Formative Comp Written Test

D. Simple meal preparation tasks such as making a sandwich. Rationale: At Level IV the individual is appropriate and goal-directed but can become confused. Cues are required. Community re-entry activities are too high-level for an individual at Level VI. They are more appropriate for Level VII and VIII. Sensory stimulation activities such as moving to music would be appropriate for Level III. Repetitive self-care tasks would be appropriate for Level V.

2. An individual recovering from traumatic brain injury is assessed to be at Level VI of the Rancho Level of Cognitive Functioning Scale. Which should the occupational therapist use in implement treatment? A. Sensory stimulation activities such as moving to music. B. Repetitive self-care tasks such as brushing hair. C. Community re-entry activities such as taking a bus. D. Simple meal preparation tasks such as making a sandwich.

D. Educate the patient about sensory deficits and related adaptive ADL strategies. Rationale: Guillain-Barre (GBS) is characterized by ascending motor weakness in the limbs, usually beginning in the hands and feet. Paresthesia and pain are also a common occurrence. The best approach to this patient is to educate the patient about the sensory deficits that are common to the condition and provide adaptive strategies for ADL so the patient is successful. Soft tissue massage will not remedy the aching in the hands as the inflammation of the peripheral nerves must decrease for this to resolve. Hot packs are contraindicated in this situation due to the potential for burns from altered sensation. Referral to a neurologist is not needed as the symptoms are typical of the syndrome.

3. An adult is hospitalized in the recovery phase of Guillain-Barre syndrome. The patient complains of tingling, aching and weakness in both hands, causing difficulty in grasping grooming supplies. The patient request relief from the hand symptoms. Which action should the occupational therapist take to address the patient's concerns? A. Provide soft tissue massage to both hands prior to grooming activities. B. Apply hot packs to both hands and complete stretching exercises prior to grooming activities. C. Refer the client to a neurologist for follow-up of possible condition regression. D. Educate the patient about sensory deficits and related adaptive ADL strategies.

C. Cutting simple figure shapes with scissors. Rationale: A- 3-4 yrs old B- 2-3 yrs old C- 4-6 yrs old D- 2-3 years old

A 5-year-old is referred to occupational therapy. Upon the completion of a standardized test evaluation, the occupational therapist determines that the child demonstrates age-appropriate cognitive and fine motor skills. Which activity would the child be able to complete at this developmental level? A. Cutting long thin strips with scissors. B. Holding and snipping with scissors. C. Cutting simple figure shapes with scissors. D. Opening and closing scissors in a controlled fashion.

D. The presence of a +STNR, which is "abnormal" and has reappeared after the TBI.

A child with a diagnosis of traumatic brain injury (TBI) is evaluated by an occupational therapist. The child presents with extension of both upper extremities and flexion of both lower extremities following a stimulus of neck extension. When interpreting this observation, which statement is most accurate for the therapist to document? A. The presence of a +ATNR, which is "abnormal" and has reappeared after the TBI. B. The presence of a +STNR, which is "normal" and not affected by the TBI. C. The presence of a +ATNR, which is "normal" and not affected by the TBI. D. The presence of a +STNR, which is "abnormal" and has reappeared after the TBI.

C. Soften the child's clothing by repeated laundering and remove clothing tags. Rationale: Children with tactile defensive sensory modulation disorder find stiff clothing, textured clothing, and clothing tags aversive. The use or avoidance of, swings and other moving play equipment is indicated for vestibular processing disorders.

A child with a tactile defensive sensory modulation disorder attends a private early intervention clinic. The occupational therapist collaborates with the child's parents to develop strategies and guidelines to help the child handle the symptoms of this disorder at home. Which is the best recommendation for the therapist to make to the parents? A. Avoid the use of swings and other moving equipment during play activities. B. Encourage the use of swings and other moving equipment during play activities. C. Soften the child's clothing by repeated laundering and remove clothing tags. D. Provide a variety of textures in the clothing the child wears.

Reprimand

A formal expression of disapproval of conduct communicated privately by letter from the EC Chairperson that is nondisclosable and non- communicative to other bodies (e.g., state regulatory boards[SRBs], National Board for Certification in Occupational Therapy [NBCOT])

Censure

A formal expression of disapproval that is publicly reported

D. Computer clubs Rationale: Ontogenesis imperfect results in brittle bones that fracture easily. Fracture prevention through activity restrictions is a primary focus. This can result in social isolation, decreased self-efficacy, and depression. Exploring passive activities like computer clubs can provide the child with a number of age-appropriate viable options for leisure activities that the child can pursue after school without risking fractures. Active - activities would highlight what the child cannot do rather than his/ her abilities. In computer clubs, physical abilities are not needed, for any physical deficit can be readily compensated for with adaptations and modifications.

A middle school-aged child with osteogenesis imperfect reports feelings of low self-esteem, social isolation, boredom, and lethargy. The occupational therapist collaborates with the child to identify resources for after-school leisure activities to promote socialization and community participation. Which of the following activities is best for the therapist to explore with the child? A. Team sports B. Therapeutic horseback riding C. Scouting programs D. Computer clubs

D. Improvement of their professional skills and competence. Rationale: The most important goal of continuing professional education is to improve skills and develop competence for service delivery. Networking opportunities, keeping up-to-date with trends and the fulfillment of external credentialing requirements are all a benefit of participation in continued education. However, these are not the primary aim of professional development activities. The most important objective is to improve service delivery skills and competencies.

A newly hired OT working at a private practice receives their registration for an advanced course on pediatric assessment paid for. Which is the most important outcome of attending this course for the OT? A. Fulfillment of continuing education requirements for independent credentialing agencies. B. Keeping up-to-date on current trends in occupational therapy. C. Networking with other pediatric professionals. D. Improvement of their professional skills and competence.

D. Explain to the director of rehabilitation why the request is inappropriate. Rationale: Volunteers are not trained health care professionals and they cannot perform transfers with patients. Therefore, the OTA cannot comply with the director's request to supervise volunteers in performing transfers. The OT is responsible for the practice of the OTA he/she supervises; therefore, he/she must inform the director of rehabilitation of the inappropriateness of this request. While it is appropriate for the OTA to decline the director's request, it is most important that the rationale for this denial be explained by the OT supervisor in order to prevent future inappropriate requests of the OTA.

A newly hired OTA is instructed by the director of rehabilitation to supervise two hospital volunteers as they learn how to assist patients safely completing bed to wheelchair transfers. The OTA informs the supervising occupational therapist of the director's request. Which is the first action the occupational therapist should take in response to this request? A. Advise the OTA to comply with the request. B. Advise the OTA to refuse the request C. Observe the OTA to assess service competence in transfer training. D. Explain to the director of rehabilitation why the request is inappropriate.

B. Sensory stimulation. Rationale: A score of 6 on the Glasgow Coma Scale is just one level above a completely non-responsive coma. As a result, a person at this level has severe deficits. The person can open his/her eyes in response to pain and make incomprehensible sounds; therefore, intervention begins at the sensory stimulation level. The other choices are at levels that are too high for this individual.

A person with a traumatic brain injury is assessed to score a 6 on the Glasgow Coma Scale. Which should the occupational therapist use to initiate intervention with this person? A. Demonstrated directions. B. Sensory stimulation. C. Verbal cues. D. Hand-over-hand assistance.

C. Stretch the right upper extremity every 15 minutes during writing activities Rationale: The neurological exam is negative. The best choice is to educate the child in AROM and stretching to increase circulation and to attempt to prevent numbness and tingling. The universal cuff and custom molded grips do not address the numbness and tingling. Elevation addresses edema - but the case does not mention edema.

A school-aged child who is right-hand dominant complains of numbness and tingling after writing for more than 15 minutes. A neurological exam shows no reason for the numbness and tingling. Which action would be most beneficial for the occupational therapist to recommend to the child? A. Use a pencil held in a universal cuff to complete writing activities B. Elevate the right upper extremity at night and whenever possible during the day C. Stretch the right upper extremity every 15 minutes during writing activities D. Use a custom-molded pencil grip made of splinting material when writing.

C. Have the client complete an occupational interest checklist. Rationale: Upon referral, the first step in the OT process is screening. Determining the person's occupational interests can help identify areas requiring further evaluation. One cannot establish short-term and long-term goals with the client until an evaluation is completed. It is unknown if the client has deficits in medication management. Modeling behavior is a component of the intervention process.

A young adult recently diagnosed with undifferentiated schizophrenia is referred to an occupational therapy day treatment program. Which should the occupational therapist do first with the client? A. Determine short-term and long-term goals for program participation. B. Model desired behaviors during occupational therapy groups. C. Have the client complete an occupational interest checklist. D. Encourage the client to maintain a daily log of medication intake.

A. Family role activity suggestions and potential adaptations. Rationale: The OT is the only one on the identified care coordination team who is qualified to provide information about role activities and potential activity adaptations. The ability of a client to engage in meaningful activities in the home and resume relevant role activities can facilitate positive family functioning and support recovery. The other choices are all relevant but other members of the team can provide this information.

A young adult with a 10-year history of serious and persistent mental illness is being discharged home in two days. The client collaborates with the care coordination team to plan discharge with the client's primary family members. The team consists of a psychiatrist, a registered nurse, a social worker, and an OT. The team conducts a pre-discharge family meeting to provide family members with information to assist them in supporting the client's recovery. Which is the most relevant information for the OT to provide to the client's primary family members at this meeting? A. Family role activity suggestions and potential adaptations. B. The therapeutic effects and potential side effects of medications. C. Advocacy strategies and consumer/family resources. D. Family dynamics information and family support groups.

The OT should talk directly to the colleague. Ignoring it is incorrect. Reporting is over-reacting at this time. It is not illegal or dangerous; however, it is unethical.

An OT becomes aware of a practice of a colleague who teaches energy conservation classes to persons with arthritis. The colleague has been sending the names of class participants to a vendor who sells adaptive equipment. Which action is best for the OT to take in response to the situation? A. Ignore the situation because it causes no harm to anyone B. Speak to the therapist privately and tell him/ her this action is unethical. C. Advise the therapist to disclose this practice and if he/ she refuses then report the therapist to the state regulatory board (SRB). D. Report the therapist's unethical behavior to the State Regulatory Board.

D. Akathisia Rationale: Akathisia is a side effect of antipsychotic medications that is exhibited by restlessness, hand tremors, and shaky legs. Akinesia is also a potential side effect, but this is evident by a lack of movement. Akinesia is also a negative symptom of schizophrenia. Pseudo-parkinsonism is also a side effect that appears as behaviors similar to the symptoms of advanced Parkinson's disease; that is, rigidity, pill rolling tremors, masked face and a shuffling gait. Tardive dyskinesia is an irreversible neurological condition caused by prolonged use of neuroleptic medications. It would not be evident in someone being treated initially with neuroleptic medications.

An individual hospitalized for the first time due to a brief psychotic episode attends an OT group. During task performance, the OT notices that the person is restless with hand tremors and shaking legs. Which of the following should the therapist document that the person seems to be exhibiting? A. Akinesia. B. Pseudo-parkinsonism C. Tardive dyskinesia D. Akathisia

C. Report the information to the physician. Rationale: The therapist must report the information to the physician, who is responsible to take action on the individual's ability to drive. The driver's license agency addresses the issues of administration of licenses. The agency does not address cognitive evaluation or remedial issues concerning driving. A driver training program is a good suggestion to help the person improve skills but it does not address the unsafe driver on the road. The option to inform the family can be presented in the context of the skills that OT addresses, such as unilateral neglect. However, it does not address the safety issue.

An individual who had a CVA one year ago continues to demonstrate unilateral neglect. The individual drives daily to therapy despite several suggestions from the OT to discontinue this activity. The therapist has determined that the client is an unsafe driver. Which is the best action for the therapist to take in response to the situation? A. Report the individual to the department of motor vehicles B. Suggest that the individual attends a driver training program C. Report the information to the physician. D. Tell the individual's family hat the client is at risk for injuring self and others while driving.

B. Active Range of Motion Rationale: Activities that use active ROM are indicated for the treatment of RA both in its acute and chronic phases. Passive ROM is generally contraindicated for a person with RA. If a person is unable to perform AROM, gentle passive ROM may be used with caution. Progressive resistance is lso contraindicated for the treatment of RA. The use of isotonic exercises are considered for an intervention - the occupational therapist must establish that the person's joints are stable and would benefit from isotonic exercises without jeopardizing other joints. The individual's response to these exercises must be monitored; therefore isotonics are not appropriate for an unmonitored home care program.

An individual with rheumatoid arthritis (RA) is currently in a stage of remission. During this inactive chronic phase of this disease, the occupational therapist works with the client to maintain rang of motion (ROM) and muscle strength. Which of the following is most effective for the therapist to recommend the client include in a daily home exercise program? A. Passive Range of Motion B. Active Range of Motion C. Isotonic Exercises D. Progressive Resistive Exercises

B. Participate as a member Rationale: In a mature group, the therapist participants at the level of a member and does not serve as a group leader except special circumstances such as a member becoming destructive to the group process. The members decide formally and informally the group norms. The therapist does not usually participate in conflict resolution except to facilitate the members' participation in extreme situation, such as deadlocked conflicts. The therapist functions in a variety of tasks, maintenance, or egocentric roles as a need to show members how these roles function in this group.

An occupational therapist conducts a communication skills group in a wellness program for a large accounting firm. In this mature group, what should the therapist do? A. Help to develop the group norms B. Participate as a member C. Actively resolve group conflicts D. Maintain a leader role

A. Communication effectively to develop a therapeutic relationship with the family Rationale: During the first visit it is essential that the OT practice effective communication and work on a therapeutic relationship with the family. Since the child has multiple disabilities, the OT will need to work closely and frequently with the family to address the child's needs over an extended period of time. The other choices can be addressed when and if the need evolves. In addition, one cannot assume that the family will need assertiveness training.

An occupational therapist conducts an initial home visit to a family with a premature infant who, at four months and 5 lbs has just been sent home. The child has multiple disabilities. Which is the best primary goal for the therapist to work on with the family during this first session. A. Communication effectively to develop a therapeutic relationship with the family B. Teach the family proper body mechanics for lifting the child C. Teach the family assertiveness training to develop advocacy skills D. Determine whether adaptive aids or positioning equipment is needed

A. Neutral Rationale: The neck should be splinted in neutral. A major focus of acute burn care is proper positioning to maintain involve areas in anti-deformity positions. The anti-deformity position for the neck is neutral. The other positions are contraindicated. A full thickness burn involves the epidermis and dermis, hair follicles, sweat glands, and nerve endings. Skin grafting is required and healing can take months. Post-operative OT care following skin grafts involves wearing splints at all times.

An occupational therapist constructs a splint for a person who incurred a full thickness facial and anterior neck burns. In which position should the therapist splint the neck? A. Neutral B. 15 degrees of flexion C. 15 degrees of lateral flexion D. 15 degrees of hyperflexion

C. Interview the person and complete a standardized depression scale. Rationale: A standardized depression scale provides objective data and an interview can obtain the person's subjective experience and viewpoints. Together this information can be used to determine the reasons for the person's observable behaviors, namely lethargy and decreased motivation to practice what is being learned in therapy. A referral for a psychiatric evaluation would be premature at this point as the cause of the person's behavior is not known. The person's lack of energy and noncompliance can be due to other factors that are not psychiatric in nature. For example, the individual could be providing care for a spouse and not have time for a home program and/or for adequate sleep. Telling a person the importance of a home program does not directly deal with the issue or lack of follow through. In addition, there is nothing in the scenario to indicate that the person is not aware of the importance of compliance. Since it is not known if the person's behaviors are due to depression, it would not be appropriate to defer treatment. If the person is depressed, the treatment for depression can be provided concurrently with the treatment for the person's physical limitations.

An occupational therapist is treating an individual with Parkinson's disease in an outpatient setting. The therapist observes that the person attends regularly but has little energy and does not seem to be performing the prescribed home program. Which is the best action for the therapist to take in response to these observations? A. Advise the physician to complete a referral for a psychiatric evaluation. B. Tell the person that the completion of the home program is vital to recovery. C. Interview the person and complete a standardized depression scale. D. Defer intervention until the person's depression is treated.

B. The child's ability to attend to and complete a task. Rationale: Children with oppositional defiant disorder tend to have difficulties with impulse control, attention span, and short-term memory and exhibit argumentative and resentful behaviors. These deficits often affect the ability to complete tasks and can hinder adaptive role functioning. A child does not have to be willing to take on a variety of roles to benefit from group activities. Some find security and stability in the same type role. This stability can be healthy as long as the role contributes to productive behavior. Distorted body image is more indicative of anorexia nervosa, bulimia nervosa or body dysmorphia. Difficulties with energy and activity levels relate more to hyperactivity disorder than to oppositional defiant disorder.

An occupational therapist plans individual and group activities for a child with oppositional defiant disorder. Which is most important for the therapist to address during group activities? A. The child's willingness to take on a variety of group roles. B. The child's ability to attend to and complete a task. C. The child's distorted body image. D. The child's self-regulation of energy and activity levels.

Co-leadership enables each leader to share his/ her professional knowledge and skills and use their unique professional expertise to assume different leadership roles and tasks. Both leaders can provide and obtain mutual support to each other, share their observations and model effective behaviors. Issues that may arise and must be dealt with to ensure effective co-leadership include the splitting by group members of one leader against the other, excessive competition among co-leaders, and unequal responsibilities resulting in an unbalanced work load among leaders.

An occupational therapist working in a long-term care facility co-leads a discharge planning group with a social worker. What are the advantages to this co-leadership? What issues may arise to impede effective co-leadership that the therapist should be prepared to address?

Probation

Continued membership is conditional, depending on fulfillment of specified terms. Failure to meet terms will subject an Association member to any of the disciplinary actions or sanctions. Terms may include but are not limited to a. remedial activity, applicable to the violation, with proof of satisfactory completion, by a specific date; and b. the corrected behavior which is expected to be maintained.

D. Notify the primary care physician that the person may need an audiological evaluation. Rationale: A- Subjective B&C- Does not deal directly with the issue at hand

During a group session at an adult day care program an older adult consistently complains that everyone is mumbling. After the group, which action should the occupational therapist take in response to these statements? A. Notify the client's primary care physician that the person exhibited evidence of paranoia. B. Collaborate with the program director to remove groups from the client's program plan. C. Document objective data about the complaints in the person's chart. D. Notify the primary care physician that the person may need an audiological evaluation.

Revocation

Permanent denial of Association membership. Publicly reported.

Staggering Reaction (Onset: 15-18 mos. Integration: persists throughout life)

Position: Child standing on solid surface Procedure: Examiner pushes child in all directions: forward, backward, and sideways with enough force to displace center of gravity off base of support. Response: Child makes correction movements of flexion and extension, adduction and abduction of limbs to restore center of gravity. Child takes one or more steps forward or backward to correct. Child sidesteps or crosses one foot over the other to correct.

Head Righting (Onset: 3 mos. Integration: Persists throughout life)

Position: Done while doing body held vertical (#10). Do not elevate shoulders. Gently tip the child forward, backward, and side to side. Response: When tipped forward, the head should move back (neck hyperextension). When tipped backward, the head should move forward (neck flexion). When tipped to the side, head should move to the opposite side from the body.

Landau (Onset: 3-4 mos. Integration: 12-24 mos.)

Position: Examiner supports child horizontally in the air in prone position with one hand under the lower part of the thorax. Procedure: Position in space. Response: Head extends, back and hips extend in sequence.

Protective extension (Onset: 6-8 mos. Integration: Persists throughout life)

Position: Examiner supports infant in vertical position in space with hands around the infant's body. Procedure: Plunge the child downward toward a table or other flat surface. Response: The child will extend head, extend and abduct arms and fingers as if to break a fall. Weight is taken on extended arms.

All fours equilibrium (Onset: 9-12 mos. Integration: Persists throughout life)

Position: Place child in quadruped position on the tilt board facing lengthwise or crosswise, the longitudinal body axis is located directly over the center of rotation of the board. Procedure: Tilt laterally to the left and right, then tilt antero-posteriorly so to displace gravity off base of support. Response: 1. To later lift, the body is flexed against the tile with the concavity of the spine upward. The head is slightly rotated so that the face turns toward the upper side. The arm and leg on the upper side flexes and the arm and leg on the lower side extend and abduct. 2. To anterior tilt, arms extend and legs flex, head is extended and trunk moves backward. Child may sit back on heels. 3. To posterior tilt, shoulder and hips extend, elbows and head tend to flex and trunk moves forward. Curving of trunk is the most important element.

Sideways Parachute/ Protective extension (Onset: 7-8 mos. Integration: persists throughout life)

Position: Place child in sitting postion with legs out in front. Procedure: Examiner pushes child on one shoulder with enought force to displace center of gravity over base of support and cause child to lose balance. Response: Child will abduct arm on side opposite of force, with extension of elbow, wrist, and fingers before contact is made with the table. Weight is taken on open palm and fingers.

Symmetrical Tonic Neck (Onset: 4-6 mos. Integration: 10-12)

Position: Place child in ventral position support the trunk, over examiner's knee. Procedure: Examiner passively first ventroflexes then dorsiflexes the child's head. Response: Ventroflexion of the head produces flexion of the upper extremities, extension of the lower extremities. Dorsiflexion of the head produces extension of the upper extremities and flexion of the lower extremities. In some children the opposite response is seen. Ventroflexion of head produces extension of upper extremities, flexion of lowers.

Standing equilibrium (Onset: 12-16 mos. Integration: persists throughout life)

Position: Place child standing facing lengthwise or crosswise on the tilt board. The body axis should be over the center of rotation of the board. Procedure: Tilt laterally to the left and the right then antero-posteriorly, to displace center of gravity off base of support. Response: 1. To lateral tilt, body is flexed against the tilt, with the concavity of the spine upward. Upper leg is flexed and upper arm abducted. The lower leg is extended and may abduct. 2. To anterior tilt, the spine extends, displacing the body backward, legs extend, arms are flexed at the shoulders and extended at the elbows. Curving of the trunk is the most important element. 3. To posterior tilt, the spine flexes, displacing the body forward, legs flex, arms are extended at the shoulders and flexed at the elbows. Curving of the trunk is the most important element.

Supine Equilibrium (Onset: 7-8 mos. Integration: Persists throughout life)

Position: Place child supine on a tilt board, center of rotation of board longitudinally along body axis. Procedure: Slowly tilt board laterally, left and right. Response: Child's trunk is curved against the tilt, with the concavity of the spine upward. The head is rotated with the face toward the upper side. Slight abduction of the upper arm and leg may be seen.

Asymmetrical Tonic Neck (Onset: Birth to 2 mos. Integration: 4-6 mos.)

Position: Place child supine with head in midline Procedure: Turn the head slowly to one side, and hold in the extreme position with jaw over the shoulder. Child may turn head actively. Response: Arm and leg on jaw side, extend. Arm and leg on skull side flex.

Plantar grasp (Onset: 28 weeks gestation Integration: 9 mos.)

Position: Place child supine with head in midline and legs relaxed. Procedure: Firm pressure against volar surface of infant's foot, directly below toes. Response: Planar flexion of all toes.

Rooting Reaction (Onset: 28 weeks gestation Integration 2-3 mos.)

Position: Place child supine with head in midline and the hands on the chest. Procedure: Using your finger, stroke the perioral skin at the corner of the mouth moving laterally toward the cheek, upper lip and lower lip, in turn. Response: After stimulation of the corners of the mouth, there is a directed head turning toward the stimulated side. Stimulation of the upper lip produces opening of the mouth and retrofexion of the head. Stimulation of lower lip produces mouth opening and ventroflexion of the head. In all instances, the infant tries to suck the stimulating finger.

Flexor Withdrawal (Onset: 28 weeks gestation Integration: 1-2 mos.)

Position: Place child supine with head in midline, legs relaxed and semi-flexed. Procedure: Noxious stimulus, such as pin prick or pinch to sole of one foot. Response: Withdrawal of stimulated leg from the stimulus. Test both lower extremities.

MORO (Onset: 28 weeks gestation Integration 5-6 mos.)

Position: Place child supine with head in the midline, arms on chest. Procedure: Support infant's head and shoulders with hand, allow head to drop back 20-30 degrees with respect to trunk, stretching neck muscles. Response: Abduction of the upper extremities with extension of the elbows, wrists, and fingers, followed by subsequent adduction of the arms at the shoulders and flexion at the elbows, and cry.

Sucking (Onset: 28 weeks gestation Integration: 2-5 mos.)

Position: Place child supine with head in the midline, hands on the chest. Procedure: Place a finger or nipple into the infant's mouth. Response: Rhythmical sucking movements.

Palmar grasp (Onset: birth- 2 mos. Integration: 4-6 mos.)

Position: Place infant supine with head in midline and hands free. Procedure: Place index finger of examiner into the hands of the infant from the ulnar side and gently press against the palmar surface. Response: Infant's fingers will flex around the examiner's index finger.

Prone equilibrium (Onset: 6 mos. Integration: Persists throughout life)

Position: Place the child prone on a tilt board. Procedure: Slowly tilt board laterally to the right and left. Response: As the center of gravity is displaced off the base of support, the child will curve against the displacement of center of gravity, concavity of the spine upward toward the tilt, the upper arm and leg may abduct in an attempt to bring center of gravity back over base of support. Curving of the trunk is the most important element.

Positive supporting (Onset: 32 weeks gestation Integration: 1-2 mos.)

Position: Support infant in the vertical position with examiner's hand under the arms and around the chest. Procedure: Allow feet to make firm contact with the tabletop or other flat surface. Response: Simultaneous contraction of flexors and extensors to bear weight on the lower extremities. The child supports only a minimal amount of body weight. Characterized by partial flexion of the hips and knees.

Locomotion/ Spontaneous Stepping/ Automatic Stepping (Onest: 37 weeks gestation Integration: 2 mos.)

Position: Support infant in the vertical position with examiner's hands under the arms and around the chest. Procedure: Allow feet to make firm contact with tabletop or other flat surface. Response: The child makes reciprocal stepping pattern as with ambulation.

Sitting Equilibrium (Onset: 7-8 mos. Integration: Persists throughout life)

Position: sitting on tilt board facing crosswise or lengthwise, with the vertical body axis directly over the center of rotation of the board. Procedure: Slowly tilt board to the right and left then antero-posteriorly, so the center of gravity is displaced off the base of support. Response: 1. To lateral tilt, the body remains upright and is flexed against the tilt, with the concavity of the spine upward, the neck is flexed laterally and the head slightly rotated with the face toward the upper side. The arm and leg on the upper side are abducted while those on the lower side are adducted and extended. 2. To anterior tilt, the body remains upright, the spine extends and the limbs are retracted. 3. To posterior tilt, the body remains upright with the spine flexing and the arms are flexed at the shoulders, elbows are extended. Curving of the trunk is the most important element.

Backward Parachute/ Protective Extension (Onset: 9-10 mos. Integration: Persists throughout life)

Position: symmetrical sitting posture with legs out in front. Procedure: Examiner pushes child backward with enough force to displace center of gravity off base of support. Response: Child extends arms backward. Full reaction is backward extension of both arms. Frequently an element of trunk rotation comes in and reaction is seen in one arm only. Child takes weight on extended arms.

Tonic Labyrinthine (Onset: Birth Integration: 6 months)

Positions: Supine-place infant in supine, head in midline or place infant in prone, head turned to one side, trunk aligned. Procedure: 1. Child in supine, push up to sitting position with examiner's hand on back of child's head, evaluate presence of extensor tone by amount of pressure of extensor of infant's head and trunk pushing back. 2. Child in prone, life his head up 90 degrees evaluate presence of flexor tone by amount of pressure of infants head pushing down. Response: 1. Supine- Extesor tone dominates, child will not flex to sit. Examiner will feel child push head back into examiners hand. Hips will be extended. 2. Prone- flexor tone dominates, child will not lift head and support weight on forearms. Hips will be flexed. Examiner will feel child push chin down into examiner's hand.

Suspension

Removal of Association membership for a specified period of time. Publicly reported.

D. Decline the gift Rationale: You could make the suggestion that they donate something to the department.

The family of an individual being admitted to a rehab center offers the OT a cash gift. The therapist refuses the money but the family continues to insist that the therapist take the cash gift. After thanking the family for the generous gesture, what is the therapist's most ethical response? A. Donate the money to the hospital B. Donate the money to charity C. Use the money to purchase an item for the OT department D. Decline the gift

C. Close Rationale: It is recommended that entry-level OT's receive close supervision, that is, daily, direct contact for patient care. Intermediate-level OT's can receive routine supervision, every two weeks, to general supervision, at least monthly. Advanced practitioner's need minimal supervision, nan as-needed basis, for patient care.

To ensure the provision of best practice, a new entry-level OT will be provided with supervision of their caseload. At what level should this supervision be provided? A. Routine B. General C. Close D. Minimal