NBCOT exam prep

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A 14-year-old client is working with a OTR to expand his social engagement and participation with peers. He presents with challenges connecting with peers and making friends. The client has indicated a personal goal to increase social engagement and friendships. What is the BEST way for the OTR to gain a perspective on the client's needs? A. Use a parent report to determine targeted areas to improve social engagement B. Use a client report to determine the youth's feelings and experiences in context C. Use parent report to determine cognitive and social engagement skills D. Use standardized testing to determine targeted areas to improve cognitive skills and work preferences

A client is referred for inpatient occupational therapy following hip surgery. What is the FIRST thing the OTR must do prior to evaluating a client's activities of daily living (ADLs) and functional ambulation? A. Confer with the client's physical therapist regarding the client's ambulatory status B. Review the client's medical record for demographics, current status, and precautions C. Review the client's most recent vital signs with the attending nurse D. Ask the client about the prior level of function, ambulation, and community mobility

A client presents with severe rheumatoid arthritis of both shoulders and hips and is limited in his ability to perform self-care activities. He lives at home with his wife. He expressed that he has not been able to help his wife with homemaking tasks and would like to avoid being a burden to his wife. He would like to be able to dress himself and complete his own bathing and grooming. Which of the following assistive devices is MOST appropriate for the client? A. Button hook B. Long-handled sponge C. Built-up handle toothbrush D. Mounted nail clipper

A client with low vision lives with a spouse and has difficulty navigating the home environment safely. The spouse often leaves cabinet doors open, the dishwasher open, and moves furniture regularly. Which strategy would be BEST for the OTR to implement with this client and spouse in order to improve safety in the home? A. Task lighting B. Organization C. Use of contrast D. Mobility training

An OTR is working in an outpatient clinic and is seeing a client with borderline personality disorder. Which of the following would the therapist do when using a client-centered approach? A. Provide strong limit setting during group settings that focus on self-help and relationships with and among peers B. Focus on the here and now; provide calmness and consistency without being drawn into power struggles C. Provide opportunities for spontaneity, productiveness, and focus on feelings and emotions rather than routines and habits D. Provide courtesy, honesty, and respect in order to gain the confidence of the client while allowing slow attempts to engage

An OTR is working in the school system with children with autism. The OTR organizes programs that use activities in a group setting to promote social participation and social skill development. What principles are MOST IMPORTANT to consider when planning social skills groups for children with autism spectrum disorder? A. The group needs to be fun and competitive B. Provide a safe and supportive environment that includes emotional regulation strategies C. Peers invited to the group are of different ages and have a variety of interest D. Members are asked to role-play perform and demonstrate learned skills

An elementary aged boy with spastic quadriplegia cerebral palsy would like to expand his leisure activities. He wants to be able to play video games on his tablet. The OTR is able to position the tablet to an accessible position, but realizes the boy would benefit from having more assistance with engaging the tablet's screen due to decreased motor control and precision. What might the OTR recommend? A. Tech Speak B. Hook and Switch Interface C. Big Mack D. Housemate Pro

An entry level OTR implements a group program for clients with rheumatoid arthritis. During a session focused on meal preparation, one client demonstrates significant pain when opening a jar. How should the OTR advise the client? A. Use two hands to open B. Utilize a jar opener C. Rest between attempts D. Ask for help from others

The OTR applies metal cylinders that vary in temperature to a client with a hand injury. The client demonstrates no response to all cylinders applied to the hand. Which BEST describes this client's impairment? A. Decreased pain and touch awareness B. Decreased temperature sensation C. Decreased stereognosis awareness D. Decreased proprioception sensation

Functional Independence Measure (FIM) Age Areas addressed Method

Adults Measures functional status, self-care, cognition, communication Observation

Tinetti Assessment Tool Age Areas addressed: Method

Adults measures risk for falls, gait/balance observation

Ashworth Scale 0 1 2 3 4

0- Normal muscle tone 1- Normal muscle tone 2- slight increase in muscle tone; "catch" when limb moved 3- considerable increase in muscle tone 4- limb rigid flexion or extension

Occupational Self-Assessment Age Areas addressed Method

14+ volition, habituation, performance, values, personal causation, interest, roles, habits, routines self-report

A 2-month-old client is struggling with food refusal and the parents are worried of failure to thrive. An OTR has been placed on consultative services to determine possible concerns related to feeding challenges. The OTR observes several clinical presentations of feeding refusal behaviors. Which of the following is the BEST example of a feeding refusal behavior in an infant? A. Refusing the nipple/spoon by closing mouth B. Coughing when food is swallowed C. Intolerance to cow's milk and vomiting D. Eye redness or watery eyes during feedings

A client is participating in occupational therapy following a cerebrovascular accident (CVA) with hemiparesis of the dominant upper extremity. The therapist provides assistive devices in order to promote occupational engagement. Which of the following interventions are BEST for the therapist to introduce? A. Rocker knife and elastic shoe laces B. WBing on the UE C. Splinting and positioning programs D. Supported reach tasks with BADLs

A client with rheumatoid arthritis is practicing meal preparation in an outpatient OT clinic. The client complains of pain in the hands with meal preparation. Which action is MOST appropriate for the OT to address? A. Use of built-up handles for stirring B. Use of heavy bowls to prevent sliding C. Use of thin-handled knives for chopping D. Use of large jars with more quantities

An OTR has completed an evaluation of a child in second grade who has handwriting difficulties. The OTR would like to use a biomechanical approach to intervention to improve handwriting and written production. What strategy BEST represents a biomechanical approach to handwriting intervention? A. Slant board to promote wrist extension and an efficient pencil grasp B. Line paper with diagrams C. Raised writing lines D. Handwriting instruction and receptive task practice

An OTR is seeing a client post-surgery with range-of-motion (ROM) limitations due to edema. Which is MOST appropriate for the OTR to recommend in order to reduce the effects of edema on ROM? A. Elevate the injured extremity B. Apply heat to the extremity C. Massage from proximal to distal

An older adult with age-related macular degeneration has been admitted to inpatient rehabilitation following total hip replacement. The OTR completes an evaluation and determines that the client has reduced contrast sensitivity. Which action is BEST for the therapist to take? A. Add high-contrast markers to adaptive equipment for dressing B. Utilize low, calm lighting to decrease stress while learning dressing C. Ensure all adaptive equipment is white to promote cleanliness

A client has developed edema in the right hand after it was immobilized in a cast. She is right-hand dominant and has difficulty using her left hand for tasks that require dexterity. She lives alone and needs to use both hands for instrumental activities of daily living (IADLs) such as meal preparation and cleaning. The OTR wants to recommend a temporary method to provide compression. Which of the following compression materials is MOST appropriate for the client? A. Low-stretch bandage B. Coban wraps C. Compression glove D. Custom-made garment

An OTR is working with a group of clients at level 5 Allen Cognitive Level in a community mental health center. They are concrete thinkers and can imitate new procedures and remember several steps at a time. What type of group intervention is MOST EFFECTIVE for clients at this level? A. Prepare and cook a simple meal B. Collate forms and stuff envelopes C. Practice medication management D. Perform basic daily grooming tasks

A B- level 3 C- Practicing medication management is a major problem because clients at Level 5 have a lack of abstract thinking which prevents them from understanding the nature of their illness or the effects of medication D- level 3

A client is beginning phase 2 of cardiac rehabilitation in an outpatient setting. After assessing the client's risk factors and cardiovascular response to exercise, the OTR develops the intervention plan to incorporate discontinuous exercise. Which is the BEST benefit for this recommendation? A. Multiple muscle groups are utilized B. Completion of 40 minutes of exercise C. Specific muscle groups are targeted D. Mimics home exercise programs

A Discontinuous exercise allows the patient to stay on one piece of equipment for one-half or one-third of the allotted time and provides an opportunity for multiple muscle groups to be utilized, boredom to be minimized, and exposure to a variety of equipment. Discontinuous exercise provides a broader rehabilitation program secondary to focusing on multiple muscle groups.

An OTR is working with a client with hemiparesis of the dominant upper extremity following a cerebrovascular accident (CVA). The client has significantly low tone in the upper extremity and no functional use. Which is BEST for the OTR to address when working with this client? A. Risk of joint and soft tissue injury during activities of daily living (ADLs) and bed mobility B. Constraint-induced movement therapy to decrease learned non-use C. Weight-bearing through the upper extremity and use for support D. Using supported reach tasks and moving objects across a table

A During the low tone stage, joints are at an increased risk for injury due to instability and are more likely to become misaligned. With low tone, the muscles do not provide the typical or normal stabilization around the joints, increasing the opportunity for misalignment to occur. In order to protect the unstable joints, the OTR must address the risk, maintenance, and protection of the joints and soft tissues during activities of daily living (ADLs) and bed mobility.

During a chart review, an OTR notes the client has experienced extensor tendon injury in zone I of the hand. Which BEST describes what the client is experiencing? A. Mallet deformity B. Clawhand deformity C. Complex regional pain D. Finger contractures

A Mallet deformity is the result of a disruption of the terminal extensor tendon and manifests itself as distal interphalangeal (DIP) extensor lag, specifically in zone 1 of the hand. A mallet finger is characterized by flexion of the DIP joint resulting in the finger losing the ability to extend the distal phalanx. Clawhand deformity is the result of high level ulnar nerve involvement resulting in the hyperextension of the metacarpophalangeal (MCP) joints of the ring and small fingers. The hyperextension is the result of the overaction of the extensor digitorum communis that results in a clawing appearance of the hand. Answer C: Complex regional pain syndrome is not unique to this injury and is a group of disorders that involve pain and dysfunction with the severity out of proportion to the initiating event. Complex regional pain syndrome can develop with any injuries and is not specific to hand injuries. Answer D: Contractures result in tissue shortening due to lack of passive motion and are not unique to this zone of the hand.

An OTR is working with a patient who had a cerebrovascular accident on increasing his/her functional hand use. What is the MOST BENEFICIAL activity to develop radial-ulnar dissociation needed to increase in-hand manipulation skills? A. Watering a plant using a spray bottle B. Wearing a serpentine splint at night C. Playing a card game of Go-Fish D. Completing a 100-piece puzzle

A Watering a plant using a spray bottle deliberately separates the radial side of the hand (the thumb, second, and third digits) from the ulnar side (fourth and fifth digit) of the hand to practice working on the dissociation of the hand to improve hand use.

An OTR is working with an infant in the neonatal intensive care unit born at 28 weeks' gestation who appears to have difficulty developing grasping patterns due to his indwelling thumbs. What is the MOST EFFECTIVE intervention to use to facilitate grasping development? A. Splinting to encourage thumb abduction needed for grasping B. Placing a towel roll in the hand C. Positioning the infant in supine flexion to encourage hands to midline D. Positioning the infant prone extension to encourage opening of hand

A Splinting to encourage thumb abduction needed for grasping is the most effective intervention to facilitate grasp development in an infant with indwelling thumbs. Splinting the thumb in abduction will create a more functional hand position for the infant to explore his or her environment and begin to grasp for toys or body parts for self-regulation and soothing. Answer B: A towel roll is not strong enough to counteract the indwelling thumb position to promote grasping. Splinting material is strong and sturdy to maintain the desired hand position so the infant can manipulate objects more efficiently to develop grasping patterns. Answer C: Positioning the infant in supine flexion addresses the needed positioning, but does not address appropriate grasping. Answer D: This child is too young to be placed in the prone position. This activity would be a good one to teach the family upon discharge.

An OTR working in an outpatient rehabilitation clinic receives a referral for a client with a high-level radial nerve laceration from a car accident. Upon evaluation, the OTR determines that the client would benefit from a splint. Which is the MOST effective splint for the OTR to create? A. Dynamic extension splint B. Long dorsal blocking splint C. Strong Velcro "buddy" splint D. Multi-dynamic flexion splint

A The radial nerve innervates the extensor-supinator group of muscles of the forearm, including: brachioradialis extensor carpi radialis longus extensor carpi radialis brevis supinator digiti minimi abductor pollicis longus extensor pollicis brevis extensor pollicis longus extensor indicis proprius Due to the innervation of the extensor muscles, a high-level radial nerve injury would result in the inability for the hand to extend. A dynamic extension splint provides wrist extension, metacarpophalangeal (MP) extension, and thumb extension, positioning the hand into a functional position. Answer B: A long dorsal blocking splint limits the full extension of the hand and is used to immobilize the joints of the hand in order to promote healing. This is often utilized following flexor tendon repair. A splint that promotes extension would be needed for a complete radial nerve injury. Answer C: A strong Velcro "buddy" splint is used to protect a finger after a fracture or to encourage movement of a stiff finger. A buddy splint would not be beneficial for a high-level radial nerve injury, as, none of the fingers have extension with this injury. Answer D: Dynamic flexion splints are utilized with median nerve injuries to promote flexion of the hand. The flexors remain intact with a radial nerve injury, making a splint that promotes flexion inappropriate.

Big Mack

A Hook + Switch Interface is designed to provide wired connections to a tablet and is intended for use linked to motor challenges. Once the hook is connected, the switch is able to engage applications on the tablet. Switches are attached to the hook and allow the child to engage in tablet features. Using a switch allows individuals with decreased motor control to engage the switch to interact with the tablet

Hook + Switch Interface

A client with multiple sclerosis is being seen for outpatient occupational therapy services. The OTR begins the evaluation by determining the client's goals for therapy, perceived performance of tasks identified, and satisfaction of performance for these tasks. Which assessment tool BEST represents what the OTR is using? A. COPM B. Home Safety and Accessibility Assessment Tool C. Six minute walk test and timed up and go test D. Multiple Sclerosis Walking and balance scale

A- COPM

A client with ataxia is receiving OT services to improve coordination and promote use of upper extremities during activity of daily living (ADL) tasks. Which of the following should the OTR recommend to promote engagement in ADLs? A. Stabilize joints proximal to distal B. Promote movements farther from body C. Request assistance for difficult activity of daily tasks D. Joint stabilization at the distal portion of task

A. Stabilizing the joints proximally (closer to the body) reduces ataxia and allows for distal (farther from the body) movements in the hands and fingers to be more accurate. In order to stabilize proximally, clients may be seated and supported using a high back chair. The support of the chair offers trunk and shoulder stabilization required for reaching tasks. Clients may also benefit from stabilizing elbows on arm rests or on a table in order to complete activity of daily living (ADL) tasks that require mobility of the hands and fingers.

An OTR is working with a 1-year-old with spastic quadriplegic cerebral palsy on the development of sensorimotor play skills. Which family-centered intervention is MOST EFFECTIVE to address this goal? A. Coaching families to use switch-operated toys with child B. Guide the child through movements in an obstacle course C. Play computer or tablet activities D. Teach caregiver massage to promote engagement in play

A. Coaching families to use switch-operated toys with the child with spastic quadriplegic is the most effective, family-centered intervention to address the goal of development of sensorimotor play skills. This intervention involves training caregivers in assistive devices that allow engagement in play for children with limited extremity movement, like a child with spastic quadriplegic cerebral palsy.Answer B: Guiding a child through movements in an obstacle course has some value in fostering motor development, but it is not the most effective because of the movement limitations of children with spastic quadriplegic cerebral palsy, such as hypertonia and postural instability. Answer C: Computer or tablet activities promote engagement in play, but they are somewhat limited in the sensory realm, especially the tactile/touch sense that you can effectively get from switch-activated toys as well as object manipulation, which is limited on a tablet. Therefore, this is not the most effective intervention. Answer D: Massage is best used to calm children who have difficulty with self-regulation or tactile sensitivities. Therefore, this is not the most effective intervention for developing sensorimotor play skills.

An OTR receives a feeding referral for a 3-year-old child with oral hypersensitivity. Which pattern of behaviors BEST represents oral hypersensitivity? A. Gags frequently, limited variety of foods, refuses tooth brushing B. coughing when swalling C. Difficulty chewing foods, weak jaw strength, poor tongue mobility. D. mouths objects regularly, pica, excessive drooling

A. Gags frequently, limited variety of foods, and refuses tooth-brushing are oral hypersensitivity behaviors of children who have oral feeding difficulties. Once recognized, an OTR can create opportunities for gradual oral sensory exploration through play and positive experiences to reduce oral hypersensitivity.Answer B: Coughing when swallowing, eating a large variety of foods, enjoying self-feeding is a pattern of behaviors ideal and typical for a 3-year-old to exhibit. It is desired that a child cough when swallowing, indicating the presence of a gag reflex. By 3 years, children should eat a large variety of table foods, feed themselves, and tolerate a variety of different textures in the mouth.Answer C: Difficulty chewing textured foods, decreased jaw strength, poor tongue mobility are indicators of oral motor impairments, specifically decreased tone or oral motor weakness and coordination difficulties, the opposite of hypersensitivity.Answer D: Mouths objects regularly, history of pica, and drooling are all indicators of low sensory registration (mouthing, eating everything/anything—even non-food items or pica), poor oral motor awareness/weakness, and poor discrimination of textures. Even though these are oral motor impairments, they are not characteristics of hypersensitivity

An OTR plans to use a sensorimotor approach to improve the handwriting skills of a 6-year-old student who has a mild learning disability. The student maintains a very tight grip on a pencil when writing, consistently uses a palmar grasp when holding the pencil, and has directional confusion when forming letters. Which activity would be MOST EFFECTIVE to include as part of the INITIAL intervention when using this approach? A. Painting letters using a wide-barrel brush on paper attached to an upright easel B. Rolling out colored modeling dough and making-cookie cutter shapes on a tabletop C. Using spring-opening scissors to cut out geometric paper shapes D. providing HOH Assistance

A. Painting letters using a wide-barrel brush on paper attached to an upright easel is the most effective initial intervention because it addresses the tight grip by using a wide-barrel brush to loosen the grip. The activity also has the student using an upright easel which places the wrist in an optimal position for writing and can help facilitate a different, more mature grasp pattern. Painting letters is also an activity that uses the sensorimotor approach which will provide the student with another sensory experience while learning to form letters correctly for improved handwriting. Answer B: Rolling out colored modeling dough and making cookie-cutter shapes on a tabletop does use a sensorimotor approach, but it does not address tight grip, grasp, or directionality

An OTR is working with a school-aged child with autism spectrum disorder in his second-grade classroom. The teacher reports that the child is continually off task, not finishing his assignments in a timely manner, and roams the classroom frequently not knowing what task to do next. What intervention is MOST BENEFICIAL to use to improve behavior and task completion in this child with autism spectrum disorder? A. Provide choices and visual schedules to ai din knowing classroom expectations B. provide movement breaks in the classroom during the off-task behavior times C. Alter the lighting, noise, and smells in the classroom D. Discuss ways to use objects based on their properties

A. Providing choices and visual schedules to aid in knowing the classroom expectations is the most beneficial intervention to use to improve behavior and task completion in the classroom for this child with autism spectrum disorder. Choices and visual schedules provide structure and predictability which foster independence with communication and an understanding of the classroom routine.Answer B: Providing movement breaks in the classroom during the off-task behavior times is most beneficial to improve motor skills and may or may not improve attention span. It could create more of a distraction in the classroom if not well thought out and orchestrated effectively

After a few months of OT services in the schools, Michael can finally flip his pencil to erase his misspelled words without dropping his pencil while writing, allowing him to finish his work in a timely manner. What hand manipulation skill pattern does this BEST represent? A. Complex rotation B. Simple rotations C. Shifting D. Palm-to-finger translation

A. Complex rotation The hand manipulation skill of complex rotation involves rotating an object 180 to 360 degrees while the thumb and fingers alternate positions; therefore, turning the pencil over to use the eraser is an example of complex rotation. Answer B: Simple rotation involves rotating or turning an object held in the fingertips 90 degrees or less while the thumb is in opposition (e.g., orienting a puzzle piece in space). Answer C: Shift is a linear movement of the object on the finger surface; the thumb remains on the radial side of the hand, and involves moving objects across the pads of the finger tips (e.g., spreading cards out in the hands or separating two pieces of paper). Answer D: Palm-to-finger translation involves moving an object from the palm to the finger tips (e.g., putting coins in a soda machine or piggy bank).

An OTR is working with a family of a 3-year-old child with autism spectrum disorder who has ongoing sleeping problems. The child has difficulty settling down to fall asleep and stay asleep and occasionally is seen night walking. What intervention is MOST EFFECTIVE for the family and child to promote sleep? A. Create a consistent bedtime B. Check on the child when the child cries C. Pain the bedroom bright yellow D. Use light-weight sheets on the child's bed

A. Create a consistent bedtime routine

A child has been referred for an occupational therapy screening in your clinic. What is the PRIMARY purpose of an occupational therapy screening? A. Determine if a comprehensive evaluation is needed B. Obtain a comprehensive assessment of performance C. Obtain data from which a treatment plan D. Measure therapeutic progress of the therapy goals

A. Determine if a comprehensive evaluation is needed

An OTR is working in an inpatient rehabilitation hospital with an individual who survived a gunshot wound to his head and sustained a traumatic brain injury. After several weeks of therapies, the patient is consistently oriented to person, place, and time and requires no assistance once new tasks or activities are learned. Which Rancho Los Amigos intervention approach BEST describes the appropriate treatment for this patient? A. Talk to him about his feelings and encourage note-taking as a way to help with memory problems B. He may need help initiating and continuing activities C. Keep comments and questions short and simple D. Keep the room quiet and calm

A. Talk to him about his feelings and encourage note-taking as a way to help with memory problems

An OTR is treating a client with complex regional pain syndrome (CRPS) in the dominant hand. The client is very protective of the hand secondary to pain and edema and becomes nauseated when the hand is touched. What is the therapist's BEST response to this situation? A. Avoid touching the hand and promote use of the non-dominant hand B. Provide a structured exercise program that includes the shoulder C. Do not initiate therapy until the pain and edema has resolved D. Avoid movement of shoulder and focus specifically on the hand function

B A continuous, severe burning pain that is often out of proportion to the severity of the injury characterizes complex regional pain syndrome (CRPS). Although the hand is the affected area, CRPS often triggers shoulder pain and stiffness; therefore, the shoulder must be incorporated into an exercise program in order to maintain or prevent shoulder dysfunction.CRPS is treated by reducing sympathetic stimulation and is most responsive in the early stages with the first goal of intervention to reduce pain and hypersensitivity.

Working in an acute care setting, an order is received for acute post-operative repair of boxer's fracture of the right dominant upper extremity. The patient has been immobilized post-operatively with gauze and ace wrapping. The surgeon has ordered an occupational therapy evaluation and treatment including splinting. What is the MOST appropriate plan of treatment, including the most appropriate splint fabrication and the most appropriate approach to post-operative edema control for this patient. A. Forearm-based resting hand splint with wrist extension at 20 degrees, begin active and passive tendon glides to promote wrist and digit mobility, positioning, and/or light massage to promote edema control B. Forearm-based ulnar gutter splint with 4th and 5th metacarpophalangeal joint flexed to 60 degrees, begin active and passive tendon glides for wrist and digit mobility, positioning, and/or light massage to promote edema control C. Forearm-based wrist cock-up splint with wrist extension at 30 degrees to allow for metacarpophalangeal joint flexion, begin passive tendon glides and active-assisted range-of-motion exercises for wrist and digital mobility and light massage to promote edema control D. Volar hand-based ulnar gutter splint with 5th metacarpophalangeal joint flexed to 45 degrees, begin tendon glides for wrist and digit mobility and positioning to promote edema control

B According to current research and evidence-based practice, ulnar gutter splints with mild wrist extension and metacarpophalangeal joint flexion to 60 degrees, if possible, is recommended. Early mobilization through tendon gliding and range of motion is indicated to promote early return to active sports in athletes with boxer's fracture.

A client was recently diagnosed with a hemorrhagic stroke that affected the upper trunk of the middle cerebral artery. He demonstrated abnormal muscle tone in the right arm. Which of the following behaviors will MOST LIKELY be observed based on the pattern of impairment and cortical involvement? A. The client does not dress the left side of the body B. The client has slow, labored, and telegraphic speech C. The client is unable to locate items on the left of the table D. The client has double vision and a drooping eyelid

B Clients who experience a stroke of the upper trunk of the middle cerebral artery in the left hemisphere present with Broca aphasia and contralateral hemiplegia. The client, in this case, presented with hemiplegia of the right arm, which is contralateral to the affected left hemisphere.

An OTR working in the school system is implementing a transition plan for a group of developmentally disabled 17-year old students. The long-term goals for the students are gainful employment and supervised independent living in a group home. What activity BEST addresses the long-term goals related to transition for these students? A. Asking for Assistance when ordering food in the classroom B. Going out to lunch in a fast-food restaurant C. Ordering a take-out lunch by phone D. ID lunch items from a picture menu in the classroom

B Going out for lunch in a fast-food restaurant is the best activity to address the suggested goals related to transition because it addresses community participation and inclusion which are two major principles of transition. This activity also develops the appropriate life skills needed for independent living such as social skills, problem solving, self-determination, and community mobility

An OTR is working with a 2-year-old child with arthrogryposis, a congenital orthopedic disorder, who has significant limitations in hand function. What is the BEST intervention to promote play skills in this child? A. HOH manipulation of a variety of toys B. Button switch to operate a toy care to move C. Mother playing peekaboo D. Finger painting

B Children with arthrogryposis have multiple contractures in small and large joints. The shoulders may be internally rotated and drawn inward (adducted), the elbows are usually extended, and the wrists are usually flexed. In most affected individuals, the fingers are flexed and stiff. These contractures impair range of motion which can impact how a child performs everyday occupations such as play. Adapted equipment and assistive devices (such as a button switch to operate a toy car) are often used in therapy to promote occupational performance for this population

An OTR has been working with a 7-year-old child with high-functioning autism spectrum disorder in an outpatient clinic setting for 3 months. The child continues to have a difficult time transitioning into the therapy gym from the waiting room. He would rather play with the toys in the waiting room and disregards the therapist and mother's requests to transition. What intervention is MOST effective for the therapist to use to promote successful transitions? A. Re-arrange seating in the waiting areas B. Use a timer to allow the child to play with the toys for a certain amount of time and then transition after the timer goes off C. Work with SLP to ID and implement effective communication strategies D. Manage the stimuli present in the clinic to prevent "flight, flight or fright" response

B Timers are the most effective intervention for the therapist to use to promote successful transitions because they provide an objective signal that something is about to occur. Timers also operate independently of an adult once set and the occupational therapist shows it to the child and informs him about what will happen and what will need to occur after the timer sounds in order to make the transition happen

An OTR is working with a 12-year-old boy who will not play on the swings or slides at school. He also has difficulty climbing up the second-floor staircase at school and cannot sit in the bleachers. Which choice BEST depicts this child's area of concern? A. Tactile defensiveness B. Gravitational insecurity C. Dyspraxia (clumsy, difficulty sequencing complex movements) D. Auditory processing problems

A OTR is completing an evaluation of a client with myasthenia gravis. The client presents with severe drooping of her eyelids. The client stated that she experiences difficulty speaking especially in the afternoon when she feels more tired. The OTR completed an occupational profile. What is the NEXT step the OTR should complete? A. Perform MMT B. Discuss psychological issues C. Fall risk assessment D. Proceed with sensory testing

B. Clients with myasthenia gravis experience changes in facial appearance, including diplopia (double vision), drooping of the eyelids, and/or the inability to move the eyes in certain directions, since the disease leads to oculomotor dysfunction. They may also experience weakness of the oropharyngeal muscles, which leads to difficulty speaking, difficulty swallowing, and fear of choking.Clients are often treated with steroids and may experience steroid-related physical changes. These physical changes may have psychosocial effects. The therapists should convey empathy and encourage a discussion of these issues. It may be necessary to refer the client to a support group or psychologist 10% only experience limb weakness fall risk more likely if they experience diplopia-double vision MG affects skeletal muscles and probably not have sensory deficits

A client is referred for an OT evaluation. The referral states that the client is experiencing ideational apraxia. Which is MOST appropriate for the OTR to observe during evaluation with this client? A. Initiation of task B. Appropriate use of toothbrush C. Manipulation of the toothbrush in hand D. Visual search for the toothbrush on the sink

B. Ideational apraxia is the inability to plan and execute motor activities while interacting with objects in daily life. Ideational apraxia occurs when clients have difficulty using objects appropriately and often experience difficulty understanding how objects are used. In this case, the client would be expected to have difficulty using the toothbrush appropriately.

The OTR works with a 19-month-old child with significant visual and motor impairments in an early intervention playgroup. Which activity is MOST BENEFICIAL to increase the child's participation in the playgroup? A. Learning to Play an instrument B. Playing in a sand/water table C. Listening to stories at circle time D. Participation in a puppet theater

B. Playing in a sand/water table is the most beneficial activity to increase the child's participation in the early intervention playgroup. Children with visual and motor impairments benefit from a variety of movement experiences to develop body awareness and directionality (e.g., playing with peers at the sand/water table feeling toys). Activities involving tactile (touch) discrimination will also help children with visual and motor impairments learn about the properties of objects needed to manipulate toys and tools. Feeling real-life objects like sand or water also builds perceptual knowledge needed for later communication

A client is referred for OT services with a diagnosis of ataxia. When the OTR is preparing for the evaluation, which of the following should the OTR prepare to assess? A. Spasticity B. Coordination C. Hypertonicity D. Hypersensitivity

B. Coordination

OTR is completing an assessment with a client who recently had a cerebrovascular accident (CVA). The OTR assessed the client's muscle tone and recorded a score of 2 on the Ashworth Scale. Which of the following performance skills would this observation have the MOST impact on its accuracy when assessed? A. ROM B. MMT C. Static 2-point discrimination D. Pinprick Test

B. MMT

An OTR is preparing to evaluate a client diagnosed with multiple sclerosis. In addition to an occupational profile, the OTR would like to use an occupation-focused assessment to gather information regarding the client's life history, how he copes with life changes, and the client's perspective on the impact of the disability. Which of the following assessment tools would be MOST beneficial for the OTR to use? A. Tinetti Assessment Tool B. Occupational Performance History Interview C. FIM D. Occupational Self-Assessment

B. Occupational Performance History Interview

A OTR is conducting a feeding intervention group in an out-patient therapy clinic for children with sensory processing disorders. These children seek oral sensory stimulation by mouthing their shirt sleeves, drooling when they eat, and over stuffing their mouths when eating. Which intervention strategy is MOST EFFECTIVE for children with poor oral sensory awareness? A. Providing foods with lumpy textures/sweet flavors B. Providing foods with strong flavors and cold temps C. Providing pureed food D. Providing bland foods/warm temps

B. Providing foods with strong flavors and at cold temperatures is the most effective intervention strategy for children with poor oral sensory awareness. During the intervention group, the OTR may start with activities involving a rubber massage brush, cold washcloth, or vibrating device to provide oral sensory stimulation and wake up the muscles in and around the mouth. During mealtimes, the OTR would recommend foods with strong flavors with cold temperatures (e.g., cold orange slices, pieces of flavored cold cuts, spicy chips) to help children take appropriate sized bites of foods. Children who consistently overstuff their mouths when eating may require foods that are cut into pieces and close supervision for safety

A client with hemiparesis of the dominant upper extremity is referred to OT. The OTR recommends the use of constraint-induced movement therapy in order to promote use of the upper extremity. Which BEST represents the OTR recommendations? A. Strengthening and exercise of the affected UE B. Restraint of the unaffected limb; focused use of affected limb C.Repetitive-task practice/task-specific practice for unaffected limbs D. Mental practice and cognitive rehearsal of a physical skill

B. Restraint of the unaffected limb; focused use of affected limn

An OTR has an elementary aged student transitioning to a new manual chair. The OTR has determined the appropriate chair type and is now determining the appropriate wheelchair features for the client. The OTR has assessed the child's functional mobility skills, the frame size of the manual chair, and the desirable seat-to-floor height. What the BEST wheelchair feature selection that can be ordered based on these measurements? A. Backrest cushion B. seat cushion C. tilt in space D. Armrest style

B. Seat cushion

A client with motor apraxia is receiving outpatient OT services. The client is participating in a meal preparation activity with the OTR. Which should the OTR provide in order to promote the carryover of skills learned during the treatment session into the home? A. Avoid variations of the tasks B. Vary treatment environments C. Avoid all meal preparation tasks D. Vary teaching strategies regularly

B. Vary treatment environment

A client works in a factory warehouse, stacking boxes on shelves. The client is recovering from a shoulder injury and was referred to occupational therapy to facilitate return to work. Which of the following is the BEST method when measuring range of motion? A. The OTR only measures joint range of motion below shoulder level if he or she suspects an unhealed fracture B. The OTR should hold the goniometer in place while moving the shoulder through range of motion C. The OTR observes the client's posture and compensatory motions when measuring the range of motion D. The OTR measures the scapular movement only with functional reaching tasks using the goniometer

An OTR is working with a child in the foster system who was born prematurely. The OTR observes that the child easily over reacts to touch, sounds, odors, and tastes. The child also has emotional outbursts of anxiety when climbing on the playground equipment or unpredictable surfaces. Which sensory integration problems BEST describe what this child appears to be experiencing? A. Under-responsiveness and poor visual perception B. over-responsiveness and dyspraxia C. Over-responsiveness and gravitational insecurity D. Under-responsiveness and vestibular-bilateral problems

An OTR provided home-based services to a client in the recovery phase of Guillain-Barre syndrome. The OTR encourages the client to sit during grooming tasks and also encourages the client to maintain needed items on the counter in order to avoid bending and reaching. Which intervention BEST describes what the therapist is using? A. Range-of-motion and strengthening programming[ 0.0%]B. Introduction of strategies that decrease anxiety[100.0%]C. Energy conservation and fatigue management[ 0.0%]D. Positioning trunk and head strategies for comfort

An OTR is working with a kindergarten classroom teacher in developing seating options for all students in her classroom. The teacher shared that her students are seated on the floor during several academic instruction times. They are positioned in a circle and often students struggle with keeping their hands to themselves and their bodies in their own space. What type of chair might the OTR recommend to the teacher? A corner chair B Infant sitter C cube chair D Howda Hug Chair

C A cube chair is a common chair used in preschool and kindergarten classrooms. It provides support as well as cues on personal space. A cube chair can provide an organized workspace for children and may help with sensory needs. Answer A: A corner chair provides external support for children with inadequate postural control of the neck, head, and trunk and who are inclined to fall sideways or back if they overstretch. This type of chair would likely be too adapted for the general population. Answer B: Infant sitters are generally designed for a smaller frame and would not meet the needs of this age group. Answer D: The Howda Hug chair provides proprioceptive feedback to those needing extra sensory input. Not all students in the classroom may benefit from this type of seating option.

An OTR is working in an outpatient therapy clinic with a 6-year-old child with a short attention span who has difficulty sitting still and following directions to complete tasks in a timely manner at home and at school. Which activity is MOST BENEFICIAL to promote attention and task completion? A. Picking up beans and receptively and dropping them a cap B. Building an airport with towers, roads and planes from legos and blocks C. Doing the wheelbarrow and walking from one room to another D. jumping on a trampoline in a circular pattern with a peer

C Wheelbarrow walking is a beneficial activity where children walk on their hands while an adult, therapist, or peer holds their legs. This type of activity involves heavy work and joint compression strategies through the upper extremity that can combat inattention and provides calming sensation through the body so that a child can lower his high arousal level to pay better attention, sit still, and follow directions more effectively after the input is provided to the body. The other activity choices do not include this type of strategy

An OTR is transferring a client to a wheelchair. In order to prepare the equipment required for the transfer, which is the BEST action for the OTR to take? A. Lock armrests in place on the wheelchair B. Unlock brakes on the wheelchair and bed C. Place wheelchair at an appropriate angle ]D. Install the lumbar supports prior to transfer

C When transferring a client to a wheelchair, the wheelchair is placed at approximately a 0° to 30° angle to the surface the client is transferring from. The specific angle of the wheelchair is based on the type of transfer and the ability of the client to assist in the transfer.

RLA Level VI

Confused-appropriate Shows goal-directed behavior but still requires structure. Able to tolerate unpleasant stimuli with assistance. Difficulty learning new information but can perform familiar activities with supervision. Selective attention to tasks can be observed but can perform common daily activities

An OTR is working with a pediatric client that demonstrates delays in hand skills when engaged in various play-based and community tasks. The OTR observes that the child is unable to hold a cup in his hand with grasp control during a feeding task. Which one BEST describes the grasping pattern that may be delayed? A. Disk grasp B. Pincer grasp C. Cylindrical grasp D. Spherical grasp

C The cylindrical grasping pattern is used to hold a glass or cup Answer A: The disk grasp is used to hold a disk shape like a lid. Answer B: The pincer grasp used to hold and manipulate small objects. Answer D: The spherical grasp is used to hold a ball.

An OTR is working with a speech-language pathologist (SLP) to create an augmentative communication system for a 7-year-old client with limited mobility or motor control in the upper and lower extremities. She is seated in a wheelchair and is able to use her head to turn from side to side. What is the OTR's FIRST role in this case? A. Recommend the type of device B. Recommend the positioning of the device C. Collaborate with the SPL to determine the type of device D. Create a visual schedule to promote

A OTR observes two children at preschool playing with a pile of blocks. They are sitting next to each other. One child is stacking blocks to make a tower. The other child is sorting all the blue blocks into a container. Which BEST describes this type of play? A. Symbolic play B. Associative play C. Parallel play D. Onlooker play

C. Parallel play occurs when children play separately from others but close to them, mimicking their actions.Answer A: Symbolic play is play with language and supports the development of children's abilities to express ideas, feelings, and experiences, for example, playing dress up or house.Answer B: Associative play is a more mature form of play that reflects social connections. It occurs when children enjoy the company of other children but have little organization of their activity, for example, borrowing toys or demonstrating toys but not being interested in the activity they are doing.Answer D: Onlooker play occurs when individuals engage in forms of social interaction, such as conversation about play, without joining in the activity, for example, a child talking to a group of children about their construction of a sand castle

A OTR in the acute care unit of a hospital would like to use a standardized assessment for a client who was referred for occupational therapy after a hemorrhagic stroke to evaluate the client's functional status and cognition. The OTR knows that the client may not be able to tolerate a lengthy evaluation session at this time. Which of the following is the MOST appropriate standardized assessment? A. Barthel Index B. National Institutes of Health Stroke Scale C. Mini FIM D. Glasgow Coma Scale

C. The Mini Functional Independence Measure (FIM) will provide a structured evaluation of the client's functional skills in self-care, mobility, and transfers. It will also evaluate the client's cognition. The total time to administer the Mini FIM is approximately 30 minutes

An OTR is working with a family to determine an appropriate chair for a 6-year-old child with spastic diplegia cerebral palsy. The child has indicated a desire to begin independent toileting. Presently the child is able to walk with a reverse walker and can don and doff elastic pants and underpants. Which is the BEST support to help this child with independent toileting? A. Special tomato Seat (comfort) B. Bath Chair C. Raised toilet seat D. Plastic Reducer ring

C. Careful consideration of a client's motor control should be weighed when evaluating self-care needs. In this case, the client is able to move his lower body using a walker and is able to independently don and doff lower body clothing items. However, the client may need support at the trunk when toileting to prevent tipping. The raised toilet seat would facilitate trunk support during the toileting task.A raised toilet seat is helpful for those needing additional supports in the lower extremity. The information above suggests the client has the ability to move his lower body, but may need increased support (walker). In this case, the client would benefit from the stability of the raised seat to lower and raise himself from the toilet independently.

An OTR has a teenaged client with decreased mobility and oral communication skills who would like to increase his independence at home. In particular, the teenager wants to use the telephone without the assistance of others including answering the phone. He feels this would increase his ability to function more independently in his home setting. What is the BEST recommendation the OTR can make for this teenager? A. Tech Speak B. iClick C. Infrared phone D. Housemate Pro

C. The infrared phone allows individuals with disabilities to use a land line telephone service in their home. In some cases, the infrared phone has capabilities to record nearly a hundred voice responses or common phrases. An individual who would benefit from supports for physical and communication needs can use this infrared phone to increase participation with social communication

An elementary aged child has recently been discharged to home after open heart surgery. Following the surgery, the child now requires oxygen to maintain appropriate oxygen saturations. The child was provided a large tank of oxygen for the home with a long tube to allow movement about in his bedroom but he cannot quite get into the bathroom. The child is not able to access the dining room or living room. The family states that they are able to order smaller tanks but didn't know why they might need them. What might the OTR recommended during a home visit to promote increased accessibility to the home environment? A. Oxygen cylider cart for smaller tanks B. Longer tubing C. Oxygen backpack carrier for smaller tanks D. Remove oxygen during family time

C. When evaluating the needs of individuals, the OTR must weigh all options and determine what best would meet the needs of the family, environment, and individual. In this case, the child needs an option that best supports independence and safety. Although several possibilities were proposed, only one would best suit the child's size, needs, and environment.There are many options for children to improve mobility and accessibility while on oxygen support. In this case, an oxygen backpack allows the child to increase independence and access to his environment. The large tank can be used when the child does not need to be mobile. The OTR might recommend this option to allow the child to choose a design that matches the child's personality while also supporting independence in the home and community

RLA Level IV

Confused-agitated Heightened level of response—may be agitated. Behavior is mostly bizarre and non-purposeful. Unable to cooperate with treatment

RLA Level V

Confused-inappropraite Able to respond to simple commands. Shows inappropriate behavior given complex instructions or when in an unstructured activity. Easily distracted and can still be agitated by certain stimuli in the environment

A 9-year-old girl is referred to an outpatient pediatric clinic for a screening for occupational therapy services. Her mother reports to the OTR that her daughter constantly breaks her pencils while doing her math homework, frequently falls out of her chair at home, and hugs her family and friends at inappropriate times. Based on the other's observations, in which area does the girl require the MOST intervention? A. Praxis B. Sensory defensiveness C. Sequencing D. Proprioceptive awareness

A client who sustained a right elbow and wrist fracture was referred for an occupational therapy evaluation. She expressed that she has difficulty feeling objects in her hand. What is the FIRST action the OTR should take during the initial evaluation? A. A complete sensory screen and ID appropriate tests B. Assess pain and protective sensation C. Complete a pinprick test to rule out digital nerve laceration D. Obtain history through client interview

An OTR is making an early intervention home visit to a family in a rural community. The grandmother, mother, and mother's sister are present during the session, and the grandmother is bottle-feeding the 8-month-old infant when the OTR arrives. The OTR's goal for the child is to work with the family on further developing the child's motor skills. What INITIAL action should the OTR take in the session with this family? A. Wait until the child finishes eating for the mother to begin therapy with the child in order to work on motor skill development B. Re-schedule the child's therapy session due to concern that motor activities are contraindicated after bottle-feeding C. Focus the treatment session on feeding skills to incorporate the natural routine and habits of the family D. Engage the caregivers in conversation about the child and the progress made since the last therapy visit33.8% of Users Answered Correctly

The therapist used the Rancho Los Amigos Scale of Cognitive Functioning during the evaluation of a client who sustained traumatic brain injury following a boating accident and determined the client was at a level VI in cognitive functioning. The client was observed to show goal-directed behavior when cued by the staff. She was able to recognize her family members and some of the nurses. The nurses observed that the client can stay focused while she brushed her teeth and washed her face. What activity is MOST appropriate during occupational therapy evaluation? A. OTR administers a set of paper and pencil tasks to assess cog skills B. perceptual skills are assessed first prior to cog assessment C. OTR completes comprehensive eval of client's vision D. The client's ability in all ADLs and IADLs

An OTR is planning group intervention utilizing a cognitive-behavioral frame of reference. Which intervention is MOST appropriate to utilize during group activities? A. Use open-ended questions to obtain understanding B. Provide feedback for members to help one another C. Explore client feelings through movement activities D. Practice and rehearse techniques learned in group

D The cognitive-behavioral frame of reference promotes that the best strategy for change is reinforcements. Change occurs when behavior is reinforced in some way. Practice and rehearsal of technique learned, or role-playing, allows clients to practice newly learned behaviors in a safe, therapeutic, and supportive environment.

A OTR is completing an initial evaluation of a client who was diagnosed with Guillain-Barre syndrome (GBS). The OTR gathers information regarding problems and concerns that the client experienced since the onset of GBS, performance strategies that the client found successful or unsuccessful, the impact of the client's environment, activity demands, and the client's priorities. The OTR is completing which component of a comprehensive evaluation? A. Performance skills assessment B. Analysis of performance patterns C. Assessment of client factors D. Completing an occupational profile

An OTR is working in an acute care rehabilitation hospital with an individual who survived a car accident and sustained a traumatic brain injury. The patient can demonstrate a generalized reflex response and his responses to external stimuli are significantly delayed. Which Rancho Los Amigos intervention approach BEST describes the appropriate treatment for this patient? A. Envourage the individual to participate in all therapies; client may not understand the extent of injury B. Keep comments and questions short and simple C. Allow as much safe movement (sitting, reaching, walking) as possible D. Tell the person who you are, where he is, why he is, in the hospital and what day it is.

An interdisciplinary educational team at a local public high school recently reassessed a 17-year-old student who sustained traumatic brain injury at the age of 6 years. After several years of intervention in the schools, the reassessment results revealed significant limitations in completing written classroom assignments and homework. What is the NEXT logical step for the educational team to consider? A. Develop discipline-specific goal B.Introduce the student to a computer C. Excuse the student from written work D. Identify appropriate transition goals

An OTR is working on increasing social participation and engagement with a teenager with a recent diagnosis of a C5 complete spinal cord injury. The teenager previously used her phone to connect with others via social media and texting. She is ready to experiment with an adapted app to access her smart phone. Which of the following would BEST suit the client's needs? A. Tech Speak B. iClick C. Universal remote control D. Housemate Pro with joystick

D. A teenager with a recent traumatic injury may be interested in re-engaging in previous social tasks with peers. Technologies are available to support teenagers with physical challenges to engage and participate in desired tasks, including smart phone access. The Housemate Pro with joystick control would allow the youth to engage in desired social engagement again.In addition to controlling household items via an app, this system allows the user to integrate phone use with adaptation. The app allows the individual to use the wheelchair joystick to control the phone. The teenager would be able to access desired social media applications using the joystick and adapted application. Answer A: Tech Speak is an augmentative communication device that can also integrate environmental home controls. A client with a C5 spinal cord injury likely has the ability to speak, as a C5 spinal cord injury does not impact the ability to speak independently. This device provides augmentative speaking options for those that have speaking challenges. Answer B: iClick allows the user to control appliances with a switch or iPad. This tool could be handy when the client is ready to independently manipulate appliances in the home. Answer C: Universal remote control is used to control several media items including TV, DVD, satellite receivers, etc. The client is seeking to control the phone, not TV, DVD, or satellite

A client with mild cognitive impairment is referred for OT evaluation. The client continues to be engaged socially and plays card games with friends each week. The client reports that friends are bothered by mistakes made when playing cards. Which intervention is MOST appropriate for the OTR to utilize to improve the client's accuracy and engagement when playing cards? A. Avoiding playing card games to decrease fustration B. Provide pictures of how to play game and C. Reduce socialization activities and avoid structures activities D. Utilize auditory, kinesthetic, and visual input to increase accuracy

D. Clients with mild cognitive impairment often appear socially and physically intact, but begin to experience a decline in some areas of performance that are often noted first by close family and friends. In order to improve function and engagement, clients are encouraged to endorse a multi-sensory approach that includes visual, auditory, tactile, and kinesthetic input. Using a multi-sensory approach provides positive feedback and allows for multiple sensory systems to engage, increasing accurate processing of information

A OTR is working with a child with autism spectrum disorder on improving play and ideational praxis. Which intervention is the LEAST APPROPRIATE to use with this child? A. Have the child help the OTR build an obstacle course B. Take turns b/t imitating the child and child imitating you C. Use movie characters and stories to begin to introduce pretend play D. Provide choice boards to aid in understanding what is to be don.

D. Providing choice cards to aid in understanding of what is to be done is the least appropriate intervention to use to improve play skills and ideational praxis for children with autism spectrum disorder. This intervention will decrease a child's ability to play and use ideation because it provides the answers already so that the child does not have to generate or initiate a new response or play in a different or creative way.

A young child with decreased trunk stability is working on toileting training with the OTR. The OTR observes the child needs a smaller toilet seat size to improve sitting support. Which is the BEST option for the OTR to try with the small child? A. Special tomato seat B. Bath chair- for bathing not toileting C. raised toilet seta D. Plastic seat reducer ring

D. A plastic reducer ring is used to prevent splashes during toileting routines and provides a small seating option for small children to increase stability. The plastic reducer ring snaps into the toilet bowl and reduces the size of the seat area to provide secure seating

The therapist used the Rancho Los Amigos Scale of Cognitive Functioning during the evaluation of a client who sustained traumatic brain injury following a boating accident and determined the client was at a level VI in cognitive functioning. The client was observed to show goal-directed behavior when cued by the staff. She was able to recognize her family members and some of the nurses. The nurses observed that the client can stay focused while she brushed her teeth and washed her face. What activity is MOST appropriate during occupational therapy evaluation? A. OTR administers set of paper and pencil tasks to assess cog skills B. The client's perceptual skills are assessed first prior to a cognitive assessment C. OTR completes a comprehensive evaluation of the client's vision D. Client's ability in all ADLs is assessed along with some instrumental ADLs

D. Assessing the ability in basic activities of daily living (ADLs) and instrumental ADLs provides the OTR an opportunity to observe the client's cognition, perceptual skills, and behavioral appropriateness. She presents with behaviors consistent with Rancho Los Amigos level VI of cognitive functioning. Clients at this level are alert, but often confused and agitated. They can follow simple two- to three-step commands but are easily distracted. It is necessary for the OTR to determine the client's ability to complete basic ADLs, instrumental ADLs, and ability to reintegrate into the community as well as the number of cues needed to support performance

A family is looking for additional seating options in the home for their 6-year-old daughter with a genetic disorder that impacts muscle control and use. The child uses a wheelchair for mobility and several adaptive seating options. The family would like to explore a supportive option for the children's playroom during movie times or family game time. What would be the BEST option for the OTR to recommend? A. Corner chair B. Therapy bench C. Rifton Modular Wooden Chair with Pommel d. Rock'er Pediatric Chill Out Chair

D. Seating options vary depending on the child's needs. In this case, a cozy seating alternative can be recommended to the family. The child's mobility and positioning needs are individually attended to by using this custom relaxation chair.The Rock'er Pediatric Chill Out Chair is designed to provide an alternative chair option for individuals who are not in their wheelchair or adaptive seating. The chair includes a soothing rocking motion that helps calm the individual. The chair is custom designed for the needs of the user. Answer A: A corner chair provides external support for children with inadequate postural control of the neck, head, and trunk and who are inclined to fall sideways or back if they overstretch. Answer B: A therapy bench is the best choice for children working on transitioning from one level to another. It provides the best option for complete use of upper extremity for play and table-top tasks. Using the therapy bench requires a certain level of lower extremity and trunk control for use. Answer C: A modular chair provides supports and can be adapted to meet the needs of the individual. This may be a good option for the family; however, it would not be the best choice given the current needs for the family.

RLA Level II

Generalized response Inconsistent and non-purposeful reaction, such as gross body movements or physiological change

RLA Level III

Generalized response Inconsistent response to stimulus. May be biased to certain stimuli and familiar voices. Withdraws limb in response to painful stimulus.

RLA Level I

No Response The patient shows no reaction and appears to be in a deep sleep

Level VII

Purposeful-Appropriate Social, emotional, and intellectual capacities enable the person to participate in society. Capable of home and community independence

Barthel Index Assessment Type: Total time to administer: Description:

Standardized outcome measure 30 minutes functional tasks eating, grooming, bathing, bowel/bladder mgt, toileting, dressing, mobility, transfers and stairs

Glasgow Coma Scale Assessment Type: Time to administer: Description:

Standardized prognostic scale 10 mins Evaluates responses- eye opening, verbal and motor response to stimuli. NOT FUNCTIONAL TASKS

National Institutes of Health (NIH) Stroke Scale Assessment Type: Total time to administer: Description:

Standardized prognostic scale 10 mins evaluations Level of consciousness, language, neglect, visual field, eye movement, motor strength, ataxia, dysarthria, sensation NOT FUNCTIONAL TASKS

Tech Speak

Tech Speak is an augmentative communication device that can also integrate environmental home controls. Tech Speak does not attach to tablets, so this is not an appropriate choice.

HouseMate Pro

The HouseMate Pro allows the user to control household items via an app and allows the user to integrate phone use with adaptation. This tool does not improve engagement with a tablet

Occupational Performance History Interview (OPHI) Age: Areas addressed: Method:

adolescent to adult activity/occuaptional choices, critical life events, daily routine, occupational roles Interview

Level VII

automatic-appropriate Able to perform daily routine. Has superficial insight but lacks realistic problem solving and ability to plan. Impaired judgment, which may make it unsafe for the person to participate in social activities and driving

Mini FIM Assessment Type Total time to administer Description

standardized outcome measure 30 mins evaluates functional tasks, including self-care, transfers, mobility and cognition

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