Neurological Impairments

A COTA® and OTR® are discussing wheelchair options with a client with incomplete T3 spinal cord injury. The client asks whether the purchase of an electric wheelchair should be considered. How would the OTR® and COTA® BEST respond? A. Electric wheelchairs are useful for long distances, although a manual wheelchair can promote improved function. B. Electric wheelchairs are very expensive and may not be covered by primary payer sources. C. Electric wheelchairs are large and bulky and will prevent accessibility in the home and community. D. Electric wheelchairs may stunt future progress in rehab.

A Clients with T3 spinal cord injury are generally independent in their wheelchair mobility; recommendations include a rigid or folding lightweight wheelchair.

A client who has a C5 spinal cord injury wants an electronic aid to daily living for operating devices in the home. Which feature is MOST IMPORTANT for the device to have? A. Speech recognition B. Contoured trackball C. Joystick control D. Touch screen

A A client with a C5 spinal cord injury will not have hand or wrist function, so operating switches and other devices in the home will require a speech-recognition electronic aid to daily living. ----- B, C, D: A client with a C5 spinal cord injury will not have hand or wrist function, so devices such as a trackball, joystick, or touchscreen that require fine motor control are not appropriate as electronic aids to daily living.

A COTA® is preparing a client with T1 spinal cord injury for discharge to home alone. What is the BEST recommendation for required home assistance? A. Homemaking assistance for a few hours a daily B. Attendant care 24 hours a day C. Attendant care 12 hours a day D. Homemaking assistance for several hours daily

A A client with low-level (T1) SCI should be independent in personal care and only require a few hours of homemaking assistance each day upon discharge.

A COTA® is working with a client in the active phase of C6 spinal cord injury. What piece of durable medical equipment would be BEST suited for assisting in the client's community mobility? A. Power recliner with standard arm drive B. Lightweight folding wheelchair C. Power recliner with head control D. Manual rigid wheelchair

A At C6, wrist extension is still preserved at some functional level, allowing for the control of a power recliner with standard arm drive.

A COTA® is treating a client who is in a vegetative state after a traumatic brain injury (TBI). The OTR®; has identified the need to use restorative strategies with the client. Which restorative strategy is MOST appropriate for this client? A. Upright positioning strategies in a wheelchair to normalize muscle tone and facilitate arousal B. Sensory stimluation program to facilitate simple command following C. Self-feeding program that simplifies the task and provides success for the client D. Behavioral reinforcement program to reinforce the client's on-task performance

A Positioning a client with a TBI upright in a wheelchair provides optimal positioning to minimize abnormal tone and increase stimulation to the client's visual and vestibular systems. ---------- B: Sensory stimluation should be implemented on a case-by-case basis and is useful in supporting the client's emergence from coma. However, evidence of the effectiveness of sensory stimluation programs is not sufficient to warrant their use as a primary intervention. C, D: The client is not at a level of consciousness sufficient to participate in ADLs or to benefit from a behavioral reinforcement program.

A COTA® is working with a patient who has spastic hemiplegia and decreased trunk control secondary to a CVA. The patient is beginning to ambulate using a quad cane with standby assistance. The COTA® observes that the patient has decreased trunk stability during dressing activities. Which activity would promote increased trunk control during a dressing task while seated? A. Using the unaffected arm to reach for clothing positioned next to the affected side B. Putting the affected arm in a shirt sleeve while looking into a mirror C. Reaching with the unaffected arm to pick up a shoe from the floor D. Weight-bearing on the affected arm while buttoning a front-opening shirt with the unaffected hand

A Reaching across the body with the unaffected arm while the affected side provides weight-bear support will facilitate trunk control in the client with a CVA.

A COTA® was informed by the supervising OTR® that an evaluation was just completed on a client who has recently experienced traumatic brain injury. The client's chart lists a Glasgow Coma Scale (GCS) score of 7. What does this score imply? A. The client has experienced a severe head injury and will provide minimal feedback. B. The client has experienced a moderate head injury and may not be able to provide discernible feedback. C. The client has experienced a mild head injury and may be confused but able to follow simple commands. D. The client has experienced an extreme head injury and will provide minimal feedback.

A Severe head injuries include GCS scores of 8 or less. ------------- B: Moderate head injuries include GCS scores of 9-12. C: Mild head injuries include GCS scores of 13-15. D: The GCS does not classify an "extreme" head injury.

A client with stroke is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg. What learning has occurred for the client? A. Generalization B. Transfer C. Automaticity D. Acquisition

A The client demonstrates generalization, which is the ability to take a strategy used with one task and apply that strategy to a new task. ------------- B: Transfer occurs when clients dress themselves at home in the same way they did in their hospital room. C: Automaticity is the ability to perform tasks with little or no contribution of consciousness; the client has not yet demonstrated automaticity. D: Acquisition is a training strategy that relies on conscious control and requires practice and drill exercises. Acquisition is a cognitive strategy, not a method of learning.

A COTA® is performing upper-extremity activities with a client experiencing left hemiparesis. The COTA® notes a decrease in ROM in the left upper extremity. What factors BEST describe this decrease in ROM? A. Edema, joint contracture, and weakness B. Edema, muscle tone, and sensation C. Sensation, muscle tone, and proprioception D. Sensation, ataxia, and proprioception

A The client is most likely experiencing weakness, edema, and contracture of the left upper extremity as a result of the left hemiparesis.

For a client with C5 spinal cord injury (SCI) in the acute phase of rehabilitation, what is the BEST position to place the client's forearms in? A. Pronation B. Supination C. Flexion D. Extension

A The forearm should be pronated because clients with C5 SCI are prone to contractures in their supinators because of their inability to pronate actively.

A COTA® is working with a client with C5 spinal cord injury. The OTR® asked the COTA® to make a splint for the client. What is the BEST position in which to splint the wrist to prevent deformity in the acute stage of injury? A. Wrist extension, thumb opposition B. Wrist neutral, thumb opposition C. Wrist extension, thumb adduction D. Wrist extension, thumb free

A When splinting in acute spinal cord injury, the wrist should be extended with thumb opposition to preserve web space and prevent deformity

A COTA® is working with a client who has cognitive deficits after a stroke. The OTR® wants the client to be able to complete transfers when the client discharges to home. What strategies should the COTA use to enhance the client's ability to transfer at home? Select the 3 BEST choices. A. Instruct the client to use a global strategy such as "goal, plan, do, check" to orient to daily occupations B. Address transfers in the client's hospital room, the clinic treatment area, and the hospital recreation room C. Provide the client with visual feedback on trunk posture by having the client sit in front of a mirror during toileting D. Practice bridging in the client's hospital room bed to increase trunk extension E. Train the client in the use of external memory strategies for transfers such as step-by-step photos or a checklist F. Complete multiple transfers in the client's hospital room throughout the day

A,B,E A: The "goal, plan, do, check" approach is a cognitive strategy from the CO-OP (Cognitive Orientation to daily Occupational Performance) program that can be used to promote ability to complete tasks such as transfers. B: Generalization involves the ability to use skills and complete tasks in different contexts. Transfers should be practiced in varied contexts to help generalize performance to the home environment. E: Use of memory strategies is one means to train the client to use existing cognitive skills to complete transfers.

A COTA® is working with a client who has an L2 spinal cord injury. What clinical signs relative to the injury level is the COTA likely to find 1-2 months postinjury? Select the 3 BEST choices. A. Lower-extremity muscles are spastic. B. Muscles are spastic relative to the level of injury. C. Sympathetic functions are hypoactive. D. Muscles are flaccid throughout innervation. E. Senses are elevated throughout the body. F. Sacral segments are spastic below the level of injury.

A,B,F A, B, F: Muscles below the level of injury generally develop spasticity because the monosynaptic reflex arc is intact but separated from higher inhibitory influences.

A client with a C5 spinal cord injury wants to read a book. Which assistive technology devices will help the client perform this activity? Select the 3 BEST choices. A. Speech recognition software B. Long opponens splint C. Joystick control D. Touch screen E. Contoured trackball F. Adaptive devices for page turning

A,B,F A: A client with a C5 spinal cord injury does not have hand or wrist function, so this client requires a speech recognition electronic aid to daily living to operate switches and other devices in the home. B: The long opponens splint provides support for muscles that are weak as a result of this level of injury. There is absence of wrist and hand movement. F: At this level of injury, there is absence of forearm pronation and elbow extension. Adaptive devices provide support to complete this activity. --------- C, D, E: A client with a C5 spinal cord injury does not have hand or wrist function, so devices such as a trackball, joystick, or touchscreen that require fine motor control are not appropriate as electronic aids to daily living.

A patient in an inpatient facility sustained a TBI 2 weeks ago and is currently functioning at Level IV (confused-agitated) on the Rancho Los Amigos scale. Which methods should the COTA® consider for getting the patient's attention at the start of a session at bedside? Select the 3 BEST choices. A. State the patient's name in a calm voice and establish direct eye contact B. Firmly rub the patient's sternum until the patient responds C. Pass a strong-smelling substance back and forth under the patient's nose D. Hold the patient by the chin so the patient cannot look away E. Listen for possible confabulation by the patient in responses to questions F. Be aware that the patient may not be able to differentiate between persons and objects

A,E,F A: Stating the patient's name in a calm voice and establishing eye contact are effective strategies for getting the attention of patients at Level IV, who are confused and agitated and have a short attention span. E: Any social interaction, including responses, may not match the question. The patient may be euphoric or hostile. Attention span is often short, and interactions may be inappropriate to the environment. F: There is often a "detachment" to the outside environment. The patient may not be able to cooperate directly with treatment.

A client who has a T2 spinal cord injury is learning to independently transfer to a variety of surfaces. Which type of transfer is BEST for this client to use when transferring from a wheelchair to a car? A. Sliding board B. Stand-step C. Stand-pivot D. Bent-pivot

A. A client with a T2 spinal cord injury is able to complete independent transfers that may require the use of a sliding board.

Performing a functional transfer with a client with CVA, the COTA® blocks the client's affected knee and instructs the client to reach for the desired surface and move toward the stronger side. What transfer technique does this BEST describe? A. Assisted stand pivot B. Bent pivot transfer C. Maximum assist transfer D. Dependent lift transfer

A. An assisted stand pivot is used to move a client from one surface to another. --------- B: This transfer involves equal weight bearing between both lower extremities and knees bent. C: Because the client is standing and performing the primary movements required for transfer, the client is not likely requiring maximum assistance from the COTA®. D: In a dependent transfer, the COTA® (or device) is completing the entirety of the work.

Which occupational therapy assessment tool for motor and sensory function would BEST be used with the population with spinal cord injury in determining baseline performance? A. American Spinal Injury Association (ASIA) Scale B. Canadian Occupational Performance Measure (COPM) C. Modified Ashworth Scale (MAS) D. Manual muscle testing

A. The ASIA Scale is used to determine baseline sensory and motor control performance for clients with spinal cord injury. ---------- B: The COPM provides information about the client's perceived satisfaction with performance of daily occupations. C: The MAS assesses muscle tone and would not provide information about sensory function. D: Manual muscle testing is used to grade muscle strength and would not provide information about sensory function.

A COTA® is working with a client with traumatic brain injury to promote orientation to place and time. The client is at Rancho Level IV (i.e., with confusion and agitation). What intervention is appropriate to improve the client's orientation to place and time? A. Have the client use a logbook that provides a calendar with the current therapy session schedule B. Engage the client in a daily self-care routine of showering, dressing, and grooming C. Allow the client to guide intervention sessions by providing minimal structure to the sessions D. Organize an orientation group in which the client can share perceptions of orientation

A. A logbook allows a client to have passive orientation provided by family or staff. Providing the current therapy schedule in the logbook may increase the client's awareness of timing.

An inpatient is functioning at Level V (confused, inappropriate) on the Rancho Los Amigos Scale after having a TBI 3 weeks ago. What should be the focus of intervention during this phase of rehabilitation? A. Simple, familiar activities B. Multisensory stimulation C. Compensatory strategies for self-care D. Dressing using assistive devices

A. A patient at Level V would be more successful completing familiar, previously learned tasks because of the patient's limited attention span, impaired memory, and lack of initiation.

An inpatient is functioning at Level V (confused, inappropriate) on the Rancho Los Amigos Scale after having a TBI 3 weeks ago. What should be the focus of intervention during this phase of rehabilitation? A. Simple, familiar activities B. Multisensory stimulation C. Compensatory strategies for self-care D. Dressing using assistive devices

A. A patient at Level V would be more successful completing familiar, previously learned tasks because of the patient's limited attention span, impaired memory, and lack of initiation. ---------------------- B: Multisensory stimulation is important at lower levels of function (Level II and Level III) as the patient attempts to increase responsiveness to the environment. C: A patient at Level V will not be able to learn new tasks or strategies, so teaching compensatory strategies would not be appropriate. D: A patient at Level V will not be able to learn new tasks or strategies, so dressing with assistive devices would not be appropriate.

An OTR® recently completed an evaluation with a client with T4 spinal cord injury (SCI). The COTA® will begin treating this client the next day. In development of a client-centered intervention plan, what INITIAL activity may the client need assistance with? A. Transfer training B. Eating training C. Cognitive training D. Dexterity training

A. Clients with T4 SCI will need assistance with transfers because of lower-extremity paralysis. -----------------

A COTA® is approaching a client with stroke to begin an intervention session in inpatient rehabilitation. The client is sitting at the dining table in a wheelchair with hips extended and is leaning on the unaffected left upper extremity. What should the COTA's FIRST approach be? A. Reposition the client in the wheelchair with hips flexed at 90° and the upper extremity resting in the lap B. Transfer the client to another wheelchair that provides a lap tray for upper-extremity support C. Transfer the client to a standard chair with arms for positioning in posterior pelvic tilt D. Recommend further assessment by the OTR®; to determine the client's postural needs

A. Ideal seated posture for a client with hemiparesis is hips flexed at 90° with shoulders over hips and arms relaxed in lap; the upper extremities should not be used to provide support in sitting. --------------------- B: Clients with hemiparesis need frequent repositioning in sitting to maintain upright posture; information has not been presented that indicates the client needs a different wheelchair. Providing a lap tray may interfere with the client's spontaneous use of the affected upper extremity, so lap tray use should be avoided unless absolutely necessary. C: Changing the chair surface does not necessarily improve the client's positioning in the chair. D: Although further assessment may be needed, correcting the client's positioning is the first priority

A client with traumatic brain injury is at Rancho Level IV (i.e., confusion with agitation). The client is demonstrating the ability to use mental repetition with cues from the COTA® during basic self-care routines. The COTA wants the client to be less reliant on the verbal cues and able to self-monitor performance during the tasks. What strategy is appropriate for the COTA to use?' A. Have the client estimate and report the difficulty of a task before completing it B. Provide the client with a verbal description of the client's task performance C. Organize increasingly complex self-care routines by providing highly structured practice D. Give consistent, reliable tactile cues throughout self-care completion

A. The client is already receiving external feedback from the COTA and needs to create internalized feedback mechanisms to decrease reliance on cueing. Self-estimation of task difficulty is one method to generate internal feedback. ------ B: Providing a verbal description of the client's task performance promotes continued reliance on the the COTA for feedback on task performance. C: Structured practice sessions require task setup by and continued reliance on the COTA for task performance. D: Tactile cues require continued interaction with the COTA during task performance and continued client reliance on cues.

A client with traumatic brain injury is at Rancho Level IV (i.e., confusion with agitation). The client is demonstrating the ability to use mental repetition with cues from the COTA® during basic self-care routines. The COTA wants the client to be less reliant on the verbal cues and able to self-monitor performance during the tasks. What strategy is appropriate for the COTA to use? A. Have the client estimate and report the difficulty of a task before completing it B. Provide the client with a verbal description of the client's task performance C. Organize increasingly complex self-care routines by providing highly structured practice D. Give consistent, reliable tactile cues throughout self-care completion

A. The client is already receiving external feedback from the COTA and needs to create internalized feedback mechanisms to decrease reliance on cueing. Self-estimation of task difficulty is one method to generate internal feedback. --------------- B: Providing a verbal description of the client's task performance promotes continued reliance on the the COTA for feedback on task performance. C: Structured practice sessions require task setup by and continued reliance on the COTA for task performance. D: Tactile cues require continued interaction with the COTA during task performance and continued client reliance on cues.

A COTA® is working with a client with C5 spinal cord injury. What is the BEST splinting strategy to use to encourage sensory feedback? A. Use of padded splints B. Use of dorsal splints C. Use of hand-based splints D. Use of dynamic splints

B A dorsally based splint will allow for maximal sensory feedback while worn. --------------------------- A: Padded splints limit sensory feedback. C: Although hand-based splints may improve sensory feedback, by removing volar obstruction, the client will be more equipped to experience sensory feedback. D: Dynamic splints prescribe a low-load resistance and generally cover a large surface of the hand and arm.

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The COTA® will be treating the client after the evaluation is completed. The client is swearing and anxiously looking for something. What Rancho Los Amigos level BEST corresponds with the client's behavior? A. VI B. IV C. V D. II

B Because the client is confused and agitated, the behavior most closely resembles Level IV: confused-agitated.. ------------------ A: At Level VI, the client would be confused, but he or she generally would not be agitated. C: Although confusion and memory issues are profound at Level V, the client would generally not be behaving erratically. D: Level II implies low levels of activity and limited responses.

For a client with an L2 spinal cord injury, which statement BEST describes the muscle segments below the injury level 1 to 2 months postinjury? A. Senses are elevated. B. Muscles are spastic. C. Sympathetic functions are hypoactive. D. Muscles are flaccid.

B Because the monosynaptic reflex arc is intact but separated from higher inhibitory influences, muscles below the level of injury generally develop spasticity. ------------------------- A: Sensory loss below the level of injury is common. C: Sympathetic functions below the level of injury are hyperactive. D: Although muscles may be initially flaccid for a short period of spinal shock, spasticity regularly develops below the injury.

During a commode-to-bed transfer, the client begins to slip from the COTA®'s grasp. What action is best for the COTA® to take? A. Continue with the transfer, and try to get the client to the bed as quickly as possible. B. Have the client return to the commode. C. Ease the client to the floor, then get assistance. D. Call for help, and get the attention of the client's nurse.

C Easing the client to the floor protects both the client and the therapist from injury.

While reviewing the chart of a client with spinal cord injury, the COTA® notices that the client has experienced past episodes of autonomic dysreflexia in the hospital. What is the BEST recommendation the COTA® can make to the client concerning dysreflexia? A. Suggest that the OTR® treat the client because the COTA® is unfamiliar with the condition. B. Suggest the client carry an emergency card describing the condition for medical personnel and others. C. Suggest the client wear elastic stockings and abdominal binders to increase blood pressure. D. Suggest the client leave sessions early if experiencing symptoms.

B Clients susceptible to autonomic dysreflexia are encouraged to carry an emergency card describing the condition and treatment. ----------------- A: COTA®s must be aware of the symptoms of and treatment for autonomic dysreflexia because it can occur at any time postinjury. C: Increasing blood pressure is not indicated to prevent autonomic dysreflexia. D: The client should not be left alone if experiencing symptoms of autonomic dysreflexia.

The upper-extremity movements of a client diagnosed with a traumatic brain injury (TBI) are exaggerated, and the client consistently over- or underreaches for an item. What term BEST describes the client's movements? A. Spasticity B. Ataxia C. Bradykinesia D. Tremor

B The client is exhibiting ataxic movements. ------------ A: Spasticity involves a velocity-dependent resistance. C: Bradykinesia involves velocity-independent resistance. D: Tremors are involuntary rhythmic oscillations, although not as exaggerated as those seen in clients with ataxia.

During passive range of motion (PROM) exercises for a client with stroke, the client's shoulder is resistant to flexion beyond 90°, although the client reports being pain free. What does this finding suggest to the COTA®? A. Shoulder subluxation is inhibiting movement. B. The scapula is not gliding to produce full flexion. C. The humerus is locked in against the acromion. D. Spasticity is preventing the shoulder from reaching full range.

B The muscles supporting the scapula have likely shortened from disuse and are limiting the full range of shoulder motion. Both the humerus and the scapula must move to support full shoulder motion. --------------------- A: Shoulder subluxation would limit ROM because of the pain it causes, but this client is without pain. C: Mechanical joint limitations such as the humerus hitting the acromion during PROM would result in painful motion. D: Spasticity limits full ROM when velocity is a factor in movement; slow passive movement with a limitation in motion suggests that soft tissue shortening of muscles is limiting the range.

What would be considered the first line of treatment in the acute setting for the medical management of a cardiovascular accident (CVA)? A. Anticoagulants B. Thrombolytic agents C. Antiplatelet treatments D. Nonsteroidal anti-inflammatory drugs

B Thrombolytic agents are the first line of treatment in the acute management of CVA to dissolve the clot that is blocking the flow of blood through its vessel. ----------- A: Anticoagulants are second in the line of treatment to prevent new clots from forming. C: Antiplatelet treatments work in the same manner as anticoagulants to prevent clots from forming and are also considered a second line of defense. D: Nonsteroidal anti-inflammatory drugs are often contraindicated for patients with CVA.

During a commode-to-bed transfer with the use of a gait belt, the client begins to slip from the COTA®'s grasp. Which actions are appropriate for the COTA to take? Select the 3 BEST choices. A. Continue with the transfer and try to get the client to the bed as quickly as possible B. Push forward against the pelvis and pull back on the anterior chest C. Ease the client to the floor, then get assistance D. Call for help and get the attention of the client's nurse E. Support the client with the use of the gait belt F. Have the client return to the commode

B,C,E B: If the client falls forward, the COTA can push forward against the client's pelvis and pull back on the anterior chest to help the client regain a standing stance and avoid a fall. C, E: Easing the client to the floor protects both the client and the COTA from injury. Support through the use of a gait belt protects the client. ------ A, F: Trying to move the client too quickly or to reverse the transfer can result in injury to both the client and the COTA. D: Help may not arrive in time to assist; calling for help increases the risk of dropping or injuring the client.

What piece of adaptive equipment is MOST useful for a client with an incomplete T2 spinal cord injury? A. A weighted spoon B. A long-handled sponge C. A plate protector D. A button hook

B. Clients with a T2 spinal cord injury will need assistance reaching and washing immobile lower extremities.

A client has C6 complete tetraplegia. Which hand functions can this client be expected to demonstrate? A. Limited grasp to pick up an item between the proximal and distal interphalanges B. Ability to pick up an object by stabilizing it between the palms of both hands C. Inability to use the hands for any functional tasks or object manipulation D. Ability to manipulate the power control of a wheelchair using the tips of the fingers

B. Radial wrist extension allows the client with C6 tetraplegia to stabilize the hands for compensatory grasp activities such as picking up a bottle or sliding an object to the edge of the table. -------------- A, D: A client with C8 tetraplegia would be able to demonstrate movement of the extrinsic finger muscles and thumb flexors to flex proximal and distal interphalanges to grasp objects. C: Clients with C1 to C5 spinal cord injury lack the wrist movement and finger innervation to functionally use both hands. Clients with injury at the C5 level are able to use the hands for feeding and other tasks when wrist supports and adaptations for grasp such as universal cuffs are included.

A client with a C6 spinal cord injury (SCI) is performing a dressing task. Which type of equipment would the COTA® most likely give the client to assist with buttoning a shirt? A. No adaptive equipment would be needed B. Palmar-cuff buttonhook C. Extended buttonhook D. Standard buttonhook

B. A client with a C6 SCI may not be able to grasp a buttonhook with the fingers, so a palmar cuff would provide the needed grasp.

A patient who has a complete C7 spinal cord injury is learning adaptive dressing techniques. What dressing goals should the patient be expected to achieve? A. Independence with upper and lower body dressing with contact guard assistance B. Independence with upper body dressing and minimal assistance with lower body dressing C. Minimal assistance with upper and lower body dressing using assistive devices D. Standby assistance for lower body dressing with adaptive equipment

B. A patient with a complete C7 spinal cord injury would be able to dress the upper body independently and the lower extremities with some assist, using assistive devices as needed. --------------------- A: A patient with a complete C7 spinal cord injury would possibly be able to dress the lower body independently with assistive devices, but this is not the most expected achievable goal. C: A patient with a complete C7 spinal cord injury would be able to dress the upper body independently and would not require minimal assistance, although minimal assistance would likely be needed for lower body dressing. D: A patient with a complete C7 spinal cord injury would be independent with upper body dressing and would not require standby assistance; he or she would require minimal assist with lower body dressing.

The COTA® is treating a client who presents with hemiplegia from a cardiovascular accident. The client's hand is flaccid. To fabricate a custom resting hand orthosis, in what position should the COTA® place the wrist and metacarpophalangeals (MCPs)? A. Wrist at 10° flexion and MCPs at 0° flexion B. Wrist at 25° extension and MCPs at 55° flexion C. Wrist at 45° flexion and MCPs at 10° flexion D. Wrist at 60° flexion and MCPs at 0° flexion

B. A resting hand orthosis keeps soft tissue positioned in optimal mobility with flexion of the MCPs at 45° to 60°; 55° would accomplish this, and 25° of slight extension would maintain the wrist in a position that would not compromise the median nerve.

A COTA® is working with a client in the active phase of C6 spinal cord injury. What is the MOST IMPORTANT treatment activity to consider? A. Providing accessibility recommendations B. Educating on preventative health measures C. Developing pressure relief methods D. Recommending durable medical equipment

C A high priority for the active phase of rehabilitation is determining a method to prevent decubitus ulcers

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The OTR® asks the COTA® to score the client on the Glasgow Coma Scale, because service competency in this assessment has been established. The client only opens the eyes when the COTA® applies a mild pinch to the client's arm. What score should the COTA® give the client on the Glasgow Coma Scale Eye-Opening Response category? A. 7 B. 3 C. 2 D. 4

C Because the client is currently responding to pain only, the COTA® would give the client a 2 for the eye-opening response category. ------------------ A: The Glasgow Coma Scale Eye Opening Response category has no Level 7. B: Level 3 requires the client to respond to verbal command or speech. D: Level 4 requires the client to open the eyes and to blink at baseline.

A client with stroke is receiving occupational therapy services to increase independence with feeding, grooming, hygiene, and toileting. What area of function is likely to MOST influence the client's performance in these ADLs? A. Decreased upper-extremity range of motion (ROM) B. Limitation in swallowing ability C. Postural instability for sitting and standing D. Deficits in visual-perceptual skills

C Clients with stroke often experience postural imbalance and difficulty making postural adjustments during activities. The client's base of support is the first consideration in improving the sitting and standing ability required to complete ADLs. ------------- A: Upper-extremity ROM is often affected by a stroke and influences postural stability. Although many clients do not regain upper-extremity function, they can be functional with ADLs by improving postural control. B: Swallowing ability is influenced by the client's postural control ability. D: Visual-perceptual skills may affect ADL ability, but postural stability provides the basis for a client's ability to complete ADLs.

The extremities of a client with brain injury in an acute care unit are in a position of spastic extension, adduction, and internal rotation. The client is displaying symptoms of which condition? A. Decorticate rigidity B. Torticollis C. Decerebrate rigidity D. Athetosis

C Decerebrate rigidity involves the client's lower and upper extremities in a position of spastic extension, adduction, and internal rotation.

A client who had a CVA is setting the table during a cooking group. The COTA® observes that the client consistently positions the eating utensils for each place setting to the right of the plate. What INITIAL action should the COTA® do based on this observation? A. Determine whether this functional deficit is evident during other tasks B. Ask the OTR® to evaluate the client for figure ground deficits C. Identify the typical routines the client uses for this task at home D. Teach the client proper techniques for preparing the dining environment

C How a client typically performs or sequences occupations in his or her daily life is important in determining whether the client's performance is deficit related or based on habit. ------- A, B: The client's typical routine for setting the table may involve putting the utensils to the right of the plate, so this performance may not be related to a deficit in other tasks or related to figure ground deficits. D: If setting the utensils to the right of the plate during meals is the client's typical routine, it is not necessary for the client to learn a proper technique for setting the table.

A COTA® is providing dressing skills training for a client with traumatic brain injury (TBI). The client has a sequencing deficit. What strategy is appropriate for the COTA to use with this client? A. Use picture cards of dressing and have the client put the steps of dressing in order B. Have the client write out the steps in dressing using paper and pencil C. Hand the client each item of clothing and provide assistance in donning the item D. Ask the client which clothing item should be selected next

C Minimizing environmental distractions and decreasing the complexity of the task allows the client with TBI to experience success with completion of one step of the task at a time. ----------------------- A, B: Tabletop activities will not generalize or transfer to the client's ability to dress successfully. D: Asking the client questions about which step of the task comes next may present too great a challenge and increase the client's frustration.

A client with spinal cord injury has been on bedrest for several days. The COTA® is preparing to begin mobility activities with the client. What device is best to use for mobilizing the client? A. Stander or standing table B. Standard wheelchair C. Tilt-in-space wheelchair D. Mat table for sitting

C Orthostatic hypotension often occurs with deconditioning from bed rest, and a tilt-in-space wheelchair allows the client to be reclined quickly if the client's blood pressure drops too low in sitting.

An inpatient is functioning at Level IV (confused-agitated) on the Rancho Los Amigos scale after sustaining a TBI 2 weeks ago. What method should be used to get the patient's attention at the start of a session at bedside? A. Pass a strong-smelling substance back and forth under the patient's nose B. Firmly rub along the patient's sternum until the patient responds C. State the patient's name in a calm voice and establish direct eye contact D. Hold the patient by the chin so the patient cannot look away

C Providing a calm environment and gaining the patient's attention through eye contact are effective strategies for a patient at Level IV, who has confusion, agitation, and a short attention span. --------------- A, B: Sensory stimulation through olfactory stimulation or tactile input are strategies for Levels II and III to increase a patient's responsiveness to the environment. D: A patient who is confused and agitated should not be restrained in an attempt to maintain attention to stimuli.

A client with stroke is demonstrating a 1-finger-width separation of the acromion and the head of the humerus. In the intervention session, what should be the FIRST step of the COTA®? A. Fit the upper extremity with a sling B. Recommend that the client not use the upper extremity C. Train the client and caregiver in safe handling of the upper extremity during transfers D. Provide PROM to minimize contractures of the upper extremity

C Providing training in safe handling techniques to properly position and move the affected upper extremity is the most important approach to addressing shoulder subluxation.

An OTR® receives orders to evaluate and treat a client with an S1 spinal cord injury. The COTA® will be assisting with the evaluation by performing a standardized assessment. Which instrument is MOST appropriate for assessing the client's current level of independence? A. Canadian Occupational Performance Measure (COPM) B. Nine-Hole Peg Test C. FIM™ D. Adult Sensory Profile

C The FIM is the most widely used disability measure in rehabilitation medicine and captures many basic disability areas. -------------- A: The COPM is used to detect changes in a client's self-perception of occupational performance over time. B: The Nine-Hole Peg Test measures finger dexterity and would not give a thorough picture of the client's level of independence. D: The Adult Sensory Profile identifies sensory process patterns and effects on functional performance.

An OTR® evaluated a client who has sustained a traumatic brain injury and used the Glasgow Coma Scale (GCS) to record the client's conscious state using the combined score. The COTA® reviews the GCS score in the client's chart in preparation for the first intervention session. Which of the following three responses is recorded with the GCS? A. Verbal, threat, autonomic B. Appropriate, motor, autonomic C. Eye opening, motor, verbal D. Eye opening, verbal, autonomic

C The GCS is an evaluative and reassessment tool that uses eye opening, verbal, and motor responses to track the level of consciousness of clients with head injuries.

What should a COTA® do for the affected upper extremity when positioning a client with hemiparesis in side lying on the affected side? A. Place in adduction B. Place on the humeral head C. Protract forward D. Support in internal rotation

C The affected upper extremity should be placed in protraction to allow optimal soft-tissue lengthening.

An OTR® has received evaluation orders for a client who recently experienced traumatic brain injury. The COTA® will be treating the client after the evaluation is completed. The client displays severe memory impairment and can only respond to simple commands without being distracted. What Rancho Los Amigos level BEST corresponds with the client's behavior? A. VII B. III C. V D. II

C The client is highly distractible and displays severe memory impairment but can respond to simple commands; therefore, the client most closely resembles Level V. ------------------------ A: A Level VII client has limited distractibility and is capable of carrying out an intelligible conversation despite minimal confusion. B: A Level III client inconsistently responds to stimuli and would not be capable of intelligibly responding to simple commands. D: A Level II client responds to stimuli only through physiological changes, gross body movement, or vocalization.

A COTA® is preparing a forearm splint for a client with a high complete spinal cord injury. What surface of the client's forearm should the base of the splint rest upon? A. Ulnar B. Medial C. Dorsal D. Volar

C The splint should be dorsal, rather than volar to ensure maximal sensory feedback while the forearm is resting on a surface. ------ A: Placing the base of the splint on the ulnar side of the client's arm reduces leverage and decreases maximal sensory ability. B: Placing the base of the splint on the medial side of the client's arm reduces leverage and decreases maximal sensory ability. D: Placing the base of the splint on the volar side of the client's arm largely blocks all sensory feedback.

The upper-extremity movements of a client with traumatic brain injury (TBI) are exaggerated, and the client consistently overreaches or underreaches for an item, such as during a feeding activity. How can the COTA address the impact of this condition? Select the 3 BEST choices. A. Allow the ataxic limb to move freely B. Provide a weighted-vest for mealtime C. Grasping a solid surface for stability D. Provide wrist weights for stabilization E. Apply resistance to reduce exaggerated movements F. Weight utensils to reduce the effects of movements

C,E,F. C: Holding onto a solid surface allows a person to provide support for the ataxic limb; although this approach will not correct the ataxia, it may serve to decrease its impact on daily activities. E: Applying resistance is a temporary means to address ataxia, but once resistance is removed, there is limited carryover of ability. F: Use of weighted utensils is a strategy for addressing ataxia during daily activities such as feeding

A COTA® is planning a feeding session with a client with a C5 spinal cord injury (SCI). Which feeding utensil or adaptive equipment would be MOST APPROPRIATE to introduce during the session? A. An electric self-feeder B. Utensils with built-up grips C. Mobile arm support D. Tenodesis orthosis

C. A mobile arm support is best for a client with a C5 injury because the client would most likely show shoulder muscle activity along with biceps and upper trapezius.

An inpatient who has a C6 spinal cord injury has met all occupational therapy goals and is preparing for discharge to live at home with caregiver assistance. What type of device should the OTR® recommend the patient use to maximize independence during self-care activities at home? A. Electronic aid to daily living B. Power wheelchair with head control C. Wheelchair-mounted mobile arm supports D. Custom-fitted tenodesis splint

D A patient with a C6 spinal cord injury can use a tenodesis splint because he or she will have partial wrist extension.

A patient who has a moderate hemiparesis is participating in homemaking activities. Which activity would MOST EFFECTIVELY incorporate graded weight bearing through the involved upper extremity? A. Vacuuming floors B. Washing dishes C. Folding towels D. Dusting a table

D Dusting a table allows the patient to bear weight through the involved upper extremity while the uninvolved upper extremity wipes the table.

A COTA® is completing an intervention to address a client's decreased postural stability when performing tasks in standing. The client has hemiparesis after a stroke. The COTA wants to elicit a postural response at the trunk when completing an intervention activity. Where should the COTA place task objects FIRST to elicit a trunk response? A. Above the client's head B. Within arm's reach C. On a moveable surface D. Beyond arm's reach

D Tasks that are beyond arm's reach will facilitate a weight shift and challenge the client's postural abilities. --------- A: Placing an object overhead facilitates a shift in the client's center of mass; however, this placement encourages the client to move up rather than forward or backward, left or right, or through rotation. B: Placing objects within arm's reach will not elicit a postural change. C: A moveable surface may elicit a client's postural shift but may be too challenging for the client as a first approach.

A client with traumatic brain injury is displaying decorticate rigidity. How would the client's upper-extremity position BEST be described? A. Flaccid and extended, with internal rotation and adduction B. Spastic and flexed, with external rotation and abduction C. Flaccid and flexed, with external rotation and abduction D. Spastic and flexed, with internal rotation and adduction

D Upper extremities in decorticate rigidity are spastic and flexed, with internal rotation and adduction.

A client with T5 spinal cord injury is having difficulty with lateral trunk flexion, which is limiting independent transfers. The client is returning to work as a banker and will be spending 4 to 6 hours continuously in a wheelchair. Which activity intervention should the COTA® consider FIRST? A. Have the client move in diagonal patterns of movement over a therapy ball B. Provide verbal cues for the client to realign the trunk during tasks C. Place objects on the floor that the client has to reach for D. Have the client practice weight shifting in the wheelchair for pressure relief

D Weight shifting for pressure relief is an essential skill to enable clients with spinal cord injury to minimize the risk of skin breakdown while completing tasks during the workday. -------- A: Dynamic seated postural tasks on a therapy ball provide too great a challenge for a client with T5 spinal cord injury and do not provide specific weight-shifting skills for the client. B: Trunk alignment is not the greatest challenge for the client in maintaining seated posture during work activities. C: A client who is having difficulty with lateral trunk flexion, especially a client with T5 spinal cord injury, is not able to immediately reach to the floor to pick up items.

A COTA® is working with a client with traumatic brain injury who is displaying decorticate rigidity. What clinical characteristics can the COTA expect to find? Select the 3 BEST choices. A. Upper extremities are flaccid, with internal rotation. B. Upper extremities are spastic, with external rotation. C. Upper extremities are flaccid, with external rotation. D. Upper extremities are spastic, with shoulder internal rotation and elbow flexion. E. Lower extremities are spastic, with hip internal rotation. F. Lower extremities are spastic, with ankle plantar flexion.

D,E,F. D: The upper extremities in clients with decorticate rigidity are spastic, with internal rotation in the shoulder and flexion in the elbow. E, F: The lower extremities in clients with decorticate rigidity are spastic, with internal rotation in the hip and plantar flexion in the ankle. -------------------- A, C: The upper extremities are spastic, not flaccid, with internal (not external) rotation in the shoulder and flexion in the elbow. B: The upper extremities are spastic, but rotation is internal.

What test is MOST APPROPRIATE to determine the level of consciousness of a client with a traumatic brain injury (TBI)? A. Canadian Occupational Performance Measure (COPM) B. Mini-Mental State Examination (MMSE) C. Minnesota Multiphasic Personality Inventory (MMPI) D. Glasgow Coma Scale (GCS)

D. The GCS is the traditional method used by health care professionals to assess levels of consciousness after traumatic brain injury. ---- A: The COPM is used to detect changes in a client's self-perception of occupational performance over time. B: The MMSE is a screening tool used to detect cognitive impairment. C: The MMPI assesses personality traits and psychopathology.

A COTA® is concerned with preventing shoulder pain in a client with hemiparesis in the acute stages of stroke recovery. Which intervention is appropriate to prevent shoulder pain in this client? A. Allow the client to dangle the hemiplegic upper extremity alongside the chair B. Position the client in side lying on the hemiplegic side with internal rotation and scapular retraction C. Use overhead pulleys with prolonged stretch at end range D. Emphasize activities that allow external rotation, shoulder flexion within 90°, and scapular protraction

The right answer is D Clients with hemiparesis should be encouraged to move the upper extremity with external rotation, shoulder flexion within 90°, and scapular protraction to allow for optimal motor recovery by promoting soft tissue elongation. ------------------- A:. The upper extremity of clients with hemiparesis should be supported at all times by resting it on a surface or using the unaffected upper extremity to position the affected upper extremity. Gravity provides too much force on already weakened muscles and may further the dissociation of the humeral head from the shoulder joint. B: Positioning of the upper extremity in clients with hemiparesis should emphasize external rotation to neutral and scapular protraction. C: Overhead pulley sytems should be avoided at all times because of the potential to increase pain in the upper extremity of clients with hemiparesis.

The COTA® reviews the cancellation test form in a client's chart. The form indicates that the client crossed out all letter Ms. What does this test assess? A. Visual acuity B. Literacy C. Spatial neglect D. Ocular motor control

c. Cross-out assessments are used in visual scanning and can be beneficial in detecting spatial neglect or visual field impairments. ----------- A: Visual acuity/clarity is more precisely measured with multiple alternate visual tests, such as the Snellen Eye Chart. B: Literacy would best be tested by sample-reading skills, not necessarily with a letter cross-out assessment. D: Ocular motor control is best assessed by observing the client's eyes for movement deficiencies when focused on an object, in light changes, and in tracking.

The extremities of a client with brain injury in an acute care unit are in a position of spastic extension, adduction, and internal rotation. The client is displaying symptoms of which condition? A. Decorticate rigidity B. Torticollis C. Decerebrate rigidity D. Athetosis

c. Decerebrate rigidity involves the client's lower and upper extremities in a position of spastic extension, adduction, and internal rotation. --------------- A: Decorticate rigidity involves upper extremities in spastic flexed position with internal rotation and adduction and the lower extremities in spastic extended position with internal rotation and adduction. B: Torticollis is a dystonic posture of the neck. D: Athetosis involves slow movements of the face, tongue, or limbs.