NBCOT Exam

what to do with agitated patients

*observe first to understand what the trigger is before trying various methods to solve the issue

Developmental (group)

-addresses how illness/disability influences life stages -reminiscences is used to facilitate typical transitions -defines healthy function as performing occupations at the appropriate life stage -life review is an effective intervention strategy -childhood, mid-life, older adulthood -Erikson/peiget -EX: parallel or cooperative group

discharge

Ascertain client's view on goal achievement Measure outcome of the occupational therapy process Summarize outcome data for program evaluation Evaluate level of goal achievement Analyze the final progress made by the client Make referrals for treatment Measure functional level document overall outcome of interventions

A 2-year-old toddler, who has a developmental delay, recently learned to release a 2-inch (5.08 cm) ball into a large toy box. What fine motor skill should the OTR work on NEXT?

Complete a 3- to 4-piece puzzle. In the development of play occupations, a child who is able to release an object into a toy box would NEXT be expected to be able to put together a 3- to 4-piece puzzle. O'Brien, J. C., & Kuhaneck, H. (2020). Case-Smith's Occupational therapy for children and adolescents (8th ed., p. 118). St. Louis, MO: Elsevier.

Domain 1: Practice Test An OTR is developing an intervention plan using a bottom-up approach for clients who have hemiplegia and hemi-neglect secondary to having a CVA more than one year ago. Which of the following intervention techniques has evidence supporting its efficacy for reducing the effects of "learned non-use" through cortical reorganization?

Constraint-induced movement therapy (CIMT) This is an evidence-based functional approach for promoting use of a hemiparetic upper extremity.

Tardieu Scale

Measures Spasticity At each speed X/Y X= Score, Y=Joint Angle V1: As slow as possible, slower than the natural drop of the limb segment under gravity V2: Speed of limb segment falling under gravity V3: As fast as possible, faster than the rate of the natural drop of the limb segment under gravity Scoring: 0 No resistance throughout the course of the passive movement 1 Slight resistance throughout the course of passive movement, no clear catch at a precise angle 2 Clear catch at a precise angle, interrupting the passive movement, followed by release 3 Fatigable clonus with less than 10 seconds when maintaining the pressure and appearing at the precise angle 4 Unfatigable clonus with more than 10 seconds when maintaining the pressure and appearing at a precise angle 5 Joint is immovable

how should you prepare the environment during the manic phase of bipolar disorder?

Minimize distractions in the environment during task performance. It is important to provide a structured environment with minimal distractions during the initial phase of intervention.

Intervention

Modify the intervention plan as required Monitor clients response during sessions Grade activities for just-right challenge Document client response to selected technique Compete on-going assessment Provide compensatory strategies Educate Select activities based on targeted outcomes Adapt environment provide adaptive devices

An inpatient had a myocardial infarction 2 days ago and is beginning phase I cardiac rehabilitation. Which activity is an ESSENTIAL component of the initial assessment with this patient?

Monitoring the patient's orthostatic tolerance during movement For the safety of the patient, the patient's physiologic response to activity must be monitored during this early phase of cardiac rehabilitation.

MOCA

Montreal Cognitive Assessment and Short Portable Mental Status Questionnaire 26 or higher score is normal range (score is 0-30) covers 8 separate cognitive domains Discriminates MCI from alzheimers quick screening for mild cognitive dysfunction alternate versions available to avoid practice effect adults ranging 55-85 ~10 minutes version available for individuals who are blind

Shoulder Flexion

Palpate muscles over the anterior glenohumeral joint Muscle being tested includes the anterior deltoid Muscle being tested includes both heads of the bicep Provide resistance to the distal humerus and push toward extension Gravity-eliminated testing occurs in a side-lying with the humerus moving anterior to the trunk Muscle being tested includes the coracobrachialis Observe the client for the substitution movement of trunk extension

OTR Study Guide Domain 1: Practice Test An inpatient in a rehabilitation setting sustained a C7 spinal cord injury 2 months ago. One of the patient's goals is to be able to prepare family meals when discharged home. What INITIAL action should the OTR complete to support the patient's success with this goal?

Identify the patient's typical mealtime routines and habits. An integral part of developing a client-centered intervention plan is to learn about the client's typical mealtime routines and habits.

An OTR is interpreting scores of a developmental test that was administered to a 3-year-old child. The child scored at the 89th percentile for the child's age and gender group. What can the OTR conclude based on this score? A.These scores are sensitive for measuring small changes in the child's overall development. B.This child displays above-average developmental skills compared to similar children. C.The child has minor developmental deficits compared to the normative sample group. D.Eleven per cent of the children in the sample group scored higher than this child.

D.Eleven per cent of the children in the sample group scored higher than this child. The percentile score is the percentage of subjects that score at or below a particular raw score.

Evaluation

Develop the occupational profile Establish frequency and duration of treatment Interpret and analyze assessment data Select and administer specific assessments Consider reasons for referral Formulate conclusions to develop an intervention plan Acquire information to understand client priorities Identify targeted intervention outcomes Generate initial problem list Collaborate with client to establish goals

OTR Study Guide Domain 1: Practice Test An OTR is assessing the reflexes of a 4-month-old infant. The OTR places the infant in a sitting position and encourages the infant to actively flex the neck forward to look at an object held near the infant's chest. Which of the following responses to this movement indicates the presence of the symmetrical tonic neck reflex?

Flexion of the upper extremities and extension of the lower extremities This movement pattern indicates the presence of the symmetrical tonic neck reflex (STNR).

OTR Study Guide Domain 1: Practice Test For a typically developing child, which postural reflex becomes evident between 6-9 months of age and continues throughout life?

Forward protective extension Forward protective extension is a postural reflex that typically becomes evident between 6-9 months of age and continues throughout life.

An OTR is evaluating an inpatient who recently had a severe TBI and is emerging from coma. The patient is functioning at a Level III (Localized response) on the Rancho Los Amigos scale. Which is the FIRST cognitive function the OTR should assess?

Level of arousal A component of the evaluation for a patient who is functioning at a Level III (Localized response) on the Rancho Los Amigos scale is to screen the patient's level of arousal and alertness.

Shoulder Abduction

Observe for substitution movement involving the long head of the biceps Provide resistance to the distal end of the humerus and push arm towards body External rotation of the shoulder should not occur Gravity eliminated starting position is supine with arm at the side of the body ROM 0-90 Observe the client for the substitution movement of trunk lateral rotation Muscle being tested includes the middle deltoid Muscle being tested includes the supraspinatus raise arms out to the side at shoulder level

Allen Cognitive Levels Screen (ACLS-5)

One subtest includes leather lacing Based on tenets of cognitive disability model Consists of learning 3 visual motor tasks Activity based screening model Assesses problem solving ability during leather lacing task Assesses learning ability during leather lacing task Interpreted using Allen's cognitive scale Tasks increase in difficulty follow me directions.... 1) Running stitch 2) Whipstitch 3)Single Cordovan Stitch

OTR Study Guide Domain 1: Practice Test An OTR is using a top-down approach to select interventions for a client who has unilateral neglect secondary to a CVA. Which intervention would be MOST BENEFICIAL to include as part of the client's intervention when using this approach?

Place commonly used toiletry items to the client's affected side during self-care tasks. This represents a top-down approach because it focuses on a strategy the client can use in everyday life. Top Down Approach: The occupational therapist evaluates the patient's functional status in relation to his or her daily occupations and develops the treatment plan based on the patient's ability to participate in those occupations. To acquire or restore the skills necessary to participate in occupation. To maximize existing skills and adapt activities to allow independence in occupation. Addresses functional performance. Treatment goals address participation in functional activity at the existing level of disability.

Allen Cognitive Level 2

Postural Actions/Gross Body Movement-->MAX ASSIST Stitches: Unable to imitate/complete 'running stitch' Motor Actions: Approximate imitations, Pacing, bending, stretches Attention Span: Minutes Tx: gross motor games, dance

perceptual skills

The child's ability to process, analyZe and interpret the information that they get through different sensory channels. brain's ability to make sense of what the eyes see. It is important for everyday activities such as dressing, eating, writing, and playing. ... Visual spatial relations is the ability to determine one form or part of a form that is turned in a different direction than the others EX: cutting on a line Paper mazes and marble mazes. Connect the dot activities. Hidden pictures. Puzzles. Copying pictures or forms. ... Wooden blocks. Patterning. Matching and sorting.

A client has persistent pitting edema of the hand secondary to mild hemiplegia. Which method would be MOST RELIABLE for monitoring the client's edema over time? A.Measure the hand circumference at the MCP joint level. B.Trace an outline of the hand and fingers placed flat on a tabletop. C.Use a volumeter to measure water displacement.

Volumetric measurement procedures are standardized and would produce the MOST RELIABLE results when measuring hand edema in clients with this diagnosis.

proliferation

When the wound is rebuilt with new tissue made up of collagen and extracellular matrix and new blood vessels develop scarring process begins Epithelial cells form a new layer of skin Matrix of collagen is formed in the wound bed Phase accelerated by a moist and protected environment Wound contraction occurs to reduce wound size Phase begins once the wound is free of debris Granulation tissue fills the wound Capillary networks are formed Wound must be free of bacteria to progress to this stage Also called the fibroblastic phase

Special education teacher

a member of the interprofessional team who works to modify academic curriculum to support the student in achieving grade level expectations. to manage the IEP team, implement the IEP, provide accommodations to general education, and support the student and other teachers.

Craig Hospital Inventory of Environmental Factors (CHEIF)

barriers to participation rated for the past year administration around 10 minutes Quantifies barriers in five environmental domains Can be administered over the phone use of data collected by proxy is not recommended not specific to barriers in the home environment 25-item questionnaire considers physical, social, and political environments client rates severity of social barriers identifies barriers perceived by the client

What is the focus of goals in a Medicare funded skilled nursing facility?

based on medical necessity and skilled services needed for function. ex:Skilled services the patient currently requires for completion of basic functional tasks.

Inflammatory

blood platelets aid in clot formation Phase continues until the wound is free of bacteria Wound is warm, red and painful to the touch Cellular debridement occurs during this phase The body's initial response to achieve homeostasis Cells release histamine to trigger vasodilation White blood cells and nutrients migrate to the area Initial response to disrupted tissue from injury or surgery Considerable amount of edema noted in this phase

Home Environment Assessment Protocol (HEAP)

caregiver observation and interview included Results guide contextual recommendations provided to the caregiver assesses only indoor home environment 192 evaluation items considers physical, social, and political environments composite score includes results from 8 areas takes into account the amount of clutter in the home sub scale quantifies the level of clutter recommendations include 4 types of adaptation for caregivers of clients with dementia identifies safety hazards within the home

decorticate posturing

characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex.

what diagnosis is good to use serial static orthoses with polymer gel sheeting?

contractures of the thumb web space ex: burns to the web space

Flaccidity

decreased muscle tone; synonym for hypotonicity -lack of tone -Muscles soft to touch -Absent deep tendon reflexes -Can be an immediate result from spinal or cerebral shock

Chorea

derived from the Greek word for 'dance' characterised by involuntary movements that are brief, abrupt, irregular and unpredictable RANDOM mild= appear fidgety or clumsy severe = display wild, violent movements that are large in amplitude (ballismus) an affect various body parts and interfere with movement, speech and swallowing may worsen with attempts to move and anxiety or stress. Movements subside during sleep. Choreiform movements may occur with athetosis and when this occurs, they are known as choreoathetosis. They may also occur with dystonia.

FIM

evaluate a users performance on 18 items including self care, bowel and bladder management, transfers, locomotion, cognition, and communication has been proven to predict the discharge disposition for patients who have had a stroke.

Erikson/peiget

-They both studied various elements of child behavior, actions, and thought processes. Piaget's: a theory that related to the various stages of childhood His key point is that cognitive development is like stepping stones, where one milestone informs the next. Piaget argued that these phases were influenced by external forces. For instance, the mental structure of a child was fluid and changing, depending on what was going on in their environment as they learned something new. The stages of development are based on age and ability but they must be passed through sequentially. The four stages include: 1) Sensorimotor stage from infancy to 2 years old 2) Preoperational period from 2 to 7 years old 3) Concrete stage from 7 to 11 years old 4) Formal operational stage from 11 years old to adulthood Erikson: also dealt with development in stages. These stages were thought of as life hurdles. Each hurdle and how it was overcome influenced how a child would progress to the next stage of their life. Some of the hurdles and stages that Erikson considered were: Trust vs mistrust Autonomy vs doubt Initiative vs guilt Industry vs inferiority Identity vs confusion Intimacy vs isolation Generativity vs stagnation Integrity vs despair These stages are dependant on ages. Thus, trust vs mistrust is the first hurdle that children face in life, between the early ages of birth to one year old. In this stage, they are completely dependent on their caregiver, so how they trust or don't trust is crucial to developing a sense of ease and security in the world. This then shapes how the child will respond to next hurdle of autonomy vs shame or doubt when they are aged between 1-3.

Cyrotherapy Contraindications

-cold intolerance, cold urticaria -cyroglobulinemia -compromised circulation -regentrating peripheral nerves -paroxysmal cold hemoglobinuria -peripher vaslcular diesease -raynauds -skin esthesia Ex: ice massage & cool whirlpool

Psychodynamic (group)

-focuses on metaphorical meaning of tasks -Activities address participant' sense of self - healthy communication of needs -leaders role= guide interpretation of conflicts -drama: strong emotions -journaling -adaptive regression through crafts -focus on reasons behind behavior -explore unconscious feelings -theoretical basis= psychoanalytic -peer support= effective strategy

Ataxia

-inability to perform coordinated movements -can affect any part of the body and impact upon the movements required to do many day-to-day activities. It can affect a person's legs, arms, hands, fingers, speech, eye movements and even muscles involved in swallowing. Effect on the upper limbs (arms and hands): a tremor or shakiness due to the over-correction of inaccurate movements - this means that when a person reaches for an object, they overshoot the target. It also results in difficulty performing tasks requiring precise finger movements such as handwriting or using cutlery, or movements that require regular repetition such as clapping. Effect on the lower limbs (legs): walking, a person is unstable and likely to fall. As a result, the person usually walks with the feet spread further apart than the hips, which is known as a 'wide-base gait'. This is done to try to compensate for their instability and poor balance. This way of walking can sometimes give the mistaken impression that the person is under the influence of alcohol or drugs. Effect on speech and swallowing: 'scanning' speech - the person uses a monotone voice with a breathy sound; sometimes there are unusual accelerations or pauses between their syllables. Effect on the eyes: Ataxia may sometimes cause slow eye movements. When the person attempts to change their eye-gaze quickly, their eyes may miss the target. The eyes overshoot or underestimate their mark and then have to make 'catch-up' movements.

OTR Study Guide Domain 1: Practice Test An OTR, who works in the home health setting, is evaluating a client with pneumonia who was recently discharged home from the hospital. The OTR plans to interview the client and administer a standardized assessment to gather information about the client and the home environment. Which additional evaluation method is MOST BENEFICIAL for the OTR to include in the information-gathering process to understand the client's priorities? A.Complete a comprehensive social participation inventory. B.Conduct skilled observations while in the client's home. C.Measure spaces and features in the natural environment.

.Conduct skilled observations while in the client's home. Observing while the client engages in functional tasks in the natural context of the home will provide the MOST BENEFICIAL information related to the client's priorities in this environment.

To influence modifiable risk factors for readmission, which action should be a priority for an OTR working in an acute care hospital to complete prior to a patient's discharge home? A.Address unmet IADL and ADL needs. B.Identify an adequate support network. C.Discuss chronic disease and co-morbidities.

A.Address unmet IADL and ADL needs. Rationale: ADL and IADL needs are considered modifiable risk factors that the OTR can address to positively influence the risk for readmission.

An OTR is preparing discharge recommendations for an inpatient who recently has been diagnosed with relapsing-remitting multiple sclerosis. The patient is an executive chef at a restaurant and wants to resume work as soon as possible after discharge. What would be MOST BENEFICIAL for the OTR to include as part of the discharge planning process for supporting this goal? A.Education about wearing a cooling vest to regulate body temperature B.Instructions on using pursed lip breathing techniques to regulate dyspnea C.Handouts outlining the general purpose and principles of energy conservation

A.Education about wearing a cooling vest to regulate body temperature Rationale: Heat intolerance is a symptom of multiple sclerosis that may be exacerbated in a client who works in a kitchen. Recommending a cooling vest is a solution to decrease this risk of overheating.

OTR Study Guide Domain 1: Practice Test A client in an outpatient setting sustained a frontal lobe TBI 2 months ago. The client has good motor control but has residual problems with executive functioning. One of the client's goals is to be independent with homemaking tasks. During a meal preparation session, the client cooks a meal, but makes no attempt to clean the cooking utensils and dishes or put the food items away after completing the cooking task. Which area of executive function appears to be MOST affected by the TBI as evidenced by this behavior? A.Emergent awareness B.Selective attention C.Environmental gnosia D.Episodic memory

A.Emergent awareness B.Selective attention C.Environmental gnosia D.Episodic memory Deficits in emergent awareness are characterized by difficulty or inability to recognize and correct errors in performance.

OTR Study Guide Domain 1: Practice Test A patient in a skilled nursing facility had a CVA one week ago. An initial screening indicates the patient has hemiplegia, ambulates using a quad cane and has good memory. Nursing staff report the patient consistently has difficulty finding the way from the dayroom to the dining room. What type of assessment should be included as part of the initial evaluation to determine the underlying neurobehavioral problem associated with this difficulty? A.Functional assessment of topographical orientation and visual perception B.Attention and depth perception subtests from a standardized cognitive assessment C.Cognitive-behavioral assessment of executive function during a familiar ADL task

A.Functional assessment of topographical orientation and visual perception Since the patient has intact memory, the behavior suggests topographical disorientation. The test for this is typically a functional test. Contributing visual perceptual deficits should also be considered.

OTR Study Guide Domain 1: Practice Test An OTR is administering the Functional Independence Measure (FIM™) as part of the initial evaluation of an inpatient who had a left CVA with aphasia 5 days ago. The patient has right hemiparesis and requires moderate assistance to maintain balance while standing. What action should the OTR take when completing this assessment? A.Observe as the patient performs ADL routines with the typical methods used prior to admission. B.Introduce a reacher and other adaptive equipment to maximize patient's level of performance. C.Provide the patient with visual and tactile cues to sequence each step of the task.

A.Observe as the patient performs ADL routines with the typical methods used prior to admission. Administration of the Functional Independence Measure (FIM™) includes assessing the patient's complete ADL routines with the typical methods used prior to admission.

An inpatient in an intensive care unit is in the initial acute phase of Guillain-Barré syndrome. The OTR modified the nurse call bell to allow the patient to use available neck movement to push against a switch attached to the pillow. What additional interventions would be MOST BENEFICIAL for the patient during this phase of the disease process? A.Positioning and PROM to minimize contractures B.Balance and vestibular training for self-care activities C.Therapeutic exercise program for strengthening

A.Positioning and PROM to minimize contractures During the initial acute phase of Guillain-Barré syndrome, intervention methods to prevent complications such as positioning and PROM are recommended. Reference: Smith-Gabai, H. (Ed.). (2017). Occupational therapy in acute care (2nd ed., pp.347-348). Bethesda, MD: AOTA Press.

OTR Study Guide Domain 2: Practice Test A young adult client was diagnosed with axonotmesis of the ulnar nerve secondary to a crush injury of the forearm 2 weeks ago. After obtaining baseline assessment information, which technique would be MOST IMPORTANT for the OTR to teach to the client as part of the intervention during the initial phase of the client's rehabilitation? A.Visual compensation B.Isometric strengthening C.Hand-dominance retraining D.Sensory re-education

A.Visual compensation Rationale: Axonotmesis results in loss of protective sensation to the affected nerve distribution. This injury does not require surgical intervention and typically resolves within 6 months from initial injury. Since sensation is impaired in the ulnar distribution, it is MOST IMPORTANT to teach the client to use visual skills as a compensatory means for protecting the hand from further injury. Reference: Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti's occupational therapy: Practice skills for the physical dysfunction (8th ed., pp. 981-983). St. Louis, MO: Elsevier.

OTR Study Guide Domain 1: Practice Test Which of the following options represent a condition that requires close monitoring of a client's wound due to having the GREATEST risk for infection? A.Vascular ulcer left uncovered during healing B.Abdominal surgical wound left open to heal C.Traumatic laceration immediately closed with clips for healing

Abdominal surgical wound left open to heal surgeon may leave a deep wound open to heal through the granulation process. This type of wound requires skilled wound care and close monitoring due to the risk of infection.

Allen Cognitive Level 1

Automatic Actions/Reflexive--> TOTAL ASSIST Stitches: None attempted Motor Actions: walking, eating, drinking, standing Attention Span: Seconds Tx: Sensory Stimulation

OTR Study Guide Domain 1: Practice Test A 5-year-old child has mild developmental delay. Motor and praxis skills are intact. Which action would be BEST to observe when screening emotional regulation skills? A.Taking turns while playing a board game B.Responding to the feelings of others C.Sharing toys during unstructured play

B. Responding to the feelings of others Emotional self-regulation is BEST observed during a situation where the child is responding to the feelings of others.

A school-based OTR is establishing a new goal for a student in middle school who has poor handwriting legibility secondary to delayed fine motor and visual motor skills. The student reports frustration with inability to complete written assignments on time, and the teacher reports that poor legibility impacts ability to grade the assignments. Which of the following is the BEST goal to meet the student's needs in the classroom by the end of the IEP cycle? A.The student will write a 5-sentence paragraph with 80% legibility when provided with a visual model and paper with a highlighted baseline. B.The student will type a 5-sentence paragraph in 20 minutes when provided with word prediction software and keyboarding device. C.The student will rotate pencil from tip to eraser 10 times without dropping on 2 consecutive data days while completing dexterity activities.

B. The student will type a 5-sentence paragraph in 20 minutes when provided with word prediction software and keyboarding device. Rationale: Recommendations for assistive technology to accommodate for poor handwriting legibility is warranted to support this middle school student to progress toward achieving full academic potential. Reference: O'Brien, J. C., & Kuhaneck, H. (2020). Case-Smith's Occupational therapy for children and adolescents (8th ed., pp. 637-639). St. Louis, MO: Elsevier.

OTR Domain 2: Mini Test An OTR, who works in medical oncology, plans to have an inpatient walk to the bathroom and complete all steps for showering. Prior to the session, the OTR reviewed the medical record and noted that the international normalized ratio (INR) value for the patient is greater than 5.0. What action should the OTR take based on this INR value? A.Proceed with the showering activity as planned. B.Cancel the intervention session planned for the day. C.Have the patient walk to the sink for a sponge bath.

B.Cancel the intervention session planned for the day. Rationale: A patient with an INR > 5 is at risk for bleeding and is typically placed on bedrest or activity restrictions. Reference: Smith-Gabai, H. (Ed.). (2017). Occupational therapy in acute care (2nd ed., p.159). Bethesda, MD: AOTA Press.

An OTR is interpreting the results of a standardized test on visual perceptual skills administered to a student in second grade who has a developmental delay. The student scored within the average range for all subtests but scored below the norm on the visual closure subtest. Based on these results, which activity would be MOST DIFFICULT for this student? A.Recognizing the similarities between a picture of a mouse in a storybook and the class pet mouse in a cage B.Determining the difference between a crayon and a marker when both are partially covered by a book C.Locating coat and hat hanging on a hook in the hallway before going outside to play on the playground

B.Determining the difference between a crayon and a marker when both are partially covered by a book Rationale: A student with impaired visual closure skills would have difficulty identifying an object when there is an inability to visually see the object in its entirety.

OTR Study Guide Domain 2: Practice Test An OTR working in a community mental health setting is using dialectical behavior therapy to guide intervention planning for a client who has a borderline personality disorder. The client works in a university setting and is at risk of losing the job due to verbal outbursts and erratic mood swings. The client is aware that behavioral changes are needed and reports a willingness to work toward these changes. Which type of intervention would be MOST BENEFICIAL for supporting progress toward this objective when using this approach? A.Individual sessions focusing on Socratic questioning and guided discovery for addressing problematic situations and emotions B.Group skills training modules in mindfulness, interpersonal effectiveness, emotion modulation, and distress tolerance C.Role-play sessions using prepared scripts for practicing problem-solving and decision-making related to workplace situations

B.Group skills training modules in mindfulness, interpersonal effectiveness, emotion modulation, and distress tolerance Rationale: These interventions should be prioritized when an OTR is using the dialectical behavior treatment protocol to guide the therapeutic process.

An inpatient had a L5 spinal cord injury one week ago. Results of the American Spinal Injury Association (ASIA) Impairment Scale (AIS) indicate the classification of the patient's injury is ASIA B. What do the results of this scale suggest? A.Motor incomplete impairment below the level of the lesion B.Sensory incomplete impairment below the level of the lesion C.Complete motor and sensory impairment below the level of the lesion

B.Sensory incomplete impairment below the level of the lesion Rationale: ASIA B classification indicates an incomplete spinal cord injury where sensory function is preserved below the level of the lesion but not motor function.

A patient who has early Stage III Alzheimer's disease is being discharged home from an inpatient facility under the supervision of a caregiver. What recommendations should the OTR provide to the caregiver as part of the discharge instructions? A.Assist the patient in developing leisure and social skills B.Simplify the home surroundings and reduce stimuli C.Encourage the patient to explore new environments

B.Simplify the home surroundings and reduce stimuli A patient at this stage of Alzheimer's disease would benefit from contextual recommendations such as simplifying the home environment and reducing stimuli.

OTR Study Guide Domain 1: Practice Test A client has a peripheral neuropathy of the dominant hand. A screening indicates thenar muscle atrophy with loss of thumb opposition and palmar abduction, inability to pick up a key or coin from a table top, and decreased grip and pinch strength compared to the non-affected hand. Based on these findings, where on the client's hand would an OTR expect to find sensory disturbances during a Semmes-Weinstein monofilament assessment? A.Volar and dorsal surfaces of the small finger and radial half of the ring finger B.Volar surface of the thumb, index, long, and radial half of the ring fingers C.Entire palm and tips of the index, long, ring, and small fingers

B.Volar surface of the thumb, index, long, and radial half of the ring fingers The client's clinical symptoms are indicative of a median nerve injury. Sensory distribution for the median nerve is to the volar surface of the thumb, index, long, and radial half of the ring fingers.

A high-school student with autism spectrum disorder excels academically but has difficulty organizing assignments and homework. The OTR plans to evaluate the student's relative strengths and weaknesses to guide intervention planning. One of the student's goals is to learn an organization system. Which of the following is the BEST assessment for this purpose? A.Canadian Occupational Performance Measure (COPM) B.Behavior Rating Inventory of Executive Function (BRIEF) C.Executive Function Performance Test (EFPT)

Behavior Rating Inventory of Executive Function (BRIEF) The objective of the Behavior Rating Inventory of Executive Function (BRIEF) is to evaluate self-regulation and executive function in adolescents who have neurological or developmental conditions.

OTR Study Guide Domain 1: Practice Test An OTR who works in an elementary school is preparing to evaluate a student in fifth grade who has a learning disability and ADHD. Which standardized assessments would be MOST EFFECTIVE for the OTR to include as part of the evaluation process?

Bruininks-Oseretsky Test of Motor Proficiency (BOT) and Evaluation Tool of Children's Handwriting (ETCH) These assessment tools are used to measure skills and abilities that are associated with school-related occupational performance.

OTR Study Guide Domain 1: Practice Test A client in an outpatient setting sustained an acquired brain injury 2 months ago. Evaluation results indicate the client has functional ROM and strength, but continues to require assistance with ADL due to moderate visual and vestibular processing deficits. Which intervention represents an adaptive approach for improving the client's performance in areas of occupation? A.Incorporating progressively more challenging tasks into a functional activity B.Engaging the client in valued activities that promote postural stability and balance C.Teaching the client to use proprioceptive cues during functional activities D.Providing the client with an exercise program for improving gaze stabilization

C .Teaching the client to use proprioceptive cues during functional activities The adaptive approach places emphasis on the client's abilities. This top-down approach aims to facilitate functional performance through compensatory techniques.

What critical functional advantage is TYPICALLY observed in a client who has a complete C6 spinal cord injury compared to a client who has a complete C5 spinal cord injury? A.Improved gross grasp from innervation of the extrinsic flexors B.Ability to use triceps strength during transfers C.Ability to use the radial wrist extensors to supplement grasp D.Improved trunk control to bend side to side without falling

C. Ability to use the radial wrist extensors to supplement grasp Clients who have a complete C6 spinal cord injury TYPICALLY have innervation of the radial wrist extensors. This allows the use of a tenodesis grasp to attain a higher level of functional independence.

Which interprofessional team member would be MOST BENEFICIAL for an OTR to refer a middle-school student who has expressed suicidal ideation? A.Social worker B.Psychologist C.Physician

C.Physician Rationale: Expression of suicidal ideation by a student warrants immediate contact with the interprofessional team and a referral to the student's primary care physician.

Allen Cognitive Level 5

Independent learning/Exploratory --> self control/inclusive reasoning stitches: imitates 'simple cordovan stitch' using trial and error X 3 stitches Alters actions with overt trial and error; poor organization, planning, and socialization Tx: Concrete tasks; NEW LEARNING AND GENERALIZATION -group facilitators role is to emphasize safety -encourage client to select a preferred project -constructing stenciling, multistep woodworking -standby cognitive assist -clear demonstration on how to safely use tools -making dolls from a pattern and sewing doll clothes -expect impulsivity that may pose as a safety risk -provide opportunity to learn new skills through trial and error -expect client to ask for materials stored in the cabinet

Home Health Care

Focus on modifying activity demands and environment to achieve outcomes The context provides information that contributes to the evaluation process Interprofessional team collaboration is enhanced by scheduling a joint visit with the client OTR can provide data to complete medication management item on the OASIS Service provision is in the context of the natural environment preferred intervention environment for clients who have dementia The IRF-PAI is used for all Medicare-covered clients for reimbursement Outcome may include self-management of a chronic condition Reassessment must be completed at a minimum of every 30 days Must be considered homebound to receive services under Medicare Part A Quality measure is the Outcome and Assessment Information Set (OASIS)

Allen Cognitive Level 4

Goal Directed/Familiar Activities-->MIN ASSIST Stitches: imitates 3 'whip stitches' Sensory: Responds to Visual Stimuli Tx: Visual cues to complete tasks, matching, several step-tasks, simple crafts (2-3 steps); NO NEW LEARNING/GENERALIZATION Attention Span: Hours 4=1 task plus 3 whip -following a recipe with 3 steps -expect client to ask for assistance -provide example of project -place materials so members can scan the area to find them -demonstration of steps and verbal instruction -select activities with a series of steps towards an end goal -4 step bird house -projects to be completed in 1-2 sessions

Housing Enabler

Interview and observation to assess accessibility in the home environment or future environment assesses outdoor and indoor environments Environmental section evaluates 188 items 3 step assessment that includes analysis predicts the degree of accessibility problems first part includes client interview and observation software recommended to calculate the results administration is around 60 minutes evaluates the person and the environment rating form has 3 parts useful for accessible housing construction

Shoulder Extension

May be measured with client in prone Observe client for the substitution movement of trunk forward flexion Instruction to the client is : "move your arm backward as far as it will go" Muscle being tested includes the latissimus dorsi Expected ROM is 0-50 degrees past midline Muscle being tested includes the posterior deltoid Muscle being tested includes teres major Palpate muscles over the posterior glenohumeral joint

OTR Study Guide Domain 1: Practice Test Which option represents the MOST EFFECTIVE method to screen an 8-month-old infant for neck-on-body automatic righting reaction?

Place the child in a supine position and observe body movements while rotating the child's head to one side and then to the other. This method describes the stimulus, response and reaction associated with testing for neck-on-body automatic righting reaction.

How do you assist an individual with severe cognitive decline when they become aggressive with HOH assistance

Provide the client environmental cues by labeling drawers and posting pictures of tasks in the bathroom. A client who has moderately severe cognitive decline secondary to Alzheimer's disease does not have the ability to use cognitive compensatory strategies but would benefit from environmental cues and modifications.

How do you structure sessions with an individual with conduct disorder?

Providing opportunities for success in a consistent structured environment Rationale: Since a symptom of this disorder includes poor impulse control, providing structure and consistency should be inherent in each treatment session with this adolescent. Additionally, successful experiences help to build self-concept.

Which activity involves the use of a closed kinetic chain movement of the upper extremity?

Pulling up on an overhead trapeze during bed mobility other examples: WRONG Hand-to-mouth patterns used for self-feeding Lifting a suitcase off the floor to carry by the handle This closed kinetic chain movement includes the distal upper extremity being stabilized and in constant contact with the trapeze.

OTR Study Guide Domain 2: Practice Test An OTR is completing a functional visual screening of a client who has macular degeneration. The OTR asks the client to read a passage from a magazine. The client misses several letters and words, and has difficulty finding their place in the text when scanning. What aspect of visual function should the OTR investigate further based on the client's performance? A.Visual acuity B.Contrast sensitivity C.Central visual field

Rationale: The performance errors made by the client during the reading task is consistent with central visual field impairment.

Allen Cognitive Level 3

Repetitive Actions-->MOD ASSIST Stitches: Imitates 3 'running stitches' Motor Actions: manipulation of familiar objects, react spontaneously to tactile stimulation Attention: 30 minutes; no written directions;increased distractability Tx: performs familiar ADL's (face washing, etc) 3=3 running * Manual actions -repeat instructions for each step of a familiar task -demonstrate how to preform a one-step task -structure the activity into clear simple steps -simple tasks that require repetition and manual actions, e.g., sanding wood -Assistance for time management -moderate cognitive assistance -group=max of 30 mins -appropriate activity= stuffing envelopes and making tile trivets -supplies within reach -activities that are repetitious and require manipulation

OTR Study Guide Domain 1: Practice Test A 2-year-old child has developmental delay due to mild spastic cerebral palsy. The child has mastered four-point positioning. Which movement component should the OTR plan to facilitate NEXT?

Rocking on hands and knees In the developmental sequence of gross motor development and mobility skills, a child who has mastered four-point positioning would be expected to progress to rocking on hands and knees NEXT.

OTR Study Guide Domain 1: Practice Test A client who has schizophrenia is participating in OT to improve functional living skills. The client's goal is to be able to independently prepare family meals. The client has successfully used a checklist strategy to gather and keep track of items while preparing a simple cold snack. Which of the following tasks would present a "just right" challenge when using the checklist strategy to progress towards the client's goal?

Setting the dining table for a group meal Results from an analysis of the task the client has mastered (gathering and keeping track of items while preparing a simple cold snack) and the task of setting the table for a group meal demonstrates that the tasks have similar demands. To successfully implement the checklist strategy during meal preparation, the client will benefit from using it across multiple task components and contexts.

OTR Study Guide Domain 1: Practice Test An OTR working in an outpatient setting is completing an initial interview with an older adult client who has recently been diagnosed with a progressive neurological disease. What method should the OTR use during the course of the interview to communicate effective listening and client-centered understanding?

Share examples of adaptations that help to overcome adversity. The OTR is demonstrating client-centered practice by using active listening skills and encouraging the client to continue to participate in the discussion.

Bradykinesia

Slowness of movement; a classic symptom of Parkinson's disease.

Bay Area Functional Performance Evaluation (BAFPE)

Standardized assessment tool administered to adults who have mental health conditions, neurological impairment, and intellectual disability Features include: • measures affective, cognitive, and performance ability • contains 2 subtests: Task-Oriented Assessment (TOA) and Social Interaction Scale (SIS) -Assessment of Task Performance: -assesses the cognitive, affective, performance, and social interaction skills required to perform activities of daily living -Method: brief interview, Task Oriented assessment, Social interaction Scale, Optional self-report social interaction questionnaire, and perceptual motor screening -population= adults with psychiatric, neurological, or developmental diagnoses -measures cognition, affect, and performance -administration contains two parts: test & interview -behavioral anchored rating scale -involves a task of drawing a house floor plan -80-120 minutes

acute care hospital

Stay can be as little as one day Abrupt change in contact may influence level of performance Stress associated with multiple medical tests and interventions Medical lines and tubes may impact level of occupational performance Emphasis of care is on promoting medical stability Associated with a sudden change in the clients functional abilities Therapeutic intervention approaches are applied within the medical model Treatment provided for new injuries and illnesses

An OTR working in an inpatient mental health setting is using a cognitive behavioral approach to select an intervention activity for a young adult undergoing treatment for symptoms associated with body dysmorphic disorder. The patient is employed in a successful career and enjoys outdoor activities such as jogging and hiking, but has difficulty forming and maintaining interpersonal relationships. One of the patient's goals is to improve self-image and the ability to express feelings. Which activity would be MOST BENEFICIAL to include as part of the intervention for supporting this goal when using this approach?

Teaching the patient to use a dysfunctional thought record for describing distressing situations and emotional responses Having the client maintain a journal of distressing events and associated feelings or thought processes is integral to a cognitive behavioral approach.

Maturation

Tensile strength increases Scar will soften and flatten Scar mobilization is utilized to improve scar quality Scar tissue may be up to 80% as strong as original tissue Collagen remodeling takes place during this phase Scar adhesions and contractors can develop Phase can last up to 2 years after initial injury Also called the remodeling phase An orthosis may be used for controlled tension on the scar

in-patient rehabilitation

The IRF-PAI is used to assess and document clinical and functional status The Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) is collected on all Medicare patients who receive services from an inpatient rehabilitation unit or hospital. The data collected for IRF-PAI are used to measure quality of care. Initial emphasis of intervention is on adjustment to disability Involves up to 3 hours of combined therapy services The context may have a simulated living space to practice specific ADL skills Evaluation includes the inpatient rehabilitation facility- patient assessment instrument (IRF-PAI) Clients in this setting may benefit from interacting with people experiencing similar conditions Medical stability is a requisite for admission

Short Form-36 Health Survey (SF-36)

This is a survey used as a measure of general health and well-being. It has been used in medical outcomes studies and is sensitive to change in health status.

An OTR is evaluating a client who has an ulnar nerve injury at the wrist level of the right dominant extremity. During which task would this injury be MOST evident? A.Turning a key in the car ignition B.Operating a desktop calculator C.Holding coins in the palm of the hand D.Carrying a briefcase

Ulnar nerve palsy at the wrist impairs the hypothenar muscles and first dorsal interosseous muscle resulting in the difficulty turning a key or performing a lateral pinch.

Which dressing task requires the MOST challenging integration of performance skills and patterns for a typically developing 3-year-old child?

Unfastening the zipper of a front-opening jacket This skill requires a complex integration of visual and somatosensory systems that typically develops by the third year of age.

Dystonia

involuntary muscle contractions that result in slow twisting or repetitive movements, or abnormal sustained postures, that are triggered by attempts to move. DURING MOVEMENT Repetitive and sustained movements Awkward postures Movements that are rapid or slow and are often painful Involuntary movements triggered by attempts at controlled movement Involuntary movements occur more frequently when the person is tired, anxious, tense or emotional Pain may also result in an increase in these movements

neuromuscular electrical stimulation

may be used as an alternative to an orthotic A clinical objective is to increase muscle strength prevent muscle atrophy facilitates muscle contraction immediate tissue response is vasodilation Adjunct to treatment to enhance wound healing promotes motor control Contraindicated over metal hardware and pins

Long-term acute care

most beneficial discharge disposition for pts. w/ high level of medical complexity -including the need for a ventilator for respiratory support ex: patient who was admitted to the hospital due to a pulmonary exacerbation of cystic fibrosis. Current medical interventions include mechanical ventilation support for breathing and multiple intravenous medications.

dystonia vs. dyskinesia

movement problems that commonly occur in Parkinson's disease (PD). You may experience one or both of them, particularly in late-stage PD. Dystonia is muscle stiffening caused by PD, while dyskinesia is a type of muscle twisting caused by some PD medications. Dystonia Prolonged, involuntary muscle contractions Affects a specific muscle or group of muscles Causes abnormal posture or muscle spasm Contorts part of the body Causes pain (sometimes debilitating) Tends to occur when effects of PD medication dip Dyskinesia Involuntary, continuous muscle movements Affects large muscle groups (arms, head, trunk, legs) Smooth, repetitive movement often described as a rolling or writing motion Can begin suddenly and stop after several minutes Not typically painful More likely to occur when PD medication effects are at their peak

Spacticity

muscle resists stretching, increased muscle tone -Either flexors or extensors are affected but not both -Hyperactivity of the muscle spindle's phasic stretch reflex -Typical lower extremity pattern is extension -Measured by the tardier scale -Quick passive stretch followed by release in sudden resistance followed by release -babinski sign is typical -modified ashworth -accompanied by clasp knife reflex type= clonus

OTR Study Guide Domain 1: Practice Test An OTR is evaluating the visual function of a patient who is emerging from coma. The patient opens eyes spontaneously and in response to auditory stimulation. What visual function is MOST IMPORTANT for the OTR to observe in a patient at this level of function?

oculomotor control It is beneficial to assess basic visual skills such as oculomotor control when a patient is emerging from coma.

Spinal Shock

physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. spinal shock presents with total flaccid paralysis and loss of all reflexes below the level of injury. Spinal shock usually lasts for days or weeks after spinal cord injury and the average duration is 4 to 12 weeks. Spinal shock is terminated earlier and the pyramidal tract signs and defense reactions occur sooner in incomplete lesions than with complete transverse lesions.

Decerebrate posturing

posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.

median nerve injury

produces carpal tunnel-like symptoms, such as palmar numbness and numbness of first digit to half of the fourth digit, with generalized weakness and pain volar surface of the thumb, index, long, and radial half of the ring fingers

superficial heat modality

skin temp increase by 18 degrees tissue 1 cm deep increases by 6 degrees 2 cm deep increase by 2 degrees Adjunct to occupation-based intervention for stiff joints Good for chronic arthritis causes perfusion (passage of fluid throughout the at the wound site ex: fluidotherapy Contraindicated over the thoracic region over acute edema

Athetosis

slow, continuous, involuntary, writhing movements that are present at rest and made worse by attempts to move DURING REST fluctuations in muscle tone - with muscle tone alternating between being floppy (hypotonia) and extremely variable motion (hyperkinesias) One difficulty caused by this fluctuation in muscle tone is the inability to maintain a posture. This means that sitting and standing still can be difficult and a person may need to work and concentrate harder than usual to get their hand to a certain spot (like scratching their nose). Noticeable slow and stormy, involuntary muscle movements Can cause a person to appear restless and constantly moving Unwanted movements may be small or big, rapid, irregularly repetitive, random or jerky Slow, writhing movements associated with athetosis usually affect the hands, feet, arms or legs The involuntary and uncontrollable movement fluctuations sometimes affect the whole body Muscles of the face and tongue can also be affected causing grimacing and drooling Athetosis can affect a person's ability to control lip and tongue movements, breathing and vocal cords. Speech can be affected to some degree in people with athetosis Similarly, a person with athetosis may experience difficulties with eating and drinking A person with athetosis is often only able to be still when they are fully relaxed Athetoid movements ususally disappear completely when a person is asleep Athetoid cerebral palsy makes it difficult to hold onto an object, like a pencil or cutlery, due to fluctuating muscle tone The abnormal movement caused by athetosis often increases in response to emotional stress.

rigidity

the physical property of being stiff and resisting bending -increased resistance through full ROM -Involves extrapyramidal pathways of basal ganglia -Associated with decorticate posturing -lead pipe and cogwheel -Associated with stiff person syndrome -Characteristic of Parkinson's

Life Review

the point in life in which people examine and evaluate their lives -effective psychological intervention, defined as a process of recalling, evaluating, and integrating life experiences to facilitate achievement of ego integrity in the final stage of life *reduced depression, increased life satisfaction, self-acceptance, bonding, reconnecting with family and friends, catharsis (process of releasing strong suppressed emotions) pop: empower older adults facing end-of-life issues to help find hope, value, and meaning in their lives. Depression, dementia (life story: build a personal biography)

Cyrotherapy

therapeutic use of cold has a numbing effect Used in conjunction with elevation to reduce edema cold compress, vapocoolant (provide transient anesthesia via evaporation-induced skin cooling, which reduces pain) administered in the acute inflammatory phase indicated for acute arthritic flare ups contradicted.... raynaurds

Cerebral Shock

time of profound depression of motor function in which all muscles of the affected body segments are involved; used to describe the temporary flaccid state in the muscles of the person following a brain injury when the nervous system is in a state of shock after a lesion of acute onset.