Chapter 10
Reisberg Level 4: Moderate Neurocognitive Decline
-Moderate cognitive declines in one or more cognitive domains (e.g. the person is more forgetful and has difficulty finding words) -Independent in simple, repetitive ADL's (e.g. grooming) and following simple VC's and demonstration to complete other IADL, leisure and social tasks -The person can live in their home with assistance
Reisberg Level 3: Mild Cognitive Impairment
-One or more of cognitive domains is affected at a level that is noticeable to themselves and others and evident on mental status exams -Activity adaptations and compensation strategies can be used to maintain independence in familiar, noncomplex ADL, IADL, work, leisure, and social activities -Challenging situations (e.g. noisy environments) are recognized by the person and avoided to minimize their deficits (e.g. distractibility)
Reisberg Level 2: Very Mild Cognitive Decline
-Typical age-related memory loss (e.g. forgets location of keys), changes are not noticed by others -Independent with ADL's, IADL's, work, leisure, and social participation -Participation may require more concentration and time and/or use of compensatory strategies
B70. To develop the social interaction skills of adolescents with autism spectrum disorder (ASD) an occupational therapist and an OTA develop a community-based after school program. Which group is best for the therapist and the OTA to include in this program? Answer Choices: A. A directive group. B. A topical group. C.A developmental group. D.A task-oriented group.
A developmental group's focus is to teach the social interaction skills needed for group participation in a sequential manner. It provides group structure and activities along a continuum that is consistent with how interaction skills typically develop. Individuals with ASD often have significant deficits in social interaction skills. However, they typically have normal intelligence and do not need interventions to address cognitive skills. A directive group uses a highly structured five-step approach to help low-functioning patients (e.g., persons with neurocognitive disorders or serious mental disorders) develop basic skills. A topical group is a discussion group that focuses on activities performed outside of the group (e.g., vocational planning). A task-oriented group's focus is to increase members' awareness of their values, ideas, and feelings as revealed through group activity. This emphasis on intra-psychic functioning would be inappropriate for individuals with ASD.
B49. An OTA implements a group for adolescents newly admitted to an eating disorders unit. Which activity is most beneficial for the OTA to use to develop the clients' task and social skills? Answer Choices: A. Discussion of reasons for admission to the unit. B. Cooking a three-course dinner to be eaten family style. C. Watching a reality television show and discussing problem scenarios. D. Completion of a group collage about personal interests.
A group collage is an activity that requires both task and social skills for completion. The OTA can provide interventions during this group to develop needed skills and reinforce observed skills. Discussion groups do not require task skills. A cooking and dining group does require task and social skills; however, it is not the best activity for persons with eating disorders who have established food-restricting behaviors and are just beginning treatment.
B188. An older adult is referred to home-based occupational therapy after surgery to correct a hip fracture resulting from a fall. The patient was recently diagnosed with a mild neurocognitive disorder. Which would the OTA expect the person to have the most difficulty with in the home environment? Answer Choices: A. Communicating personal preferences to family members. B. Completing a morning grooming routine. C. Choosing appropriate clothing to wear. D. Complying with total hip precautions.
A mild neurocognitive disorder is characterized by short-term memory loss, distractibility, and difficulty learning, remembering, and using new information. Because complying with total hip precautions requires learning, remembering, and using new information, it can be expected that this will be difficult for this per-son. However, the person with a mild neurocognitive disorder does not have difficulty with routine tasks such as grooming and dressing. The progression of neurocognitive disorders is characterized by gradual onset and continuing cognitive decline. Difficulties with BADL would be evident at a moderately severe level of a neuro-cognitive disorder. Communication would not be affected until the disorder has progressed to a severe level.
C153. A person diagnosed with a mild neurocognitive disorder, is evaluated by an occupational therapist and an OTA. Although the client demonstrates attention and memory deficits, the occupational therapist and OTA determine that the person is still able to live at home with supportive structure. They collaborate with the person to identify activities to include in a structured routine that enables their continued participation. Which activity is best to recommend the client include in their daily routine? Answer Choices: A. Cooking dinner. B. Doing laundry. C. Walking with a neighbor D. Watching favorite television shows.
A person with a mild neurocognitive disorder can perform familiar, noncomplex ADL, IADL, leisure, and social participation activities with activity adaptations and compensation strategies. None of the answer options in this item include these therapeutic techniques. Walking with a neighbor is an activity that can be safely pursued by a person with attention and memory deficits without the use of any activity adaptations or compensatory strategies. This activity can meet the person's needs for social participation and physical exer-cise. Cooking is unsafe for a person with attention and memory deficits. Forgetting to turn the stove off can be a fire hazard. Inattention could result in the person accidentally touching the stove's hot surfaces or going too close to a burner's flames. Doing laundry requires remembering and attending to multiple steps that would make this task difficult to complete without adaptations or compensatory strategies. While watching television is safe for a person with cognitive deficits, it is passive activity that does not support the use of the person's intact abilities. Table 10-1 in Chapter 10 provides the Global Deterioration Scale for Assessment of Primary Degenerative Dementia which describes the capabilities and limitations of persons with neurocognitive disorders.
tardive dyskinesia
A side effect of long-term use of traditional antipsychotic drugs causing the person to have uncontrollable facial tics, grimaces, and other involuntary movements of the lips, jaw, and tongue.
A139. An adult with schizophrenia has been experiencing negative symptoms of restricted emotion, decreased engagement, and a lack of energy. Which group is the best for the OTA to include in the client's intervention plan? Answer Choices: A. An arts and crafts group in which each client works on a self-selected individual project. B. A meal planning and preparation group in which clients works collaboratively with others. C. A stress management group that includes biofeedback and visualization. D.A support group for persons with schizophrenia in which all clients share their stories.
A. An arts and crafts group in which each client works on a self-selected individual project. Experiencing negative symptoms associated with schizophrenia can have a significant impact on a person's ability to attain life goals, live independently, maintain a job, and nurture healthy personal and social rela-tionships. Given the person's presenting negative symptoms of restricted emotion, decreased engagement, and a lack of energy, it is best to include the person in a group with minimal expectations to share or socialize with others. According to Mosey's developmental groups, this is called a parallel group. The use of Mosey's developmental groups can assist clients in acquiring and developing group interaction skills. An arts and crafts group in which each client works on a self-selected individual project meets the criteria of a parallel group. Enabling a client to choose an individual activity to complete will assist the client in developing a comfort level in the presence of others. Providing the client with a choice of activity and a means to express feelings through media is an effective approach to develop self-efficacy and group interaction skills. The OTA can structure a parallel group to allow graded expression and interactions with others in a safe environment as the client develops trust and comfort in the presence of others. As the client's comfort level increases in social situations, they can work collaboratively on a joint project, share life stories, and offer support to oth-ers. The concentrated focus that is required to effectively engage in biofeedback and visualization would make these approaches difficult for a person with negative symptoms.
A102. An OTA working in a skilled nursing facility conducts an inservice on validation therapy for the recently hired staff of a new psychogeriatric unit. Which fundamental principle of validation therapy is important for the OTA to include in this presentation? Answer Choices: A. Listen to the words the residents use to ascertain each person's underlying message. B. Provide highly structured activities to refocus the residents on reality. C. Provide unstructured activities to facilitate the residents' expression of feelings. D. Listen to the words the residents use and provide reality orientation for invalid statements.
A. Listen to the words the residents use to ascertain each person's underlying message. Validation therapy is an approach to working with individuals with neurocognitive disorders founded on the principle that the unspoken messages an individual conveys in their speech are more important than the actual content of the speech. Individuals with neurocognitive disorders often make statements that are not based in reality. For example, an individual introduces a daughter as their mother. In validation therapy, the factual aspects of this familial relationship are irrelevant and do not need to be addressed at all. However, the underlying message that this relationship is valued and important is worthy of comment. The use of structured or unstructured activities is not a component of validation therapy. The focus of validation therapy is to facilitate communication with persons with neurocognitive disorders in a caring, respectful, and empathetic manner.
neurocognitive disorders
acquired (not lifelong) disorders marked by cognitive deficits; often related to Alzheimer's disease, brain injury or disease, or substance abuse. In older adults neurocognitive disorders were formerly called dementia
Reality orientation typically involves
activities that require remembering the current day, date, time, season, and activity sequence.
A176. An elementary school student with autism spectrum disorder is referred to occupational therapy. One of the student's goals is to self-initiate goal-directed play to decrease the frequency of self-stimulating behaviors of hand waving and rocking. The student's verbal communication is impaired, but the student compensates by using picture cards to let others know what is wanted or needed. Which of the following approaches to initiate self-play in the home environment is best for the OTA to suggest to the student's parents?
Answer Choices: A. Provide limited play choices using picture cards, encourage choosing. and give verbal praise when the child chooses an activity. B. Allow the child time to choose a play activity from several options and do not provide guidance to ensure self-directed decision making. C. Provide limited choices using picture cards and only give verbal praise when the child participates in the chosen play activity. D. Include the child in after-school programs to socialize with other children and provide role-modeling opportunities for typical play behaviors.
B127. Children with a diversity of developmental disabilities participate in an after-school play group that uses a behavioral frame of reference. The play group is conducted by Level I occupational therapy assistant students who are each partnered with a child to facilitate the development of play and social interaction skills. Which should the supervising OTA advise the students to do when working with each child? Select the three BEST responses.Answer Choices: A. Set expectations that match and build upon each child's capabilities. B. Speak loudly and repeat directions frequently. C. Provide consistent directions and guidance. D. Give detailed descriptions about the goals of each activity. E. Provide a diversity of sensory stimulation activities. F. Reinforce developmentally appropriate behaviors.
According to a behavioral frame of reference, interventions should focus on the child's strengths and potential; therefore, the students should set expectations that match and build upon each child's capabilities. When using a behavioral approach, consistency and reinforcement are used to develop skills. In this scenario, there is no information provided to indicate that the children have auditory or sensory processing deficits; there-fore, there is no need to speak loudly or provide sensory stimulation activities. The usefulness of detailed descriptions relies on the children's ability to process this information. This skill is often limited in children with developmental delays.
C177/ An older adult diagnosed with panic disorder and agoraphobia receives home-based occupational therapy services. The client reports that the panic attacks worsen when the client drives to work and to complete home management errands. The client states "I just want to be normal again." Which approach is best for the OTA to use during intervention sessions with the client?Answer Choices: A. Instruct the client on the use of online shopping and banking. B. Teach the client to use public transportation independently. C. Advocate for the client to be able to telecommute to work. D.Train the client to use cognitive-behavioral techniques prior to driving.
Agoraphobia is anxiety about being in places or situations from which escape may be difficult or embarrassing or in which help may not be available if needed. As a result, situations are avoided or endured with anxiety about having a panic attack. Cognitive-behavioral therapy (CBT) can help people examine their thoughts, beliefs, and actions and learn to change maladaptive patterns of behavior. CBT techniques are used to help the person identify current problems and potential solutions and challenge maladaptive and inaccurate cognitions. The client's active role in the therapeutic process is facilitated by the OTA frequently providing homework and structured graded assignments (e.g., driving around the block to mail a letter) as part of the intervention process. Diversion techniques (eg., listening to a book on tape while driving) and visual imagery (e.g., imagining a peaceful country road) are used to decrease anxiety. Advocating that the client telecommute to work and teaching the client to use online shopping, online banking, and public transportation do not address the client's expressed desire to address the agoraphobia.
A38. An OTA provides caregiver education to the spouse of a client with a moderately severe neurocognitive disorder and a secondary diagnosis of left CVA. The client is dependent upon a wheelchair for mobility. The spouse reports that the client becomes restless at mealtimes, consistently undoes the lap belt, and tries to get up from the wheelchair. The spouse reports that the need to constantly say "sit down" is personally exhausting and often increases the client's agitation. Frequently, neither eats a complete dinner. Which is the most effective recommendation for the OTA to make to the spouse?
Answer Choices: A. Allow the spouse to get up when restless and provide dinner to the client at a later time. B. Use a wheelchair lap tray to serve several smaller meals to the client at intervals throughout the day. C. Hire a home care attendant to assist the client at mealtimes and provide some respite to the spouse. D. Use a wheelchair lap tray to serve the client large meals at breakfast, lunch, and dinner.
B99. An older adult who incurred a hip fracture resides with a family caregiver. Prior to the hip fracture, the person lived independently in their own home. Upon discharge from the hospital, the person was referred to home-based occupational therapy services. During the initial home visit, the OTA observes that the individual demonstrates impaired short-term memory, disorientation to time and situation, and difficulty engaging in activities. The family caregiver expresses many concerns about the client's decreased functional capacity and reports feeling stressed. Which recommendation is best for the OTA to make first to the caregiver?
Answer Choices: A. Explore residential placement to ensure the client's safety. B. Contact a local office for aging to attain caregiver support. C. Contact the local adult day treatment center to explore respite programs. D. Make an appointment with the client's physician for a complete medical evaluation.
C162. An OTA works in a halfway house with a new resident who takes antipsychotic medications to manage symptoms. The resident wants to become actively involved with maintaining the home's vegetable and flower gar-dens. After reviewing the precautions for the side effect of photosensitivity with the resident, which potential medication side effect should the OTA review next with the resident?Answer Choices: A. Akathisia. B. Orthostatic hypotension. C. Akinesia. D. Tardive dyskinesia.
Antipsychotic medications can result in all of the side effects or conditions listed. However, the side effects of photosensitivity and orthostatic hypotension would be of the greatest concern in this case given the resident's stated interest in working in the home's gardens. A person who takes psychotropic medications can incur severe sunburns if the precautions of wearing sunscreen, hats, and/or long-sleeved shirts are not taken while in the sun. While this is the most important side effect for the OTA to review with the resident, the resident should also be made aware of the risk for orthostatic hypotension. Orthostatic hypotension or postural hypotension is a form of low blood pressure that happens when a person stands up very quickly from sitting, crouching, and/or lying down. It can make a person feel dizzy or lightheaded and fainting may occur. Typically, when people garden, they sit, kneel, or crouch to reach the garden beds. Thus, the person should be advised to move slowly when standing up to avoid this side effect. There are no precautions to prevent akathisia or akinesia other than medication adjustments by a physician. Tardive dyskinesia is not a medication side effect. It is an irreversible neurological condition caused by prolonged use of neuroleptic medications.
A. Provide limited play choices using picture cards, encourage choosing. and give verbal praise when the child chooses an activity.
Autism often presents as impaired development of social interactions and communication and a limited repertoire of activities of interest. Symptoms can include repetitive movements or self-stimulating behaviors. Persons with autism may not speak. They may have a limited vocabulary and may typically not ask for help or request things. Children with autism often prefer to play alone and have difficulty sharing experiences with others. The goal of therapy is to encourage engagement in purposeful activity, self-direction, imitation, and social interaction. Using the child's form of communication of picture cards, the parents can provide a choice between a limited number of play activities at home to encourage the self-directed activity of choosing a play activity. Providing verbal praise immediately after a decision is made will reinforce a positive behavior and support continued decision making over time. As the child makes decisions more readily, verbal praise can be reduced. When decision making is difficult, providing several options to choose from can be overstimulating and cause stress. The resultant stress typically increases repetitive or self-stimulating behaviors. Including the child in after-school programs can be an option when the child is able to participate in purposeful activities and benefit from learning through imitation. At this point, an after-school program will likely be too stress-ful, which may result in social isolation or lost opportunity for self-directed decision making. In addition, this scenario specifically asked for an intervention strategy for the parents to use in the home environment, not within the school environment.
A90. An individual receives treatment for major depression on an inpatient psychiatric unit. The patient has received an electroconvulsive treatment (ECT) treatment at 8 am. At 2 pm, the patient walks into the occupational therapy department stating a desire to participate in the leisure skills group. Which is the OTA's best response? Answer Choices: A. Call nursing staff to escort the client back to the client's room. B. Encourage the client to select one of three structured leisure activities to complete. C. Provide the client with a leisure history questionnaire to complete. D.Commend the client's motivation but remind the client that rest is recommended for 24 hours after ECT.
B. Encourage the client to select one of three structured leisure activities to complete. Six hours after ECT, the individual is capable of engaging in a structured task. Giving the individual a choice of structured activities to complete can increase the likelihood that the person will be interested in the selected task. There is no need to return the client to their room, and 24 hours of rest is not necessary after an ECT. However, there is some temporary memory loss after an ECT; therefore, it would not be appropriate to give the individual an activity that requires memory to complete.
A27. The parents of a 5-year-old with attention deficit with hyperactivity disorder (ADHD) express difficulty managing the child's aggressive behavior toward older siblings. Which is the most effective strategy for the OTA to recommend to the parents? Answer Choices: A. Allow the child to vent aggressive feelings on a stuffed animal or doll. B. Redirect the child's energy into acceptable and safe play activities. C. Provide consistent punishment for aggressive behaviors.
B. Redirect the child's energy into acceptable and safe play activities. Redirecting the child's energy to activities can be an effective management of the child's aggressive behavior. It would also be effective to advise the parents to observe and record the precipitants to these behaviors to determine potential environmental modifications. This is not an option provided. Allowing the child to vent aggression onto a stuffed animal or doll would not provide the structure the child needs to learn appropri-ate, safe behaviors. Also, aggressive behaviors are not always coupled with aggressive feelings. Sometimes the hyperactivity of a child simply manifests itself in socially unacceptable ways, such as when a child pushes a sibling very hard in an effort to get the sibling to play 'chase. Punishing the child does not address the child's needs. Taking punitive actions toward the child can increase feelings of resentment and promote a decrease in feelings of self-worth, which are typically already low in children with ADHD. This can fuel aggressive behavior.
A28. An employed individual is completing an inpatient program for substance abuse. The OTA consults with the supervising occupational therapist to review the discharge plan. Which would be most beneficial for the OTA and therapist to recommend as part of the individual's discharge plan? Answer Choices: A. Assignment to a member of a local Narcotics Anonymous group. B. Regular attendance at one or more Narcotics Anonymous meetings weekly. C. Attendance at the psychosocial clubhouse for leisure skills groups. D. Referral to the state vocational rehabilitation services.
B. Regular attendance at one or more Narcotics Anonymous meetings weekly. Narcotics Anonymous (NA) is based on the same 12-step principles as AA (Alcoholics Anonymous) and has been found to be an effective resource for those in recovery. NA and AA provide critical support to maintain abstinence. NA and AA stress that the individual seek out meetings and enlist a sponsor independently. Psychosocial clubhouses provide a diversity of supportive services for persons with mental illnesses. Since the person is employed and has no secondary diagnosis of mental illness, this setting would not be an appropriate referral recommendation. Based on the information provided, one cannot assume that vocational rehabilitation is a potential goal or need for this person.
B132. An OTA collaborates with the occupational therapist to plan individual and group activities for a child with oppositional defiant disorder. Which is most important for the OTA to address during group activities? Answer Choices: A. The child's willingness to take on a variety of group roles. B. The child's ability to attend to and complete a task. C. The child's distorted body image. D. The child's self-regulation of energy and activity levels
B. The child's ability to attend to and complete a task. Children with oppositional defiant disorder tend to have difficulties with impulse control, attention span, and short-term memory and exhibit argumentative and resentful behaviors. These deficits often affect the ability to complete tasks and can hinder adaptive role functioning. A child does not have to be willing to take on a variety of roles to benefit from group activities. Some find security and stability in the same type of role. This stability can be healthy as long as the role contributes to productive behavior. Distorted body image is typically indicative of anorexia nervosa, bulimia nervosa, or body dysmorphia, not oppositional defiant dis-order. Difficulties with energy and activity levels relate more to hyperactivity disorder than to oppositional defiant disorder.
B. Use a wheelchair lap tray to serve several smaller meals to the client at intervals throughout the day.
Because a person deemed dependent upon a wheelchair for mobility has significant motor deficits, they must be considered at risk for falling if they get up without supervision. A lap tray is a permissible and reasonable restraint if it is necessary to maintain a person's safety, allows for increased function, and less-restrictive restraints have been attempted. A family member can approve the use of this device if a person is not cognitively intact. These criteria apply to this case. A lap belt has been applied, but it has not been successful. A lap tray with food on it can provide physical and sensory cues necessary to keep the client seated for a time that is sufficient for eating a small meal. It is advisable to provide small meals at frequent intervals rather than three large meals when a person has significant cognitive impairments. Hiring a home care attendant can relieve the spouse's caregiver stress, but it does not address the client's risk of falling when attempting to get up from the wheelchair. It is unlikely that this behavior would cease with the presence of a home care attendant.
antisocial tendencies
Behaviors as a child such as purposely setting fires and repeatedly torturing animals predict:
A157. A recent high school graduate diagnosed with depression and anorexia nervosa attends an evening work adjustment group for 90 minutes each week. The client states that this group is the only activity engaged in outside of work. The OTA collaborates with the client to develop a plan to increase involvement in personally meaningful non-work activities. The client expresses interests in exercise and volunteerism and reports past roles to have included captain of the high school swim team, competitive tennis player, and volunteer in an after-school activities program for young children. Which of the following is the best resource for the OTA to recommend the client explore? Answer Choices: A. A local fitness center for exercise classes. B. The town swimming pool for open swimming sessions. C. A local community center for volunteer opportunities. D.An area soup kitchen for volunteer opportunities.
C. A local community center for volunteer opportunities. Volunteering at a local community center can facilitate the client's stated altruistic interests while providing a diversity of potential activity pursuits. Exercise and swimming can be contraindicated for persons with anorexia nervosa because they often engage in these activities in an excessive (sometimes self-abusive) manner that is counterproductive to healthy leisure. Volunteering in a soup kitchen is altruistic, but persons recovering from eating disorders often find food-related activities difficult.
A20. A client with a persistent depressive disorder and their spouse attend a discharge meeting with the OTA following the client's four day hospitalization for a major depressive episode. They express concern they have few shared activity interests and spend little time together. The client retired four months ago. The spouse continues to work full time. Which of the following should the OTA encourage this couple to do first to address this concern? Answer Choices: A. Immediately participate in one activity together. B. Engage in their individual activities of interest during the week. C. Explore activities they have enjoyed together and alone. D.Delay planning activities until the depression is totally resolved.
C. Explore activities they have enjoyed together and alone. Rationale: Assistance with an exploration of activities is a priority given the client's recent hospitalization for depression. The client's life has changed significantly with the loss of the worker role due to retirement and the resultant change in the amount of time spent alone. It will be important for the client to explore activities they have enjoyed alone so that retirement and time separated from their spouse will be enjoyable and meaningful. Exploring activities that the couple has enjoyed together will assist both in the maintenance of their relationship and in the establishment of a new post-retirement activities pattern. Immediate participation in one activity together is premature for there has been no determination of shared interests. Involvement in their own individual activities of interest during the week may be helpful but it does not address their expressed concerns about having few shared interests and spending little time together. A delay in planning activities until the depression is totally resolved ignores the client's expressed concerns.
C100 A young adult admitted to a locked inpatient psychiatric unit is referred to occupational therapy. The referral states that the client is exhibiting symptoms of bipolar disorder, manic episode, with anxiety. Which approach is best for the OTA to use to engage the client in the occupational therapy program? Answer Choices: A. In a scrapbooking group, encourage the client to make a page using shared decorative paper, stickers, and pens to create a unique design. B. Ask the client to help decorate the unit for an upcoming holiday using supplies from a storage box of last year's decorations. C. In a cooking group, have the client cut shapes to construct a gingerbread house using templates and written directions.
C. In a cooking group, have the client cut shapes to construct a gingerbread house using templates and written directions. Correct Answer: Rationale: Choosing a structured activity with clearly defined task steps is a good choice. Because bipolar disorder interferes with executive functions of the brain, structuring the activity with directions and patterns would lessen information processing demands and lend itself to greater potential for success. Additionally, this activity can be individualized so the client works on the task alone in a parallel group or in an assembly line fashion in a project group. This action would allow for the activity to be meaningful, graded for task demands and social interaction, and organized to minimize stress. A client in a manic phase of bipolar disorder would typically approach the tasks of scrapbooking and decorating the unit in a disorganized manner. During scrapbook-ing, the client would likely have difficulty negotiating for shared materials and supplies, making the task difficult for other group members. The resulting psychosocial reactions would present a challenging group dynamic for the OTA to manage using therapeutic use of self. This would not be helpful to the client or group members. The task of decorating the unit has not been structured to facilitate goal attainment for this client. Instead, it can contribute to the client's mania by its lack of structure, unclear definition of roles for client par-ticipation, and laissez-faire leadership approach. The aim of inpatient hospitalization is to facilitate symptom management, so this is not an effective action.
A130. An OTA leads an outpatient wellness program. An individual with obsessive-compulsive disorder asks for suggestions to manage symptoms that are interfering with life satisfaction. Which is the best recommendation for the OTA to make to the individual? A. Approach activities in a nonchalant manner without high expectations. B. Engage in concrete activities that can be broken down into simple steps. C. Redirect thoughts and energies into meaningful activities. D.Set limits on the number of activities done in a day.
C. Redirect thoughts and energies into meaningful activities. The focus of OT in a wellness program is to help individuals attain and maintain life satisfaction through the engagement in meaningful activities. Individuals with obsessive-compulsive disorder have recurring and persistent thoughts (obsessions) and the need to engage in repetitious or ritualistic behaviors (compulsions) that interfere with functional activities. Therefore, redirecting thoughts and energy into meaningful activities can be an effective behavior management strategy. Approaching activities in a nonchalant manner without high expectations and limiting the number of activities performed during a day would not address the person's need to refocus thoughts and behaviors away from their obsessions and compulsions. Engaging in activities that can be broken down into simple steps is helpful for persons with cognitive deficits. Individuals with obsessive-compulsive disorders typically do not have cognitive deficits.
C86. A college student with post-concussion syndrome is referred to occupational therapy for cognitive rehabilitation. The occupational therapist reviews the client's evaluation results with the OTA. The therapist reports that the client has prospective memory deficits. The OTA and therapist collaborate to design interventions to address this deficit using an adaptive/functional approach. Which activity is best for the OTA to teach the client to incorporate into their daily routine? Answer Choices: A. The use of a step-by-step instruction sheet to enable the completion of basic activities of daily living. B. The authorship of subject-specific index cards to help with the recall of essential course information. C. The use of a day planner in which the student records course assignment due dates and scheduled exams. D.Audio-taping class lectures and reviewing them after each class.
C. The use of a day planner in which the student records course assignment due dates and scheduled exams. The adaptive/functional approach to cognitive rehabilitation teaches persons how to use compensatory techniques and adaptive strategies to complete desired tasks. These can include the use of step-by-step instructions, study cards, and audio-taping. However, the focus of the answer choices which include these approaches do not address prospective memory. Prospective memory is the capacity to remember to carry out actions in the future (e.g., knowing you have appointments scheduled, knowing when to pay a bill). Teaching the student to incorporate the use of a day planner in which they have recorded their course assignment due dates and scheduled exams into their daily routine is the only option that effectively addresses prospective memory deficits. Teaching the client to use a step-by-step instruction sheet to complete basic activities of daily living would be an effective compensatory strategy for procedural memory deficits. The authorship of subject-specific index cards to help with the recall of essential course information would be an effective compensatory strategy for declarative memory deficits. Audio-taping lectures is a compensatory strategy that is typically used for those with poor sustained attention
C44 An OTA leads a social skills group for children aged 10-12 years with conduct disorders. One of the children complains that the group activity is stupid and boring. Which is the most effective response for the OTA to provide in response to this complaint? Answer Choices: A. Encourage the child to complete the activity with the group. B. Allow the child to leave the group since uninterested. C. Allow the child to suggest a different group activity. D. Tell the child the complaint will be discussed at the next family meeting.
Children between the ages of 10 and 12 are typically at the developmental age of cooperative play, which emerges at age 7 years. During this stage of development, children participate in games and learn to play according to rules in a cooperative manner. Encouraging the child to complete the activity with the group provides the child with the opportunity to develop age-appropriate social skills. Children with conduct disorders often show disregard for others and tend to violate rules; therefore, completing a planned activity with others is particularly relevant. Allowing the child to alter the group's in-progress activity does not address these issues. There is no need for the child to leave the group or for the behavior to be discussed at a family meeting.
C45 An older adult diagnosed three years ago with a neurocognitive disorder has been admitted to a hospital for regulation of medication. The occupational therapist and OTA determine that the patient demonstrates diminished memory skills since the evaluation completed during a previous hospitalization. However, they determine the person is still able to live at home with support and supervision. During the discharge planning meeting, which activity should the OTA recommend family members perform for the patient?Answer Choices: A. Weeding the garden. B. Sorting and folding laundry. C. Preparing cold sandwiches. D. Cooking hot meals.
Cooking hot meals provides the main opportunity for the person who is increasingly forgetful to be unsafe. Leaving the stove on due to memory loss can be a fire hazard. The person can continue the other activities without compromising personal safety. In addition, weeding and sorting and folding laundry are structured and repetitive activities that can facilitate the person's active engagement.
A52. During an intervention session, a client complains of dry mouth due to prescribed medications. What is the most effective strategy for an OTA to suggest to the client to manage this side effect? Answer Choices: A. Suck on ice. B. Sip water. C. Drink iced tea. D.Suck on hard candies.
Correct Answer: Rationale: Sipping water is the best choice to relieve dry mouth. Sucking ice and/or hard candies presents a possible choking risk. Hard candies might present a dietary risk for some clients. Iced tea contains caffeine, which can increase dehydration. Caffeinated tea can cause serious, even fatal reactions, when taken with certain medications (e.g., MAO inhibitors
C72 During a therapeutic feeding session, an older adult resident with a neurocognitive disorder becomes upset and cries for their mother. Which is best for the OTA to say in response to the resident's statements? Answer Choices: A. "Remember that you are now in a nursing home and your mother is not here." B. "Remember your mother passed away years ago." C. "I will tell the nurse that you want your mother contacted." D. "You must miss your mother, tell me about her."
D. "You must miss your mother, tell me about her." This response validates the person's feelings and provides them with the opportunity to reminisce about a pleasant memory. Even a few minutes of reminiscing can provide solace to the individual, which can help calm the person. This can then enable the resident to re-engage in the feeding activity. Individuals with neu-rocognitive disorders generally respond well to validation therapy and reminiscence activities. Asking the individual to recall that their mother is deceased and/or not available is inappropriate, for they are asking the resident to remember something that is no longer part of their reality. Telling the person that that there is a potential for their mother to be contacted is offering an action that cannot be completed in reality. In addi-tion, it does not address the individual's valid feelings, which need to be addressed at the moment.
C26. A person who is a home maintainer and parent is hospitalized for depression and prescribed Parnate to treat depressive symptoms. The patient's hobbies are gardening and jogging. Upon discussing the functional effects of medications with the patient, which is the most important precaution for the OTA to review? Answer Choices: A. Photosensitivity. B. Orthostatic hypotension. C. Amenorrhea. (absence of menstruation) D. Dietary restrictions.
D. Dietary restrictions. Parnate is a monoamine oxidase inhibitor (MAOI). It has serious side effects when a person eats foods that contain the amino acid tyramine. Tyramine increases blood pressure and may lead to stroke or other cardiovascular reactions. Photosensitivity, orthostatic hypotension, and amenorrhea can be side effects of psychiatric medications, but they are not typically a major concern of MAOIs. These side effects are a more common concern with antipsychotic medications.
A93. A graduate student with an anxiety disorder reports feeling confused about the future. During the OT evaluation, the client relates decreased feelings of competence for a chosen field of study and overall poor personal causation. Which is the best initial action for the OTA to take in response to the client's stated concerns? Answer Choices: A. Administer a vocational interest inventory. B. Provide activities related to the client's chosen field of study. C. Refer the client to the state office of vocational and educational services. D. Establish short-term goals with high potential for attainment.
D. Establish short-term goals with high potential for attainment. Decreased personal causation and feelings of incompetence are common symptoms of anxiety disorders. The stablishment of short-term goals with high potential for attainment can provide the individual with the suc-essful experiences needed to develop a sense of competence and improve personal causation. Once these kills are developed, the need for further vocational exploration and/or services can be determined.
A26. An older adult with a mild neurocognitive disorder consistent with Reisberg's Level 3 has been told to stop driving by their primary care physician. The client and spouse seek services from an OTA who has attained service competency in driver rehabilitation. The client and spouse are upset about the physician's advice because the spouse does not drive. Which response is best for the OTA to provide to this client and spouse? Answer Choices: A. Advise the client and spouse to seek a second opinion from a physician who specializes in neurocognitive disorders. B. Train the spouse to use a navigation system to provide verbal directional prompts to the client. C. Schedule the client for a full evaluation of performance skills and client factors. D. Explore available driving alternatives to maintain community mobility and participation.
D. Explore available driving alternatives to maintain community mobility and participation. A person with a mild neurocognitive disorder that is consistent with Reisberg's Level 3 will have difficulty completing complex occupational tasks. Their participation in activities requires more concentration and time. Driving is complex and unpredictable and may require a split-second reaction time to ensure safety.Based on these activity demands and the progressive nature of neurocognitive disorders, it is best for the person to learn alternatives to driving while they are capable. At this stage, a person is independent in basic and instrumental activities of daily living, can recognize challenging situations to avoid, and utilize compensation as an adaptive mechanism. Consequently, the OTA can build on these strengths to enable community mobility.
A3. A middle school student with moderate intellectual disability does not eat lunch during the school's lunch hour. Instead the student spends the lunch period socializing with peers. A 1:1 aide is not assigned to the student. Which is the first intervention the school-based OTA should use to promote the activity of eating lunch? Answer Choices: A. Schedule the student's lunch to be in the classroom to limit distractions. B. Provide positive feedback for attending to eating at 10-minute intervals. C. Practice role playing lunch conversations in the classroom. D. Have the student share a lunchroom table with one peer.
D. Have the student share a lunchroom table with one peer. Persons with moderate intellectual disabilities can be distractible and have limited attention spans. Having the student share a lunchroom table with one peer will allow for socialization without too many distractors. Scheduling the student's lunch to be in the classroom can limit distractions, but this will isolate the student from peers. In addition, this action would require a staff member to be present, which would likely not be feasible. In school settings, specific staff members are typically assigned to monitor the lunchroom and/or playgrounds during students' lunchtime. These primary staff responsibilities would preclude the availability of a staff member to provide supervision in the classroom or feedback at 10-minute intervals during the student's lunch. Role-modeling is an effective learning strategy in which the participant can watch, imitate, and then practice a skill. This process can increase understanding of role expectations through active participation and feedback, rather than by verbal explanation. However, in this scenario the student has a moderate intellectual disability (ID). With moderate ID, intervention is typically focused on the individual acquiring independence in routine daily tasks and skills necessary to perform in desired occupational roles with support and structure. Therefore, working with the student in the lunchroom environment is best.
A106. An individual attends an outpatient parenting skills group. The person has a major depressive disorder and is taking Nardil. The client complains of recurrent headaches and difficulty focusing during the day (e.g., when helping children with their homework). Which action is best for the OTA to make in response to the client's expressed concerns? Answer Choices: A. Instruct the client in stress reduction techniques. B. Ask the group for suggestions on how to deal with the parenting stress of homework. C. Suggest that the individual consult with a nurse practitioner for headache relief strategies. D. Tell the client you will be notifying the psychiatrist of these complaints.
D. Tell the client you will be notifying the psychiatrist of these complaints. Rationale: Nardil is a monoamine oxidase inhibitor (MAOI). It has serious side effects when a person eats foods that contain the amino acid tyramine. Tyramine increases blood pressure and may lead to stroke or other cardiovascular reactions. Headache and heart palpitations are the first sign of a problem. This must be considered a serious medical situation and the physician must be contacted. To assume that the headaches are stress-related is dangerous. Suggesting that the person contact a nurse practitioner does not guarantee follow through. The individual needs to collaborate with the psychiatrist to determine if an MAOI is the best medi-cation, given its restrictions. Chapter 10 in this text provides these
A38. The transition plan for an 18-year-old with developmental delay includes employment in a vocational rehabilitation workshop job setting. The student has set a goal to live independent of family. Which is the best living environment for the OTA to recommend for this student?The transition plan for an 18-year-old with developmental delay includes employment in a vocational rehabilitation workshop job setting. The student has set a goal to live independent of family. Which is the best lis ing environment for the OTA to recommend for this student? Answer Choices: A. An apartment in a subsidized housing project. B. A group home with case managers available on-call. C. A supported apartment with a roommate. D.A group home with daily on-site supervision.
D.A group home with daily on-site supervision. A person with developmental disabilities who meets the employment criteria for a vocational rehabilitation (formerly called sheltered) workshop will typically have cognitive deficits that require structure and supervision to successfully and safely complete tasks. A group home with on-site staff would provide this type of support. In addition, since this student has lived with family for all of their life, they may need training to develop instrumental activities of daily living (IADL) skills. Upon the attainment of IADL skills in the group home and vocational skills in the vocational rehabilitation (sheltered) workshop, the person may be able to progress to a higher level of independence in work and home management. The person would have to first develop IADL skills to live more independently in a housing project apartment, unsupervised group home, or supported apartment
A71. An OTA works in a school setting with adolescents with autism spectrum disorder (ASD). The need for a social skills training group is identified. One activity that the OTA plans to use in the group is role playing. Which is the most effective way for the OTA to determine relevant scenarios for the role-play activities? Answer Choices: A. Survey the teachers on social difficulties displayed in class. B. Survey parents on social difficulties they have observed in the adolescents. C. Review literature on adolescent social skill development. D.Ask the group members about their social concerns.
D.Ask the group members about their social concerns. Correct Answer: Directly asking members about their concerns will enable the OTA to identify areas of common concern that can serve as the basis of relevant role-play scenarios. This will foster Yalom's curative factor of universal-ity. The ability to express one's concerns and needs is especially important to adolescents since their main developmental task is to separate from parents and develop their own self-identity. Surveying others provides information on their perceptions of the adolescents' needs. This may or may not be an accurate reflection of members' needs. Reviewing developmental literature can be helpful to understand adolescent concerns, but it cannot be used to plan role-play scenarios for a specific group of adolescents with unique needs.
cognitive behavioral therapy examples
Depression ◦ Cognitive: Become aware of irrational negative thinking, replace it with new thinking ◦ Behavioral: Practice positive approach/use diary to monitor symptoms OCD ◦ Cognitive: Re-label compulsive urges (attribute urge to brain's abnormal activity) ◦ Behavioral: Confront feared situation, such as public bathrooms
Gravitational insecurity
Inability of the central nervous system to regulate vestibular input resulting in overreaction to changes in head position and movement during ordinary activities Behavioral manifestations may include intense fear or avoidance of: riding on toys heights gross motor activities
thought blocking
Interruption of a thought process before it is carried through to completion
C93. An individual with schizophrenia is referred to a partial hospitalization program. The referring psychiatrist notes that the individual's positive symptoms have responded well to a new medication, but negative symptoms remain. During the evaluation, what will the OTA most likely observe?Answer Choices: A. Inappropriate verbalizations due to delusions. B. Limited engagement in tasks due to anergia. C. Poor concentration and distractibility due to hallucinations. D. Immobility due to akathisia.
Limited engagement in tasks due to anergia is the only negative symptom listed. Delusions and hallucinations are positive symptoms. Akathisia results in restlessness, not immobility.
B41. A home care OTA collaborates with an occupational therapist to plan intervention for an individual with agoraphobia with panic attacks. The OTA and occupational therapist use the principles of cognitive-behavioral therapy(CBT) to guide their intervention planning. Which approach is best for the OTA and therapist to use when implementing the intervention plan? Answer Choices: A. A token reward system. B. Behavioral extinction. C. Relaxation techniques. D.Systematic desensitization.
Panic attacks are symptoms of anxiety. A main focus of cognitive behavioral therapy (CT) is to help people develop relaxation skills to decrease the incidence and severity of symptoms. Systematic desensitization is also a CBT approach that is used with individuals with phobias. While systematic desensitization is an effective CBT intervention, specialized training is required to effectively use this approach. There is no information in the item scenario to indicate that the OTA has completed this training. In systematic desensitization, exposure to the anxiety-producing stimulus is initially presented to the person through the use of imagery. Incremental and graded contact with the anxiety-producing stimulus is combined with reframing and relaxation until the stimulus no longer produces an anxiety response. If the scenario did indicate that the OTA had been trained in the use of systematic desensitization, relaxation techniques would still be the best approach to use in the initial intervention session. It is important to recognize that visualizing an anxiety-producing stimulus can precipitate a panic attack. Therefore, the first intervention priority is to help the client learn to manage and decrease anxiety. The use of relaxation techniques during the initial intervention session can attain this goal. A token reward system involves the granting of tokens as a reward for desired behaviors. Behavioral extinction is a technique used to decrease undesirable behaviors by ignoring them and reinforcing desirable behaviors. These are not effective techniques for agoraphobia or panic attacks because the person's anxiety must be directly treated.
A127. An individual hospitalized for the first time due to a brief psychotic episode attends an occupational therapy group. During task performance, the OTA notices that the person is restless with hand tremors and shaking legs. Which of the following should the OTA document that the person seems to be exhibiting? A. Akinesia. B. Pseudo-parkinsonism. C. Akathisia. D. Tardive dyskinesia
Rationale: Akathisia is a side effect of antipsychotic medications that is exhibited by restlessness, hand tremors, and shaky legs. Akinesia is also a potential side effect, but this is evident by a lack of movement. Akinesia is also a negative symptom of schizophrenia. Pseudo-parkinsonism is also a side effect that appears as behaviors similar to the symptoms of advanced Parkinson's disease; that is, rigidity, pill-rolling tremors, masked face, and a shuffling gait. Tardive dyskinesia is an irreversible neurological condition caused by years of taking neuroleptic medications. It would not be evident in someone being treated for a first break with neuroleptic medications.
B96. A young adult recently diagnosed with a major depressive disorder attends a goal-setting group for persons living with depression. Which is the most helpful approach for the OTA leading this group to take with the group members?Answer Choices: A. Encourage the members to discuss long-range planning. B. Say as little as possible to allow the members to do most of the talking. C. Remain cheerful and upbeat to alleviate the members' depression. D. Facilitate reality testing of the members' negative thinking.
People with depression often interpret events and the behaviors of themselves and others with unfounded or exaggerated negativity. Developing the group members' ability to test and correct negative thinking is an important precursor to developing the ability to set goals. This approach is consistent with cognitive behavioral therapy (CBT), which has been shown to be effective in the treatment of individuals with depression. CBT works to alter an individual's negative thoughts about themselves, the world, and the future by correcting misinterpretations of life events. Long-range planning is limited when an individual is initially adjusting to a new diagnosis. In addition, persons with depression often have difficulty with this ability. Persons with depression may also have difficulty independently initiating conversation. Cheerful, upbeat behavior may be offensive as it can highlight the members' depressed mood and appear to minimize the group members' affective state. This can bring the OTA's empathy into question.
B73. An individual with schizophrenia is referred to a partial hospitalization program. During the intake interview, the client answers each question by consistently returning to the focus of the first question. Each time the OTA introduces a new topic to discuss in the interview, the client ignores this topic and returns to the original question. When reviewing the interview with the supervising occupational therapist, which behavior is most accurate for the OTA to report the client is demonstrating? A. Thought blocking. B. Perseveration. C. Obsessive thinking. D. Poverty of speech.
Perseveration is a persistent focus on a previous topic or behavior after a new topic or behavior is introduced. Thought blocking is the interruption of a thought process before it is carried to completion. Obsessive thinking involves the persistence of an illogical thought. Poverty of speech is speech that is limited in amount and content.
B9. An adult with obsessive-compulsive disorder is hospitalized due to the exacerbation of symptoms. During the patient's first occupational therapy group, which is the most beneficial activity for the OTA to employ with this person?Answer Choices: A. Sanding a cutting board. B. Repotting plants. C. Stringing small beads into a necklace. D.Lacing a wallet with the double cordovan stitch.
Persons with obsessive compulsive disorders exhibit behaviors that are characterized by orderliness, perseverance, and driven by a pursuit for perfection. Repotting plants is the activity choice that offers an opportunity to break away from the repetitive behavioral patterns of obsessive compulsive disorder. The other activities all have elements that could reinforce the repetitive behavioral components of the disorder; that is, sanding back and forth, stringing bead after bead, and lacing the stitch over and over. In addition, these activities could be held to a standard of perfection; that is, a perfectly smooth surface, the perfect bead pattern, a complex stitch with no twists.
A147. An OTA employed at a day treatment center for clients with psychiatric disorders is conducting a leisure-planning group. The members of the group decide to take a day trip to the local sculpture garden. Which side effect of psychotropic medications is most important for the OTA to discuss in terms of preventative precau tions with the group? Answer Choices: A. Orthostatic hypotension. B. Akathisia. C. Photosensitivity. D. Tremors.
Photosensitivity results in severe sunburn which can occur during an outdoor trip. The other options are potential side effects of medications, but they are not exacerbated by being outside.
C145. A child with attention deficit disorder with hyperactivity (ADHD) receives school-based occupational therapy services. During intervention sessions, which behaviors will the OTA most likely observe the child demonstrate?Answer Choices: A. An excessively high energy level that can be lessened by eliminating consumption of caffeine and certain foods. B. Symptoms of learning disabilities as evidenced by difficulties with reading and math. C. Poor attention to school and play activities over the past three months. D. Non-purposeful activity that interferes with the functional use of age-appropriate skills.
Rationale: One of the key behavioral characteristics for the diagnosis of ADHD is the presence of non-purposeful hyperactive behavior that interferes with the functional use of age-appropriate skills in school, play, and/or social settings. In the adolescent and adult, these behaviors must also interfere with work tasks. High energy levels that are relieved by elimination of foods are more likely food allergies or sensitivities rather than ADHD. Not all children with ADHD have learning disabilities; the two conditions are separate disorders. To be considered ADHD, the behaviors must last at least six months.
B83. An OTA working in a psychogeriatric unit provides services to older adults with mid-stage neurocognitive disorders. Which groups are best for the OTA to use with this population? Answer Choices: A. Reality orientation. B. Sensory stimulation. C. Reminiscence. D. Coping skills.
Reminiscence groups are designed to review past life experiences to promote use of intact long-term memory. Current memory is not required for successful participation in reminiscence groups. Individuals with mid-stage neurocognitive disorders typically have poor recent memory but good long-term memory. Reality orientation typically involves activities that require remembering the current day, date, time, season, and activity sequence. Individuals with mid-stage neurocognitive disorders have current memory deficits that would preclude their ability to successfully participate in reality orientation activities. This lack of success can highlight deficits and increase frustration. Sensory stimulation activities are indicated for individuals with later-stage neurocognitive disorders who are at risk for sensory deprivation. Coping skills groups use activities to problem solve, apply, and critique alternative solutions that can be used to effectively manage potential life stressors/problems. These activities require cognitive abilities that are beyond the capacity of persons with mid-stage neurocognitive disorders.
B66. An OTA provides pediatric home-based occupational therapy services. The parents of a school-aged child with Rett syndrome ask the OTA for activities to help their child regain lost skills. Which of the following should the OTA include in the home program?Answer Choices: A. Encourage the child to use pressure distribution techniques. B. Use four-step sequencing cards to increase attention. C. Give positive feedback for active ROM performance. D. Perform passive ROM to prevent contractures.
Rett syndrome is a genetic progressive disorder in which motor, cognitive, social, and language skills deteriorate. If the child is school-aged, it is highly likely that the child has experienced significant functional decline. Regardless of the child's current functional level, children with this progressive condition cannot regain lost skills. Therefore, the home program must focus on maintaining function and preventing complications. Passive ROM is an activity that the parents can do to prevent contractures, which are a complication of this progressive condition. The child will not be able to respond to encouragement to use pressure distribution techniques. Since pressure relief is important to prevent the complication of skin breakdown, a more effective approach is to make sure that the parents are aware of correct positioning and the need to change positions frequently. The child in this scenario will not be able to attend to sequencing cards to increase attention or independently perform ROM.
B18. An OTA works with members of a psychosocial clubhouse who have decided to participate in the annual mental health awareness and fundraiser walk organized by the National Alliance for Mental Illness (NAMI. The NAMI walk is 5K long and circles around an urban park. Many clubhouse members express interest in training for the walk by taking extended walks four times per week. Which recommendation is most important for the OTA to make to these clients? Answer Choices: A. Do leg stretches before beginning each walk to prevent leg cramps. B. Avoid sudden postural changes to prevent orthostatic hypotension. C. Apply sunscreen to all exposed body parts to prevent sunburn.
The application of sunscreen is essential for persons on psychotropic medications, which can make the skin highly sensitive to sunlight. Photosensitivity results in a skin rash and sunburn, which can be severe. The amount of sun exposure required for a person to have a reaction varies greatly. Some individuals may develop a rash or burn after very little sun exposure. Others will have a reaction only after prolonged exposure. Because the clubhouse members are planning extended walks, the likelihood of a photosensitive reaction must be addressed. Because extended sun exposure contributes to skin cancer, the consistent use of sunscreen is an important health measure for all members, regardless of their medications. The other answer choices provide recommendations which can be helpful for preventing the outcome identified as being the focus of each choice. However, they are not as important as preventing the sunburn that can occur due to photosensitivity.
C49. An OTA provides services to a client with depression. The client consistently makes negative comments about personal capabilities, reports feeling hopeless for the future, and has a pessimistic view of the world. The OTA collaborates with the occupational therapist and client to develop an intervention plan. Which approach is best to include in this plan? A. The identification of unhelpful thinking patterns, changing inaccurate beliefs, acquiring coping skills, and developing self-reliance and meaningful healthy occupational patterns. B. The provision of environmental modifications and activity adaptations to compensate for cognitive defi-cits, support existing abilities, and allow the greatest degree of independence. C. The use of projective tasks to promote self-awareness, identify and explore intrapsychic content, bring unconscious conflicts to consciousness, and facilitate intrapsychic conflict resolution.
The client's pattern of negative thinking is consistent with the 'cognitive triad' identified in the cognitive behavioral frame of reference. This triad underlies depression and is comprised of negative self-evaluation, a pessimistic world view, and a sense of hopelessness regarding the future. To treat these symptoms of depression, cognitive behavioral therapy (CBT) has been shown to be effective. Because an individual with depression tends to distort reality through dysfunctional thought processes, CBT works to alter negative thoughts about oneself, the world, and the future by correcting misinterpretations of life events. It combines principles of cognitive therapy and behavioral therapy by looking at a person's thoughts, beliefs, and actions and attempting to change maladaptive patterns of behavior. Identifying unhelpful thinking patterns, changing inaccurate beliefs, acquiring coping skills, and developing self-reliance and meaningful healthy occupational patterns are consistent with CBT and are appropriate to include in the intervention plan for a person with depression. Providing environmental modifications and activity adaptations to compensate for cognitive deficits, support existing abilities, and allow the greatest degree of independence are all consistent with Allen's cognitive disabilities model. This model proposes that cognitive ability is determined by biological factors and that the person's cognitive level cannot change. Using projective tasks to promote self-awareness, identify and explore intrapsychic content, bring unconscious conflicts to consciousness, and facilitate intrapsychic conflict resolution are consistent with a psychodynamic/psychoanalytic frame of reference. The use of this approach by OT practitioners requires specialized training.
Make an appointment with the client's physician for a complete medical evaluation.
The client's symptoms may be due to a neurocognitive disorder or a reversible cause of mental confusion. Reversible causes of confusion include depression, polymedication, viral, bacterial, or urinary tract infec tions; gallbladder disease, and metabolic problems such as thyroid disorders or poorly controlled diabetes. A complete medical evaluation is needed to determine the causes) of the client's behavior prior to making any treatment or referral recommendations. See Chapter 10.
C137. An OTA is working with an individual recovering from a traumatic hand injury. The person regularly attends all outpatient intervention sessions but has little energy and is very difficult to engage. The person reports disinterest in performing the prescribed home program. Which is the best action for the OTA to take in response to this situation? Answer Choices: A. Advise the occupational therapist that a referral to a psychiatrist for the completion of a mental status examination should be made. B. Tell the person that active engagement in intervention sessions and the completion of the home program is vital to recovery. C. Inform the occupational therapist that the patient is exhibiting behaviors that indicate the need to screen for depression. D. Defer intervention until the person's depression is evaluated and the occupational therapy intervention plan modified as needed.
The patient's observable behaviors (i.e., lethargy and disengagement) and reported disinterest can be indicative of depression. Thus, the OTA must inform the occupational therapist that the patient is exhibiting and reporting behaviors that indicate the need to screen for depression. The occupational therapist can then complete a standardized depression scale that provides objective data about the person's affective state. The therapist can also interview the person to determine contextual factors that may be impacting the person. A referral for a psychiatric evaluation would be premature at this point, as the cause of the person's behavior is not known. The person's lack of energy and non-compliance can be due to other factors that are not psychiatric in nature. For example, the individual could be providing care for a spouse and not have time for a home program and/or for adequate sleep.Explaining the importance of engaging in therapy and completing a home program does not directly deal with the issue of lack of engagement and follow through. In addition, there is nothing in the scenario to indicate that the person is not aware of the importance of compliance. Since it is not known if the person's behaviors are due to depression, it would not be effective to defer occupational therapy treatment. If the person is depressed, the treatment for depression can be provided concurrently with the treatment for the person's physical limitations.
C40. A middle school student with learning disabilities exhibits no behavioral problems in the classroom. However, whenever the class is in a line waiting to switch classrooms, the student becomes agitated and often pushes classmates. The OTA consultant advises the teacher that this behavior may be indicative of an underlying problem. Which of the following is most accurate for the OTA to identify as a potential disorder warranting further evaluation?Answer Choices: A. Gravitational insecurity. B. A conduct disorder. C. Antisocial tendencies. D. Tactile defensiveness.
The tactile stimuli due to closeness of peers in a line can become overwhelming to an individual with tactile defensiveness. The behavior described in the scenario is not reflective of behavior indicative of the other disorders listed.
Behavioral frame of reference
To reward positive behaviors and ignore negative ones.
A developmental group
a continuum of groups consisting of parallel, project, egocentric cooperative, cooperative, and mature groups. Purpose to teach and develop members' group interaction skills
Psychosocial clubhouses
community-based service environments that fill a variety of needs across the continuum of recovery supports and services
task-oriented group
group's focus is to increase members' awareness of their values, ideas, and feelings as revealed through group activity.
Sensory stimulation activities are indicated for
individuals with later-stage neurocognitive disorders who are at risk for sensory deprivation.
A topical group
is a discussion group that focuses on activities performed outside of the group (e.g., vocational planning)
poverty of speech
limited amount and content
conduct disorder
patterns of behavior in which the rights of others or basic social rules are violated
obsessive thinking
persistence of an illogical thought
Perseveration
persistent repetition of the same word or idea in response to different questions
Coping skills groups use activities to
problem solve, apply, and critique alternative solutions that can be used to effectively manage potential life stressors/problems.
Rett Syndrome
progressive neurological developmental disorder featuring constant hand-wringing, intellectual disability, and impaired motor skills
prospective memory
remembering to do things in the future
Pseudo-parkinsonism.
side effect of antipsychotic drug, rigidity, pill rolling, masked face, shuffling gait
Akathisia signs
side effect of antipsychotic medications that is exhibited by restlessness, hand tremors, and shaky legs
Akinesia
side effectof antipsychotic medications , but this is evident by a lack of movement
A directive group
uses a highly structured five-step approach to help low-functioning patients (e.g., persons with neurocognitive disorders or serious mental disorders) develop basic skills
