Neurodegenerative Diseases
An OTR® is working with a client in the acute phase of Guillain-Barré syndrome. Which client action demonstrates the ability to direct care? A. Stating that assistance is needed to change position in bed B. Reporting that less anxiety is experienced with ADL C. Making a phone call using the phone in the hospital room D. Telling nursing staff about the home living environment
The correct answer is A. A client in the acute phase of Guillain-Barré syndrome may not be able to participate directly in activities; asking for help with changing position in bed reflects an awareness of needs and the ability to request assistance. NOTE: B: A decrease in anxiety is beneficial, but it does not indicate ability to provide direction for care. C: Independent use of the phone does not indicate an ability to direct care. D: Telling nursing information about the home may be beneficial for discharge planning, but it does not demonstrate the client's ability to direct care.
An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The client requires close supervision on the stairs and seems to be very fearful when putting the foot down on each step. To further ensure the client's safety in getting up and down the stairs at the back door, what would the OTR® MOST likely recommend? A. Yellow contrasting tapes on the edge of each step B. Installing a ramp with handrails over the steps C. Teaching the client to use a cane on the stairs D. Referring the client to physical therapy for stair training
The correct answer is A. A client with Stage III Alzheimer's disease often begins to experience changes in vision and perception. Having yellow tape on the edge of each step helps to differentiate each step and prevent the client from missing one. NOTE: B: It is important to maintain what the client can do. Because the client can still walk and manage the stairs, a ramp is not necessary. C: Teaching the client to use a new assistive device such as a cane will be difficult and may even pose further fall risk when the client is not able to use the cane correctly. D: A referral to physical therapy is not indicated at this time because the client does not appear to have strength or balance deficits in negotiating the stairs.
A client who has Parkinson's disease reports increased tremors, problems knocking items over while eating, and poor articulation, leading to recent social isolation. Which intervention strategy would be MOST effective for this client? A. Educate about timing social activities when medication is most effective. B. Train in facial exercises to improve speech quality and communication. C. Provide utensils with built-up handles during mealtimes to decrease spills. D. Suggest a community support group to provide a social outlet.
The correct answer is A. Activities should be timed during medication "on" times. Determining a client's optimal time of day for activities promotes increased success in occupational performance. NOTE: B: Facial exercises may help improve communication but do not address increased tremors. C: Adaptive equipment for mealtimes addresses motor impairments but does not address speech concerns. D: A community support group may be an effective intervention once the motor impairment and communication difficulty issues are addressed.
An OTR® is evaluating a client with Guillain-Barré syndrome in a hospital setting. Which client factor should the OTR assess FIRST? A. Sensation B. Cognition C. Vision D. Hearing
The correct answer is A. Because of the painful sensations that are initially reported with Guillain-Barré syndrome, assessing the client's tolerance for tactile input and sensory abilities is important in determining an appropriate intervention plan. NOTE: B, C, D: Cognition, vision, and hearing are not affected by Guillain-Barré syndrome.
The caregiver of a client with Alzheimer's disease questions the home health OTR® about a recent increase in the client's dosage of donepezil (Aricept) prescribed by the physician. The caregiver is particularly concerned about potential consequences of the increased dosage. What is the OTR®'s most appropriate suggestion for the caregiver? A. Observe the client for signs of dizziness, which increases potential for falls. B. Because the medication can cause photosensitivity, keep the client out of direct sunlight. C. The physician will probably monitor the client closely for potential drug toxicity. D. Monitor the client's hydration carefully because the drug can cause dry mouth and constipation.
The correct answer is A. Donepezil is a cholinergic-modulating drug that may improve memory and cognition and reduce negative mood, anxiety, and hallucinations; however, dizziness is a side effect. NOTE: B, C, D: These side effects are not common with donepezil.
An OTR® is working with a client with Guillain-Barré syndrome who is in the recovery phase. Which intervention BEST addresses the needs of the client in this phase? A. Instruct the client in energy conservation and fatigue management strategies B. Start progressive resistive activities for strengthening at the client's greatest level of tolerance C. Advise the client to use assistive devices as much as possible to avoid fatigue while performing ADLs D. Provide wrist and finger resting splints to help the client avoid overuse of the hands
The correct answer is A. In the recovery phase of Guillain-Barré syndrome, taking rest periods without pushing to the point of fatigue is recommended while gradually increasing tolerance for activity. NOTE: B: Clients with Guillain-Barré syndrome should not be pushed to the point of fatigue, which will occur with strengthening at the highest level of tolerance. C: In the recovery phase, the client should be encouraged to achieve optimal function by gradually increasing tolerance for the number and complexity of tasks, so use of assistive devices would be discouraged. D: The client should be encouraged to use the upper extremities within tolerance for ADLs; use of a resting splint is not indicated.
As part of an intervention plan, a client with multiple sclerosis has had training in strategies to limit energy expenditure on meaningful activities. The client reports increased fatigue when grocery shopping in the afternoon. Which of the following items is a recognized energy management strategy to address this fatigue? A. Do grocery shopping in the morning. B. Maintain a lower body temperature to decrease fatigue. C. Use adaptive equipment for meal preparation. D. Participate in a water exercise program to help reduce weakness.
The correct answer is A. Moving important activities to the morning, when the client's energy is highest, can maximize activity completion. NOTE: B: Although increased body temperature can increase fatigue, no contextual factor is present that may increase the client's body temperature during the task of grocery shopping. C, D: These are not related to the client's problem.
Which suggestion that an OTR® might provide to a caregiver who is living with a client who has Alzheimer's disease (AD) is the BEST? A. Suggest appropriate activities that can engage the client during unoccupied time and improve daily structure. B. Suggest that the caregiver allow the client to continue cooking independently with adapted cooking utensils to improve safety. C. Suggest that the caregiver provide challenge to the client's daily routine by maintaining distance during routine tasks. D. Suggest modifications to the home environment to include arrows that lead to the bedroom and bathroom.
The correct answer is A. Providing structure to unoccupied time is an important consideration for clients with AD to prevent behavior problems and maintain quality of life. In addition, structure promotes an increase in goal-directed activity and may aid in more regular sleep patterns. NOTE: B: Providing education to the caregiver about when it would be appropriate to discontinue certain tasks is important; if cooking is unsafe, it is probably best to do it with supervision. C: Providing too much challenge to a client with AD can be frustrating and lead to an increase in problem behaviors. D: Visual cues could be useful, but structured time would be the best choice because it is a more holistic approach.
For a client with multiple sclerosis, which compensatory cognitive strategy would BEST aid in performance of daily activities? A. Schedule demanding tasks at intervals throughout the day B. Simplify daily tasks to conserve energy C. Modify the environment to decrease clutter D. Decrease visual stimulation to promote focused attention
The correct answer is A. Spreading demanding tasks throughout the day allows for rest periods to promote cognitive ability. Clients with multiple sclerosis typically have greater cognitive abilities in the morning and after rest breaks. NOTE: B: Simplifying tasks conserves energy but does not directly address the cognitive demands of task performance. C: Organizing the environment decreases the energy required to complete tasks but does not directly address the cognitive demands of task performance. D: Decreasing visual stimulation may improve visual attention but would not improve the client's ability to focus attention, which is a cognitive skill.
A client with advanced amyotrophic lateral sclerosis (ALS) is new to a computerized communication device. On what would the OTR® treating this patient focus? A. Positioning, to ensure proximal support, with the device on a lap tray B. ROM exercises, to enable the patient to adequately reach the device C. Trunk strengthening, to enable upright sitting during use of the device D. Adapting the device with larger buttons and controls, to enable independent use
The correct answer is A. The simplest and first approach would be to ensure positioning so that the client can see the device and having the neck and shoulder (proximal muscles) stabilized to allow the most distal control. The placement of the device is also important, with a lap tray to secure the device in bed or on the wheelchair. NOTE: B, C: These are more remedial or restorative approaches that are not appropriate for a client with a progressive disease, especially in advanced stages. D: Adaptations such as larger buttons and controls may be appropriate if proper positioning alone is insufficient for independent use of the device.
An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house; the client has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances and a fenced backyard. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. To provide a defined, safe environment for the client to wander in the house, what will the OTR MOST likely recommend? A. A deadbolt lock at the front door B. A slide bolt lock high on the front door and back door C. A gated area in the living room, using child safety gates D. A walk with the client several times a day
The correct answer is B. A slide bolt lock that is not within reach of the client is one strategy to prevent the client from opening the front door and wandering away from the house without the daughter's awareness. NOTE: A: A deadbolt lock should not be used in case the client locks the daughter out when she steps out of the house. C: A gated area can be too confining for the client and increase the risk of a fall if the client attempts to climb out of it. D: Taking a client for a walk several times a day may or may not decrease wandering behavior. If the client is exhausted from the walks, the risk of a fall when wandering in the house may increase.
An OTR® is evaluating a client in the plateau phase of Guillain-Barré syndrome in a hospital setting. Which symptom is the OTR MOST likely to observe? A. Unilateral pain in a lower extremity B. Inability to communicate vocally C. Confusion from short-term memory loss D. Hyposensitivity to tactile input
The correct answer is B. Because of paralysis of muscles in the head and neck, spoken communication is often impaired in the plateau phase of Guillain-Barré syndrome. NOTE: A: Guillain-Barré syndrome is symmetrical (bilateral) in its presentation. C: Cognitive impairments are not typical with Guillain-Barré syndrome. D: Hypersensitivity, rather than hyposensitivity, is typical in the plateau phase of Guillain-Barré syndrome.
OTR®s can assist caregivers of clients with Alzheimer's disease (AD) with reducing stress and burden by providing what type of intervention? A. Habit training to improve independence in ADLs B. Education related to the progression of AD C. Environmental modifications to the home D. Recommendations related to assistive technology
The correct answer is B. Education related to the progression of AD would be the most important intervention because such knowledge would allow the caregiver to have more control in choosing what types of intervention would be appropriate for the client and would, in turn, reduce caregiver stress. In addition, they would learn to distinguish the normal progression of AD from abnormal progression to advocate for better care of the client with AD. NOTE: A: Habit training would not be an appropriate intervention strategy for clients with AD, because it is likely to be ineffective. New learning diminishes as the client progresses through the stages of dementia. C, D: Environmental modifications and assistive technology are likely to be appropriate interventions for clients with AD; however, caregiver education is more important because it gives the caregiver information they need to properly care for the person with AD and puts them more in control when collaborating with the OTR®.
A client with middle-stage Alzheimer's disease (AD) in a long-term care facility presents with new behavioral concerns. The client's spouse expresses concerns to the staff, and the OTR® is asked to evaluate the client and make recommendations. The OTR observes the client during routine activities in the facility. What should the OTR do next? A. Use the Assessment of Motor and Process Skills (AMPS) to assess motor and praxis skills in the client's current context. B. Interview the spouse and caregivers to complete the client's occupational profile. C. Establish rapport with the client by assisting the client in activities run by the recreational therapist. D. Provide the client a challenging activity to assess attention and emotional regulation skills.
The correct answer is B. Observation and interview are the primary methods of assessment recommended for clients with AD. After observation, it would be important to interview family and caregivers to complete the assessment. NOTE: A: Although using the AMPS might be helpful with clients with early-stage dementia who are living at home, it might not be as helpful with clients living in a long-term care facility and at a later stage of the disease. C: Establishing rapport would be important, but it would probably not be the next step in the assessment process; observation and interview are recommended as the primary means of assessment for clients with dementia. D: Giving a client with dementia too difficult a task during the assessment process would not be advisable; observation and interview are recommended as the primary means of assessment for clients with dementia.
A client in the late stage of Parkinson's disease presents for an occupational therapy evaluation. Which of the following symptoms can the OTR® expect to see? A. Resting tremor, spasticity, tingling sensations B. Resting tremor, rigidity, oral motor deficits C. Spasticity, paralysis, decorticate posture D. Spasticity, rigidity, impaired respiratory muscles
The correct answer is B. Swallowing difficulties become apparent in the late stage of the disease because of impairments in the oral motor muscles as motor control becomes further compromised. Resting tremor is a symptom that manifests in the early stage of Parkinson's disease and continues throughout the disease course. Rigidity often onsets in the early stage of Parkinson's disease and progresses in severity in later stages. NOTE: A, C, D: Tingling sensations (paresthesia), decorticate posture, and impaired respiratory muscles do not occur with Parkinson's disease. Spasticity does not typically occur with Parkinson's disease.
An OTR® is working with a client with amyotrophic lateral sclerosis to address interosseous muscle wasting and atrophy in the dominant hand and to promote self-feeding. Which compensatory strategy would be MOST beneficial? A. Weighted utensils B. Built-up foam grip C. Universal cuff with a D-ring D. Hands-free options
The correct answer is C. A universal cuff compensates for loss of finger extension and facilitates grip to allow the client to hold utensils. NOTE: A: The client's progressive loss of upper-extremity and grip strength indicates that weighted utensils would be too difficult to use during self-feeding. B: A built-up foam grip would require the client to grasp and release the utensils, but atrophy of the hand muscles would not allow the client to grip the foam, even if it is built up. D: The client is still able to use the hand and upper extremity for self-feeding, so selecting a hands-free option would not allow for optimized client participation in feeding.
An OTR® wishes to prioritize the focus of intervention for a client with Guillain-Barré syndrome in the acute inflammatory phase. Which factors should the OTR evaluate? A. Sensory loss, pain, cognitive impairment B. Pain, fatigue, cognitive impairment C. Pain, fatigue, swallowing problems D. Rigidity, pain, swallowing problems
The correct answer is C. Because ascending paralysis is typical of Guillain-Barré syndrome, evaluation consistently addresses pain, fatigue, and swallowing problems. This constellation of symptoms best fits the clinical reasoning for prioritizing issues to be evaluated. NOTE: A, B: Cognition remains intact with Guillain-Barré syndrome and therefore does not typically require evaluation. D: Rigidity does not occur with Guillain-Barré syndrome and therefore does not typically require evaluation.
Which of the following clients is MOST likely to be a person in the middle stage of Alzheimer's disease? A. A client who sees long-dead family members in the room. B. A client who has difficulty planning familiar activities. C. A client who is confused by simple directions and recall of recent events. D. A client who becomes extremely excited over mundane events.
The correct answer is C. Confusion is commonly associated with the middle stage of dementia. NOTE: A: Hallucinations are usually associated with late-stage dementia. B. A person will develop difficulty with planning and organizing in early stages of dementia. D. Elation is not typically a symptom of dementia.
An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client's daughter is determined to have the client remain at home with her as long as possible. The daughter has expressed fear that the client might fall down the stairs at the back door while wandering. To prevent the client from using the back door, what would the OTR® MOST likely recommend? A. Painting a big "STOP" sign on the back door B. Painting the door yellow to contrast with the environment C. Using a poster to camouflage the back door and the door knob D. Installing a motion-detecting light at the stairs to the garage
The correct answer is C. Evidence has shown that camouflaging a door and its doorknob can decrease way-finding behavior when an client with Alzheimer's disease wanders. NOTE: A: A big "STOP" sign requires that the client be able to recognize and understand it. This ability will not be preserved in a client with Stage III Alzheimer's disease; therefore, this option will not be useful in deterring the client from using the back door. B: Making the door contrast with the environment enhances visualperceptual acuity and might actually increase the possibility of the client's opening and using the back door. D: A motion-detector light can light up the stairs at the garage but cannot prevent the client from wandering out and using them.
What is an effective strategy to facilitate maximal independence in self-feeding with a client who has middle- to late-stage dementia and does not initiate feeding? A. Change the client's diet to foods that are palatable and easy to chew. B. Change the consistency of foods to allow for easier chewing and swallowing. C. Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions. D. Provide constant verbal cues throughout feeding to improve attention to the self-feeding task.
The correct answer is C. Hand-over-hand guidance is an effective strategy to encourage maximal independence through participation in daily living tasks, including self-feeding. NOTE: A, B: Changing the diet and changing the consistency of foods might encourage the client to eat more but will not specifically address maximal independence in self-feeding. D: Although structured prompting is effective in assisting clients with dementia, continual verbal cues might be overwhelming.
What skills might a client with middle-stage dementia have difficulty performing on the basis of typical psychosocial or cognitive abilities present during this stage of dementia? A. Speaking B. Swallowing and chewing C. Managing finances D. Posture and balance
The correct answer is C. In middle-stage dementia, a person will begin having moderate impairment in IADLs, such as finances, shopping, medication management, and complex meal preparation. NOTE: A: Although comprehension of written and spoken language is affected in the middle stage of dementia, speaking itself is not affected until the late stage. B, D: Problems with swallowing and chewing, as well as and posture and balance difficulties, are most likely encountered by clients with late-stage dementia.
An OTR® is evaluating a client with multiple sclerosis (MS). What main evaluation finding related to neuromusculoskeletal function can the OTR anticipate? A. Slowed movement of the extremities B. Uniform resistance to passive movement C. Tremor when moving the extremities to reach D. Inability to initiate movement in the extremities
The correct answer is C. Intention tremor is commonly seen in people with MS. NOTE: A: Slowness of movement is not typically seen in people with MS. They may, however, have unsteady or incoordinated movements. B: Uniform resistance to passive movement indicates that rigidity is occurring, a symptom not typically present in people with MS. D: Ability to initiate movement is not typically impaired in people with MS.
A client with middle-stage dementia has maintained the ability to complete repetitive tasks common in middle adulthood. For example, if given a basket of socks, the client will reflexively fold them until the task is complete. Given this information, what recommendation would be appropriate for the OTR® to give caregivers? A. Provide challenge to the client by placing the laundry basket at various heights to improve trunk stability and balance. B. Provide challenge to the client by putting various types of clothing into the laundry basket, which will aid in maintaining this skill. C. Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day. D. Provide the caregivers with information about how they can use a basket of socks to decrease agitation in the client.
The correct answer is C. Interventions to control the daily structure of a person with dementia have been documented to provide balance between the times the person is in high arousal versus low arousal. NOTE: A, B: Providing too much challenge to a client with dementia might increase agitation; providing structure to the client's day is the best option to decrease agitation and promote better balance. D: Engaging a client in a task once the client is agitated might be difficult; providing structure to the client's day is the best option to decrease overall agitation and promote better balance.
An OTR® is providing training in cognitive compensation strategies for a client with multiple sclerosis. Which of the following modifications would facilitate cognitive function? A. Decrease time spent on an activity to conserve cognitive focus. B. Use an adaptive bath bench to conserve energy during bathing. C. Perform cognitively demanding tasks in a setting with minimal distractions. D. Use strategies to cope with changes in daily activities and routines.
The correct answer is C. Performing cognitively demanding tasks in a setting with minimal distractions is an example of a cognitive compensation strategy. NOTE: A: Increasing the time spent on activities improves attention and task completion. B: Use of a bath bench is not a cognitive compensation strategy but an adaptive equipment intervention. D: Emotion-focused strategies best address coping skills to decrease the client's stress and are not as beneficial as problem-solving techniques in compensating for cognitive deficits.
The OTR® observes as a client with multiple sclerosis (MS) demonstrates ataxia in the upper extremities when reaching for an item on the table. Which intervention is BEST to modify tabletop activities to control ataxia in task performance? A. Support the trunk against the table B. Support the dominant arm on the table C. Support the arms and trunk against the table D. Support both arms on the table with no trunk support
The correct answer is C. Supporting the arms and trunk against the table provides three points of stability against a stable surface, offering optimum support for task performance. NOTE: A: Trunk support on the table would provide one point of stability when reaching but would not enable the client to compensate for upper-extremity ataxia. B: Supporting the dominant arm on the table provides only one point of stability, which may offer inadequate support for reaching. D: Supporting both upper extremities on the table would provide stability when reaching, but ataxia in clients with MS also affects trunk control, so the client would benefit from stabilizing the trunk as well.
To facilitate independence in familiar daily living tasks by clients with dementia, what would be an appropriate INITIAL stage of intervention? A. Recommend home modifications. B. Provide caregiver education. C. Develop strategies to simplify familiar tasks. D. Establish appropriate daily routines.
The correct answer is C. Task simplification is a primary intervention used with clients with dementia to maintain independence in daily living tasks. NOTE: A, B, D: These answers are interventions that would be appropriate with dementia; however, developing strategies to simplify familiar tasks must come before the others.
An OTR® and a client with multiple sclerosis (MS) collaborate to set client-centered goals; the client expresses interest in starting an exercise program but states that weakness and fatigue are barriers. What program should the OTR recommend FIRST? A. A home program that includes bike riding, walking, and free weights with careful monitoring of fatigue B. A strengthening program to reduce weakness associated with the disease's deconditioning process C. Aquatic fitness classes to reduce the effects of weakness while promoting gentle exercise D. Progressive resistive exercises under the supervision of the OTR to avoid overexertion
The correct answer is C. The buoyancy of water helps reduce the effects of weakness; aquatic exercise programs for clients with MS should be in room-temperature or cooler waters because of heat sensitivity. Gyms and community recreation facilities with swimming pools often offer classes for people with conditions that benefit from gentle exercise. With all exercise programs, it is important to educate people with MS in how to monitor their fatigue and prevent overexertion. NOTE: A: A home exercise program, especially one with this many components, may be intimidating to someone new to exercise. Group exercise classes might promote better adherence to an exercise program. In addition, a program this extensive might be too strenuous for this client. B, D: Strengthening would likely not be a first approach to introducing an exercise program. Evidence shows that fatigue can be reduced by participating in a structured aerobic program. Strengthening will not reverse the neurological weakness from MS, but it can reduce the weakness from being deconditioned.
A client diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago is admitted to the hospital because of worsening mobility at home. Before the hospitalization, the client was independent with ADLs but required assistance for IADLs, including cooking, shopping, and home management. Which approach is MOST likely to be the priority for this client in the acute care setting? A. Maximize the client's participation in IADLs B. Identify appropriate positioning for the client in bed C. Guide the caregiver in assisting the client with ADLs D. Facilitate increased strength to maximize abilities
The correct answer is C. The caregiver should be trained in skills for assisting the client with ADLs, because the client will require greater assistance for tasks as symptoms progress. NOTE: A: Focusing on maintaining the client's participation in ADLs would be more appropriate than promoting independence in IADLs, given the progressive nature of ALS. B: Instruction on positioning in bed is not indicated at this time, given the client's ability to be mobile and participate in ADLs. D: The client's strength should be optimized to maintain abilities as long as possible, but increasing strength should not be a focus of intervention because of the progressive nature of ALS.
An OTR® has received a referral to evaluate a client with dementia who lives alone in the community and is otherwise healthy. When the OTR arrives at the client's home, the OTR notices that the client is well groomed but appears to have forgotten that the OTR had called earlier in the day to set up the appointment. Which area of occupation would be a priority to assess during the initial occupational therapy assessment? A. Bathing and showering B. Sleep C. Safety and emergency maintenance D. Personal care device management
The correct answer is C. The client has early-stage dementia, as evidenced by short-term memory deficits, but maintains the ability to complete routine ADLs. Other ADLs are likely intact, but IADLs, in particular those that require higher level executive function, would be affected at this stage. The client lives alone, so understanding the client's ability to stay safe in the community would be important. NOTE: A: Bathing and showering are ADLs that appear to be intact, since the client is well groomed. B: Sleep, although an IADL and possibly affected, would not be a priority at this time. D: The client is healthy; the scenario suggests that the IADL of personal care device management is not likely to be a major issue.
During the initial evaluation for a client with Parkinson's disease, the OTR® asks the client to "pretend you are brushing your teeth," that is, show the movement of brushing teeth without using the supplies needed for brushing teeth. The client is unable to initiate movement of the dominant arm toward the mouth to demonstrate oral hygiene. Which step should the OTR take NEXT in the evaluation of this client? A. Try a wrist weight to stabilize the arm during teeth brushing B. Ask whether the caregiver can provide arm support to bring the hand to the mouth C. Observe as the client brushes teeth with toothbrush and toothpaste at the bathroom sink D. Provide a mobile arm support to compensate for arm movement when brushing teeth
The correct answer is C. The client may not have understood the verbal instructions, and performing the task in the actual context may allow for more accurate demonstration of the client's abilities. NOTE: A: If the client is unable to initiate movement of the dominant arm during simulated teeth brushing, it is unlikely that adding weight would facilitate movement. B: Suggesting the assistance of a caregiver for brushing teeth may entail a greater level of assistance than the client actually requires. The client should be provided opportunity to complete ADLs at the highest level of independence desired. D: Clients with Parkinson's disease may have difficulty initiating or limitations in movement because of rigidity. Use of a mobile arm support would not be appropriate without further evaluation of the client's needs.
What assistive technology would be appropriate to recommend to the client's caregivers for a client who has middle-stage dementia ? A. Medication dispensers B. Medication reminder boxes C. Door alarms D. Electric hospital bed
The correct answer is C. When used in middle-stage dementia, door alarms can be useful in improving safety of the client with dementia and reducing caregiver burden. NOTE: A, B: Medication dispensers and reminder boxes would be most appropriate in early-stage dementia. D: An electric hospital bed would be most useful during late-stage dementia.
An OTR® is evaluating a client with Stage 4 Parkinson's disease (PD). During ROM and manual muscle testing, the client presents with cogwheel motions and is mostly quiet with an occasional moan. What would be the BEST action for the OTR® to take? A. Continue testing, then apply heat or ice (to the client's preference) to reduce pain associated with stiffness. B. Study the client's facial expressions and body language to determine which specific movements elicit a pain response. C. Discontinue the manual muscle testing and assess at a later time. D. Continue with gentle stretching, and determine pain by asking clear questions that require a one- or two-word response.
The correct answer is D. A client with advanced PD would likely experience common symptoms such as muscle rigidity, which may be exacerbated by ROM or manual muscle testing. "Cogwheeling, common in clients with Parkinson's disease, is identified by jerky movements and is considered rigidity superimposed on tremor. Rigidity often is associated with musculoskeletal pain" (Cooper, 2008, p. 477). The client may not be able to tell the OTR® that he or she is experiencing pain; it is critical that the OTR® help the client feel comfortable with hands-on techniques and assess verbally in clear, concise language, with close-ended questions. NOTE: A: The OTR® must further evaluate the pain before intervening with a modality; although moist heat is a modality that may lessen the pain from rigidity, ice may worsen symptoms. B: A common symptom of PD is a masklike facial expression; the flat affect and lack of nonverbal communication makes it necessary to assess pain by other means. C: For a thorough evaluation, it would not be best to fully discontinue the ROM and manual muscle testing without further measuring the client's movements and pain.
A client presents with decreased memory resulting from dementia. What is the MOST EFFECTIVE strategy for an OTR® to implement to intervene with this cognitive impairment? A. Chunking or grouping similar items together B. Repeating information over and over again to oneself C. Rhymes to recall information D. Cue cards or signs in key places
The correct answer is D. Adaptations, as opposed to targeted interventions, are the most effective strategy for decreased memory in clients with dementia. NOTE: A, B, C: Chunking, repeating information, and rhymes are effective strategies for clients whose memory loss is not progressive in nature.
During the initial evaluation, a client with multiple sclerosis (MS) reports feeling overwhelmed by choices for daily activities and symptom management. Which intervention is MOST appropriate for this client? A. Collaborate with the caregiver to plan routines for the client B. Refer the client to a social worker to manage daily activities and symptoms C. Refer the client to a psychologist to discuss feelings of being overwhelmed D. Collaborate with the client to develop self-management skills
The correct answer is D. Clients who develop self-management skills have higher quality of life. Using self-management skills allows clients to make sure their needs are met and their unique circumstances are addressed. NOTE: A: Clients with MS should have as much control over their daily routines as possible, so having the caregiver plan routines for the client is not the most appropriate strategy. B: A social worker does not specialize in establishing daily activity routines, which are best addressed through occupational therapy intervention. C: Referral to a psychologist may be necessary to allow the client to discuss feelings of being overwhelmed; however, occupational therapy is the discipline that best addresses daily activity needs and symptom management for clients with MS.
An OTR® is working with a client with Stage III amyotrophic lateral sclerosis (ALS). Which strategy is BEST to help this client maintain the current level of participation in daily activities? A. Pain management B. Decubitus ulcer prevention C. Strengthening activities D. Caregiver assistance with ADLs
The correct answer is D. Of the choices listed, having the caregiver assist the client with ADLs is the best strategy at ALS Stage III, which is characterized by an increased level of fatigue. NOTE: A: Pain is not a significant factor until later stages of the disease, particularly Stages V and VI. B: Ulcer prevention is needed in Stages V and VI, when clients are confined to a wheelchair and have limited independence with bed mobility. C: Stage III of the disease is characterized by muscle function loss, and strengthening is no longer beneficial. The focus in Stage III is on active assistive and passive range of motion.
A client with multiple sclerosis (MS) is experiencing memory deficits that are hindering the client's ability to take medications accurately. Which intervention is the MOST appropriate to support performance in medication management for this client? NOTE: Simplify the task steps in managing medications Change the time when the client takes medications Have the client use a timer to take medication at designated times Provide the client with written directions for medication management
The correct answer is D. The use of memory aids, such as written directions, has been shown to improve cognitive function for clients with MS. Providing written directions can promote independence and accuracy in managing medications. NOTE: A: Simplifying task steps addresses the cognitive deficit of sequencing and is an energy conservation strategy to manage fatigue; however, this intervention does not provide support for memory. B: Changing the time when the client takes medications would require the involvement of the physician, and there may be little flexibility in the medication schedule. C: If the client is experiencing memory deficts that interfere with taking medications, the client will likely not remember to use a timer or may not remember which medications to take when the timer goes off. Written directions are a low-tech way to improve medication management and can provide as much information as the client needs. Smartphones are another way to handle reminders, as long as the client is familiar with their use.
An OTR® is evaluating a client with Parkinson's disease who lives at home but has begun to have mobility challenges. Which intervention is BEST to facilitate lifestyle changes to improve mobility? A. Issue a long-handled reacher and teach the client how to use it B. Advise the client to continue to carry items during functional mobility C. Issue a rolling walker and educate the client how to use it D. Introduce use of a rhythmic beat to facilitate mobility
The correct answer is D. The use of rhythm has been shown to support mobility in people with Parkinson's disease. This approach can minimize the impact of the immobilization that may occur from this disease. NOTE: A: A long-handled reacher may be difficult for a client with Parkinson's disease to use because of tremors and rigidity. B: Carrying items during mobility may decrease postural stability responses. C: A rolling walker may not be effective because the motoric freezing and festinating gait characteristic of this condition cause people to take smaller steps to adjust for postural instability.
A client with amyotrophic lateral sclerosis reports functional limitations when completing his daily routine. The OTR® has completed ADL and IADL assessments as part of the evaluation and is considering how the client's upper-extremity motor control is affecting his functional ability. Which assessment would be MOST effective for assessing this client's upper-extremity ability? A. Modified Ashworth Scale B. Trigger point evaluation C. FIM D. Purdue Pegboard test
The correct answer is D. The Purdue Pegboard test is a timed test of upper-extremity function and is useful in determining a client's functional limitations. NOTE: A, B, C: These do not assess functional ability of the upper extremities. The Modified Ashworth Scale is a measure of spasticity. Trigger point evaluation is a measure of localized soft-tissue pain. The FIM is a measure of ADL independence.
