NBCOT review
The Coping Inventory Observation Form
This assessment is for children ages 3-16 years.
ACL 4.2 ACL 4
4.2= This client could be discharged home alone with weekly checks for novel safety issues and health maintenance needs and reminders. 4.0= This client could be discharged to a supported living arrangement with the expectation that the client can independently complete the morning self-care routine
Custom chair for..?
A custom seating system is indicated for a client who will likely be a long-time wheelchair user (e.g., a person with MS) to prevent deformity and skin breakdown.
What is the OPTIMAL intervention to prevent formation of elbow contracture?
A dorsal elbow extension splint to position the elbow at extension and the forearm in neutral.= The antideformity position for the elbow is elbow extension and forearm in neutral position. Also, because the client has a partial-thickness skin graft at the anterior aspect of the forearm and to maintain maximum surface area of the grafted area, it is better to position the forearm in a neutral position.
Habits, routines= OT Domain, What are OT Process..?
A. Occupational profile C. Intervention plan D. Outcomes
Rancho levels- simple commands=
A: A Level VII client has limited distractibility and is capable of carrying out a intelligible conversation despite minimal confusion. B: A Level III client inconsistently responds to stimuli and would not be capable of intelligibly responding to simple commands. 5 -Because the client is highly distractible and displays severe memory impairment but can respond to simple commands, the client most closely resembles Level V. D: A Level II client responds to stimuli only through physiological changes, gross body movement, or vocalization
A. Primary intervention B. Secondary intervention C. Tertiary intervention
A: Primary programs focus on protecting healthy workers against a targeted condition before the condition occurs. B: Secondary programs emphasize early detection and intervention with asymptomatic workers at risk for work-related medical problems or treatment of workers with mild medical symptoms or reversible stages of injury. Comprehensive injury prevention programs incorporate all three phases of prevention programs (primary, secondary, and tertiary) and may include worksite and ergonomic interventions. A tertiary prevention program occurs after the worker sustains an injury, illness, or disease. It includes treatment of medical problems and attempts to restore maximum function in the workplace and prevention of injury, illness, or disease-related complications.
A. Understanding the interaction between the client's perceived level of task mastery and the demands of the environment B. Understanding the client's dimensions of occupational participation and performance C. Understanding how the environment can be adapted, modified, and restored to enable effective performance D. Understanding how the client uses sensory information in the environment
A: This approach is based on occupational adaptation theory. B. The "dimensions of doing" is part of MOHO C: This approach is based on the Ecology of Human Performance model. D: This approach is based on the sensory integration model
accommodative infacility
Accommodation is the ability of the eye to adjust focus at different distances. Accommodative facility is the speed of focus adjustment and ability to maintain focus over time. Driving a car would be most difficult for this client because looking at the speedometer and then at the road requires adjusting focus at different distances (near distance for the speedometer and farther distance for the road) A, D: Watching sports or a play requires visual tracking or smooth pursuits; accommodative facility would not be challenged. B: Reading a book or other materials requires convergence and ability to focus on an object at near distance; accommodative facility would not be challenged.
Ayers sensory A-lone
Alone- not in small groups
Trigger finger is a condition in which edema in the tendon and synovium of the digit results in lack of smooth flexion or extension of the finger. To rest the tendon and prevent snapping as the tendon pulls through the finger pulleys, the MCP joint is blocked by splinting, then gentle pull through with bending and straightening of the distal and proximal interphalangeal joints is recommended 20 times every 2 hours while the client is awake.
An OTR is working with a client who presents with digital tenosynovitis in the index finger, or "trigger finger." After the OTR fabricates a splint to support the metacarpophalangeal joint in extension, which exercise should the OTR advise the client to perform FIRST? CorrectA. Hook fist with splint on
toilet 2yrs
At age 2, children typically begin to show interest in toileting, can stay dry for 2 or more hours, and can flush the toilet independently and urinate regularly. The next developmental challenges include telling someone that they have to use the bathroom, waking up dry after sleeping, wiping self after urinating, and washing hands independently.
B. The pencil rests against the radial side of the middle finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint. IncorrectC. The pencil rests against the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is not opposed to the index finger and rests on the distal interphalangeal joint. D. The pencil rests against the distal phalanx of the radial side of the ring finger, and the pads of the fingers control the movement; the thumb is opposed to the index finger NOT GOOD: The pencil rests on the distal phalanx of the radial side of the little finger, and the pads of all five fingers control the movement; the thumb is opposed to the ring finger and the wrist is flexed
B, C, D: These grips are functional grips. B describes the lateral tripod. C describes the lateral quadruped. D describes the dynamic quadruped. Another functional grip is the dynamic tripod. A= not functional
What pt would require a warm up & cool down because of their heart?
Because a donor heart is denervated, the autonomic nervous system does not control the client's heart rate. The heart relies on circulating hormones, which take longer to increase and decrease the heart rate. In congenital heart disease and after cardiac surgery, the heart remains innervated, so the client's autonomic nervous system regulates the heart rate
Guillain-Barré syndrome in the acute inflammatory phase- what factors should the OTR evaluate?
Because ascending paralysis is typical of Guillain-Barré syndrome, evaluation consistently addresses pain, fatigue, and swallowing problems. This constellation of symptoms best fits the clinical reasoning for prioritizing issues to be evaluated.
What deformity involves PIP flexion combined with DIP hyperextension?
Boutonnière deformity
Fractures of the hand..
C: A boxer's fracture is the result of a clenched fist hitting an object with enough force to break the metacarpophalangeal neck, most commonly seen in the fourth and fifth digits A: Bennett's fracture is an intraarticular fracture of the thumb metacarpal bone. B: Colles fracture is a common distal radial fracture. D: Kienbock's disease is associated with lunate fractures.
arthrogryposis multiplex congenital have incomplete contractures or fibrous ankylosis
Children with arthrogryposis multiplex congenital have incomplete contractures or fibrous ankylosis of all or many of their joints, which would make donning a shirt, the only occupation that involves the use of the extremities, difficult without adaptive equipment or modified techniques.
Children with motor planning problems benefit from what sensory input?
Children with motor planning problems benefit from vestibular and proprioceptive input. They might also have difficulties with tactile perception
preventing shoulder pain post CVA
Clients with hemiparesis should be encouraged to move the upper extremity with external rotation, shoulder flexion within 90°, and scapular protraction to allow for optimal motor recovery by promoting soft-tissue elongation
An OTR® working in a neurology unit was referred a client with low back pain. During the interview, the client confides that stressful life events have recently been prominent in the client's life. The client added that the low back pain started after the stressful life events. Malingering and fear of illness do not seem to be a part of this scenario. What is the client's likely diagnosis?
Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.
group dynamics
D. Performing In group dynamics, the performing stage is characterized by group productivity derived fro A: Forming is characterized by dependence. B: Storming is characterized by conflict and competition. C: Norming is characterized by initiation of cohesion
electroconvulsive therapy (ECT)
ECT is immediately followed by a short, required bed rest, especially if residual symptoms include headache, nausea, and dizziness; regular activities can then be resumed. Can cause some memory loss and jaw pain.. Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses
A 6-year-old child with autism is trying to kick a ball through a goal 10 feet away. The child has made six attempts already. Although the child is able to kick the ball with correct movements, the child does not seem to be able to calibrate the amount of motor input to approximate the goal. When the child kicks the ball, it always lands beyond the goal. What skill seems to be impaired for this child
Feedforward praxis enables a person to compare previous motor plans and sensory information to detect potential errors and correct the plan before attempting it again.
Work injury prevention program
Four characteristics of successful implementation of a successful work injury prevention program are ongoing management support, supervisory support, employee participation, and ongoing support and reinforcement of program. The meat packing plant sought out the services of the consultant, therefore demonstrating a commitment to establishing a culture of safety and wellness for its employees. Employee participation is a key component of success.
pinch terms... f- first, w- wlittle, jean is hyper
Froment's sign occurs when the flexor pollicis longus compensates for a weak or paralyzed adductor pollicis and flexor pollicis brevis. When a client attempts to pinch, the interphalangeal joint of the thumb flexes more than usual. B: Wartenberg's sign is the little finger held in abduction. C: Jeanne's sign is hyperextension of the proximal phalanx of the thumb when pinching
COAST method
Goals should describe what a client will be able to do after successful occupational therapy intervention. Accordingly, goals should be written using measurable action verbs such as demonstrate, perform, and complete.
FIM score 3 guillain barre syndrome
Guillain-Barré syndrome typically results in more extreme distal muscle weakness rather than proximal muscle weakness, so addressing trunk control will not be an effective intervention. Guillain-Barré syndrome is a rare but serious autoimmune disorder in which the immune system attacks healthy nerve cells in your peripheral nervous system. This leads to weakness, numbness, and tingling. It can eventually cause paralysis. According to the FIM score, the patient requires moderate assistance for performing activities. In the acute phase of Guillain-Barré syndrome, the patient may be experiencing muscle belly tenderness and overall fatigue; energy conservation techniques will allow the patient to engage more productively in daily self-care tasks.
ALS early stages- work outs?
In the early stages of ALS, smaller distal muscles are weak, but gross proximal muscles have not yet been affected. ROM exercises, light strengthening, and endurance training are all effective at this point. It is important for the OTR® to advise on precautions such as avoiding overexertion, stopping if a client experiences muscle cramps or spasms, and monitoring fatigue. Moreover, the client states a goal is to continue frequenting the gym, which likely also offers social benefits
Job demand analysis step 1
Job demand analysis looks to define the essential actual job demands. It often includes questionnaires, interviews, observation, and formal measurements and is conducted in the actual work environment. OTR®s are recommended to use objective means to gather information, because interview may not be considered the most accurate means to determine job demands. Clinicians often use interview in conjunction with functional capacity evaluation and job description. Interviewing staff is therefore an appropriate first course of action, because the OTR® must determine which tasks are considered essential to job performance.
Tennis elbow
Lateral epicondylitis is a repetitive strain injury. The client is likely experiencing these symptoms as a result of job tasks that require repetitive gripping and supination. The best approach is to discuss environmental modifications with the client and implement strategies during the work day to decrease symptom aggravation caused by job tasks
Allen Cog levels- what level would you give a model of the completed project with Simple tasks? When does new learning occur? What level are repetitive and unstructured activities good for? What level can assess hypothetical situations?
Level 4 activities typically require a model as a guide to task completion, simple directions, and unshared tools. A: . A client at Level 5 has new learning occurring, and inductive reasoning enables new ways of performing activities. B: This choice is appropriate for Level 3 of the Allen Cognitive Level Screen. A client at Level 3 can engage in repetitive, unstructured actions. D: A client at Level 6 can think of hypothetical situations and do mental trial and error.
planning an occupational therapy intervention focused on leisure exploration for a client with oppositional defiant disorder who likes graffiti, body piercings, and tattoos. Which activity would be MOST appropriate?
Making posters with colored markers on poster paper. People with oppositional defiant disorder respond best to moderate, but not too much, structure. The choice of activities should be client centered and should capture the interests of the individual. Making posters allows the client to capture the style of art found in graffiti and tattoos while providing clear boundaries in the form of the poster paper and safe tools.
Work hardening
Medium work requires exerting 20-50 lb of force occasionally, 10-25 lb of force frequently, or more than negligible weight to as much as 10 lb of force constantly to move objects. Explanations of Incorrect Answers B: Heavy work requires exerting 50-100 lb of force occasionally, 25-50 lb of force frequently, or 10-20 lb of force constantly to move objects. C: Very heavy work requires exerting 100 lb of force occasionally, in excess of 50 lb of force frequently, or in excess of 20 lb of force constantly to move objects. D: Light work requires exerting as much as 20 lb of force occasionally, as much as 10 lb of force frequently, or a negligible amount of force constantly to move objects. The physical demands are in excess of those for sedentary work.
Driving hierarchy
Michon's (1985) Hierarchy of Driving categorizes drivers' behaviors into the strategic, tactical, and operational categories.
Limited ROM
Mild heat before or during a passive stretch will give the best results and increase range of motion and circulation, because the heat will have a soothing effect and decrease discomfort.
post peripheral nerve injury for tactile-kinesthetic abilities.
Once protective sensation and touch sensation have returned to fingertips, intervention includes a variety of stimuli presented repetitively: The client first observes what is happening, then closes the eyes to concentrate on the touch sensation. This process provides feedback to retrain further tactile-kinesthetic abilities.
Pacemaker precautions
Pacemaker precautions include no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks.
working with a client who had a pacemaker implanted 10 days ago. Which activity would be contraindicated because of pacemaker precautions?
Pacemaker precautions include no shoulder flexion or abduction greater than 90° on the side on which the pacemaker was implanted for the first 4 weeks. Placing hair in a ponytail using both upper extremities simultaneously
absence seizure
People having absence seizures look like they are "zoning out" or daydreaming; these seizures are characterized by a brief lapse or loss of awareness. In addition, clients who experience absence seizures will suspend all motor activity (even eye blinking) during a seizure. These seizures usually last less than 30 seconds
syndromes in arm/ hand nerves
Post CTS: Over time, diminished blood flow to a peripheral nerve can result in serial impingements, called double crush syndrome. A: Thoracic outlet syndrome involves the shoulder region. C: Ulnar tunnel syndrome involves the ulnar nerve. D: Cubital tunnel syndrome involves the ulnar nerve.
the client describes an area extending from the radial head to the proximal aspect of the supinator muscle as having a dull ache and burning sensation. Which syndrome is the client describing?
Radial tunnel syndrome is compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm.
4 basic WC measurements
Seat width, seat depth, seat height, seat-back height
An OTR® is performing a home evaluation for a client with Stage IV amyotrophic lateral sclerosis (ALS). On what will the OTR®'s recommendations MOST LIKELY focus? Creation of a first-floor setup and increased accessibility to a wheelchair or durable medical equipment
Someone with Stage IV ALS is likely to have severe weakness in the lower extremities, causing an inability to ambulate. Working with a client and his or her family to create a safe, accessible first-floor setup is the best option; the patient and family will need recommendations for moving furniture, creating spaces that a wheelchair or power chair can navigate, and the most appropriate durable medical equipment such as a hospital bed and specialized mattresses to prevent pressure sores.
When your pain is a TEN use..
TENS Transcutaneous electrical nerve stimulation. Good for Crps Not for pain... A: Cold spray is used to treat trigger points and increase passive stretch of a muscle tendon unit. B: NMES is best used to facilitate muscle contraction. D: Iontophoresis is used to control inflammatory conditions
Barthel scale
The Barthel scale or Barthel ADL index is an ordinal scale used to measure performance in activities of daily living. Each performance item is rated on this scale with a given number of points assigned to each level or ranking. It uses ten variables describing ADL and mobility.
Eating disorder inventory
The EDI-3 consists of 91 items organized into 12 primary scales: Drive for Thinness, Bulimia, Body Dissatisfaction, Low Self-Esteem, Personal Alienation, Interpersonal Insecurity, Interpersonal Alienation, Interoceptive Deficits, Emotional Dysregulation, Perfectionism, Asceticism ...
brace is recommended for children with kyphosis or a posterior convexity
The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace used in the treatment of spinal curvatures in children. It is a full-torso brace that extends from the pelvis to the base of the skull
MMSE
The Mini-Mental State Examination (MMSE) or Folstein test is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. It is commonly used in medicine and allied health to screen for dementia.
2005 Federal Bill that encouraged all children to bike/ walk to school to reduce pollution and increase health.
The Safe Routes to School program was funded from 2005 to 2012 as part of the SAFETEA-LU legislation (Pub. L. 109-59) and provided 100% federal funding to facilitate states' initiatives to create safe environments surrounding schools and encourage children to bike and walk to school as part of developing a healthy lifestyle. In 2012 these initiatives were combined with others as part of the federal Transportation Alternatives Program.
early dementia rigid- why?
The client may be aware of memory loss at this stage and compensate by becoming rigid in routines so that the client still appears intact to others
impulsive dementia
The distinguishing feature of frontotemporal dementia is behavioral changes with an increase in disinhibited behavior, decreased social tact, lack of empathy, and lack of interest.
a client with a flexor tendon injury. One week after repair surgery, the OTR removes the cast made postsurgery and fabricates a splint. Which splint is appropriate for this client?
The dorsal blocking splint protects the surgery and guards against flexor tendon rupture.
Do they really have pain..?
The game player (traditionally known as a malingerer) uses symptoms for positive gain and consciously attempts to convince others of the reality of the symptoms.
parallel -> cooperative group
The group can progress from a parallel to a cooperative group by taking an already mastered skill—making a quilt square—and adding the component of cooperation needed to make a community quilt. Participants will still work on their own, but they will need to interact with one another to design the quilt using each participant's square color and size.
Commission on Accreditation of Rehabilitation Facilities (CARF). According to CARF, what is the most commonly accepted client-to-staff ratio
The most commonly accepted ratio is 5 clients to 1 staff member. A trained professional is required to monitor clients for problem identification and appropriate interventions. 1:1 individual attention is required for the OTR® to complete evaluations and attendance at meetings
A 6-year-old child has hypotonia and poor sitting balance. Which activity would be MOST BENEFICIAL to include in the initial intervention for facilitating the child's active trunk extension?
The prone position will facilitate an active trunk extension posture as the child works to hold the head and limbs away from the ground. Though this activity provides movement, the child's body position is starting from a point of stability in prone.
Therapeutic exercise
Therapeutic exercise and activity assist the client with improving strength and function while preventing further complications, including muscle imbalances
Tier 1 (for everyone!) ,2 (for some of you) ,3 (just you and me.. direct) RtI
Tier 1: High-Quality Classroom Instruction, Screening, and Group Interventions. Within Tier 1, all students receive high-quality, scientifically based instruction provided by qualified personnel to ensure that their difficulties are not due to inadequate instruction- EX. a presentation to all teachers on multisensory handwriting In other words, Tier 2 is likely to involve small groups of students with similar learning needs who work daily with a teacher using a specific instructional practice or program. Tier 2 instructional materials and methods are typically similar to those used for the Tier 1 core instruction. Providing a social skills program is a Tier 2 service. Direct client services and technology integration for specific clients are Tier 3 services.
The OTR® suspects compression of the ulnar nerve at the elbow, or cubital tunnel syndrome. Which two nerve-related assessments would be used when cubital tunnel syndrome is suspected?
Wartenburg's sign is the fifth finger held away from the fourth finger, indicating palmar adductor interossei weakness. Froment's sign is flexion of the interphalangeal joint of the thumb when the client performs a lateral pinch. The flexor pollicis longus is compensating for the adductor pollicis and flexor pollicis brevis. indicating weakness of the ulnar nerve. Wartenburg's and Froment's signs are tests of ulnar nerve compression or cubital tunnel syndrome
HD- what type of questions?
With a client with early-stage HD, it is important to use close-ended questions that require yes-no responses or use a list of choices to prevent frustration associated with word retrieval problems
identify skills for working
Work readiness programs help individuals who want to work identify vocational options that match their interests, skill, and abilities
the benefits and description of work therapy programs
Work therapy may occur during any point in the healing of injured tissues. It typically occurs during the acute phase of rehabilitation before tissue homeostasis.
macular degeneration
middle of the eye- central vision is lost
WC position pelvis
position the client's pelvis directly over the rear wheel axle, which will make propulsion easier