of Visual Motor Skills (TVMS) and Test of Visual Motor Skills: Upper Level (TVMS-UL)

focus: eye hand coordination skills for copying geometric designs pop: TVMS: 2-13 yrs TVMS-UL: 12-40 yrs

Transdisciplinary Play-Based Assessment (TPBA)

focus: measures child's development, learning style, interaction patterns, behaviors to determine need for services pop: infancy - 6 yrs

Sensory Profile (SP) and Infant/Toddler SP

focus: measures reactions to daily sensory experiences pop: SP: 3-10 yrs; Infant/Toddler SP: 0-36 mo

Miller Assessment for Preschoolers (MAP)

focus: standardized task performance screening tool that assesses sensory and motor abilities consisting of foundation and coordination, cog abilities including verbal and nonverbal, and combined abilities including complex tasks pop: 2 yrs 9 mo - 5 yrs 8 mo

Medical Model:

o Views the individual with a disability as a person who has incurred a physiological insult that has resulted in reduced functional capacity.

What is the focus of the Educational Model?

o Focus is placed on learning and making the behavioral changes needed to interact successfully in the environment. o An individual's skill deficits are determined, and related goals are established, to promote learning to adequately perform within a particular environment. o Behaviors are measured in terms of obtaining skills, knowledge, and competency to successfully meet the demands of the environment. o OT frames of reference are based on learning theories to facilitate adaptation in the environment (e.g. role acquisition, cognitive remediation).

What is the OT intervention focus for Forensic Setting?

• Determination of individual's competency to stand trial, in forensic psychiatry settings. • Areas similar to those described under Rehabilitation Hospitals to develop community living skills needed for successful community reintegration upon release. • Facilitation of skills and provision of structured programs to enable the person to function at his/her highest level within their current environment since d/c may be delayed or not possible, depending on the nature of the crime. • Restoration of competency to stand trial in forensic psychiatry settings.

What is the OT intervention focus for rehabilitation hospitals?

• Functional improvement in performance skills and patterns, areas of occupation, and occupational roles. • Development of compensatory strategies for residual deficits and client factors • Provision of adaptive equipment and training in use of the equipment to promote independent function. • Modification of the d/c environment, as needed, to enhance function. • Education of the individual, family, and caregivers on abilities, limitations, compensatory techniques, and advocacy skills.

Types of EADL technology

-Phones: large number pads, automatic dialing phones, speaker-phones, amplifiers -monitoring systems allow for communication between areas -personal emergency response system (PERS): enables client to summon help by the push of a button -electronically controlled door openers and closers -computers enable individuals with disabilities to more fully participate in social, leisure, work, and productive activities a. facilitate performance of multiple functional tasks (eg turning on and off household items, banking, shopping) b. allow for communication and socialization through e-mail and internet support groups c. provide the means for productive work via tele-commuting d. have alternative access modes that can compensate for a diversity of disabilities -Augmentative alternative communication: methods of communication that do not require speech. Need to consider: a. speed at which message is conveyed b. portability: easy to use in a variety of environmental settings c. accessibility: ability of individual to independently operate d. dependability: quality, durability, and warranty/service record e. independence of user f. vocabulary flexibility e. time for repairs and maintenance g. types range from simple communication boards or albums w/limited number of pictures to complex portable computer systems with extensive language capacity

Additional attachments: w/c components

-anti-tippers to prevent w/c from tupping backward or forward (can get caught on doorsills and curbs) -seatbelts for safety during mobility and functional activities a. attach at hip level not waist level b. 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 UE and prevent edema through elevation -head supports allow for improved eye contact, improved communication, and feed assistance, as the head is kept in a neutral position -mobile arm supports allow for use of an UE with proximal weakness to engage in feeding and other activities -brake extensions allow a person with limited range in one UE to independently manipulate the w/c's brakes -handrim projections ease independent propulsion in persons with weak handgrip a. these increase the width of the chair and can decrease mobility through narrow doors and/or narrow spaces -hillholder devices allow the w/c to move forward but automatically brake when the chair goes backward a. useful for individuals unable to ascend a long ramp or hill without rest

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

chorded keyboards

-consist of a few keys which generate standard characters by pressing various combination of keys for persons with one-handed use (eg individuals with hemiplegia)

High tech

-costly devices that may require custom ordering and may require specific training to use (eg: ECUs, augmentative communication devices, computers) -some components of high tech devices can be fabricated in a cost-effective manner using inexpensive commercially available micro-switch technology (eg simple switches to turn on and off lights, appliances, and other electronic equipment)

Seating & Positioning Assessment Considerations

-crucial to distinguish between flexible deformity (where the OT can manually correct the position), and fixed abnormal postures and deformities (where changes cannot occur) -the pelvis should be evaluated first, and then LEs, trunk, UEs, head/neck, and feet as stability is required prior to mobility and proximal control allows for better distal function

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

Legrests: w/c components

-fixed: minimal benefit but may be seen in older wheelchairs and/or in 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

Footplates: w/c components

-fixed: minimal benefit but may be seen in older wheelchairs and/or in rentals -swing-away: allows feet to reach the floor -heel loops: prevent feet from slipping of footrest in a posterior direction -ankle straps: prevent slipping off footrest

Frame: w/c components

-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, light-weight, standard and heavy duty frame construction are available -the lighter the weight of the w/c generally, the greater the ease of use -the demands of the individuals expected and desired activities must be considered

Linear seating

-flat, non-contoured -custom or factory-ordered -firm, rigid seating -good for active individuals, those who perform independent transfers and/or those with minimal musculoskeltel involvement

Electronic Aids to Daily Living (EADLS)

-formerly known as 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: a. maximize functional ability and independence in home, school, work, and other environments b. allow ECTs during home mgmt and work tasks -Uses: a. turn on/off lights and appliances, open and close doors/drapes b. allow use of phones and machinery c. summon assistance -Considerations in device selection: a. input method: selection reqs knowledge of the distance of throughput/transmission b. output method c. portability d. safety e. reliability f. durability g. assembly ease h. operation ease i. maintenance schedule j. current and future affordability

Rehabilitation Engineers Society of North America (RESNA)

-helps to develop standards and measuring tools to ensure proper design, fabrication, prescription, and delivery of rehabilitation technology -offers certification programs for Assistive Technology Professionals (ATPs), Seating and Mobility Specialist (SMSs)

Bed mobility aids

-hospital beds, usually with bedrails and elevating head and foot surfaces -trapeze frame attached to bed -hoyer lift/trans-aid: hammock device that is attached to either hydraulic or manual lift systems to transfer individuals who are dependent -bedpans and urinals to decrease need to leave bed

Evaluation Goals- ATDs

-identify the tasks an individual with a disability wants to accomplish and the occupational roles the person wants to pursue -assess the individuals abilities and deficits, including client factors and performance skills a. stability of positioning and seating must be assessed as this will affect ability to use device b. the anatomic site at which the person demonstrates purposeful controlled movement must be determined as this will influence device's control site (device activated by should, head, elbow, hand, tongue, or eye movements) -determine the environments in which the device will be used and when it will be used -identify assistive technology devices: a. consider input method; how the device will be activated (infrared, sonic, electric, or radio frequency switches) b. consider the processing method; how the device will process the information from the input method. c. consider the output method; results are needed (response from input occurs) d. consider the feedback method; ensures the device is being used in the right way (could be auditory, visual, or proprioceptive)

Interventions to Prevent Falls

-improve functional mobility: a. active or resistive muscle strengthening to exercises and general conditioning exercises (GCE) to improve or maintain flexibility, strength, endurance and coordination b. PROM stretching to increase joint ROM c. specific coordination training d. neuromuscular reeducation training e. balance training: sit and stand, static and dynamic, turning/walking/stairs f. transfer training g. bed mobility training h. wheelchair safety training i. referral to PT for gain/ambulation training -provide sensory compensation strategies -modify ADLs, teach ECTs, caregiver education

temporal context

-includes stages of life, time of year, time of day, and duration rhythm of activity, or history

tilt-in-space w/c

-indicated for pressure relief or for an individual with severe extensor spasms that may throw him or her out of the chair; entire seat and back tilt back to maintain a normal seat to back angle

seat height

-knees and ankles should be positioned at 90 degrees; measure from distal thigh to heel -footrests should have 2" clearance from the floor, so cushion selected will affect this measurement -standard height: 19.5" -hemi-height: 17.5" -super-low: 14.5"

Kitchen considerations

-location of meal preparation devices that the individual uses most frequently (oven, microwave, stove) -presence of a countertop area between the stove and sink, between the stove and refridgerator -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

maximum height individual can reach forward

-maximal height the individual can reach forward from sitting is 48 inch and at least 15 inch is needed to prevent tipping -max height for reaching sideways s 48 inch and when an obstruction is present is 46 inches

S/P CVA positioning

-may need education regarding proper positioning of UE to increase awareness, minimize pain, decrease swelling, and promote normalization of tone -may also req use of pillows between knees while in side-lying to increase comfort and promote proper positioning

S/P THR positioning

-may not be permitted to roll on the non-operated side; this may result in internal rotation of the operated hip, which may cause dislocation -may req use of abductor pillow between LEs to prevent adduction of the operated hip

S/P amputation of LE

-may req training regarding use of pillows to prevent edema in LE -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

seat depth

-measure both LEs and take the greatest length; measure from the posterior portion of the buttocks to the popliteal fossa and then subtract 2 inches from this measurement -this prevents rubbing and potential decubiti to posterior knee region, while also allowing maximal leg swing

seat width

-measure the widest point across the hips and thighs to allow for maximal seating space and comfort, then add 2 inches -this allows for clearance on the sides to prevent friction/rubbing and to allow the individual to wear heavier material clothing without being cumbersome -the bariatric client with a pear-shape will have increased gluteal femoral weight distribution a. measurement should consider the widest portion of the seated position (eg at the forward edge of the seated position) b. also consider room for weightshifting maneuvers for pressure relief, and possible use of lift devices)

Minimum clear width for doorways and halls

-minimum of 32inch of doorway width is required; ideal is 36 inches -hallways should be minimum of 36 inch wide to provide sufficient clearance for w/c passage and allow the user to propel the chair without scraping the hands

Ramps

-minimum of 36 inches wide and should have a non-skid surface on upper and lower levels -ratio of slope to rise is 1:12 (for every 1" of vertical rise, 12" of ramp is req) -railings should be between 29" and 36" high depending on persons arm reach; 32" is avg -curbs on ramps should be at least 4" high -level platforms must be included in ramp design -if person using ramp has limited UE strength or decreased cardiopulmonary capacity, 4ft X 4ft landings are req -if there is a sharp turn in the direction of the ramp, landings are required for turning space. A 90 degree turn reqs a minimum 4ft X 4ft landing; a 180 degree turn reqs a minimum of 4ft X 8ft landing -if the ramp leads to a door, there must be a 5ft X 5ft 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 u

Bathroom considerations

-number of bathrooms in home -location of bathrooms relative to bedroom, living room, kitchen and other living spaces important to the individual -width of the bathroom doorway -type of bathing the individual with a disability performs (bath, shower, sponge bath) -type of shower: seperate 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 rental, landlords agreement to allow grab bars to be installed if needed -height of tub, sink, toilet -presence of a non-skid mat or skid-free surface in shower/tub -presence of a throw rug outside of shower -availability of a hand-held shower -presence of anti-scaled valves and/or faucets

Tires: w/c components

-pneumatic: air-filled, reqs 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

Overall characteristics of Home

-presence/use of drive way -entrance: w/c access, ramp, level entrance, stairs -number of entrances accessible to individual -steps -railings: a. interior railings: should be mounted 1.5 inch from wall to ease grasp b. exterior railings should be waist high for those who walk; 34-38 inches depending on persons height c. railings should be 1.5-2inch in diameter with nonskid surfaces -width of entrance door: measure from open door to frame -space to accommodate door swing must be available: a. minimum of 18inch is needed for those using walkers b. minimum of 26 inch is needed for those using wheelchairs

contracted keyboards

-provide smaller keys in a constrained space for persons with limited ROM and functional motor control (eg individuals with arthritis)

Seating & Positioning Goals

-provide stability, control, and comfort -promote proximal stability -decrease the risk of muscle contracture, deformity, and decubiti -increase sitting tolerance and energy level -increase function as proper seating will allow for use of UE in ADL -allow for pressure distribution and support -allow for proper positioning and correct alignment of trunk and extremities

personal context

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

Client factor & performance skill assessments: W/C prescription

-sensory (eg sensory loss places the person at risk for the development of decubiti, therefore necessitating a special seat cushion) -neuromuscular (eg the individuals sitting posture can require application of seating and positioning knowledge. Poor trunk control reqs postural supports -musculoskeletal (eg physical limitations, such as a compromised respiratory status, may impede mobility, requiring a powered wheelchair prescription) -cognition (eg deficits in cognitive function may impede ability to operate powered devices) -psychosocial (eg the availability of social supports to assist with transporting and transferring to the wheelchair)

armrest height

-shoulders should be neutral; arms hanging at the sides; elbows flexed to 90 degrees -measure under each elbow to cushioned seating surface -armrests that are too low will encourage leaning forward -armrests that are too high will cause shoulder elevation

Casters: w/c components

-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

Social-cultural/human environment

-social roles: "an organized pattern of behavior that is characteristic and expected of the occupant of a defined position in a social system" -social network: the web of voluntary relationships that make up an individuals social environment" -cultural aspects: "the social structures, values, norms, and expectations that are accepted and shared by a group of people" -psychological aspects: enivornmental characteristics that can effect mood and stress level

sports w/c

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

walkers

-standard: requires the person to have fair balance and the ability to lift device with UEs to advance -hemi-walker: for those who do not have the ability to use 2 hands -side-stepper: a walker situated on a non-affected side of a person -rolling walker: for those who cannot lift a standard walker due to UE weakness or impaired balance -walker bags, trays and baskets to assist in transporting personal items

Crutches

-standard: situated in persons 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 -slings provide support to UE which may have fractured, and prevent poor handling of flaccid UE

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

Sociocultural considerations

-the individuals social netowrk: 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 function -community resources available

Developmental Considerations in W/C assessment

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

mechanical lift

-use of ceiling lift, track lift, hoyer lift, or trans-aid