OTA Combo set 1
Common Diagnoses:Delusions
All psychotic disorders, some personality disorders, and eating disorders
Respect:
Seeing things from patient's point of view.
The art of stating things simply, directly, and concretely- focusing only on what is relevant
Specificity
Gerontology
Study of the aged and the aging process
What are the motions of the GH joint?
Flexion/Extension Abduction/Adduction Horizontal abduction/Adduction Internal rotation/External rotation
What are the movements of the hand?
Flexion/Extension Abduction/Adduction Thumb palmar opposition, Thumb ulnar deviation
Flexor muscles of the forearm and wrist...
Flexor Carpi Radialis Flexor Carpi Ulnaris Palmeris Longus
Name the Extrinsic muscles of the Hand.
Flexor Digitorum Superficialis Flexor Digitorum Profundus Flexor Pollicis Longus
Wellness Model
Focus is on self-management and positive attitudes Topics include: smoking cessation, AIDS education, and nutrition
Establishing leadership requires preparation. Four areas demand particular attention:
Knowledge Space Materials Paperwork
Communication and Social Skills
Looking Gesturing Maintaining acceptable space Initiating and answering Taking turns Acknowledging
What is the origin and insertion of the Brachioradialis
Origin: Supracondylar ridge of the humerus, Insertion: Styloid process of the ulna
The first stage ( skills training) in the cycle of skills training, in which the target behavior is identified and importance explained
motivation
which social skill training phases: identifying the behavior to be learned and why
motivation
General term for emotional vulnerability
nervios
What is the name of the specialized cells of the nervous system?
neurons
The skill needed for living deficits in psychoeducation represent
faulty learning or failure to learn appropriate and successful strategies
Adult siblings may have
fears of the genetic component of mental illness.
which social skill training phase: provided at the end of treatment to identify what has been learned and what will be learned next time?
feedback
Normal ROM for shoulder complex AD
not usually measured because it is the return to zero starting position from full abduction
Changes in sensory receptors increase
pain threshold and impair pain localization.
Cluster A disorders- personality
paranoid schizoid schizotypal
The lumbar plexis innervates what?
pelvis, buttocks, perineum, and parts of the LE
The beginning of the session sets the stage for how the session will
progress.
what senses are integrated in SI model?
proprioceptive kinesthia vestibular awareness sight sound tactile smell taste
What are the Origin, Insertation and Innervation of the supraspinatus of the shoulder joint?
Origin: Supraspinous fossa, Insertion: superior aspect of the greater tubercle. Innervation: suprascapular nerve
What are the origin, insertion and innervation of the Anterior Deltoid of the shoulder joint?
Origin: The lateral third of the clavicle./ Insertion: Deltoid tuberosity. Innervation: Axillary nerve
What are the origin, insertion and innervation of the Coracobrachialis (of the shoulder join)?
Origin: corocoid process of scapula. Insertion: humerus Innervation: Musculocutaneous nerve
Ensure that the elder has access to emergency assistance.
Phones Phone numbers Neighbor Family members
T/F Leisure exploration does not automatically result in sustained performance
True-people experience many obstacles, both internally and external
What population/setting is served by Psychoeducational?
psychiatric setting patients needing to address life skills and role acquisition
What axis does the transverse plane revolve around?
vertical
Quality Assurance and Improvement
!.systematic approach to the evaluation of patient care that enables the identification, assessment, and resolution of problems in order to improve health care benefits for patients 2.Generally handled by the manager of an entire OT program. 3.Quality assurance is retrospective (looking backward). 4.Continuous quality improvement is ongoing.
Health may be defined as the
"ability to live and function effectively in society and to exercise self-reliance and autonomy to maximum extent feasible, but not necessarily as total freedom from disease" (p. 51). .
6 area of adaptive skills
1. Sensory integration 2. Cognitive skills 3. Dyadic interaction skill 4. Group interaction skill 5. Self- identity skill 6. Sexual identity skill
What Is Accepted as "Truth"
Acts on faith Acts on fact Acts on feelings
Human occupation traditionally hs been divided into 2 main categories
1. Work 2. Play
what are the 4 phases of social skills training?
1. motivation 2. demonstration 3. pracrice 4. feedback
How many cranial nerves do we have?
12
Normal ROM for Wrist Radial Deviation
20 AMA
COTA's role in fall prevention
: Inspect the client's living environment for hazards that may lead to a fall.
Empathy
: Understanding how someone else feels.
Cohesiveness:
A sense of solidarity among members
Sources of anxiety reduction
How does the elder handle stress? COTAs should know who supports the elders in times of stress when decisions need to be made.
Education to supervise level II OTA students. Colleagues you might supervise include:
Aides Mental health workers Volunteers Students
Cognitive Style
How information is organized by the client—not an assessment of cognitive function for brain dysfunction Open-mindedness or closed-mindedness
Domestic Violence
Any violence that occurs in the home between family members. Forms of domestic violence include: Child maltreatment Intimate partner violence Sexual violence Suicide Youth violence
Common diagnoses for Mania
Affective disorder paranoid schizophrenia substance abuse personality disorder
The components of a normal gait stance phase are:
Initial contact - heel strike Load response - foot flat Midstance - single leg stance Terminal stance - heel off Preswing - toe off
The original program covered most people 65 years of age and older. The program now covers those:
Age 65 years and older Entitled to disability benefits for at least 24 months With end-stage renal disease Who buy into the program
Treatment Focus- Psychosocial problems- Elders
Age- appropriate roles Mutual Goal setting Collaborative approach to nonintervention Education in special needs of elders- safety, fall prevention, nutrition Wellness and lifestyle redesign Reconnect ion to previously enjoyed activities Education of/and consultation with caregiver(s)
What can we offer customers?
According to Karen Jacobs, "the greatest value we bring to our clients is our ability to help each of them find paths that best meet their individual needs. This, if you will, is our intellectual capital...Our challenge is to find new ways to leverage our intellectual capital in this changing environment." Jacobs (1999), Presidential Address, AJOT
What is the most common neurotransmitter in the body?
Acetlycholine
desire to attain or surpass a level of excellence in occupation. Standard may be externally or internally determined. When competent at action, th eperson continues to perofrm it to achieve success according to a standard. Exploration Competence Excellence
Achievement
Negative symptoms of schizophrenia
Apathy generally unexpressive mood- Affective flattening lack of goal directed behavior ( avolition) deterioration of hygiene diminished functioning and participating in daily life social isolation psychomotor slowing
OT's premise has been to promote a healthy balance of activities for persons who seek treatment. Why?
Activities perceived by an individual to be meaningful occupations are believed to influence the state of actual or possible health and well-being. Humans find meaning in what they do.
Analysis of Activities of an activity
Activities should be examined from every perspective. -Goal of activity -Steps involved -Level of complexity -Tools and materials required Client should also be examined from these perspectives.
Approaches-Cognitive Deficits-activities
Activities: Varies depending on patient prognosis
Intervention methods may include:
Activity Environment Therapeutic Approach
What motion of the shoulder joint is aided by the supraspinatus?
Abduction
Trendelenberg, Footdrop, and Quadriceps are all:
Abnormal gaits
A change to facilitates performance
Adaptation
Psychiatric Emergencies
Are more common in the inpatient setting but can happen anywhere.
Task Role- Information seeker
Ask for facts and further explanation
AOTA OT Awareness Initiatives
Backpack awareness (National Backpack Awareness Day) Older drivers (CarFit - www.car-fit.org) Rebuilding Together (www.rebuildingtogether.org) Occupational Therapy Month (April)
Not having enough money- Economic Marginalization means:
Missing appointments Not have a phone Living in unsafe place Use single sink for kitchen and bath Doing Laundry infrequently Eating for economy rather than nutrition
______ theories focus on brain anatomy and chemistry
Neuroscience
The Cervical plexus located in the neck has its roots between...
C2-C4
Suggest tending to or supervising someone as in child care and elder care
Care
Inappropriate approaches-Cognitive deficits
Never punish a client for making a mistake or showing bad judgment due to impaired cognitive ability.
A behavior that interferes with the client meeting his/her needs or doing the things he/she wants to do
Deficit:
what are the 7 OT practice models
Development of adaptive skills role acquisition Psychoeducation Sensory Integration Cognitive Disabilities MOHO ( model of human occupations) social skill training
Expectation that things will never change
Fatalism
Approaches- sexual- activities
Gross motor activities. Masturbation in private may also be suggested.
MOHO
Human being have a natural, inborn tendency to act on the environement to explore and master it
What movements does the Latissimus Dorsi help the shoulder joint to perform?
Internal Rotation, Adduction, Horizontal abduction, extension
The sacral process overlaps what plexus?
Lumbar plexus
Outcome
Measuring the client's progress toward meeting the treatment goals
are the things necessary for life and health.
Needs
Community Mobility
Pedestrian safety Alternative transportation Safe driving
Contexts: Conditions surrounding occupational functioning
Physical context Social context Personal context Spiritual context Temporal context
Task Role- Information giver
Provides facts or information from own experience
Mind changing
Psychotropic
6.Intervention review
Reporting that occurs at regular intervals during treatment Depending on results, treatment plan may be modified
Rest and sleep
Rest Sleep Sleep Preparation Sleep Participation
Observable behaviors that reflect underlying illness
Symptoms
8.Discontinuation of service
The patient is discharged from the program OT handles final documentation with input from the OTA
Name motions of the shoulder girdle.
Think about what the scapula is capable of doing. protraction/abduction retraction/adduction elevation and depression
What is a "covered entity"?
Under HIPAA, this is a health plan, a health care clearinghouse, or a health care provider who transmits any health information in electronic form in connection with a HIPAA transaction.
Intervention:
action undertaken to bring about change in the life of a mentally ill person
define dyadic skill
ability to participate in a variety of relationships involving one other person
Many psychiatric disorders such as schizophrenia and mood disorders often make their first appearanceT in
adolescence
what are SI programs directed towards?
balance, posture, increased ROM, spontaneity of movement, correction of abnormal hop and shoulder positions
MOHO
based on occupational behavior theory
What is the expected end-feel of the GH
firm
Self-concept is not
easily changed
Only a few disorders first appear
in childhood
Research has not clearly established an association between aging changes and specific declines
in functional performance.
Practice ________ is used to promote generalization
in vivo
Why is proper diagnosis important for mental health
leads to effective treatment
provide an experience of discovery, exploration, and problem solving
puzzles
which social skill group category? stating feelings, opinions
self expressive skills
This means one can shape or contain emotions and thought and exercise control over one's actions
self-control
Positioning and goniometric alignment for Shoulder Complex medial (internal0 rotation
supine fulcrum: over the olecranon proximal arm: perpendicular or parallel to the floor distal arm: align with ulna using olecranon and ulnar styloid process as reference
The occipital lobe receives and interprets what:
visual stimuli
Health
". . . the absence of disease or other abnormal condition" (Potter & Perry 2002) Optimal level of functioning for a person's age and condition
Cohort
"A collection or sampling of individuals who share a common characteristic such as age group" (Potter & Perry, 2002)
Ageism
"An attitude that discriminates, separates, stigmatizes, or otherwise disadvantages older adults on the basis of chronological age"
Definition of health promotion
"Any planned combination of educational, political, regulatory, environmental, and organizational supports for actions and conditions of living conducive to the health of persons, groups, or communities" (p. 54).
Promotion & Occupational Therapy
"Promotion is the vehicle of communicating information to the consumer about the products' or services' merits. (Occupational therapy practitioners should remember to reframe the message to primarily promote the benefits of products and services.)." Jacobs (1998), Innovation to Action - Marketing Occupational Therapy, AJOT
Psychotropic means
"mind-changing." These drugs alter how the mind works.
In general, the OT and OTA working with the child or adolescent who has mental illness will focus on the young person's
"occupations and interest of choice rather than the disorder"
Medicare is divided into four parts
(A,B,C and D)
Occupations
(activities) permit the patient to participate in desired roles and life situations in the home, school, workplace, and community.
Busking
(performing for tips)
Assessments the OTA Can Administer
*Interviews Occupational Performance History Interview T*he Role Checklist The Canadian Occupational Performance Measure Model of Human Occupation Screening Test *Observation Checklists Assessments of Daily Living Skills Milwaukee Evaluation of Daily Living Skills The Kohlman Evaluation of Living Skills *Assessment of Time Use Occupational Questionnaire Barth Time Construction *Assessment of Process Skills and Mental Functions The Bay Area Functional Performance Evaluation Allen Cognitive Level Test *Assessments of Psychological Function *Assessments of Sensory Function *Assessments of Leisure Interest and Social Participation The NPI Interest Checklist Modified Interest Checklist Adolescent Leisure Interest Profile Nonstandardized Assessments
OTA Methods for Data Collection
*Review of Medical Records Quickly obtain information on a wide variety of subjects (age, marital status, psychiatric history, living situation, etc.) *Interviewing *Questionnaires and Checklists *Observation Take note of behavior, appearance, and other information that can be gathered using your senses. Do not interpret this information, or make judgments of the client based on your observations. *Tests and Assessments
what is role of OT in the Cognitive Disability model?
*identify level of cognition *monitor changes *adapt environment to accommodate disability *select and modify task to match ability
what are some specific postures and movements that impact individual with chronic schizophrenia disorder?
*s curved posture *shuffling gait *difficulty raising arms above head *inflexibility of neck and shoulder joints *resting posture in which shoulder and hips are flexed, adduction, internally rotated *changes in hand, including grip weakness, and loss of tone in thumb muscles
When client data is analyzed
, assets and deficits can be identified.
Allen Level One
- aware only what penetrates the threshold of conscious awareness one/two worded directions should be used Physical contact is need to start the action can only do one action at a time and may not repeat unless prompted
Grading Problem solving
- begin with minor problems with relatively obvious solutions and little chance of failure work with problems client face in their lives
Factors for activities for decision making
- crafts work for this - real life decisions are important to the client and functionally relevant should be included Clients should participate in selecting their goals ( OT must provide concrete examples)
Avoid thinking that all elders have
. cognitive impairments.
Each of the 10 leading health indicators has one or more objectives from Healthy People 2010 associated with it. As a group, the leading health indicators reflect the major health concerns in the United States at the beginning of the 21st century
.1.Physical activity 2. Overweight and obesity 3.Tobacco use 4. Substance abuse 5..Responsible sexual behavior 6. Mental health 7. Injury and violence 8. Environmental quality 9. Immunization 10.Access to health care
Family Members
.Parents Young siblings Adult siblings
Rote exercise is not as meaningful or as productive for elders as personally meaningful occupations because
.Personally meaningful occupations are intrinsically motivating. Picking up 10-lb grandchild versus a 10-lb weight Using an actual task versus an exercise may be more beneficial to elderly clients.
Issues in Therapeutic Relationships
.Transference Countertransference Dependence :Stigma Helpless, anger, depression .
T/F Patients with mild mental illness rarely require OT
.True
Allen's 6 levels of Cognitive
1-person mostly unaware of what is going on 2- person seems to unaware of movement and position and effects of gravity 3. Person is interested in what is going on- easily distracted 4. able to copy and demonstrate directions 5. Person shows interest in relationships between objects- cutting through fabric when emoving price tag 6.Person appreciates relationship between objects- dark clothing may run in the wash
3 Characteristics of Flow
1. A clear set of goals that require appropriate responses 2. Provision of immediate feedback 3. Use of skills to meet a challenge that is just about mangeable
How to wash hands
1. Bring at 3 paper towels to the sink 2. Remove hand jewelry- include watch 3. Turn water to good stream of tolerable but hot water 4. Using soap-make lather 5. Using one hand- wash the other up to including the wrist, taking care to clean between fingers and under fingernails 6. Repeat procedure for other hand 7. Dry hands- one hand using patting motion 8. Use last towel to turn off faucets 9. Use last towel to turn doorknob 10. Discard towels in trash can 11. Apply hand lotion to prevent cracking
5 subtypes of schizophrenia
1. Catatonic- extreme psychomotor disturbance 2. Disorganized-incoherent thinking, ineffective, bizarre communication 3. Paranoid - systematized delusional thinking organized around themes of persecution 4. Undifferentiated- when criteria for other types not completely present 5. Residual type- assigned when active psychotic symptoms are not present but residual negative symptoms are found
Gradation of decision making
1. Choose one of two colors 2. Select project from 3 options 3. Choose 2 colors and a pattern 4. Select own materials and design 5. Design own project
10 Principles for planning and providing treatment for Role Acquisition
1. Client Participation 2. Personalized Goals 3. Ability Based Goals 4. Increasing Challenges 5. Natural Progression 6. Client Knowledge 7. Client Awareness 8. Practice makes perfect 9. Parts of the whole 10. Imitation
what are the 10 principles identified for treatment of role acquisition?
1. Client participation 2. personalized goals 3. ability based goals 4. increasing challenge 5. natural progression 6. client knowledge 7. client awareness 8. practice makes perfect 9. parts of the whole 10. imitation
7 Guiding Principles
1. Demonstrate concern for safety and wellbeing 2. Shall take measure to ensure a recipients safety and avoid imposing or inflicting harm 3. Respect recipients to assure their rights 4. Shall achieve and contually maintain high standards 5. Comply with laws 6. provide accurate information about OT services 7. Treat colleagues and other professional with fairness, discretion and integrity
6 occupational therapy practice models
1. Development of adaptive skills 2. Role acquisition 3. Psychoeducation 4. Sensory integration 5. Cognitive disabilities 6. MOHO
Two major factors to consider when selecting an activity
1. How well it suits its purpose in the OT intervention process. 2. The fit between the activity and the client
The specific purposes of the Occupational Therapy Code of Ethics and Ethics Standards (2010) are to
1. Identify and describe the principles supported by the occupational therapy profession. 2. Educate the general public and members regarding established principles to which occupational therapy personnel are accountable. 3. Socialize occupational therapy personnel to expected standards of conduct. 4. Assist occupational therapy personnel in recognition and resolution of ethical dilem
4 Layers of the environment
1. Objects 2. Tasks 3. Social groups 4. Culture
3 Phases of Schizophrenia
1. Prodromal phase- level of functioning deteriorates 2. Active phase- psychotic symptoms surface 3. Residual phase- remission of psychotic symptoms
3 Phases of schizophrenia
1. Prodromal phase-level of functioning deteriorates 2. Active phase-psychotic symptoms 3. Residual phase-remission of the psychotic
3 types of retirement
1. Regressive 2. Stable 3. Progressive
When a pt with symptoms, the OTA has the ability to modify these 3 variables
1. Self- the way the OTA communicates ( verbally or non verbal) 2. Activity- The thing you and the pt doing together 3. Environment- Surroundings
what are some 'Development of Adaptive skills model' Treatment Methods?
1. Take pt. sequentially through developmental growth stages of performance skill 2. performance skills are mastered in particular order 3. sub skills from various areas can be worked on concurrently 4. clinician assists client with mastering skills in a STEP BY STEP manner.
The 5 important points of the OT Practice framework process
1. The process is dynamic and evolving 2. Context is embedded in our understanding 3. Clients are individuals, whether they receive services as individuals or as members of groups or populations 4. The client must be an active participant (client-centered process) 5. The outcomes is engagement in occupation
Four basic concepts guide the adaptive skill model
1. The therapist must provide and environment that facilitates growth 2. The sub-skills are mastered in order 3. Sub-skills from different area may be addressed at the same time, provided they are normally acquired at the same chronological age 4. The pts intrinsic motivation or desire for mastery of subskills must be engaged
The population of large public psychiatric centers consist of 3 main categories
1. Those who to violent or suicidal to be released 2. Those that have intact families or social support systems but who are so severely impaired and disorganized that they cannot live alone or in the community even with support 3. Those who lack social support from family or others and who despite apparently adequate skills have shown on repeated discharge that they cannot succeed in the community without support and stucture
MOHO has 3 subsystems. What are they?
1. Volition - motivation 2. Habituation- habits and internalized roles 3. Performance - physician and mental skills supporting engagement in occupation.
Three elements must be satisfied before you are deemed a covered entity for HIPPA
1. You must be a healthcare provider as defined under Medicare regulations; 2. You must engage in one or more HIPAA transactions; and 3. You must engage in this transaction electronically or have someone else perform the electronic transaction on the provider's behalf.
Two treatment principles for Sensory Intergration
1. attention should be focused on the outcome of the activity or the object used in it rather than on the movements 2. Activity must be pleasurable
Anger management technique
1. define anger 2.manage anger through techniques- visualization, empathizing, relaxation and conflict resolution 3. put these strategies into their own lives
what 2 treatment principles of SI Model should be followed?
1. focus on the outcome of activity not movement requirements ( must move without having to think about it) 2. must be pleasurable, presented in noncompetitive, cheerful manner
Steps to organize OT clinic properly
1. keep track of your keys 2. Make sure restricted items are not taken onto inpatient wards 3.Have everything ready before pt arrive in the clinic or treatment area 4. Use shatterproof mirrors 5. Use good judgement about who comes to OT services 6. Organize and supply cabinets to permit fast accurate count of all potentially dangerous items 7. Alert consumers to potential dangers in activities 8. Follow safety precaution for toxins 9 never use container that might be mistaken for food0 9. Know and use proper safety equipment 10. Observe the local fire code 11. Pay attention to the condition of the floor 12. Eliminate electrical hazard 13. Observe food safety guidelines 14. Apply techniques for proper positioning energy conservation, work simplification 15. Provide increased structure for those functioning at lower cognitive levels
Two step approach to assisting clients in leisure exploration
1. leisure evaluation 2. involve client in one or more leisure activities or in a group designed to present leisure opportunities
what are social skills 4 groups categories?
1. self expressive skills 2. other-enhancing skills 3. assertive skills 4. communication skills
Supervision has three functions:
1.Administration: 2.Evaluation: 3.Education:
Relationships are affected by the individuals' personal qualities.
1.Emotional Needs You may need guidance whereas your supervisor needs you to be autonomous You may desire more independence whereas your supervisor desires close supervision of your work 2.Social and Professional Roles Differing ideas about appropriate workplace behavior, attire, or friendships may cause conflict 3.Personal Values and Beliefs Cultural beliefs can cause conflicts, such as when the supervisor is younger than the supervisee, or is of the opposite sex 4.Communication Style Conflicts can arise when you or your supervisor are not listening actively when the other speaks Communication mishaps can occur when one or more members of a team speak English as a second language
Three levels of motivation toward occupation:
1.Exploration: 2.Competency: 3.Achievement:
Implementing and Modifying a Plan
1.OT is responsible for carrying out the plan, and may delegate tasks to the OTA. 2.OTA should report progress to the OT so that periodic modifications may be made to the plan. 3.Formal re-evaluation is the responsibility of the OT. At the close of treatment, the OT will assess progress as compared to original goals.
3 pattern of alcohol abuse
1.Regular daily drinking 2. Heavy weekend drinking 3. Periodic or episodic binge drinking
Self-awareness can be characterized based on three aspects:
1.Values: what one finds important and meaningful Interests: what one finds enjoyable and satisfying 2.Self-concept: the feelings and ideas one has about his/her own identity, worth, capabilities, and limitations 3.Childhood experiences and family/peer interactions contribute to self-concept
What is normal ROM for elbow flexion?
140 AMA
Expected ROM for elbow flexion
140 degrees AMA
Grading attention span
15 minutes- client can hold attention, start with 15 minutes Gradually ask the client to work for longer 20, 30 45 etc
What is the normal ROM for shoulder complex ABduction?
180 AMA
What is the normal ROM for shoulder complex flexion?
180 AMA
What is the normal ROM for shoulder flexion?
180 AMA
OT brands (or slogans)
1980's Occupational Therapy Makes Learning Possible (AOTA) Occupational Therapy Makes Good Sense (AOTA) Occupational Therapy Improving Function (AOTA) Skills for the Job of Living (AOTA - 1990s) Living Life to It's Fullest (AOTA - 2000s) Building Skills for a Better Life (promotional merchandise) Helping You Live Life Your Way (UK) Enabling the Occupations of Life (Canada) Occupation: It's What We Do (Australia)
How many joints are in the ankle?
3
Normal ROM for Wrist Ulnar Deviation
30 AMA
Hearing
37% of people older than 65 years of age experience some hearing loss. Hearing is needed for horns, sirens, train whistles, ambulances, fire trucks, police vehicles, and so on. Elders may need hearing aids to assist with this problem.
How many metacarpels are in each hand?
5
What is the normal ROM for shoulder complex extension
50 AMA
what does Allen's Cognitive Level (ACL) measure?
6 levels of cognitive ability and disability related to task performance
Normal ROM for wrist flexion
60 AMA
What is the normal ROM for wrist flexion?
60 AMA
Normal ROM for forearm supination
80 AMA
What is the normal ROM for forearm pronation?
80 AMA
Normal ROM for Shoulder complex horiz ABduction.
90
Normal ROM for shoulder complex medial (internal ) rotation
90 AMA
What is the normal ROM for shoulder complex lateral (external)rotation?
90 AMA
Sensitivity
: Being attuned to the patient's behaviors.
Warmth
: Being friendly, interested, and enthusiastic.
Treatment Care: long-term mental health assistance for patients who require continued supervision
: medical care for disease, injury, or other medically treatable condition
Medicare Part B
= doctors' services, outpatient care, services not covered by part A (including some OT, PT, HHC)
Fluid intelligence
= intellectual processes that impact numerical reasoning and logic
Crystallized intelligence
= knowledge accumulated through the life span
Medicare Part C
= managed care, fee for service, and medical savings accounts (private plans approved by Medicare)
Clinical documentation practices and forms vary by setting, policy and procedures; nevertheless, the appropriate documentation forms should follow the most conservative guidelines, whether they are CMS final rules, state or fiscal intermediary or local medical determinations.
? Physician Orders Occupational Therapy services cannot commence without a written, Signed and dated Order, preferably to "Evaluate and Treat" ? Initial Evaluation The Initial Evaluation is the source document for the Plan of Care. At a Minimum it will include important patient information to include, but Not limited to; Patient Name, Provider Name/ rovider Number, Reason for Referral, Recent Hospitalizations, Primary/Secondary medical Diagnoses with ICD-9s, Co-morbidities, Previous Living Arrangement, History related to current episode, Referring Physician, Start of Care Also, Prior Level of Function, Recent hospitalization, Surgical Procedure/s, Precautions, Baseline findings such as ROM, Strength, Sensation, Rehab Potential, Function, Cognition, Pain, Gross- Fine-Motor Coordination, Adaptive Equipment, Short- & Long-term Goals, Safety Concerns, Therapeutic Interventions and Discharge Plan, and clinician signature and date. ? Orders This practice varies by setting and provider. However, it is a "Best Practice" to submit these orders. Rationale: You don't know what the Specific interventions and plan are until the Evaluation is complete - even If the Referring Physician writes an order simply for "Occupationa Therapy. These orders will include the Discipline - Treatment Dx, Therapeutic Interventions, frequency and duration. Extended Clarification Orders are required should the Plan of Care exceed the Initial Certification Period. ? Progress Notes Whether your Provider requires Daily or Weekly entries, it is considered a Best Practice to document a "Per Visit" entry. This practice enables the therapist and or Therapy Assistant to follow the Plan of Care more consistently from visit to visit. It will note the specific interventions or CPT's, the skilled services actually administered, the Patient's response to Therapy, Patient and or caregiver training and modalities. A Weekly Summary identifies the Functional progress made and plan for continued Care.? Updated POC Generally, an Updated Plan of Care occurs every 14 days or 10 visits, whichever occurs first. The Recertification note does not require the physician signature. However, it serves as an Updated Plan of Care to include Progress made to Initial goals and added goals accordingly. The patient should be provided with a written notice of an anticipated Discharge date with reasons. This is known as part of an "Expedited Review" process. It enables the patient to appeal the decision. In essence, The Discharge Summary is a comprehensive summary of patient progress From Start of Care to discharge. It needs to clearly document the Interventions, Baseline updates, Functional Gains achieved and Discharge Plan. ? Discharge Plan No episode of care is complete without an initial and ongoing Patient Education program. Clinicians often document "HEP" for Home Exercise Program, however we seem to forget other education such as Proper Body Mechanics, Splint wear and care, adaptive equipment, Energy Conservation, Joint Protection, Safety and similar topics. Included in the Discharge Summary is the Discharge Plan including Home Care, Support Group resources, Caregiver support systems And referrals to other health care professionals.
Occupational performance
?? Examples: Playing golf (occupational form) Golf course available (physical characteristic) Socialization while playing (sociocultural)
What is a business associate?
A business associate is a person or organization that performs a function or activity on behalf of a "covered entity.
Clinical documentation skills (medical record entries) must parallel clinical competence.
A complete medical record should be a well written document that clearly "connects the dots" or "paints a picture" of the patient's baseline, skilled interventions, functional progress, discharge status and follow-up recommendations. The medical record must articulate the complete story of an idividual's medical episode of care, including relevant medical history, recent medical episode of events, and the medical necessity for skilled services, including details of functional outcomes and discharge disposition..
What functional, evidence-based outcomes were achieved?
A medical record may be well-documented, but can fail to connect improved patient functional outcomes with skilled services in a reasonable amount of time. Insurers wish to quantify beneficiary gains in terms of the patient's recovered or renewed function as a result of the services received..Incorporate a proactive clinical documentation approach to avoid documentation pitfalls.
Anxiety Disorders
A person with an anxiety disorder has fear and worry that May be severe or last a long time May often be out of proportion to the actual situation Can force him or her to take extreme action to avoid the source of the anxiety
What guidance do the Occupational Therapy Ethics Standards provide?
A philosophical and practical translation of how to maintain professionalism in practice. A regulatory code: guidelines for conduct are stated, and sanctions are provided for failure to comply with the code Sanctions are stated in the Enforcement Procedures for the Code of Ethics.
Communicating Healthcare Information
A prevalent myth is that HIPAA bans the faxing of protected healthcare information or that HIPAA precludes the use of e-mail communication. HIPAA does neither. Instead, HIPAA requires that covered entities exercise caution when faxing health information, such as using pre-programmed phone numbers for frequently called numbers and locating fax machines in areas where only those with a need to access the fax machine can do so. As to e-mail usage, providers should use customary safeguards when using e-mail and, if practicable, encrypt the e-mail messages.
Mental health-infancy
A stable, secure, and predictable environment is one of the most important factors in helping a child at any age to develop trust in self, other people, and the world in general
NONMALEFICENCE-Occupational therapy personnel shall
A. Avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees. B. Make every effort to ensure continuity of services or options for transition to appropriate services to avoid abandoning the service recipient if the current provider is unavailable due to medical or other absence or loss of employment. C. Avoid relationships that exploit the recipient of services, students, research participants, or employees physically, emotionally, psychologically, financially, socially, or in any other manner that conflicts or interferes with professional judgment and objectivity. D. Avoid engaging in any sexual relationship or activity, whether consensual or nonconsensual, with any recipient of service, including family or significant other, student, research participant, or employee, while a relationship exists as an occupational therapy practitioner, educator, researcher, supervisor, or employer. E. Recognize and take appropriate action to remedy personal problems and limitations that might cause harm to recipients of service, colleagues, students, research participants, or others. F. Avoid any undue influences, such as alcohol or drugs, that may compromise the provision of occupational therapy services, education, or research. G. Avoid situations in which a practitioner, educator, researcher, or employer is unable to maintain clear professional boundaries or objectivity to ensure the safety and well-being of recipients of service, students, research participants, and employees. H. Maintain awareness of and adherence to theCode and Ethics Standards when participating in volunteer roles. I. Avoid compromising client rights or well-being based on arbitrary administrative directives by exercising professional judgment and critical analysis. J.Avoid exploiting any relationship established as an occupational therapist or occupational therapy assistant to further one's own physical, emotional, financial, political, or business interests at the expense of the best interests of recipients of services, students, research participants, employees, or colleagues. K. Avoid participating in bartering for services because of the potential for exploitation and conflict of interest unless there are clearly no contraindications or bartering is a culturally appropriate custom. L. Determine the proportion of risk to benefit for participants in research prior to implementing a study.
PROCEDURAL JUSTICE -Occupational therapy personnel shall
A. Be familiar with and apply the Code and Ethics Standards to the work setting, and share them with employers, other employees, colleagues, students, and researchers. B. Be familiar with and seek to understand and abide by institutional rules, and when those rules conflict with ethical practice, take steps to resolve the conflict. C. Be familiar with revisions in those laws and AOTA policies that apply to the profession of occupational therapy and inform employers, employees, colleagues, students, and researchers of those changes. D. Be familiar with established policies and procedures for handling concerns about the Code and Ethics Standards, including familiarity with national, state, local, district, and territorial procedures for handling ethics complaints as well as policies and procedures created by AOTA and certification, licensing, and regulatory agencies. E. Hold appropriate national, state, or other requisite credentials for the occupational therapy services they provide. F. Take responsibility for maintaining high standards and continuing competence in practice, education, and research by participating in professional development and educational activities to improve and update knowledge and skills. G. Ensure that all duties assumed by or assigned to other occupational therapy personnel match credentials, qualifications, experience, and scope of practice. H. Provide appropriate supervision to individuals for whom they have supervisory responsibility in accordance with AOTA official documents and local, state, and federal or national laws, rules, regulations, policies, procedures, standards, and guidelines. Obtain all necessary approvals prior to initiating research activities. J. Report all gifts and remuneration from individuals, agencies, or companies in accordance with employer policies as well as state and federal guidelines. K. Use funds for intended purposes, and avoid misappropriation of funds. L. Take reasonable steps to ensure that employers are aware of occupational therapy's ethical obligations as set forth in this Code and Ethics Standards and of the implications of those obligations for occupational therapy practice, education, and research. M. Actively work with employers to prevent discrimination and unfair labor practices, and advocate for employees with disabilities to ensure the provision of reasonable accommodations. N. Actively participate with employers in the formulation of policies and procedures to ensure legal, regulatory, and ethical compliance. O. Collect fees legally. Fees shall be fair, reasonable, and commensurate with services delivered. Fee schedules must be available and equitable regardless of actual payer reimbursements/contracts. P. Maintain the ethical principles and standards of the profession when participating in a business arrangement as owner, stockholder, partner, or employee, and refrain from working for or doing business with organizations that engage in illegal or unethical business practices (e.g., fraudulent billing, providing occupational therapy services beyond the scope of occupational therapy practice)
AUTONOMY AND CONFIDENTIALITY -Occupational therapy personnel shall
A. Establish a collaborative relationship with recipients of service including families, significant others, and caregivers in setting goals and priorities throughout the intervention process. This includes full disclosure of the benefits, risks, and potential outcomes of any intervention; the personnel who will be providing the intervention(s); and/or any reasonable alternatives to the proposed intervention. B. Obtain consent before administering any occupational therapy service, including evaluation, and ensure that recipients of service (or their legal representatives) are kept informed of the progress in meeting goals specified in the plan of intervention/care. If the service recipient cannot give consent, the practitioner must be sure that consent has been obtained from the person who is legally responsible for that recipient. C. Respect the recipient of service's right to refuse occupational therapy services temporarily or permanently without negative consequences. D. Provide students with access to accurate information regarding educational requirements and academic policies and procedures relative to the occupational therapy program/educational institution. E. Obtain informed consent from participants involved in research activities, and ensure that they understand the benefits, risks, and potential outcomes as a result of their participation as research subjects. F. Respect research participant's right to withdraw from a research study without consequences. G. Ensure that confidentiality and the right to privacy are respected and maintained regarding all information obtained about recipients of service, students, research participants, colleagues, or employees. The only exceptions are when a practitioner or staff member believes that an individual is in serious foreseeable or imminent harm. Laws and regulations may require disclosure to appropriate authorities without consent. H. Maintain the confidentiality of all verbal, written, electronic, augmentative, and nonverbal communications, including compliance with HIPAA regulations. I. Take appropriate steps to facilitate meaningful communication and comprehension in cases in which the recipient of service, student, or research participant has limited ability to communicate (e.g., aphasia or differences in language, literacy, culture). J. Make every effort to facilitate open and collaborative dialogue with clients and/or responsible parties to facilitate comprehension of services and their potential risks/benefits.
FIDELITY -Occupational therapy personnel shall
A. Respect the traditions, practices, competencies, and responsibilities of their own and other professions, as well as those of the institutions and agencies that constitute the working environment. B. Preserve, respect, and safeguard private information about employees, colleagues, and students unless otherwise mandated by national, state, or local laws or permission to disclose is given by the individual. C. Take adequate measures to discourage, prevent, expose, and correct any breaches of the Code and Ethics Standards and report any breaches of the former to the appropriate authorities. D. Attempt to resolve perceived institutional violations of the Code and Ethics Standards by utilizing internal resources first. E. Avoid conflicts of interest or conflicts of commitment in employment, volunteer roles, or research. F. Avoid using one's position (employee or volunteer) or knowledge gained from that position in such a manner that gives rise to real or perceived conflict of interest among the person, the employer, other Association members, and/or other organizations. G. Use conflict resolution and/or alternative dispute resolution resources to resolve organizational and interpersonal conflicts. H. Be diligent stewards of human, financial, and material resources of their employers, and refrain from exploiting these resources for personal gain.
Occupational therapy personnel shall
A. Respond to requests for occupational therapy services (e.g., a referral) in a timely manner as determined by law, regulation, or policy. B. Provide appropriate evaluation and a plan of intervention for all recipients of occupational therapy services specific to their needs. C. Reevaluate and reassess recipients of service in a timely manner to determine if goals are being achieved and whether intervention plans should be revised. D. Avoid the inappropriate use of outdated or obsolete tests/assessments or data obtained from such tests in making intervention decisions or recommendations. E. Provide occupational therapy services that are within each practitioner's level of competence and scope of practice (e.g., qualifications, experience, the law). F. Use, to the extent possible, evaluation, planning, intervention techniques, and therapeutic equipment that are evidence-based and within the recognized scope of occupational therapy practice. G. Take responsible steps (e.g., continuing education, research, supervision, training) and use careful judgment to ensure their own competence and weigh potential for client harm when generally recognized standards do not exist in emerging technology or areas of practice. H. Terminate occupational therapy services in collaboration with the service recipient or responsible party when the needs and goals of the recipient have been met or when services no longer produce a measurable change or outcome. I. Refer to other health care specialists solely on the basis of the needs of the client. J. Provide occupational therapy education, continuing education, instruction, and training that are within the instructor's subject area of expertise and level of competence. K. Provide students and employees with information about the Code and Ethics Standards, opportunities to discuss ethical conflicts, and procedures for reporting unresolved ethical conflicts. L. Ensure that occupational therapy research is conducted in accordance with currently accepted ethical guidelines and standards for the protection of research participants and the dissemination of results. M. Report to appropriate authorities any acts in practice, education, and research that appear unethical or illegal. 3N. Take responsibility for promoting and practicing occupational therapy on the basis of current knowledge and research and for further developing the profession's body of knowledge
SOCIAL JUSTICE-Occupational therapy personnel shall
A. Uphold the profession's altruistic responsibilities to help ensure the common good. B. Take responsibility for educating the public and society about the value of occupational therapy services in promoting health and wellness and reducing the impact of disease and disability. C. Make every effort to promote activities that benefit the health status of the community. D. Advocate for just and fair treatment for all patients, clients, employees, and colleagues, and encourage employers and colleagues to abide by the highest standards of social justice and the ethical standards set forth by the occupational therapy profession. E. Make efforts to advocate for recipients of occupational therapy services to obtain needed services through available means. Provide services that reflect an understanding of how occupational therapy service delivery can be affected by factors such as economic status, age, ethnicity, race, geography, disability, marital status, sexual orientation, gender, gender identity, religion, culture, and political affiliation. G. Consider offering pro bono ("for the good") or reduced-fee occupational therapy services for selected individuals when consistent with guidelines of the employer, third-party payer, and/or government agency.
Functional causes of falls
ADLs become challenging Functional mobility problems Transferring from bed to chair or toilet, tub, or shower Reaching, sitting, standing, and walking unsupported Lack of assistive aids for ambulation or an inability to use them Carrying a walker instead of using it to walk Old, lost, borrowed, or smudged glasses impair vision Poorly fitting shoes, loose pants that drag, and flimsy sandals affect balance
Why promote OT ?
AOTA Centennial Vision "We envision that occupational therapy is a powerful, widely recognized,science‐driven, and evidence‐based profession with a globally connected and diverse workforce meeting society's occupational needs."
What motions of the shoulder joint does the Posterior Deltoid assist with?
Abduction, shoulder extension, horizontal abduction, and ER
What motions does the Anterior Deltoid assist the shoulder joint with?
Abduction, shoulder flexion, horizontal adduction, IR
Group Therapy Benefits include:
Ability to treat multiple patients simultaneously Group members learn from each other as well as from the therapist
What is function in the Psychoeducational model?
Able to use life skills in a variety of environments and situations. Able to assume a variety of roles.
Secondary aging
Abnormal changes in organ systems Experienced by some individuals but not all Associated with disease, impairment, or disability Frequently preventable through lifestyle changes
Introduction to Marketing.-
According to Peter Drucker: Customers are the foundation of a business and the purpose of its existence. The aim of marketing is to know and understand a customer so well that a product or service fits and sells itself. The customer determines what a business is, what it produces and whether it will prosper.
Adaptation of Activity
Activities can be adapted in different ways: Adaptations of the task Fewer steps Simpler tools Adaptations of the environment One-on-one versus small group work Changes in lighting or ambient noise Position of client relative to activity
Social Theories of Aging
Activity theory Continuity theory External continuity Lifespan or life course theory Erickson's theory of human Peck's stages of psychological development in the second half of lifel Exchange theory Thriving: a holistic lifespan theory
a change that facilitates performance.
Adaptation:
What movements does the Teres Minor assist the shoulder joint in completing?
Adduction, External Rotaion
Mental Health Factors Throughout Life-Adolescence
Adolescence Teenagers must develop a sense of identity separate from their parents. Experiences include moodiness, irritability, and sadness. Major psychiatric disorders may appear at this age: schizophrenia, mania, and depression. OT approaches include: Tech-based approaches (computer or video games) Self-care lessons, including sex education Vocational training (assembly-line tasks)
acts out the unexpressed tensions of the family - may be seen as trouble maker-
Adversary
Common Diagnoses for Depresson
Affective mood disorder, schizophrenia. personality disorders, substance abuse
What can we offer customers?
Again, according to Karen Jacobs, "our profession helps people rediscover and reclaim their sense of meaning and purpose." Jacobs (2000), Presidential Address, AJOT
Treatment Focus- Psychosocial problems- Adolescents
Age appropriate roles Mutual Collaboration Attention to development of occupational choice ( education, career, and social skills) Education in special needs of this age group ( sexuality, gender identity, prevention o f substance abuse) Education of and consultation with parents of expectations and behavior management Scheduling compatible with school schedule and needs of family
Environmental Safety Modifications
All consumers, and particularly the elderly, are at risk from conditions in the home. OTAs can help by: Educating consumer about smoking- or obesity-related health risks Providing management techniques for taking multiple medications Organizing areas for those with cognitive or visual impairments Modifying the home for those with physical disability
Goals of Psychiatric OT
All goals should address functional occupation-centered outcomes
Documentation of OT Services (Cont'd)
All medical notes should follow some basic criteria: Record observations, not interpretations Avoid judgmental language Avoid jargon Omit extraneous detail Be brief, precise, and factual Organize information logically Write legibly (for handwritten records)
Approaches to Depression- Self
Allow client to talk about their feelings. Mirror messages back client Reinforce self care task
Psychotropic Drugs and their Side Effects- Antimanic Drugs
Also called mood stabilizers, used to reduce mood swings and control mania. Some antimanics contain lithium carbonate; lithium toxicity requires that patients on such drugs undergo routine blood tests. Side effects include: Diarrhea Dry mouth Frequent urination Fatigue
Phenomenon called "the anorexia of aging"
Alterations in smell and taste have been found to be associated with decreased food intake and nutritional status.
Pedestrian Safety Tips (Box 14-6)
Always use a crosswalk. Use the pedestrian push button and wait for the WALK sign to appear. Before stepping into the roadway, search for turning vehicles and look left and right before crossing. Wear bright (fluorescent) colors during daylight and wear retroreflective material and carry a flashlight if walking at night.
Successful Aging
An optimal state attained by avoiding disease and disability, maintaining high cognitive and physical functioning, and continuing to be actively engaged with life
Medicare Part D
An optional benefit
Dynamic Performance Analysis
Analysis should take place in the presence of the client as he or she is performing the activity. This avoids the mistake of assuming a client has skills he or she does not actually possess. Provides opportunity to re-teach activity or adapt it to meet client needs.
Unfriendly feelings, attitudes, and actions toward others Anger, Hostility, and Aggression: Unfriendly feelings, attitudes, and actions toward others Approaches: Self: Be aware of client's nonverbal cues. Help them use words rather than stance or actions to express emotion Environment: Isolation from other patients may be necessary. Keep sharp objects our of reach Activities: Dance, sanding wood, anger management Inappropriate Approaches: Do not directly face hostile patients. Do not allow patient to come between you and an exit.
Anger, Hostility, and Aggression:
what are the 6 areas involved in development of adaptive skills model? and who came up with this model?
Anne Mosely 1. sensory intergration skill 2. cognitive skills 3. dyadic skill 4. group interaction skill 5. self identify skill 6. sexual identify skill
Eating Disorders
Anorexia Bulimia
State of tension or uneasiness
Anxiety
Common Mental Health Diagnoses
Anxiety Disorders Panic Disorders Bipolar Disorders Mood Disorders
Paranoia approaches-Activities:
Anything the patient can control
Cognitive Disabilities Model
Applies to OT services designed for clients with cognitive impairments. Cognitive impairments can result from psychiatric illness, medical disease, brain traumas, or developmental disorders. In this model, "occupation" is synonymous with voluntary motor action (e.g., dressing, crafting, preparing a meal). Observing a cognitively impaired client's voluntary motor action gives insight into the relationships among the three domains.
Areas for Data Collection
Areas of occupation Performance skills Performance patterns Contexts Client factors Mental/emotional functions Psychosocial and psychological skills Experience of self Sensory functions Physical condition or disability
Techniques to promote interaction in a group- Environment
Arrange group in circle Position talkative member with non-talkative Leader sit next to members who monopolize, act out etc
How skillful were the services? What was the level of expertise and competence?
As creatures of habit, over time, many clinicians fall into clinical routines, both in terms of treatment approaches and subsequent documentation practices. Documenting skilled and technical intervention is paramount to preventive denial management. Skilled levels of intervention need to be consistently present throughout the medical record. From a clinical evaluative perspective, document results of standardized assessment tools and current functional inabilities. From a treatment perspective, ensure the technical level of expertise is consistently documented and supported by functional outcome improvements. Use approved medical record abbreviations and incorporate discipline-specific technical jargon. The goal is to demonstrate that a non-skilled individual would not be able to provide the service documented. For example, which statement is skilled? A) Patient completed red thera-band exercises 20 X 2 or B) Patient executed bilateral upper-extremity progressive resistive exercises to all major muscle groups utilizing medium resistive thera-band, 20 repetitions X 2).
Responsibilities of the Supervisee
As you begin your career as an OTA, you will be responsible for the following: Meeting regularly with your supervisor at assigned times Following through with assigned responsibilities Asking for clarification for responsibilities you do not understand Letting your supervisor know when you are incapable of performing an assigned task Identifying problems in your work Responding to your supervisor as someone who is there to help you learn
Responsibilities of the Supervisee (Cont'd)
As you begin your career as an OTA, you will be responsible for the following: Taking an active role in setting learning goals Following through on learning opportunities Asking for assistance when you need it Accepting evaluation feedback as an opportunity to learn Respecting the confidences of your supervisor Abiding by the administrative chain of command Abiding by the rules of the institution
How the OT staff should focus on logical approaches to gathering information and generating goals and methods:
Ask the right questions Use multiple reasoning tracks: Procedural Interactive Conditional Narrative Pragmatic
Task Role- Opinion seeker
Asks for opinions and feelings about issues under discussion
The ability to state's one needs, thoughts and feelings in an appropriate, direct and honest way
Assertiveness
COTA's Role
Assess the client's developmental stage and potential disruptions in each adaptive skills area. Analyze the collected data for effects on age-appropriate occupational performance in the areas of work, education, self-care, and play and leisure. Devise intervention strategies that facilitate development of a specific skill needed for successful occupational performance. Sensory, developmental, symbolic, and daily life tasks Interventions continue until the client reaches sufficient competence in performing the skills and activities described as developmentally appropriate. Continue to monitor and reevaluate the client's progress in improving, maintaining, or restoring areas of occupational performance.
Task Role- Evaluator-critic
Assesses accomplishment of group relation to some standard
Allen Cognitive Levels (ACL) Test
Assesses cognitive level by assessing response to verbal instructions and problem-solving techniques when a client is presented with a leather lacing project.
Domestic Violence- OT interventions include:
Assessment (with the occupational therapist) Anger management skills (for the abuser) Assertiveness and emotional identification Organization and routines (for survivors) Skills that lead to self-reliance and employment (for survivors)
a useful, adaptive behavior that helps the client meet needs and carry out ADLs
Asset:
Administration:
Assigning tasks Monitoring progress
Education
Assigning tasks that allow for skill development Acting as mentor to entry-level colleagues
COTA's Role- Driver Rehabilitation
Assist elders in applying for disabled parking placard issues by the Department of Motor Vehicles. Help the elder determine the requirements for the disabled parking placard. Paperwork usually needs to be signed by a licensed physician.
Role of COTAs in Elder Community Mobility
Assist elders in being as independent as safely possible. Help elders identify realistic goals and treatment plans for moving around the community. Provide resources for transportation when they can no longer drive. Groceries, pharmacy, medical appointments, activities
Driver Rehabilitation Professionals
Assist elders needing scooters that are transported in a van. This professional takes into account the type of wheelchair or scooter, whether the person needing the equipment will be a driver or passenger, and the length of time the equipment will be needed.
The Role of the OTA-Drugs
Assist patients in managing uncomfortable side effects of drug therapy. Monitor patient activity, behaviors, and health; report any unusual findings to supervisory staff. Encourage compliance with drug treatment regimens. Educate family members on the benefits of patient adherence to the drug regimen.
Benefits of Correct Positioning in a Wheelchair
Assists breathing, swallowing, digestion Improves socialization by changing elder's eye gaze Promotes comfort (reduces pain, sliding, leaning) Provides easy rolls for the client Insurance restrictions sometimes lead to use of sling upholstered wheelchairs really meant for short-term use only Insert a solid seat or back. Add padded cushions. Adjust the wheelchair if able. Make sure elders can reach the brakes and wheels.
Exchange theory
Assumes people attempt to maximize their rewards and minimize their costs in interactions with others. Continuing interaction is based on what the elder perceives as rewarding or costly. Elders continue with interactions that are beneficial and withdraw from those perceived as having no benefit.
Responsibilities of the Supervisor
At the beginning of a working relationship, the supervisor should do the following: 1.Assign times for meetings 2.Identify supervisee responsibilities 3.Set reasonable expectations 4.Respond to supervisee as an individual 5.Explain evaluation criteria 6.Clarify team roles and responsibilities 7.Arrange for initial supervisee orientation
Problems directing attention to a task or maintaining attention for a reasonable length of time
Attention Deficits:
Inappropriate Approaches to delusions:
Avoid discussing a client's delusions so as not to reinforce them. Do not choose activities that may inadvertently reinforce the delusions
Inappropriate Approaches: to paranoia
Avoid startling patients by approaching them suddenly or from behind. Do not whisper
Kitchen modifications- Fall prevention
Avoid step stools. Keep objects within reach. Provide simple meal preparation guidance. Use a microwave instead of the stove.
Strive for a balance in organization.
Avoid unimportant activities that do not contribute to achieving goals, such as: Cataloging useless papers Rearranging desk supplies Surfing the Web or replying to personal emails
Allen Level Two
Aware of their own movement and those of others able to perform simple gross motor activities Calisthenics and sensorimotor activities can be used person will show interest in familiar objects Verbal directions include names of body parts must also demonstrate desired action ( one at a time) repetitions or variations on the same action can be introduced
Stages to ethical problem solving:
Awareness: What is going on? What kind of ethical problem is it? Who is involved? Which laws and institutional rules apply? What guidance does the AOTA provide? What are my options? Reflection: What do I think should happen? Support: With whom do I need to talk? Action: What will I do?
Nerves and muscles of the shoulder joint
Axillary nerve - Anterior, Middle, Posterior Deltoids, Teres Minor Suprascapular nerve - Supraspinatus, Infraspinatus Subscapular nerve - Teres Major, subscapularis Musculocutaneous nerve - coracobrachialis Pectoral nerve - Pectoralis Major Thoracodorsal nerve - Latissimus Dorsi
Techniques
Basic Counseling skills you can use: Use active listening skills Be mindful of your body language and your client's body language Use a combination of open-ended and closed-ended questions Paraphrase and summarize what you have heard to all for clarification Empathize with your clients Reframing skills Be creative
ADLs
Bathing/showering Bowel and Bladder management Dressing Eating Feeding Functional mobility Personal device care Personal hygiene and grooming Sexual Activity Toilet hygiene
Approaches Anger-Self
Be aware of client's nonverbal cues. Help them use words rather than stance or actions to express emotion
Approaches to mania- Self
Be calm matter of fact consistent Guide client to focus on one task at a time maintain leadership
Paranoia Approaches: Self
Be clear, consistent, directive, and unambiguous. If patient seeks out a special relationship, encourage this trust by giving him/her special activities and tasks
Steps to success- Restraint Program
Begins with a multidisciplinary team Family members should be included because they may continue to ask for a restraint to prevent falls. The family needs to sign a consent for a restraint. Family education is critical to success. Policies and procedures for applying a restraint and removing restraints should be developed. Alternatives to restraints should be available in the facility. After removal, follow-up and assessment of patient safety is needed. Additional alternatives may need to be tried.
Specificity:
Being able to state things simply
Genuineness:
Being oneself openly.
Ageism:
Belief that one age group is superior to another Avoid stereotyping or assumptions about inferiority.
Antigroup ( Egocentric) roles- Aggressor
Belittles or attacks group memebers
Motor and praxis
Bending and reaching Pacing Coordinating Maintaining balance Anticipating or adjusting posture and body position Manipulating
What muscles comprise the Flexors of the Elbow?
Biceps Brachii, Brachialis, , Brachioradialis
Psychotherapy
Biofeedback- special devices that are used to help the client learn how to relax their body Group therapy CBT - Combines cognitive and behavioral therapy To help clients learn how to recognize and then change anxiety-producing thoughts Ride out feelings of panic rather than becoming frightened by them Calming techniques Face situations you fear by exposing yourself to them gradually
Bipolar Disorders
Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Bipolar Disorder NOS
Common examples of comorbidity
Bipolar disorder and substance abuse Bipolar and personality disorder Schizophrenia and alcohol abuse Eating disorder and other personality disorder Anxiety disorder and substance abuse Borderline personality disorder and other personality disorders
Secondary prevention strategies
Blood pressure screening, cancer screening. Educate elders about the importance of having annual screenings done. Minority groups are especially at risk for lack of screenings. Increasing access to health care when needed, even for those with mobility problems.
The Supervisory Contract
Both supervisor and supervisee must be in agreement about what is expected from the supervisee Contracts can help clarify and outline roles and responsibilities Contracts can be written down or discussed orally Written contracts have advantages over oral agreements Roles/responsibilities are clearly defined Agreement can be reviewed and referenced later on
Whose job it to select activities?
Both the OT and the OTA
The two major structures of the CNS are:
Brain, Spinal cord
What ate the twin foundations of an intervention with children
Building a trusting relationship Modifying the environment
Visual Acuity
By age 70 years, most elders have poor acuity without corrective lenses or glasses. This makes driving more hazardous for them. With aging, changes in the lenses of the eye occur, and the eye muscles weaken. Pupil size decreases, which results in not being able to see well at night. Field of vision decreases with age, and this contributes to collisions. Special mirrors on the car can be used to improve vision. Glare occurs when too much light or light from the wrong direction is present. Elders' eyes recover more slowly when glare is present. Color of traffic lights can be a problem because elders require additional time to read road signs.
more detached ; less central to meeting the needs of family- coolly analyze the situation
Bystander
What are the two major parts of the nervous system?
CNS - Central Nervous System PNS - Peripheral Nervous System
Reflection: What do I think should happen?
COTAs must decide what they want to happen and must be able to explain their position. Ethical reflection involves careful and critical examination of feelings and values, a rational estimate of benefits and burdens, and a sense of professional duty. Free writing for reflection
Knowledge of the aging process allows
COTAs to discriminate between normal signs of aging and possible signs of pathology.
Ethical conflicts Action: What will I do?
COTAs will need to take action; doing nothing can also be perceived as an action. COTAs may retain uncertainty but take comfort in knowing they gave deep thought to their position.
Antigroup ( Egocentric) roles- Recognition seeker
Calls attention to self by boasting, talking about own talent, insist on having powerful position
Leisure can:
Can be a source for development of personal identity Requires a level of energy and initiative
IADLs
Care of others Care of pets Child rearing Communication device use Community mobility Financial management Health management and maintenance Home establishment and management meal pre and cleanup Religious observance Safety and emergency maintenance Shopping
Demonstrates friendliness and support of caregiver
Caring
Who identifies the goals for psychoeducation?
Case manger and student jointly and should be focuses on specific behavioral objective or outcomes
The Phrenic Nerve is powered by which plexus?
Cervical
The four segmental levels of the spinal cord are:
Cervical C1-C5 Thoracic T1-T12 Lumbar L1-L5 Sacral S1-S5
Name the four plexuses
Cervical, Brachial, Lumbar, Sacral
Environment- Restraint Reduction
Chair selection: Reclining chairs Alarms for chairs and beds Low beds that rest on or very near the floor Fall mats Moving furniture away from beds so that rolling out of a low bed to the floor is safer Wrap-around walkers Nursery intercoms that can help monitor safe ambulators Families can help decorate elders' rooms so they appear familiar and safe.
Games of _____ provide experiences whose outcome is based mostly luck
Chance
Immunosenescence:
Changes in immune function that contribute to the increased susceptibility to disease in elders May not be the result of primary aging but rather secondary changes caused by environmental and lifestyle factors
Neurologic or musculoskeletal causes of falls
Changes in the center of gravity, gait, stride, strength, and joint stability increase the risk for falls. Changes in posture control include decreased proprioception, slower righting reflexes, decreased muscle tone, and increased postural sway. Decreased height in stepping Medical conditions that contribute to instability include degenerative joint disease, deconditioning, neuropathy, stroke, Parkinson's disease, and dementia. Musculoskeletal conditions include osteoarthritis and decreased range of motion.
Cybernetic theory
Changes in the neuroendocrine system (endocrine and hypothalamus) result in organ changes.
Settings for Children and Adolescents-mental health
Children should be kept with the family if at all possible OTAs may encounter children in three settings: Home: goals include success in relationships, chores, and structured play activities School: goals include handwriting skills, note-taking, attention, organization, and stress management Camp: provides opportunities for new experiences, relationships, and challenges
Steps for making a schedule:
Choose an easy-to-use blank schedule form. Fill in scheduled activities that occur regularly. Highlight the times of your involvement in the activities. Schedule other responsibilities around these activities. Leave time for unscheduled work assignments. Offer your schedule to your supervisor for approval.
________________ schizophrenia suffer from a propriceptive deficits
Chronic
who developed Cognitive Disability model
Claudia Allen, OTR
Activity variable
Clay modeling, journaling, resume building, or grocery shopping
To begin with, why were services ordered and provided?
Clear and concise documentation that specifies recent health changes, pain, functional abilities, behavior and safety supports medical necessity for skilled services. These facts build the case for referral, admission and later, reason for continued services. A well-documented prior functional level compared to a measured and objective current functional level, including a clinical assessment and treatment plan in the baseline evaluation, further support the need for skilled services. It is absence of function or function deficits that leads to medical intervention. Document it!
Microenvironement
Client and Family- OT- teach compensatory techniques, develop skills, train caregiver
Social Conduct: Communication and Interaction Skills
Clients may misread social cues and react inappropriately Client may have trouble with verbal communication, nonverbal communication, or both
Axis I
Clinical disorders and other conditions
Impairment in mental functions needed for thinking
Cognitive Deficit:
what OT practice model focus has to do with the effects of impaired cognition on the individuals ability to perform tasks.?
Cognitive Disability Model
OT approaches to anxiety disorders
Cognitive behavioral interventions Development of relaxation skills and activities
OT approaches for mood disorders
Cognitive behavioral interventions Establishment of routines, roles and habits Social and vocational functioning Cognitive skills-judgement and planning
This model focuses on impaired cognition for psychiatric disorders
Cognitive disabilities- Allen mental disorganization can impair performance of task such as getting dressed
The ability to perceive, represent, and organize sensory information for the thinking and problem solving
Cognitive skill
Groups that work well share the following characteristics:
Cohesiveness Shared goals and norms Established functional roles
The OTA Assists in Evaluation
Collects information, administers assessments and interviews, records observations and results, and organizes this information as directed by the OT Contributes to the evaluation under the OT's supervision
Social participation
Community Family Peer, friend
Mesoenvironment
Community OT- solicit supported, transitional employment, develop housing rsources
Outpatient Settings-mental health
Community Mental Health Centers Community Rehabilitation Programs Partial Hospitalization Day Hospitals Day Programs
The diagnosis of two or more psychiatric disorders in the same person
Comorbidity
desire to influence one's environment in a meaningful way, seeking feedback and practicing to make improvements. Individual will practice over and over again It is a second level of motivation
Competency
What are my options for conflicts of ethics ?
Conflicts of conscience = conflicts between personal and professional duties in which the ethical course of action is not clear Ethicists suggest estimating the consequences of a given option weighed against the consequences of other options. Ethically preferable course of action = action that carries the greatest probability of a good outcome (benefits) and the least amount of damage (burdens)
Diversity
Conformity An individual or cultural group forsakes values, beliefs, and customs to eliminate differences with another culture. Examples: Americanizing first or last names, speaking only English, abandoning religious practices or social rituals, not wearing a particular ethnic dress Bias: "a personal and sometimes unreasoned judgment" Prejudice: "an irrational attitude of hostility directed against an individual, a group, a race, or their supposed characteristics" Discrimination: "prejudiced or prejudicial outlook, action, or treatment" Definitions are from Merriam-Webster's Online Dictionary at http://www.merriam-webster.com/
Characteristics of leader behavior include:
Consistency Autonomy Nurturing Interpersonal Learning
Types of Documentation
Contact, Treatment, or Visit Note Initial Note Assessment Report Intervention Plan Progress Report SOAP Note (subjective-objective assessment plan) Discontinuation or Discharge Report Special Reports
The ability to express feelings within a group and to be aware of and respond to the feelings of others
Cooperative level
Medicare Part A
Covers "inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities" (not custodial or long-term care) Also covers hospice care and some home health care Beneficiaries must meet certain conditions
Lesiure Activities
Crafts Hobbies Art Gardening and horticulture Games Sports and exercise connections to the natural world
Common leisure activities include:
Crafts Hobbies The Arts Gardening and Horticulture Connecting to the Natural World Games Sports and Exercise
Executive function
Crucial in setting and managing doctor appointments, anticipating medication refills, anticipating and identifying hazards, and problem solving
Fluid abilities
Crucial when faced with new situations (e.g., those encountered when learning novel ways of doing routine activities, managing new medical and dietary regimes, or applying safety precautions)
Culture Is Learned?
Culture is learned or acquired through socialization. Not genetic Environment is central to culture. Shared with others Cultural beliefs can change over time. Culture can be subconscious. Essentially, every belief and value that humans acquire as members of a society can be included in their culture, thus explaining the broadness of the concept of culture.
Different communication styles -culture
Cultures differ in the amount of information communicated. Cultures differ in verbal and nonverbal language. High-context cultures have understanding through shared experiences and history. Low-context cultures focus on precise, direct, and logical verbal communication. Depending on which context culture you are from and which the client or family is from, communication needs to be adjusted so that understanding occurs.
Risk Factors for Suicide
Current Axis/major mental disorders Past suicide attempts More lethal the attempt the greater the risk Less likely the rescue the greater the risk Comorbid axis II disorder Family history of suicide Adverse childhood experiences Unemployment Poor physical health Alcoholism or drug abuse Cigarette smoking Sudden life changes Living alone Gender, race, age- older white men, adolescent males Psychosocial problems
mini-parent, is super responsible and fills in for preoccupied parent
Custodian
Alternating moods between mild high and mild low
Cyclothymic
The Occupational Therapy Code of Ethics and Ethics Standards (2010) define the set of principles that apply to occupational therapy personnel at all levels:
DEFINITIONS • Recipient of service: Individuals or groups receiving occupational therapy. • Student: A person who is enrolled in an accredited occupational therapy education program. • Research participant: A prospective participant or one who has agreed to participate in an approved research project. • Employee: A person who is hired by a business (facility or organization) to provide occupational therapy services. • Colleague: A person who provides services in the same or different business (facility or organization) to which a professional relationship exists or may exist. • Public: The community of people at large
Do's & Don'ts of OT promotion
DO prepare an "elevator" definition (brief, less than 20 seconds), considering your audience DO prepare an "unabridged" definition (2 min. max)that explains the purpose and role of OT. Avoid describing only one population or area of practice. DO use words and phrases that your audience will understand.
Do's & Don'ts of OT promotion
DON'T be too narrow in focus when describing OT DON'T describe OT by relating how it is different from other profession. DON'T use too much technical jargon (examples??) DON'T be too wordy - make your point!
Checklists for Patient Mastery of Symptoms
Daily maintenance list of routines and activities List of personal triggers List of personal early warning signs along with appropriate responses List of ways to recognize when symptoms worsen, as well as strategies to respond to this A crisis plan or advance directive
Approaches Anger-Activities
Dance, sanding wood, anger management
Avoid condescending references:
Dear, darling, sweetie, grandma, honey, and so on Call the person by Mr., Mrs., and so on until the person gives you permission to use his or her first name. Be respectful.
Latino
Decision and behaviors are based on pleasing the family father or oldest direct male may make the decision in the family may be passive when ill- OT needs to educate on taking active role avoid euphemisms may be hesitant to ask questions modesty is valued spiritual and religious influences play a major role in lives reluctant to seek mental health services depression usually presents with somatic symptoms like headaches
Changes in the integumentary System
Decrease in number of hair follicles Decrease in the production of melanin Loss of collagen, elastin, proteins Thinning of epidermis A thinning epidermis combined with fragile capillaries and loss of fatty tissue increases the risk of bruising in older adults.
Difficulties in marketing/promoting OT
Defining occupational therapy Explaining the benefit of OT in a variety of settings while also maintaining our uniqueness Understanding the value of our services Attributing clinical decisions to "common sense." OT Practice, April 23, 2012 Solomon & Jacobs (2003), Management Skills for the OTA "Advocacy begins with the person in your mirror." (OT Practice, April 23, 2012) Effective marketing for OT, especially in emerging or non-traditional practice settings, is explaining OT in a way that emphasizes how OT fits into that specific setting.
Secondary Prevention
Definition: "Identification and treatment of persons with early, minimally symptomatic disease to improve outcomes and maintain health" (p. 57).
Tertiary Prevention
Definition: Prevention of the progression of existing conditions Relates to the functional assessment and rehabilitation both to reverse and prevent the progression of the burden of illness
Individualism
Degree to which a person considers only himself or herself when making a decision
Collectivism
Degree to which a person must abide with the consensus of the collective group
Characterized by reduced alertness and awareness, disorganized thinking, probable physiological cause
Delirium
Cognitive Disorders
Delirium Dementia Dementia of Alzheimer Vascular dementia Substance related disorder
Beliefs that are contray to reality
Delusions
Name the three parts of a neuron
Dendrite, cell body, axon
Intense sadness, despair and hopelessness
Depression
Mood is low spirited with loss of activities that were previous pleasurable
Depression
____ The most common psychiatric diagnosis in th eelderly population
Depression
Consequences of Using Restraints-Psychosocial
Depression, withdrawal, anxiety, fear, panic, and so on Less social contact, humiliation, decreases in dignity and self-esteem
OTAs can make the most of the space they have by doing the following:
Designate an area for all large-group activities. Choose small-group areas that will accommodate both the number of participants and the space needed to complete the activity. Set aside an area for private conversations. Keep computer areas free of clutter. Keep messy activities to one area that is easy to clean. Make all client-accessible areas clean, inviting, comfortable, and appropriate for the activity at hand.
Crisis Intervention
Designed for short-term, immediate assistance Focus is on nuclear, skills, coping, and symbolic tasks
Model of Human Occupation
Designed for use with any individual experiencing difficulties in performing occupation. Explains for the way occupation is motivated, organized, and performed. Input Throughput Output (behavior) Model emphasizes the importance of the external environment to the performance of expected behaviors. The internal environment consists of subsystems. See Figure 7-2 and 7-3.
Three types dependence occur in the therapeutic relationship:
Detrimental: Excessive dependence on the therapist. Patient is capable of doing more, but is overreliant on therapist to overcome challenges. Constructive: Dependent on therapist only for things the patient truly cannot manage. Self: Synonymous with independence. Can become problematic if patients overestimate their abilities to be self-reliant.
Aims to engage the caregiver in carrying out treatment ; this may include giving instruction or advice
Directing
Approaches for hallucinations- self
Discuss external reality calmly and rhythmically Identify and define confusing external stimuli
Successful aging
Disease prevention, health maintenance, and health promotion
Social Theories of Aging
Disengagement theory Activity theory Continuity theory Lifespan or life course theory Erickson's theory of human development Peck's stages of psychological development Exchange theory Thriving: a holistic lifespan theory
Traditional one-on-one supervision is becoming less common. You may encounter these models of supervision in your workplace:
Distance supervision Group supervision Collaborative supervision
Mnemonic for Brachial Plexus nerves
Do Ants Move Mud Under Raw Leafy Spinach? Let Me See This.
Inappropriate Approaches Sexual
Do not allow patients to entertain the idea of a sexual relationship with you or any staff member.
Inappropriate approaches -Anger
Do not directly face hostile patients. Do not allow patient to come between you and an exit.
Approaches to sexual relationships
Do not enter into a sexual or emotional relationship with a patient. Remind patients that a sexual relationship is inappropriate. T
What's your elevator speech?
Doctor High school student General education student - college level Healthcare student - college level General public Patient/client
Documentation and Communication
Documentation can take two forms: 1.Written record 2.Oral report Study oral and written reports of experienced colleagues to learn what is expected of the OTA at your facility of employment. Practice public speaking if you are nervous about presenting information orally.
Documentation of OT Services
Documentation is classified as follows: Evaluation report Intervention plan Contact, treatment, or visit note Progress report Reevaluation report Transition plan Discontinuation report
Assessment-Restraint Reduction
Documented need for an intervention should be completed first. Assess posture, alignment, balance, strength, and visual acuity. Examine head control, trunk stability, upper extremity support, and ability to self-propel if in a wheelchair. Perform a cognitive assessment.
Inappropriate Approaches Attention Deficit:
Don't force a client to continue working on a task that is beyond his/her ability. Redirect client to another simpler task instead.
Nerves of the brachial plexus and their roots are:
Dorsal Scapular C5 Axillary nerve C5-C6 Musculocutaneous nerve C5-C7 Median Nerve C5-C7 Ulnar Nerve C8-T1 Radial Nerve C5-C8 Long Thoracic nerve C5-C7 Suprascapular nerve C5-C6 Lateral Pectoral nerve C5-C7 Medial Pectoral nerve C8-T1 Subscapular nerve (upper & lower) C5& C6 Thoracodorsal nerve C6-C8
Nerves and roots of the Brachial Plexus
Dorsal scapular nerve C5 Axillary nerve C5-C6 Musculocutaneous nerve C5-C7 Median nerve C6-T1 Ulnar nerve C8-T1 Radial nerve C5-C8
Mental Health Factors Throughout Life-Early adulthood
Driven to achieve in the workplace and find a mate. Internal and external stressors can result in: anxiety disorders, depression, violence, and substance abuse. OT approaches include: Goal identification Development of skills needed to succeed in ADLs Completing education Obtaining and maintaining employment Developing coping skills for life stress
Maintaining Independence in Community Mobility
Driving is an important factor in elders' independence and mental health. By 2030, 20% of drivers will be 65 years old or older. Elders account for a large number of traffic fatalities. In the past decade, highway traffic fatalities increased by 33% in the elderly population. Causes: Age-related vision, mobility changes; medications, decreased reaction time, and decreased decision-making skills
The ability to participate in a variety of relationships involving one other person
Dyadic interaction skill
A method for analyzing the activity during the client performance of the activity providing observation and therapist relection
Dynamic performance analysis
A low mood, a milder form of depression
Dysthymic disorder
Pro of Electronic medical records
EMRs minimize errors The use of EMRs supposedly reduces errors in medical records. There is no doubt that handwritten records are subject to lots of human errors due to misspelling, illegibility, and differing terminologies. With the use of EMRs standardization of patient health records may eventually become acheivable. EMRs keep records safe Paper records can be easily lost. We have heard how fires, floods and other natural catastrophes destroy physical records of many years, data which are lost forever. Digital records can be stored virtually forever and can be kept long after the physical records are gone. EMRs also help keep records of health information that patients tend to forget with time, i.e. inoculations, previous illnesses and medications. Online services such as the Cleveland Clinic's MyChart and HealthVault can help patients in record keeping. EMRs make health care cost-efficient EMRs consolidate all data in one place. Previously, paper-based records are located in different places and getting access to all of them takes a lot of time and money. Think of the amount of time and money spent on phone calls, emails, and faxes to get access to records from other places. In some cases, medical tests that have already been done are repeated all over again, incurring unnecessary costs to the patients and the health care system. In 2009, the first city-wide electronic health information exchange in the U.S. was implemented in Indianapolis. The Indiana Network for Patient Care was developed from the Regenstrief Medical Record System which is a database of 9.6 million patients. The system is expected to improve health and lower costs.1 EMRs facilitate coordination between health professionals The coordination between primary care providers and the hospital care of patients has always been problematic. In a systematic review, Kripalani et al. evaluated the communication transfer between primary care physicians and hospital-based physicians and found significant deficits in medical information exchange. They reported that discharge reports from hospitals frequently do not get to the general practitioners in time, resulting in decreased quality of care after hospitalization. Furthermore, the reports tended to be inaccurate and incomplete, often lacking relevant data about tests and new medications. The review recommended the use of EMRs to resolve these issues and facilitate the continuity of care before, during and after hospitalization.2 The Cleveland Clinic has been always been on the leading edge in health information technology and was one of the very first to offer secure online services. The DrConnect service provide primary care clinicians "real-time electronic medical record information about the treatment their patients receive at Cleveland Clinic".3 EMRs translate into better treatment for patients Efficiency and speed of diagnosis translates into better health care service for patients. Similar to the previously discussed point, correct and timely information can significantly increase the quality of health care service rendered to patients. EMRs can save lives In many cases, EMRs may save peoples' lives. Researchers at the Regenstrief Institute in Indiana have been working on EMRs for years which can be used in disease surveillance during epidemics and bioterrorism. And although controversial, implantable chips that store your medical records are on the way. The U.S. FDA recently gave approval to VeriChip corporation, now Positive ID to market an implantable RFID microchip for use in both humans and pets. EMRs give patients control over their health records Based on the principle that since it's the patient's medical record, the patient should control it, decide what should be in it, and who gets access to it there are currently many online EMRs available including Microsoft's HealthVault. Several prestigious medical institutions including the Cleveland clinic have synced up with HealthVault.5
Cons to EHR
EMRs threaten our privacy In this day and age when people's mantra is "I need my privacy", not many people are comfortable about having their entire medical history recorded and digitized for almost just anybody to see - in other words, incursion into people's privacy. The confidentiality of doctor - patient relationship is still sacrosanct. In addition, there is criticism over whether online EMRs satisfy the requirements of the Health Insurance Portability and Accountability Act of 1996 for the privacy of patients' health records. Besides, medical data can be used against a person in some cases - be it for a job application, insurance coverage or a college scholarship. Although it is against the law to discriminate against people with illnesses and disabilities, it is a fact of life that the fitter you are, the more competitive you are in the job market. The planned incorporation of genetic data in EMRs further adds to people's fear of incursion into their private sphere.8 EMRs can lead to loss of human touch in health care In the process of digitalization, the interpersonal aspect in health care may be lost. In handwritten hospital charts, doctors and other health care practitioners may write what they think and they feel based on their personal observations in their very own words. EMR is simply about ticking off boxes and crossing out things in electronic forms. The doctors are forced to think in categories and can seldom express a personal opinion on an individual case. Because of the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported.9 EMRs are not that efficient Yet, despite efforts in digitalization and standardization, EMRs are actually far from being standardized and not as efficient as it is purported to be. It often happens that one clinic's EMR system is not compatible with that of a general practitioner or another clinic's system, thus belying the claim of added efficiency. In addition, not all users of EMRs are satisfied with the current state of the art. Although the objective is mainly efficiency and healthcare quality, one study showed that nurses in the Netherlands are not completely satisfied with their EMR implemented in 2006-2007. Furthermore, there was no marked improvement in time efficiency.10 EMRs are not safe and secure Very few people are confident about the data protection and security of electronic data such as those stored in EMRs. Many people are not convinced that their data are safe from those who would want to misuse it. There are cases wherein passwords and encryptions do not seem to be adequate as data protection tools. Stories of data hacking, stolen identities and blackmail abound. Even high security databases such as those run by banks and credit institutions are often compromised. This impression was aggravated by the many well-publicized incidences of data loss or breach. A few examples are listed below: -November 26, 2007, Canada. Hackers accessed medical information on HIV and hepatitis from a Canadian health agency computer. -September 22, 2008, UK. The National Health Service (NHS) reported the loss of 4 CDs in the mail containing information on 17,990 employees. -September 30, 2008, U.S. The company Blue Cross and Blue Shield of Louisiana confirmed breach of personal data, including Social Security numbers, phone numbers and addresses of about 1,700 brokers. The data was accidentally attached to a general email. HealthVault is quick in assuring patients of the safety of their online health accounts. Access to the patient's account is only possible using log ins and password. In addition, HealthVault assures that "all health information transmitted between HealthVault servers and program providers' systems is encrypted" and that Microsoft does it best to use the "highest standards of security to safeguard consumer health information from theft, loss, or damage." Implantable EMRs are not for humans It is to be expected that although many of us are amenable to the use of RFID chips in pets, the idea of implanting similar chips in human beings is bound to raise hackles in humans. No matter what the U.S. FDA says. As expected, the introduction of VeriChip, as previously described, has been met with strong opposition. A big opponent of the VeriChip and similar chips of its kind is the consumer advocacy group Spychip.com. In a position paper, Spychip and many advocacy and consumer awareness groups see RFID tagging (be it on your person or on the items you buy) as a major threat to privacy and civil liberties. They see the tagging as some kind of "Big Brother" operation. Another group, the No VeriChip Inside Movement, likens VeriChip as "cataloguing" humans similar to the way the Nazis have tattooed numbers on the skin of concentration camp detainees. And popular Hollywood films on privacy incursions (e.g. The Net, Public Enemy No. 1) have added to people's paranoia about personal data. As expected due primarily to 'privacy concerns' the ID chip has never taken off.11
Overview of Cultural Diversity
Each client has his or her own culture with his or her own blend of values and beliefs. Clients are unique in race, gender, age, ethnicity, physical ability, and sexual orientation. Their families, place of birth, religion, levels of education, and work experiences are also diverse. COTAs contribute to the creation of a therapeutic environment where diversity and differences are valued and where elders can work to reach their diverse goals.
How COTAs Influence Health Promotion in Elders
Educate elders who can benefit from assistance in making positive choices to improve the quality of their lives. Influence their clients' considerations of healthy lifestyles and assist them in improving the quality of their lives. Encourage elders to explore health-promoting activities and provide them with education. Motivate elders to take actions that promote health and limit potential for occupational deprivation, alienation, or imbalance.
Pulmonary changes associated with aging:
Effective gas exchange is compromised by a decrease in lung volume. Loss of elasticity occurs in the lungs and in the medium and small airways. Neuromuscular and musculoskeletal changes increase the effort required to breathe. General efficiency of the pulmonary system is reduced.
Awareness of the groups goal and norms and willingness to abide by them
Egocentric cooperative level
Terminology for older adults
Elders Older adults Elder population Aged
Pedestrian Safety
Elders account for approximately 17% of all pedestrian fatalities. Wheelchairs, walkers, and scooters require more time for crosswalks and may overturn when going down ramps. A mobility expert should evaluate the type of equipment needed by the elder. Safety training on the equipment an elder uses is critical for the COTA.
Continuity theory
Elders adapt to changes by using strategies to maintain continuity in their lives.
Muscles and Joints
Elders experience back pain, making it difficult to sit for long periods of time. Arthritis may cause stiffness in the neck, making turning the head limited or painful. Reaction time is lengthened in elders, making sudden changes in traffic or sudden stops almost impossible. AARP has courses for elder drivers to improve unsafe habits. Behind-the-wheel evaluation is the best method to determine driver safety. Unsafe or questionable drivers should be reported to the DMV in each state.
Fall Statistics
Elders older than 75 years of age fall more frequently than any other age group except infants and toddlers. Accidents are the sixth leading cause of death for those older than 65 years. Leading type of accident in the home One in 40 elders who have fallen will be hospitalized, and only about half will be alive 1 year later.
Other Biologic Treatments
Electroconvulsive Therapy (ECT), sometimes inappropriately referred to as "shock therapy" Electricity applied to temples, causing a convulsion Can relieve severe depression and suicide risk Psychosurgery Therapeutic removal of brain tissue. Can relieve severe seizures, depression, violence Vagus nerve stimulation (VNS) Repetitive transranial magnetic stimulation (rTMS) Magnetic seizure therapy Herbal and alternative therapies Kava root is used to reduce anxiety St. John's Wort is used to treat depression Valerian is used to treat insomnia
Approaches to mania- Environment
Eliminate or reduce distractions ( television, room decor, music)
The ability to understand how the other person feels
Empathy
Therapeutic Qualities
Empathy Sensitivity Respect Warmth Genuineness Self-disclosure Specificity Immediacy
Work
Employment interest and pursuits Employment seeking and acquisition Job performance Retirement preparation and adjustment Volunteer exploration Volunteer participation
Cardiovascular changes associated with aging:
Endocardium becomes fibrotic. Fatty tissue builds up in the heart and surrounding area. Number of pacemaker cells declines. Arterial walls become thicker, more rigid, dilated, elongated, and twisted. Stroke volume, maximum heart rate, and cardiac output decrease.
Aging Factors can determine whether we can:
Engage in valued occupations, including employment Enjoy adequate and safe living conditions Have access to nutritious food Have access to adequate health care
Attention Deficit Approaches- Environment
Environment: Distractions should be removed.
Approaches-sexual- environement
Environment: Should not be overcrowded
Causes of falls
Environmental Biological Cognitive or psychosocial Functional
Causes of Falls
Environmental causes Poorly kept home or yard Poor lighting or glare Uneven stairs, lack of handrails on stairs Uneven and unsafe surfaces (frayed rug edges, slippery floors in showers and tubs, polished floors, cracks in cement) Unstable or low furniture (chairs, beds, toilets) Pets, young children, clutter or electric cords in walkways Inaccessible items Limited space for ADLs
Dominant American culture value system
Equality of all people Informality in interactions with others Emphasis on the future Change Progress Punctuality Materialism Achievement
How OTA's can assist the client in achieving mental health
Establish rapport Create a professional relationship Create a treatment plan Evaluate the interventions Know your scope of practice Know when to refer clients out for additional services
Which laws and institutional rules apply?
Ethical action = making morally good choices Legal action = right and wrong as a principle of justice Ethics can be said to hold practitioners to a higher standard than the law. Laws and institutional rules both help clarify the role of COTAs in a given ethics problem.
Support: With whom do I need to talk for ethical conflicts?
Ethical commitments are shaped by social influences; outcomes of ethical decisions also have social effects. Before acting according to moral convictions, COTAs should solicit the support of others who will be affected by the issue. Involved parties generally include: The client, the client's family, other staff members, and possibly the organization's ethics committee
What kind of ethical problem is it?
Ethical dilemma = a situation in which there are two or more ethically correct options for action Ethical distress = a situation in which the COTA knows which course of action to take but feels constrained to not carry it out Distributive justice = a situation in which there is not enough of something that is valued
_______ of outcome is important in psychoeducation
Evaluation
is the planned process of collecting, interpreting, and documenting information needed to plan intervention.
Evaluation
OT process consists of three dynamic and interactive phases:
Evaluation Intervention Outcome
What is the frontal lobe of the brain responsible for?
Executive functions
Keeping Elders Active
Exercise programs Research supports the need for some form of exercise for all individuals. Can help reduce falls by increasing endurance, improving balance, and improving confidence. Muscle strength decreases 15% per decade after age 50 years and 30% per decade after age 70 years. Resistance training can result in 25% to 100% strength gains in older people.
Factors contributing to successful aging:
Experiencing a sense of control over one's life Practicing healthy habits Achieving continuity with one's past Performing happy activities Participating in a social network of family and friends Exercising regularly Engaging one's mind in complex cognitive activities Stopping smoking, maintaining a healthy diet, and consuming fewer calories Taking aspirin and antioxidant vitamins
desire to act or explore purely for pleasure. Primary motivation for infants and children, also a motivation for adults. Adults do this when encounter new situations
Exploration
Antigroup ( Egocentric) roles- Self-confessor
Express personal problems, political ideology, or other concerns to captive audience
Group maintenance roles-Standard Setter
Expresses norms or standards for the group
Name the extrinsic muscles of the forearm and wrist.
Extensor Carpi Ulnaris Extensor Carpi Radialis Brevis Extensor Carpi Radialis Longus
Name the intrinsic muscles of the hand
Extensor Digitum Extensor Digiti Minimi Extensor Indicis Extensor Pollicis Longus Extensor Pollicis Brevis Adductor Pollicis Longus
The extensor muscles of the forearm are also known as...
Extrinsic muscles
Explain and demonstrate the importance of clinical estimates of ROM
Eyeballing a ROM gives us a rough idea of what type of measurement our goniometer should read, but is not encouraged for us to use at this stage of the game without more experience.
T/F Research has not confirmed play is need for later development in children
False- Research confirms that play is essential for later development
Sensory integration can be used for all schizophrenia diagnosises
False- can not be use for paranoid because of the increase hallunciations
T/F Psychoeducation is a occupational therapy practice model
False- strictly speaking it is not an OT practice model
_____ should be given throughout the learning process and should be immediate, specific, positive, concrete and directive
Feedback
The two LE nerves innervated by the lumbar plexus are:
Femoral nerve Obturator nerve
Associative styles:
Filter new data through a screen of personal experience—only in terms of past experiences
What is the expected end-feel of the GH joint?
Firm
Approaches- sexual-Self
Firmly inform client that his/her behavior is inappropriate. Halt activities if the behavior continues
What are movements of the elbow and forearm?
Flexion, Extension Pronation, Supination
Motions of the GH joint
Flexion/Extension Abduction/Adduction Horiz. AB Horiz AD IR/ER
Hip muscle groups and locations are:
Flexors: anterior side of hip Extensors: posterior side of hip Adductors: located medially Abductors: located laterally
Essential Content for OT Notes
Focus on Patient Goals Focus on Functional Goals Focus on Deficits and Solutions for Problems in Occupational Performance Document Cognitive Deficits Highlight Needs need for assistance need for supervision need for external structure
Task Role- Orienter
Focuses on group goals - keeps discusssion from wandering
Must fieldwork contracts be updated to include a HIPAA statement?
For any site that is required to meet HIPAA guidelines, the contract should be updated to reflect any changes in responsibility by the school or the site. This is true with any fieldwork contractual agreement - the contract should reflect shared responsibilities as well as individual responsibilities of the school and the fieldwork site. The school or fieldwork site can choose to initiate these changes per contract guidelines.
Education
Formal Educational participation Informal personal educational needs or interest exploration Informal personal education participation
Occupational Therapy Practice Framework Purpose
Framework is intended to help OTRs and COTAs analyze their current practice and consider new applications in emerging areas. Developed to help the external healthcare professionals (e.g., physicians, payors, community) understand the profession's emphasis on function and participation in social life.
What axis goes with the sagittal plane?
Frontal which separates the body into anterior and posterior halves
What are the four lobes of the brain?
Frontal, Parietal, Temporal, Occipital
Goniometry alignment for Shoulder complex Flexion.
Fulcrum: over lateral aspect of greater tubercle Proximal Arm: parallel to the midaxillary line of thorax Distal Arm: lateral midline of humerus with lateral epicondyle and olecranon as references
Anxiety Disorders
GAD OCD PTSD
Axis III
General medical disorders
Causes of depression
Genetics Brain Chemistry Hormonal changes Drug and/or Alcohol abuse
Attention Deficits Approaches- Self
Gently but firmly get client's attention. Make client feel competent in completing simple tasks
The ability to be oneself openly
Genuineness
Group maintenance roles-Compromiser
Gives in to a dispute and changes his or her position to preserve group harmony
What is the importance of recording starting and ending points with goniometry?
Gives therapist a base line to know if joint ROM is normal or not. Allows therapist to see improvement as therapy progress
Immediacy:
Giving feedback immediately.
Axis V
Global assessment functioning
Health promotion programs
Goal is for elders to prevent the progression of disease and decrease risks of disability and death. Health promotion should help maintain functional independence and autonomy.
Wellness Program for Elders
Goals Enhance awareness of the positive effect of wellness on health at any age. Promote awareness of the sensory changes that occur as aging progresses. Improve knowledge of food consumption and effects on health. Improve decision-making skills. Encourage self-responsibility for health. Maximize a positive focus. Heighten awareness of behaviors that inhibit health and perpetuate disease. Encourage independence in self-care.
Writing an Intervention Goal
Goals should: describe clearly what the person will do. be written with client participation (if possible) follow logically from identified problems. be evaluated using the RUMBA criteria:
Gradation of Activity
Goals that are currently unreachable can be attained through small steps forward over time Increase attention span Make decisions Solve problems Develop greater self awareness Increase interpersonal skills Develop independence and self-direction
Group maintenance roles-Follower
Goes along with general mood and decisions of the group
What Can Be Marketed?
Goods Services Experiences Events Persons Places Properties Organizations Information Ideas
The process of advancing step by step, the course of gradual progress
Gradation
"the process of advancing step by step; the course of gradual progress" (OED)
Gradation:
Nontraditional roles for elders
Grandparents in the parenting role Across all socioeconomic and ethnic groups Grandmothers raising grandchildren are more likely to be living in poverty. Causes: drug and alcohol abuse, teen pregnancy, divorce Increasing numbers of elderly in the workforce Increasing use of computer technology Challenges include low vision, arthritis in hands and joints, and expense.
Tasks to Assess with Expanded Routine Task Inventory (RTI)
Grooming, dressing, bathing Walking, exercising Feeding, toileting Taking medications, use of adaptive equipment Housekeeping and doing laundry Food preparation Spending and managing money Communication such as reading, writing, speaking Following instructions, safety, responding to emergencies
The sense of solidarity the members feel toward each other and the group
Group cohesiveness
The purpose which the group meets
Group goals
The ability to participate successfully in a variety of groups; generally this means being able to act as productive member of the group
Group interaction skill
Purpose of Group Treatment
Group treatment is a planned process for creating changes in individuals by bringing them together for this purpose.
The Oldest of Old: Centenarians (>100 years old)
Growing in numbers worldwide Lifestyle Genes Socioeconomic state 30% have minimal functional limitations
Patterns:
Habits, routines, and roles
Sensory experience that does not correspond to the external reality
Hallucinations
Positive symptoms of schizophrenia
Hallucinations Delusions Loosening of association Grossly disorganized speech and behavior - responds to older type drugs
Universal Precautions-Set of procedures recommended to prevent the spread of infection. These include:
Hand washing Establishment of protective barriers Infection control in common areas Daily disinfection of tables and counters Maintenance of adequate cleaning supplies Availability of gloves, bandages, and first-aid kits
Acts on faith
Has a belief system based on religion or political ideology and uses it to determine "good" or "bad" Screen for faith-based beliefs before planning care
Four key strategies for keeping on top of paperwork are:
Have a filing system. Make sure you are prepared with all the supplies you need. Set aside blocks of time for paperwork. Use the wastebasket.
Psychosocial approaches-Restraint Reduction
Have a written plan of interventions for cognitively impaired elders who may wander. The elder may have an agenda behavior that is repeated and can be expected and planned for. Keys to responding successfully to agenda behavior are to allow elders to act on their plan, find a point at which they will accept a suggestion or guidance, and allow them to keep their dignity.
Consequences of Using Restraints-Physical
Hazards of immobility, incontinence, constipation Loss of balance, falls, pressure ulcers Pneumonia, infection, dehydration, impaired circulation, respiratory problems Abrasions, cuts, loss of freedom Death by suffocation or strangulation
Anxiety disorders can a harm a person's
Health Job performance Relationships with others Ability to handle every day tasks and situations
Key Chronic Diseases: The Facts (from the CDC)
Heart disease and stroke are the first and third leading causes of death, accounting for more than 30% of all U.S. deaths each year. Cancer, the second leading cause of death, claims more than half a million lives each year. .
Furniture-Fall prevention
Height of seats can be increased with firm cushions. Chairs with armrests are helpful. Chairs with wheels should be avoided. Elder's feet should be flat on the floor when seated.
Alternative Transportation
Help the elder navigate the public transportation system if one exists. Call the local senior center. Independent living centers in the community may also have resources for elders. Title II of the Americans with Disabilities Act (ADA) addresses elders with disabilities. Public transportation services are designed to be usable by individuals with disabilities (physical or mental) who need assistance of another to board, ride, or disembark.
Risk factors for Falls
History of falls, neurologic illness Multiple medications Poor eyesight, deconditioning Environmental hazards, poor lighting, loose carpets, no clear walking pathway in the home or room
Clients may feel lonely, but also uncomfortable in social situations. OTAs can provide support and guidance as follows:
Holding social-skills support and practice groups within a mental health setting Hosting parties to provide further opportunities to practice social skills Providing structure and feedback during and after practice sessions
What motions of the shoulder joint are assisted by the Infraspinatus?
Horizontal abduction, External rotation
What actions does the Pectoralis Major assist with?
Horizontal adduction, flexion, internal roation, and adduction
Factors to Consider when selecting an activity
How well does the activity suit the purpose of the OT intervention process? Does the activity need to be modified or structured? Will the activity provide assessment data? How well does the activity fit with the personality of the client? Is it consistent with the client's values and goals? Can the client do the activity at his/her functional level?
Elevated mood, a milder form of mania
Hypomanic disorder
What are the intrinsic muscles of the hand called?
Hypothenar Muscle group
Several key issues regarding services to an aging population:
IOM identified gaps in knowledge of the aging process that potentially compromise the care provided to older persons. The CDC and Healthy People 2020 established goals for the health of the nation and identified health indicators to track progress toward these goals (e.g., improving health and wellness, preventing injuries, reducing disabilities, addressing health disparities).
4,Intervention planning
Identify goals and develop a plan to reach those goals Considerations include time frames, applicable standards, and other guidelines. OT selects specific treatment activities
What are the consequences, if any, if a student violates the policy while on fieldwork?
If a student violates HIPAA guidelines while on fieldwork, the school and fieldwork site should develop an action plan to address the issue. While up to the site and/or school, possible steps to take could range anywhere from a review of HIPAA policy to removal of the student from fieldwork - depending upon the severity of the violation. Schools should work with fieldwork sites so that the action taken with a student violation is similar or no greater than an action that would be taken with an employee.
Chronic Illness
Illness that cannot be cured but that can be managed through medications, diet, exercise, surgery, and technology
Is training required for occupational therapy and occupational therapy assistant students? If so, how can it be accomplished?
In order to meet HIPAA guidelines, individual fieldwork sites will require students to be trained, according to HIPAA standards, to follow privacy and confidentiality guidelines. Sites may meet this objective in several ways. They may send a video to the school and require that student watch the video prior to beginning the fieldwork. They may accept HIPAA training that is covered in the academic coursework, or they may stipulate that all HIPAA training be completed at their facility. It is important to remember that the fieldwork site is responsible for making sure that students meet the HIPAA guidelines as interpreted by their facility, and that there is clear communication between fieldwork site(s) and the school regarding how the school can best help meet those requirements.
The Therapeutic Relationship: Stages and Roles
In therapeutic relationships, giving is a one-way street. Therapist is responsible for developing and maintaining a healthy relationship with the patient.
Needs of the Old Old
Increased risk for disability Cardiovascular disease, vision and hearing deficits Risk for cognitive impairment High cost of health care as they use more health care resources More likely than younger persons to be institutionalized but more likely to be in the community Need support for activities of daily living (ADLs) Family provides care, transportation, food, housing Less formal education
Where is the cerebellum located ?
Inferiorly to the occipital lobe and posterior/dorsal to the brain stem
COTA Responsibility Elders:
Influence change in the quality of lives of elders by implementation of occupation-centered care. Demonstrate leadership in helping individuals plan health-promoting engagement in meaningful occupations as the path to a long and healthy life. Assisting people of all ages to actively participate in taking responsibility for improving the quality of their health. Creating healthy environments through consultation with state, city, and institutional levels of care.
Task Assessment by the COTA
Information is obtained from the client (if possible) and caregivers regarding the client's most familiar tasks. The client is observed performing activities and tasks that are part of his or her daily routines. The OTR and COTA team can compare the performance with the characteristic behavior for each cognitive level. Knowledge of the client's optimal functioning (can also depend on the time of day) helps the team design intervention strategies that maximize the client's abilities.
Focuses on giving, obtaining or clarifying information
Informing
The OT is the Manager of Evaluation
Initiates, manages, guides, and documents the evaluation and has final responsibility for obtaining and interpreting the information needed to plan treatment Decides what information is needed and how to obtain it
Increased sense of hopefulness from seeing that other group members improve
Instillation of hope
Multifactor causes of falls/preventation
Interdisciplinary team should work together Not only ask the elders about their routines and ability to perform ADLs; also observe them doing the activities. Shoes: Wear sturdy, rubber-soled shoes that fit well; slip-on shoes should fit well. Dressing techniques should be taught.
What motion does the subscapularis help the shoulder joint complete?
Internal rotation
What movements of the shoulder joint are assisted by the Teres Major?
Internal rotation, Adduction, horizontal abduction, extension
Broad term meaning- an action undertaken in order to change what is happening or might happen in another affairs
Intervention
Eight Stages in the Intervention Process
Intervention actions can be categorized into eight stages: 1.Referral 2.Screening 3.Evaluation 4.Intervention planning 5.Intervention implementation 6.Intervention review 7.Transition planning OT works with client, family, and others to arrange for successful transition out of the treatment program May include living arrangements, daily transportation, and continuation of other treatments 8.Discontinuation of service The patient is discharged from the program OT handles final documentation with input from the OTA
Steps in Intervention Planning
Intervention planning can be organized into six steps: 1.Review the results of the individual assessment(s) and the evaluation and discuss them with the client. 2.Identify problems and, if possible, their causes. 3.Identify the person's strengths and assess/estimate the person's readiness and motivation for intervention. 4.Collaborate with the client to set goals (long and short term, in order of priority). 5.Identify intervention principles using the practice model. 6.Select methods appropriate to the practice model.
Antigroup ( Egocentric) roles- Playboy
Isn't involved with group- shows disinterest by clowning around
Approaches Anger- Environment
Isolation from other patients may be necessary. Keep sharp objects our of reach
Leisure and recreation serves and important function-
It restores and refreshes their energies to work again
What is the function of the brain stem?
It supports the automatic functions that maintain life (internal organs), serves as a pathway for spinal tract and contains the nuclei for 10 of the 12 cranial nerves
Techniques to promote interaction in a group- Questions
James what do think about what Brenda just said? James do you agree with Brenda? Hmm, i wonder if anyone else has something to share on this topic James you've had a lot to say- time to give someone else a turn
What determines end-feels?
Joint capsule, Ligaments, soft tissue, muscles, skin, joint surfaces,bones
Cognitive
Judging Selecting Sequencing Organizing Prioritizing Creating Multitasking
Functional goals are not simply goals that reflect changes in strength, range of motion or edema. They are goals that are written to specifically address one of the seven performance areas as described in the Occupational Therapy Practice Framework (OTPF). In other words, functional treatment goals (also known as long-term goals) will describe the ability of the client to ultimately engage in the specified performance area
Just to review, the performance areas are: activities of daily living, instrumental activities of daily living, work, play, leisure, education and social participation. Imbedded within these seven areas are the many sub-components, including occupations such as bathing, dressing, attending school, feeding pets, typing, volunteering and meeting friends for lunch.
Accessing your own medical records
Keep It Simple Allowing employees to access their own records whenever they want could result in a string of unintended consequences. The policy allowing access would have to be much more complex than one that simply states employees can't access their records through work at any time, said Kelley Meeusen, RHIT, a former privacy officer who now works as an instructor in the health information technology program at Tacoma Community College in Washington. Partial allowance could also create complexity, as that policy would have to include what parts of the record the employee can see and how often. Trying to enforce something like that could get hectic, according to Kevin Kerestus, vice president in charge of internal audits and information security at Geisinger Health System in Danville, PA. Geisinger has a no-tolerance policy that is pretty black and white, Kerestus said. Don't Run Risks A no-tolerance policy may also protect a facility from violating HIPAA. Employees may not be allowed to access their own information if their PHI has limited or denied access for reasons such as the patient temporarily waived access because they're participating in a research study, or another person or a reference to another person is in the PHI and may cause substantial harm to that person. "Those requirements under the HIPAA rule make it almost mandatory that you have a way to limit access, because if you don't and at some point need to restrict access, you don't have procedure to accomplish it," said Jill Burrington-Brown, MS, RHIA, manager of professional practice resources with the American Health Information Management Association (AHIMA). In addition to running the risk of violating HIPAA, an all-access policy may encourage people to see how far they can go with what they're given, Burrington-Brown said. If employees are accessing their own -information, they may be tempted to look up a relative or neighbor's PHI as well. Make It Known HIPAA training is the time for administrators to bring up the policy on employees' access to their own PHI. Reminding employees throughout the year may also be a good idea, Burrington-Brown said. It's important that employees know the rules, so they are less likely to violate them. At Geisinger, as employees get access to the facility's electronic health record system, they are told that the access to record is for business purposes only, and a pop-up screen reminds them that they're not supposed to be looking at their own records or the records of family members. Other facilities implement "break the glass" enforcement techniques where an employee trying to gain access to his/her own record faces a few unique screens cautioning them about accessing that particular record. The employee would have to click through the screens, or "break the glass," to gain access. Whatever technique is used to inform employees about the policy, sanctions for breaking that policy should be well outlined. At Geisinger, sanctions include anything from a written warning to termination. Provide Alternatives To keep employees on the straight and narrow, they should know the acceptable ways to access their own health information. Most employees who are also patients would have to go through the same process as any other patient. Geisinger patients, including employee-patients, can use MyGeisinger, a patient portal. The portal allows people to go in and get snapshots of their medical records, Kerestus said, although not the full record. This gives an employee-patient an alternative to peeking at his own PHI. "We believe we've given folks enough options to get to that information that they don't need to use their normal security profile to get there," he said
The clinical environment is only as safe as you make it. Procedures for maintaining a safe environment include:
Keeping track of your keys Making sure restricted items are not taken to wards Having everything ready before patients arrive Using shatterproof mirrors Using good judgment about who attends therapy Organizing tools to permit quick, accurate counts of potentially dangerous items Alerting consumers to potential dangers Following safety precautions for toxins Knowing and using proper safety equipment Observing the local fire code Paying attention to the condition of the floor Eliminating electrical hazards Observing food/fire safety guidelines in the kitchen Applying and teaching positioning techniques Providing increased structure when necessary
Group maintenance roles-Gatekeeper
Keeps communication going- this means asking others to speak or suggest ways everyone can get a chance to talk
OTAs are effective in educating consumers on the following:
Knowledge of household safety hazards Application of basic first aid Hand-washing, disinfecting cuts, applying bandages Dialing 9-1-1 in the event of an emergency Obtaining emergency medical care
The Lumbar nerve (L1-L5) innervates what area of the body?
LE
OT treatment of persons with dementia
Labeling drawers
Inpatient Settings-mental health
Large State Hospitals and Other Institutions Behavioral Units Intensive Psychiatric Rehabilitation Services Units Acute Care Inpatient Wards Proprietary Hospitals
Mental Health Factors Throughout Life-Late Adulthood and aging
Late Adulthood and Aging Life stress increases greatly due to illness, loss of social roles (worker, parent, spouse), and money issues. Many older adults experience clinical depression. OT staff can support older patients with these approaches: reality orientation. reminiscence techniques. life-review activities. leisure activities (games and puzzles). physical activities (modified for physical ability).
Where are the Peroneus muscles of the ankle and foot?
Lateral aspect fibula
Macroenvironement
Law and Society OT- assist and support consumers seeking policy changes, lobby legislators for parity and access, teach public about the needs of person with severe and persistent mental illness
Use these strategies to enhance communication with your supervisor:
Leave your anger behind you. Assume that your supervisor is as willing as you are to resolve the problem. Prepare in advance exactly what you are going to say. Be specific and focus on observable facts. Listen actively, try to understand your supervisor's point of view, and be willing to compromise.
Can be a source of personal identity and can provide a continuous thread of meaning over a lifetime
Leisure
In retirement ______ replaces work as the primary occupation
Leisure
is the use of time for activities that are personally satisfying and generally not related to work.
Leisure
Leisure
Leisure exploration Leisure participation
Activity Modification for Ability Level 1
Level 1 Shout 1- or 2-word directions Offer physical contact and direction Require only one action at a time
Activity Modification for Ability Level 2
Level 2 Use verbal directions including names of body parts Demonstrate actions along with verbal directions Require only one action at a time Introduce concept of repetition or variations on a pattern
Activity Modification for Ability Level 3
Level 3 Encourage repetitive activities Identify materials used during activity Remind client of the goal of activity
Activity Modification for Ability Level 4
Level 4 Offer activities that require multiple steps Demonstrate each step separately Use adjectives and adverbs in verbal directions Introduce simple tools such as scissors and hammers
Activity Modification for Ability Level 5
Level 5 Demonstrate activities with up to 3 separate steps Use prepositions and spatial terms in verbal directions Encourage new learning and self-initiation
Activity Modification for Ability Level 6
Level 6 Offer written directions and diagrams rather than verbal steps Provide a wide variety of activities to alleviate boredom Offer all safe and appropriate tools to complete the activity
Lifespan or life course theory
Life course: "an age-graded sequence of socially defined roles and events that are enacted over historical time and place" Influenced by the age of the person and by birth cohort Life course stages are related to specific chronological ages.
Variability of the aging process influenced by:
Lifestyle choices and behaviors over the lifespan Proximal contexts or environments Distal contexts
Variability of the aging process influenced by:
Lifestyle choices and behaviors over the lifespan Proximal contexts or environments Distal contexts Factors can determine whether we can: Engage in valued occupations, including employment Enjoy adequate and safe living conditions Have access to nutritious food Have access to adequate health care
Fall prevention-limit reach
Limited reach Use reachers, extended handles on bath brushes, shoe horns, carts, walker trays or bags, or sock aids. COTAs can determine the best way to attach the reacher to a walker or wheelchair. Rearranging an elder's environment is inexpensive and effective in fall prevention.
What are the roots of the Cervical plexus and what body parts do they support?
Located in the neck root: C1-C4 Diaphragm and respiration
Disuse Syndrome
Loss in the ability to perform ADL functions as a result of a sedentary lifestyle disability Approximately 14.2% of elders living in the community experience difficulty completing one or more ADLs because of health-related problems. Approximately 21.6% of elders report difficulties with instrumental ADLs (IADLs). The need for assistance in ADLs and IADLs increases with age.
MDS relevant to COTAs: tool identifies strengths and deficits for further assessment
MDS are also used to determine Medicare payment for eligible residents. Even if no intervention has taken place, data collection and resident interview may help COTAs give the necessary information to others on the interdisciplinary team.
what Model of Practice is used when interventions consist of: all areas of OT practice ones natural environment, individuals interest and beliefs, modified environment to increase occupational performance
MOHO
which model states, humans have innate desire to interact with their environment, and to be able to master it?
MOHO model of human occupations
One or more major depressive episodes lasting two weeks or more
Major depressive disorder
How prepare for the interview
Make the client comfortable Begin the interview Obtain and remember information End the interview
OTAs might delegate the following tasks:
Making phone calls to get information Collating, filing, and organizing non-confidential papers Sorting and organizing supplies and materials Following up on details of tasks that have already been laid out Researching and gathering information Locating community resources
Excessive happiness, generosity, irritability, distractibility and increased activity level
Mania
Mood that is elevated
Mania
Mood Disorders
Mania depression bipolar
Bipolar Disorders involves the presence of
Manic, Mixed or Hypomanic Episodes usually accompanied by the presence or history of Major Depressive Episodes
Myth #5: Elders become more conservative as they age.
Many elders are receptive to new ideas and accept fresh roles. Adults learn continuously from their life experiences and may pursue new interests and goals. Their habits and preferences contribute to consistency in personality, but personality may be influenced as individuals deal with crisis points in each phase of life.
The most widely available illegal drug in the US
Marijuana
What is marketing?
Marketing is a process that involves developing and promoting a product or service that meets the specific needs of an identified consumer or consumer group. Palmer & Stull (1991), Principles of Marketing Pride & Ferrell (1997), Marketing Concepts and Strategies
What is Marketing?
Marketing is the activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large. American Marketing Association (2007), www.ama.org
Marketing vs. Promotion
Marketing is the process of communicating the value of a product or service to customers. Promotion is a component of marketing, which involves spreading the word about and igniting interest in your product or service.
Is marketing important for the field of OT?
Marketing may be viewed in terms of promoting occupational therapy in the larger scheme of health care and the community.
The ability to take on a variety of group roles, both task and group maintence
Mature level
Approaches-Cognitive Deficits-environment
Maximize safety, cue desired behavior, and avoid cues that trigger undesirable behavior
mnemonic for nerves of the shoulder girdle
May Lisa Always Dream Median Pectoral Nerve, Long Thoracic nerve, Accessory nerve, Dorsal Scapular nerve
Mnemonic for nerves of the shoulder girdle:
May Lisa Always Dream, Median Pectoral, Long Thoracic, Accessory, Dorsal Scapula
Approaches to hallucinations- activities
May be challenging as suited to intellctual
Delusions approaches-Activities:
May be challenging as suited to intellectual level
Assessment and Measurement
Measurements should be standardized, so that accuracy and consistency can be maintained Normative scores, based on extensive testing on a wide variety of individuals, ensures that scores provide clear insights into diagnosis Criterion-referenced assessments measure against an objective standard, such as ability to complete simple arithmetic problems A reliable test shows the same score if it is repeated with the same subject. A valid test actually measures what it says it is measuring
Nerves and muscles of the shoulder girdle and root
Median Pectoral nerve - Pectoralis Minor Long Thoracic nerve - Serratus Anterior Accessory nerve - Upper Trapezius, Middle Trapezius, Lower Trapezius Dorsal scapular nerve - Levator Scapula, Rhomboid Major, Rhomboid Minor
Geriatrics
Medical interventions with the elderly; clinical specialty
Compliance rules for nursing facility reimbursement through
Medicare or Medicaid established through OBRA (health care law) Act of Congress effected October 1990; final rules were published in 1995
Considerations when Planning an Activity Group
Members Needs and Skill Level Rules and Resources Focus and Goals t
Shared goals and norms:
Members feel that their needs as well as the needs of others can be met through group treatment
The point in the life cycle when an individual realizes that the time is limited and that he or she cannot accomplish everything hoped and planned for
Menks defines midlife
Mental Health Factors Throughout Life-Infancy and Early childhood
Mental health disorders rarely diagnosed in infancy. If problems are discovered, they are quite severe: ADD/ADHD, PDD, ODD OT approaches focus on sensory integrative techniques. Structured play experiences build routines and trust. Very demanding and complex area of practice; OTAs generally require additional training beyond basic skills.
Family Therapy
Mental illness intensely connected to family relationships Treatment approaches must involve family members Model is not in wide use, but some aspects may be considered in the context of other approaches
Axis II- intellectual functioning that is significantly below average as measured by IQ
Mental retardation
Disorders that first appear in infancy, childhood or adolescene
Mental retardation Learning Disorders motor skills disorder communication disorders Asperger ADD or ADHD Disruptive behavior
Mental Health Factors Throughout Life-Middle Childhood
Middle Childhood During school years, children develop concepts of social norms and learn to delay gratification. Mental health problems are infrequent but may include: Conduct disorders, ODD, ADHD, OCD, drugs/alcohol OT staff works with other professionals to aid the child. Approaches involve helping child define and understand his/her role in society (student, sibling, friend). Skills such as self-control, stress management, and progressive relaxation can be taught.
The is the time when the role of student and contributing family member is gradually adopted
Middle childhood
_______ practices provide another route to self-awareness and self-control
Mindful
An assessment tool was needed;
Minimum Data Set (MDS) created.
Approaches-Cognitive Deficits-self
Modify discussions to match patient's cognitive level and ability. Remind patients frequently of who you are.
Evaluation:
Monitoring job-related competence Determining is supervisee is ready for more challenges
Different use of time, monochronic and polychronic
Monochronic: "One thing at a time" Adherence to schedules is important May be offended if kept waiting Polychronic: Organize their lives around social relationships May be late to appointments Enjoy conversation Want to know the COTA personally
Mood Disorders
Mood Disorders Major Depressive D/O Major Depressive Dysthymic Disorder Depressive Disorder NOS
Allen Level Three
More aware of surrounding- particularly objects that can be seen and touched enjoys hand movements that are repeated will participate in activities that have repetitive manual actions fails to comprehend the end product or goal directions can include name of objects used in action- but action must also be demonstrated same action repeated over and over
Reasons for Postponing Retirement (CareerBuilder Survey 2010
More than 7 out of 10 workers over age 60 are putting off retirement due to financial inability (72 percent) Enjoy where they work and don't want to leave it (71 percent) Need for health insurance and additional benefits provided (50 percent) Fear retirement may be boring (24 percent) Enjoy feeling needed (15 percent)
Economic Demographics for Age >65 Years
Most elders are not impoverished. Elder women have greater poverty rates than elder men. Wide economic disparities exist between white elders and minority elders. Many elderly continue to work past age 65 years. Public policy (Social Security) provides retirement income. Increasing health costs are not favorable for the elderly.
The Immigration Experience
Most foreign-born persons living in America adopt some American cultural norm while retaining some from their country of origin. In many countries, the concept of "mental illness" does not exist. OTAs need to modify language to communicate American concepts of mental illness and health. Focus should be on achieving wellness, not labeling.
Allen Level Four
Motivated by desire to make the project rather than the interest in motions involved interested in color and shapes of objects and materials prefers contrasting colors and clear shapes activity has several steps, but each must be demonstrated separately then performed by the person before the next step is demonstrated spoken directions can include adjectives and adverbs that clarify the standards of performance can use simple tools may get fustrated by tools covering/hide part of the project
Performance skills
Motor and praxis Sensory -perceptual Emotional Regulation Cognitive Communication and social
What is the main function of the cerebellum?
Movement. Damage to this part of the brain can cause a person to have fine motor control, equilibrium, posture and motor learning problems
Nerves and muscles of the elbow and forearm
Musculocutaneous nerve - biceps brachii, brachialis Radial nerve - Brachioradialis, Supinator, Triceps Brachii, Anconeous Median nerve - Pronator quadratus, Pronator teres
Mind-brain-body performance
Musculoskeletal, neurologic, cardiopulmonary, symbolic images
Positioning and goni alignment for elbow extension
N/A as we don't usually measure this motion as it is the return to the starting position from the end of the elbow flexion.
Group Protocol Format Elements:
Name Description Structure Behavioral Objectives Referral Criteria MethodologyMethod Role of the Leader Evaluation Exit Criteria Reason for Discontinuation Resources/References
A rare but life-threatening effect of antipsychotic medication- signs include rigidity and catatonia
Neuroleptic malignant syndrome (NMS)
Name the types of cells found in the brain (on a global level)
Neurons, Neuroglia or glial cells
Table 7-3, Characteristics of Maturity Stage of Development
Neurophysiologic and physical development Psychosocial: ego integrity and maturity Psychodynamic Sociocultural Social language development ADLs and developmental tasks Ego-adaptive skills Intellectual development
What is the theory base for Sensory Integration?
Neuroscience
What position do we measure shoulder ADduction in?
None . We don't measure this as it is the return to the zero starting position from full ABduction of the shoulder complex
Primary Aging
Normal gradual changes in organ systems Experienced by everyone Not associated with disease, impairment, or disability
The behavior the leader supports and promotes the growth of the individual members
Nurturing behavior
O and I of Latissimus Dorsi
O: Broad aponeurosis along spine I: Humerus
O and I of Pronator Teres
O: Humerus & Ulna I: radius
O and I of Middle Deltoid
O: acromion process I: humerus
O and I of Levator Scapulae
O: cervical vertebrae I: scapula
O and I of Anterior Deltoid
O: clavicle I: humerus
O and I of Anconeus
O: humerus I: olecranon process and ulna
O and I of Palmaris Longus
O: humerus I: palmer aponeurosis
O and I of Brachioradialis
O: humerus I: radius
O and I of Supinator
O: humerus I: radius
O and I of Brachialis
O: humerus I: ulna
O and I of Subclavius
O: rib I: clavicle
O and I of Pectoralis Major
O: ribs I: humurus
O and I of Pectoralis Minor
O: ribs I: scapula
O and I of Serratus Anterior
O: ribs I: scapula
O and I of Corocobrachialis
O: scapula I: humerus
O and I of Infraspinatus
O: scapula I: humerus
O and I of Posterior Deltoid
O: scapula I: humerus
O and I of Subscapularis
O: scapula I: humerus
O and I of Teres Major
O: scapula I: humerus
O and I of Teres Minor
O: scapula I: humerus
O and I of Triceps Brachii
O: scapula I: humerus
O and I of Supraspinatus
O: scapula I: humurus
O and I of Biceps Brachii
O: scapula I: radius, bicipital aponeurosis
O and I of Rhomboid Minor
O: spinous processes of vertebrae I: scapula
O and I of Rhomboid Major
O: thoracic vertebrae I: scapula
O and I of lower trapezius
O: thoracic vertebrae I: scapula
O and I of Pronator Quadratus
O: ulna I: radius
obsessions and compulsions which are time consuming and distressing to the pt and interfere with functioning
OCD
Prevention and Health Promotion Among Elders
OT practitioners provide health-promoting activities that provide a means of preventing the unhealthy effects of inactivity.
7.Transition planning
OT works with client, family, and others to arrange for successful transition out of the treatment program May include living arrangements, daily transportation, and continuation of other treatments
AOTA provided the blueprint for delivery of OT services through the Occupational Therapy Practice Framework
OTPF outlines the principles and procedures that guide our interventions by delineating the domains and process of occupational therapy practice.
COTA's Role in Determining Activities
OTRs and COTAs must match the activities with the characteristics of the matter, mind, and behavior domains appropriate to the client's cognitive level.
The emphasis is on clarifying the environment by removing distracting objects and drawing attention to the objects the person is expected to use
Object layer
Evaluation
Obtaining the client's occupational profile Analyzing the client's occupational performance
OT approaches adolescents psychotic disorders include:
Occupation-based assessment Collaborative goal-setting Communication and social skills development Special-needs education (gender/sexuality, substance abuse prevention) Organization skills for school and family responsibilities
OT approaches for the elderly include:
Occupation-based assessment Collaborative goal-setting intervention approach Memory-enhancing activities and skills Special-needs education (safety, fall prevention, nutrition) Wellness and reconnection with previously enjoyed leisure activities
__________________________can have a positive effect on the lives of elders in any living environment
Occupational engagement
Occupational form
Occupational situations, including environmental context of the individual's life Physical and sociocultural characteristics
VERACITY
Occupational therapy personnel shall A. Represent the credentials, qualifications, education, experience, training, roles, duties, competence, views, contributions, and findings accurately in all forms of communication about recipients of service, students, employees, research participants, and colleagues. B. Refrain from using or participating in the use of any form of communication that contains false, fraudulent, deceptive, misleading, or unfair statements or claims. 8C. Record and report in an accurate and timely manner, and in accordance with applicable regulations, all information related to professional activities. D. Ensure that documentation for reimbursement purposes is done in accordance with applicable laws, guidelines, and regulations. E. Accept responsibility for any action that reduces the public's trust in occupational therapy. F. Ensure that all marketing and advertising are truthful, accurate, and carefully presented to avoid misleading recipients of service, students, research participants, or the public. G. Describe the type and duration of occupational therapy services accurately in professional contracts, including the duties and responsibilities of all involved parties. H. Be honest, fair, accurate, respectful, and timely in gathering and reporting fact-based information regarding employee job performance and student performance. I. Give credit and recognition when using the work of others in written, oral, or electronic media. J. Not plagiarize the work of others.
Occupational imbalance include
Occurs when a person engages in to much of the same activities
Preventing orthostatic hypotension
Occurs when an elder goes from a lying to a sitting position or a sitting to a standing position. It is a drop in blood pressure enough to cause dizziness or passing out. Prevention Educate elders to sit up slowly and sit for a few minutes before standing. Elders can dress while seated. Physician should be informed about this form of hypotension.
Occupational deprivation
Occurs when factors beyond themselves limit the individual's choice or opportunity
Learned Helplessness
Occurs when people perceive that they have no control over their lives and must depend on others. Elders who experience a loss of control also experience diminishing coping skills and are at risk for illness. What to do: Encourage independence and self-care. Give choices and options as much as possible. Challenge the client to work at a greater level than currently functioning. Relinquish some of the power in the relationship and empower the client to problem solve.
Treating Anxiety
Offer resources for your clients to seek help Ask what anxiety stops the client from doing Ask how you can help Re-assure your clients the process of psychotherapy is a team effort Treatment may include Psychotherapy - keep an anxiety diary Medication Combination of the two
Appropriate Principles and Methods
Once goals are set, the OTA must assist clients in trying to reach them. Attempt to discover reasons behind deficits and any underlying cognitive challenges
Responsibilities of the Supervisor-Established relationship
Once the relationship is established, the supervisor should do the following: Identify and focus on supervisee learning goals Provide timely feedback on progress Perform periodic evaluations of performance Arrange for learning opportunities Provide an atmosphere of security, acceptance, recognition, and enthusiasm Respect the confidences of the supervisee
Well-being
Optimal level of functioning for a person's age and condition
OTAs are generally tasked with stocking and managing supplies and equipment. Some tips:
Order supplies in bulk; this allows you to make orders less often while also saving money. Be aware of lengthy ship times so your replacement orders arrive before you run out of supplies. Develop storage systems for the many tools and materials used in occupational therapy activities. Before an activity, prepare supplies so they are well-organized and can easily be used by clients. Use rolling bins to make supplies portable. Do not repair equipment unless you are qualified to do so.
Attention Deficits Common Diagnoses:
Organic mental disorders, PCP and alcohol abuse, schizophrenia, learning disorders
Common Diagnoses-Cognitive Deficit
Organic mental disorders, physical disease, substance abuse, post ECT therapy Approaches:
_______ should be include and explanation of why the activity is being done, what steps are involved, how long the activity will take, and what is required for successful performance
Orientation
What are the origin, insertion and innervation of the Middle Deltoid of the shoulder joint?
Origin: Acromion process. Insertion: humerous Innervation: Axillary nerve
The origin and insertion of the Brachialis are...
Origin: Distal third of the anterior humerus, Insertion: Ulnar tuberosity of the ulna
What are the origin, insertion and innervation of the Infraspinatus of the shoulder girdle?
Origin: Infraspinatus fossa. Insertion: Posterosuperior greater tubercle. Innervation: suprascapular nerve
What are the points of origin, insertion, and the innervation of the Pectoralis Major in the shoulder joint?
Origin: Lateral border of the body of the manubrium of the sternum and the meidal third of the clavicle. Insertion: Bicipital groove of the humerus Innervation: Pectoral nerve
What are the origin, insertion and innervation of the Latissimus Dorsi?
Origin: Spinous processes of T7-L5, the sacrum, and the medial portion of the ischium. Insertion: Bicipital groove of the humerus. Innervation: Thoracodorsal nerve
What are the origin, insertion, and innervation of the Teres Major of the shoulder joint?
Origin: inferior angle of the scapula. Insertion : Greater tubercle. Innervation: suprascpular nerve
What are the origin, insertion and innervation of the posterior deltoid?
Origin: lateral half of the spinous process of the scapula Insertion: Deltoid tuberosity. Innervation: Axillary nerve
What are the origin, insertion and innervation of the Teres Minor?
Origin: middle third, Insertion: Greater tubercle, Innervation: Suprascapular nerve
What are the origin, Insertion, and innervation of the Subscapularis of the shoulder joint?
Origin: subscapular fossa. Inseretion: Lesser Tubercle of the humerus Innervation: upper and lower subscapular nerve
Free radical theory
Oxidation of lipids, proteins, fats, and carbohydrates Low-level free radical damage occurs over time, resulting in age-associate decline of function in major organs. Environmental contaminants increase free radical damage.
An anxiety disorder that follows an event so stressful that it would upset almost anyone
PTSD
Anxiety disorders include
Panic disorder Phobias OCD PTSD
Anxiety disorders
Panic disorders Phobias OCD PTSD Generalized anxiety
Occupational therapist Anne Mosey established 5 levels of group skill, or the ability to be successful navigating group dynamics.
Parallel Level: Ability to work and play in the presence of others (18 months to 2 years) Project Level: Ability to share a short-term task with one or two other people (2 to 4 years) Egocentric-Cooperative Level: Awareness of group norms and willingness to abide by them (5 to 7 years) Cooperative Level: Ability to express feelings as well as be aware of and respond to others' feelings in a group (9 to 12 years) Mature Level: Ability to take on various group roles, such as task and group maintenance (15 to 18 years)
Thinking predominated by grandiose and persecutory ideas
Paranoia
Personality Disorders
Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive compulsivve
Common Diagnoses for paranoia:
Paranoid schizophrenia, psychotic depression, and paranoid personality disorder
Special Transportation Services
Paratransit services: Elders usually must be able to independently leave their home or have someone help them leave the home and enter the paratransit vehicle. COTAs help elders navigate this paratransit system to secure transportation to appointments and so on.
Ethnicity
Part of a person's identity that is derived from membership in a racial, religious, national, or linguistic group Ethnocentricity The belief held by members of a particular ethnic group that their expression of beliefs and values is superior to that of others Can be underlying, subconscious beliefs that guide a person's behavior COTAs should examine their cultural beliefs and biases.
Enganges in caregivers in decision making
Partnering
Labels are applied to persons in psychiatric care. Labels serve to categorize, but also carry stigmas. Common labels include:
Patient Care recipient Client Consumer Member Inmate Resident Survivor
What is a name?
Patient- suggest dependent relationship Care Recipient- suggest person requires substantial supervision Client- suggest person is hiring the clinician to perform service Consumer- preferred by person with severe and persistent mental illness Member- preferred by person who belong to psychosocial club Inmate- connotes that the person has been in jail Resident- used when a person with mental illness lives in a nursing home Survivor- serious mental disorders to connote their commitment to living with the threat of relapse
Who are our customers?
Patients / clients Family members / friends of clients Other health professionals (inside or outside work setting) Co-workers / staff in workplace
OTAs should recognize how their cultural norms
Patients come from a wide variety of backgrounds. might be perceived by patients from other cultures. If possible, learn about the patient's cultural norms. Attempt to bridge the gap by respecting differences.
Good candidates for group treatment include:
Patients with a greater potential for problem-solving Patients who need opportunities for reality-testing Patients who have adequate trust in other human beings
COTAs should understand and follow specific guidelines to receive payment.
Payment claims may be denied without all guidelines addressed (e.g., not having the physician sign off on the plan of care).
Name the muscles of the Shoulder Joint GH.
Pectoralis Major, Coracobrachialis, Anterior Deltoid, Middle Deltoid, Posterior Deltoid, Latissimus Dorsi, Teres Major, Teres Minor, Infraspinatus, Supraspinatus, Subscapularis
Specific muscles and innervations of the shoulder girdle
Pectoralis Minor - Median pectoral nerve, Serratus Anterior - Long Thoracic nerve, Upper Trapezius - Accessory Nerve, Middle Trapezius - Accessory Nerve, Lower Trapezius - Accessory Nerve; Levator Scapula - Dorsal Scapula nerve, Rhomboids Major - Dorsal Scapula Nerve, Rhomboids Minor - Dorsal Scapula nerve
Schools may employ OTAs to facilitate school-wide anti-violence programs. Techniques include:
Peer mediation Conflict resolution Education on the value of respect and nonviolent communication Anger management Stress management and coping skills
Optimal seating position wheelchair
Pelvis: Neutral position with weight equally distributed between the left and right ischial tuberosities Trunk: Slight lordosis in lumbar area, slight kyphosis in thoracic area, and small amount of cervical extension Femurs: Neutral position; slight abduction of the hips; and 90 degrees of flexion at the hip, knee, and ankle Arms: Supported by armrests but without shoulder elevation
Disengagement Theory
People withdraw from roles or activities and reduce their activity levels or involvement. "Turning inward"; increased involvement with family Criticism of theory: It is a decline in opportunities to activities that cause disengagement. It may be a belief that the elder perceives other people thinking he or she is "too old."
Task Role- Procedural technician
Performs routine tasks that help group accomplish its task
Volition
Personal causation: Knowledge of capacity, sense of efficacy Values: Personal convictions, sense of obligation Interests: Attraction, preference
______ is emphasized as the central characteristic of occupation.
Personal meaning
Axis II
Personality disorders Mental retardation
Development of adaptive skills model would be used on what Population/Setting
Persons who lack social skills, fulfilling roles. For all levels of psychiatric function.
Mnemonic for muscles of the shoulder girdle
Pete Said U Made Lou Learn Radical Reasoning
Establishing a Restraint Reduction Program
Philosophy Empowerment of elders and staff Elders' dignity and quality of life Elder safety and freedom within the facility Policy OBRA law requires restraints be used only in certain conditions and limitation. Each facility has its own policy that meets the OBRA law. Know your facility's policy. Know the facility's alternatives to restraints. Education Staff, clients, and families need education on the use of restraints and restraint reduction. Alternative to restraints should be investigated and selected. Teaching strategies may include having the facility staff restrained for a short period of time. Few individuals would choose restraints for themselves as a suitable intervention.
History of restraints
Physical restraints have been used since the 1700s in the United States to manage psychotic behavior. Until the late 1980s, restraints were almost universally used in nursing homes. Restraints continue to be used today in hospitals with a physician's order. Nursing homes have almost universally eliminated restraints.
Maslow identified levels of need, called the hierarchy of needs:
Physiological needs Safety needs Love/belongingness needs Esteem needs Self-actualization needs First-level needs must be satisfied before higher need levels. The OTA can offer assistance in meeting each level of need.
Strategies for limited endurance
Place chairs strategically around the home. Sit while performing ADLs. Have a commode chair near the bed. Perform general strengthening exercises. Try community exercise programs such as swimming, dance, or walking clubs.
Consists of activities engaged in for pleasure, relaxation,self-exploration or self-expression
Play
Play
Play exploration Play participation
Changes in Occupation over the Life Span-Adolescence
Play time exceeds work time. School is a form of work. Adolescents may become focused on competence in one or more tasks (sports, grades, popularity) May also begin to consider future adult occupations.
Cognitive or psychosocial causes of falls
Poor judgment, insight, and problem-solving skills Confusion or inattention Fatigue, depression, dementia Drug reactions, fear of falling Unfamiliarity with a new environment or caregiver Strong drive for independence
Sensory-perceptual
Positioning the body Hearing and locating Visually determining Locating by touch Timing Discerning flavors
Stress Management
Positive and negative stressors identified Stress management techniques are focus of treatment
Stress Management
Positive and negative stressors identified Stress management techniques are focus of treatment Focus is on self-management and positive attitudes Topics include: smoking cessation, AIDS education, and nutrition
COTA's Role in Seating and Positioning
Posture should be monitored continuously. Pressure relief to prevent skin breakdown Elders have very fragile skin, and pressure causes breakdown quickly. Pressures sores develop when the blood circulation to an area is decreased; sitting in one position for too long can cause this to occur. Teach elders to monitor their own skin. Look for areas of redness over bony prominences. Change positions every 1 to 2 hours. Use a mirror to inspect their skin.
Group maintenance roles-Encourager
Praises, accepts and supports other in the group- encourages different points of view
Stereotype
Preconceived ideas about how a person should act, think, or feel based on fear of the unknown or lack of contact Examples: Elders are in ill health; elders are slow; elders are too old to work; elders cannot enjoy sexual activity.
Psychotropic Drugs and their Side Effects - Psychostimulant Drugs
Prescribed for ADD/ADHD. Though these drugs are stimulants, they are effective for calming behaviors of children with ADD/ADHD. Side effects include: Impaired growth Tics Insomnia
Psychotropic Drugs and their Side Effects-Antipsychotic Drugs
Prescribed for schizophrenia and psychotic disorders. Control hallucinations and delusions; newer drugs also lessen negative symptoms (ex. apathy). Newer drugs are expensive; some patients only have access to older, less-effective drug options. Side effects include: Movement disorders (such as Tardive dyskinesia) Photosensitivity Dry mouth, blurred vision
Psychotropic Drugs and their Side Effects- Antiparkinsonian Drugs
Prescribed to counteract the antipsychotic drug side effect of movement disorders Side effects include: Dry mouth Blurred vision Dizziness Nausea
Islam
Present life is a trail for afterlife never estimate life expectancy Disability brings shame conflicts are almost exclusively dealt with within family, community and religious support prohibits the consumption of alcohol males are traditionally authority figures teaching should involve family members do not remove the evil eye amulets silence often indicates acceptance or approval healthcare decisions are a collaborative effort by the family direct eye contact can be disrespectful
Evaluation procedures include
Pretest/posttest evaluation: members are evaluated before and after therapy; any changes are noted. Posttest evaluation: members are evaluated after therapy; results are compared to norms of behavior if therapy had not been attempted.
Antigroup ( Egocentric) roles- Blocker
Prevents group from progressing- resist change, opposing decisions, rehashing dead issues
Prevention strategies fall into three categories
Primary Secondary Tertiary
BENEFICENCE
Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services.
NONMALEFICENCE
Principle 2. Occupational therapy personnel shall intentionally refrain from actions that cause harm.
AUTONOMY AND CONFIDENTIALITY
Principle 3. Occupational therapy personnel shall respect the right of the individual to self-determination.
SOCIAL JUSTICE
Principle 4. Occupational therapy personnel shall provide services in a fair and equitable manner
PROCEDURAL JUSTICE
Principle 5. Occupational therapy personnel shall comply with institutional rules, local, state, federal, and international laws and AOTA documents applicable to the profession of occupational therapy.
VERACITY
Principle 6. Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession
FIDELITY
Principle 7. Occupational therapy personnel shall treat colleagues and other professionals with respect, fairness, discretion, and integrity.
Program Evaluation
Procedure for measuring whether a program has been effective. Part of the total quality measurement (TQM) approach. Evaluation focuses on whether participation in the group resulted in behavioral changes specified in the goals.
2,Screening
Process to determine whether OT is needed, and if so what approaches would be most beneficial
Task Role- Engergizer
Prods or arouses group to act; stimulates and boost morale
Other Community Programs-mental helath
Program for Assertive Community Treatment Prevention Programs Prevocational and Vocational Rehabilitation Home Health Care Community Residences Supportive Housing Assisted Living and Residential Care Homes
Genetic theories
Programmed aging Somatic mutation theory Cybernetic theory Free radical theory Nongenetic theoryry
May be either positive, focusing on new activities, or negative, focusing on getting rid of unpleasant work situation- retirement
Progressive
"Definitely retirement will be improvement for me, My whole body aches, after a long day at work, and frankly, I'm a little tired of work situation. It will be a relief"
Progressive (negative)
"I have just been waiting so long for this, I'll have more time for the garden, travel and support group and just about everything else I wanted to do more of"
Progressive (positive)
The ability to share short term task with one or two other people
Project level
Impairments in smell and taste have safety implications:
Proper olfactory function can alert to noxious odors (e.g., methane or smoke). Proper gustatory function can alert to spoiled food (increasing danger of food poisoning). Age-related changes are not reversible, but elders can compensate for impairment of these senses.
The 3 senses that are not commonly recognized
Proprioception- ( where parts of body are in even when we can not see them)- feet undr desk Kinesthesis- gives you info about movement and position of the body as it changes with muscular effort- walking in shallow water Vestibular awareness- the sense that detects motion and pull of gavity during the movement-catching your self when falling
Activity alternatives-Restraint Reductions
Provide meaningful occupations for elders. Relate activities to their past occupation if able. Provide an activity kit: Sewing basket, briefcase, fanny pack, or tackle box of items that can be manipulated by the elder
What are the treatment methods for Sensory Integration?
Provide opportunities for enhanced sensory intake provided in the context of a meaningful activity.
Role of COTA in Wellness and Health Promotion
Provide professional evaluation, intervention, and educational programs. Prevent the progress of disease and risks of disability or death. Help elders maintain functional autonomy as long as possible. A: Attitude B: Balancing productive activities, positive social support, emotional expression, and environmental interaction C: Controlling health through education
Patient Rights
Providers are not the only individuals subject to believing HIPAA myths. Patients have their fair share of misconceptions about HIPAA. For example, many patients are confused about the implications of opting into or out of a facility's directory. In particular, patients and their families do not realize that if they opt out of being listed in the facility's directory, then staff members may not disclose the patient's whereabouts in the facility — even when visitors come to see them. Similarly, the facility will not be able to confirm for clergy that the patient has been admitted to the facility. Some patients also panic that they will no longer be privy to their spouse's or loved one's medical information — a distortion that is partly fueled by healthcare workers who refuse to help family members navigate HIPAA. HIPAA requires clinicians only to check with patients before disclosing their protected health information to families and to release the patient information upon reasonable assurances that the person is a family mem.ber entitled to that information. HIPAA was never intended to obstruct communication with family members. Patients also are misinformed about their rights to amend their medical records. Some erroneously believe that simply because they do not like what is in their record they may amend it. While HIPAA does allow a patient to amend the record under certain circumstances, the provider is not required to do so when the provider believes the medical record is correct as written.
What are the three areas of the phalanges
Proximal Medial Distal
The thumb only has two areas making up its phalanx. What are they?
Proximal and Distal
Common Diagnoses-Sexual
Psychosis, psychosexual disorders Approaches:
Consumer-Operated Programs
Psychosocial Rehabilitation: The Psychosocial Club Fosters a sense of participation in one's own care Participants are called "members" Social milieu (members and staff are equals) Success in achieving BADLs is emphasized
Axis IV
Psychosocial and environmental problems
Common Diagnosis- Anger
Psychotic disorders, substance abuse, antisocial personality disorders
Task Role- Coordinator
Pulls ideas together by showing relationships among different ideas
Considerations when Writing a Group Protocol
Purpose Format
3.Evaluation
Purpose is to learn about client wants, needs, and challenges OTAs may conduct interviews and collect data for the OT
OT Intervention Goals for Cognitively Impaired
Purpose of OT intervention is to document alterations and improvements in functional abilities, sustain current performance, and reduce pain and stress associated with the symptoms. Goals do not aim to improve cognitive level. Goals aim to ensure consistency of performance at the safest and least restrictive level.
What does ROM stand for
Range of Motion, the arc if motion that occurs at a joint or a series of joints
When a child stops responding to other people because she or he has been neglected or ignored
Reactive attachment disorder
Changes in Occupation over the Life Span-Childhood
Reality is learned through play. Early childhood involves no work at all. As child matures, simple work is introduced (chores). Adolescence
Mental Health Factors Throughout Life-Midlife
Realization that not all life goals will be accomplished. Life goals may be reevaluated; life trajectory altered. Mental health patients at midlife include: those with persistent, lifelong mental illness. those with adjustment disorders (poor coping skills). those developing dementia. Each of these subgroups requires a different approach by the OT staff. For patients with persistent mental illness, focus on: improving/maintaining daily living skills. providing opportunities for productive work. facilitating independent functioning. For patients with adjustment disorders, focus on: identifying and resolving issues that confront them: death divorce unsatisfying career For patients with onset of dementia, focus on: encouraging the patient to seek supervision for daily tasks such as cooking. support for living in the home for as long as is deemed safe. reality-orientation exercises. memory training. sensory stimulation. physical activities.
Group maintenance roles- Group Observer
Records communication of group- offers this record to group for comment and interpretation
Delusions approaches-Self:
Redirect discussion of delusions to focus on activities. Relate to the client as an intelligent adult
Helping the Elder Cope
Reduce fears about the illness through education. Listen and be sensitive to the feelings expressed verbally and nonverbally. Provide encouragement. Assist in the development of creative yet realistic ways to gain more control over the illnesses or losses. Identify ways to reduce stress and promote social support. Surround the elder with familiar objectives that may help with the sense of continuity, provide them comfort and security, and aid their memory.
Changes in Cognition
Reduction in information processing and psychomotor speed Deficits in tasks requiring abstraction, set shifting, and divided attention Declines in fluid intelligence
Problems with definition of successful aging
Reflects experience of a segment of population Fails to account for individual constructions of successful aging Risks devaluing disabled or institutionalized elders and those with chronic illness
" I can't imagine not going to work. I don't have a plan for how to spend the time"
Regressive
Anxious uncertain, dreading the future about retirement
Regressive
The primary function of the CNS is?
Regulating consciousness, Maintaining awareness, Interpreting stimuli, Executing thought process
RUMBA criteria:
Relevant Understandable Measurable Behavioral Achievable
Ethical conflicts Action: Reporting
Reporting another's unethical behavior is sometimes referred to as whistle-blowing. Reporting another's unethical behavior can take courage, especially if a COTA's job is threatened. If possible, COTAs should work with the support of others, especially those in a supervisory position. COTAs should make sure to document their actions so their systematic efforts to address the problem are well established.
1,Referral
Request for service OTAs should relay referral requests to supervisors
Emotional Regulation
Responding to feelings of others Persisting despite frustration Controlling anger Recovering from disappointment Displaying emotion Utilizing coping strategies
Self-Expression
Revealing one's thoughts, feelings, and needs Some clients may be emotionally disconnected Some clients gravitate toward extremes in emotion
Self-Disclosure:
Revealing things about oneself.
Perfectionistic organizing can also be a time-waster. The following tasks are often unnecessary:
Rewriting paperwork to make it look nicer Trying to save money by reusing supplies that could be discarded Using overly-detailed and cumbersome filing systems
Social media recommended best practices include:
Risk profiling -- Create risk profiles of your employees, contractors and partners. Such profiles, which are based on activity and role, help to determine which employees might be more likely to share confidential information or break important regulations. User activity monitoring -- Monitor your employees' activities on social networking sites such as Facebook and LinkedIn. With keyword alerts, employers can also receive notification when employees enter certain words or phrases. This helps detect problematic or suspicious behavior before it escalates into a larger problem. Look at the whole picture -- Utilizing user activity monitoring, organizations can view all of the activities that take place on an employee's computer screen. In some instances, healthcare organizations, have cleared employees accused of HIPAA violations after reviewing their activities. Don't forget mobile -- Monitor all organization-provisioned devices including laptops, desktops, smartphones and tablets. Train, train, train -- It's critical to provide training for employees outlining key compliance regulations and security risks such as data theft, fraud, identity theft and best practices on sharing information on social networking sites. Teachable moments -- When employees engage in improper behavior, use it as an opportunity to stress the organization's regulations and expected behavior.
Part I: Restraint Reduction-COTA role
Role of COTAs in restraint reduction Assessment Consultation Environmental adaptations Psychosocial approaches Activity alternatives Treatment
OT approaches to eating disorders
Role performance art therapy group discussions
Consultation-Restraint Reduction
Roles as consultant: Advocate, observer, teacher, information specialist, team problem solver, identifier of resources Formal restraint reduction training Development of alternative to restraint use e.g., splints if indicated Examine the environment for needs and psychosocial and activity-related alternatives. Teach the staff alternatives.
What are the roots of the Brachial plexus and what body parts do they support?
Roots: C5-T1 Innervate the upper extremities
What are the roots of the Lumbar plexus and what do they innervate?
Roots: L1-L5 Innervates the LE's
Postural and movement patterns in chronic schizophernia
S-curve Shuffling gait Difficulty raising arms above head Inflexibility of neck and shoulders Resting posture- shoulders and hips are flexed Various changes in hand- weakness grip
Mnemonic for Rotator Cuff muscles
SITS
Approaches to Depression- Environment
Safe and Subdued Minimal stimulation for severely depressed Some can not tolerate others- group therapy
Fall Prevention-Difficulty with transfers and mobility during ADLs
Safety training with a cane, walker, or wheelchair Good night lights for elders who get up to urinate at night Wider walkways by moving furniture or eliminating too much furniture
Common Diagnoses for hallucinations
Schizophrenia Manic and depressive psychoses organic mental disorders substance abuse
Youth and School Violence info
School violence may be connected to domestic violence.
Behavior seen as explicitly sexual or as provoking sexual response in others
Seductive Behavior and Sexual Acting-Out:
Closed-minded persons:
See only a narrow range of data and ignore additional information
Open-minded persons:
Seek additional information before making decisions Ask many questions, listen to alternatives
Guidelines to identify the most common of medical emergencies include:
Seizures: Patient may become rigid and then exhibit jerking motions. May also void urine or feces or stop breathing. Follow first-aid techniques as instructed. Bleeding: Minor cuts may be managed by the OTA; severe wounds will require intervention by hospital staff. Universal precautions should be followed at all times. Burns: Minor first-degree burns are treatable with basic first aid. The OTA should seek assistance in treating any burns with blistering or charred skin. Sunburn: Photosensitivity is a side effect of some medications. Prevention includes applying sunscreen prior to any outdoor activities. Strains, Sprains, Contusions: Minor bumps and bruises are treated with RICE (Rest, Ice, Compression, and Elevation)
Intervention
Selection of the occupational strategies to meet improve the functioning of the client Identifying treatment goals and outcomes with the client
Approaches to anxiety
Self- encourage pts to express themselves Environment- Calm, quiet, and comforting is best Activities- Client directed and relaxing- Projects that can be picked up and put down are often ideal- Exercise is also helpful
The ability to recognize one's own assets and limitations and to perceive the self as worthwhile, self- directed,consistent and reliable
Self- identify skill
Grading self-concept and self awareness
Self-awareness has many layers- basic aware of body and environment clients with severe deficits may need to begin with sensorimotor must include experiences that allow exploration of one's effect on the world and the opportunities to discuss these experiences with other people verbalize one's ideas and feelings and to receive feedback
Treatment- Restraint Reductions
Self-care techniques Must be done as part of the elder's agenda and routine Upper body positioning Best support possible is needed. A full lapboard can be used if it doesn't promote agitation for the elder. Swing-away lap tray; foam wedges or bean bags Seating adaptations Correctly fitted wheelchairs with pads that support elders Drop seat chairs and reclining chairs that can prevent elders from rising or rising too quickly but do not restrict other movements Foam pads that support and position elders
The practice of revealing things about oneself
Self-disclosure
The showing, demonstrating or revealing one's thoughts, feelings and needs
Self-expression
Evaluation methods for psychoeducation
Semi-structured interview-identify area where student and theripst may jointly establish goals Task checklist-checklist for assessing a student competencies and setting treatment goals Kohlman Evaluation- measures basic skills in literacy, money mgt, self-care etc Pretest and post test-assess student content of various learning modules before and after
Myth #7: All elders become senile.
Senility: "the physical and mental infirmity of old age" (Merriam-Webster Dictionary Online at http://www.merriam-webster.com/dictionary/senility) When elders appear confused or require more time for directions, take your time. Getting older is not synonymous with feeblemindedness. Other contributing factors may be depression, grief, anxiety, or dementia.
Proprioception:
Sense that makes us aware of our body's position in space.
The alertness to the patients needs and awareness of your effect on him or her
Sensitivty
Biological causes of falls
Sensory Visual changes, loss of depth perception, peripheral vision, color discrimination, acuity, accommodation It becomes difficult to judge the depth of stairs. Bifocals and trifocals take time to get adjusted to. Vision Macular degeneration, cataracts, diabetic retinopathy, glaucoma, and stroke all affect vision. Spatial organization or figure ground may cause an elder to perceive a change in rug color or flooring as a stair. Misinterpreting visual information leads to falls. Cardiovascular Blood pressure changes Orthostatic hypotension, neuropathy, diabetes, medication side effects, syncope Lower cardiac output Results in lightheadedness, dizziness, impaired venous return; may occur from prolonged bed rest
The ability to receive, select, combine, and use information from the balance (vestibular), touch ( tactile) and position (proprioceptive) senses to perform functional activities
Sensory Integration skills
the neurobiological process involved in organizing multiple sensations from the environment and the individuals own body is what OT Model?
Sensory Intergration
_____must come into account when designing and implementing treatment activities for elders.
Sensory changes
OT approaches for children with psychotic disorder include:
Sensory integration techniques Applied behavioral analysis (ABA) Functional behavioral analysis (FBA) The Alert Program
Work done by somebody for somebody else as a job or duty
Service
Patterns:Role Performance
Set of behaviors that have a socially-agreed-upon function Role stress involves fear that one will not live up to his/her role Role conflict involves feeling that one's role is not aligned with his/her self-concept
Group maintenance roles-harmonizer
Settles differences between members by reconciling disputes or relieves tension by joking
The ability to accept one's sexual nature as natural and pleasurable and to participate in a relatively long term sexual relationships that considers the need of both partners
Sexual identity
Mnemonic for Carpal Bones
She Likes To Play. Try To Catch Her Scaphoid, Lunate, Triquetrim, Pisoform, Trapezium, Trapezoid, Capitate, Hamate
Paranoia approaches-Environment
Should be kept as stable as possible. Patient should be notified of any scheduled changes
What are the main differences/purposes between the muscles of the shoulder girdle and shoulder (GH) joint?
Shoulder Girdle: movement of the scapula Shoulder GH Joint: movement of the entire shoulder complex
Fairweather Lodge Program
Similar to the psychosocial club Small group of members participate in BADLs as well as running the home and a small business
approaches to Activities
Simple Short-term Familiar task
Attention Deficit Approaches- Activities
Simple, well-delineated activities with a definite sequence consisting of very few steps
Concepts of skilled and unskilled therapy are important to Medicare reimbursement rules. Key issue is whether the skills of a therapist are needed for the required services.
Skilled services involve the therapist directly. Unskilled services involve the therapist indirectly.
OT approaches to schizophrenia
Social interaction communication behavioral daily living skills leisure work and productive activity parenting Cognitive functions patterns, routines and habits Chronicity of illness
Populations in Economic Distress
Socioeconomic factors also affect perceptions of culture. Limited means and education causes some patients to be reluctant to receive services or follow treatment plans. Services available to low-income populations may be of poor quality or insufficient quantity. OTAs should recognize the role limited means has in patient ability to follow treatment plans. OTAs may need to help patients guard against fatalistic thinking ("Things will never change.").
Issues equality and inequality
Socioeconomic status, gender, and age are factors to consider when assessing how decision making occurs for the client
What are the normal categories of end-feels?
Soft, Firm, Hard
What are the two main systems of the peripheral nervous system?
Somatic and Autonomic
Medicare Part C
Some plans have offered more benefits than the traditional Medicare plans.
Types of Records
Source-Oriented Records and Integrated Records Source-oriented: each discipline has its own section, so all OT notes are included in one location Integrated: Notes from all disciplines are in one section, in chronological order Problem-Oriented Medical Record Computerized Documentation
Panic Disorders
Specific phobia Social Phobia Agoraphobia
Task Role- Elaborator
Spells out suggestions by giving examples or developing scenarios of how it might work out
Expecting little change-may be either positive or negative about retirement
Stable
" well, you know, I can't say that life will be different. Just more of the same, The same old, dreary routine"
Stable (negative)
" I do so many things now that I will be continuing ( golf, volunteer) that I think very little will change, except that will have more time
Stable (positive)
Define the major phases of normal gait.
Stance Phase is 60% of gait Swing Phase is 40% of gait
Boney landmarks of the GH joint...
Sternum Clavicle Scapula Acromion Process Greater Tubercle of the humerus
Identify boney landmarks of the shoulder girdle.
Sternum Clavicle Scapula: Acromion Process
What bones comprise the shoulder girdle?
Sternum (Manubrium section), Clavicle, Scapula
Delusions approaches-Environment:
Stimulating, with opportunities to engage on many levels
Primary Prevention
Strategies that reduce risk for disease BEFORE its onset. Facilitation of lifestyle changes Use of necessary medications to reduce development of life-threatening conditions Immunizations, accident prevention Nutritional counseling Smoking and alcohol cessation Prevention of falls in the elderly
Games of _____ give participants the opportunity to use skills and planning to influence the outcome
Strategy
Healthcare Systems will become even more integrated because
Stronger focus on quality, cost-efficient care. Electronic records as a result of public policy will become a reality. Increasing costs + rapidly growing population of elders = increased pressure on, and discussion of, programs such as Medicare, Medicaid, and Social Security.
Habituation (habits)
Style, routine, occupational behavior Internalized roles: Style of action, occupational forms of roles, temporal order of roles
__________________depends on recognizing and gratifying needs without unduly compromising the needs of other
Successful functioning
______ depends on accurate reception and interpretation of sensory input
Successful motor output
Task Role- Initiator-contributor
Suggests new ideas or new ways to look at a problem
Psychiatric Emergencies include
Suicide: Prevention involves keeping the suicidal patient away from hazardous objects and far from windows or access to building roofs. Assault: OT is not appropriate for persons likely to commit assault. If an assault is imminent, call for help and remove others from the area. Elopement: Refers to running away from a facility. Secure doors and windows to reduce likelihood of occurrence.
How does the transverse plane divide the body
Superiorly and Inferiorly (top and bottom)
Relationship progresses through three stages:
Support-building stage Working relationship Ongoing working relationship
What are the muscles of the rotator cuff ?
Supraspinatus Infraspinatus Teres Minor Subscapularis
True/ False cognitive disability will limit an individual;s ability to do a voluntary motor action.
TRUE ( cognitive disability model) according to Claudia Allen
Observation
Take note of behavior, appearance, and other information that can be gathered using your senses. Do not interpret this information, or make judgments of the client based on your observations.
The sandwich generation
Taking care of parents and their own children-
Signs of Suicidal Intent
Talk about killing oneself or wanting to die Recent acquisition of the means to die Making a will or taking out life insurance Giving away personal belonging Seeking promises that someone else will take care of pets, children etc Passive suicidal behavior- not eating, drinking too much, engaging in unsafe behavior
Movement disorder that becomes permanent unless pt stops taking medication
Tardive dyskinesia (TD)
Engel OT suggestions for pain
Teaching and reinforcing socially appropriate pain expression Praising and reinforcing social interaction about issues other than pain Encouraging appropriate physical activity Introducing the pt to support groups Teaching distraction as a method of pain mgt
Skilled service example
Teaching patient adaptive skills for dressing, eating, or going to the toilet Assisting patients in instances in which safety is an issue (e.g., after surgery)
What is the importance of testing procedures?
Tests should be performed the same way every time to replicate results. They determine which joints to measure, the sequence of testing, needed supplies, help us explain why we are testing and what we will be doing, We need to confirm patient understanding
What is HIPAA?
The Health Insurance Portability and Accountability Act, otherwise known as HIPAA, was enacted by Congress in 1996 to address insurance portability (when moving from employer to employer), to reduce fraud, and to protect confidential medical information.
Myth #2: You can't teach an old dog new tricks.
The ability to learn does not decline with age. Elder adults learn differently than children or young adults do. Crystallized intelligence (wisdom) associated with experience or education changes less with age. Elders may take longer to learn. Physical changes that affect learning: Body aches, joints, decreased stamina Ergonomics of computers may cause neck or back stiffness. Vision and hearing deficits may slow learning. In times of stress, elders may be less flexible.
Assertiveness:
The ability to state one's needs openly and directly Assertiveness may have been unlearned through years of hospitalizations First identify needs, then ask to have them met
What does it mean to palpate boney landmarks?
The body has specific landmarks which are used as reference points for muscle, bone and nerve identification purposes. Touching and using a set of specific landmarks for a joint etc, we can always find the anatomical part and others will be able to find the same structure using the same landmarks.
Theories change in olfaction
The cause is unclear, but there are theories: Anatomical changes in the taste system Loss of taste buds Changes to the taste cell membranes Medical conditions, viruses, and medication can all be contributors to alterations in taste and smell function.
What Is Culture?
The contexts that influence performance skills and performance patterns (observable behaviors of occupations) Include physical, social, personal, spiritual, temporal, and virtual factors that influence occupation "Customs, beliefs, activity patterns, behavior standards, and expectations accepted by the society of which the individual is a member" (AOTA, 2008).
How Psychotropic Drugs Work
The drugs affect neurotransmitters in the brain. serotonin dopamine norepinephrine Can be administered orally (tablets or liquid) as well as by injection
Dynamic Process: A Holistic Perspective
The eight stages of intervention often merge with one another. For example, OT staff may need to consider transition planning at the intervention planning stage During intervention process, OT staff should maintain a client centered approach, maximizing client participation Activities should be occupation centered: focused on occupations important to the client's life Intervention plans should be outcome oriented, or developed with a clear focus toward successful transition and discontinuation of service
Expected environment:
The environment a patient is expected to re-enter after treatment is completed
Locus of Decision Making
The extent to which a culture prizes individualism as opposed to collectivism
Homeless Persons
The homeless are extremely marginalized in society. Many of today's homeless persons would have been institutionalized for severe mental illness 50 years ago. Healthcare providers should not underestimate the level of ingenuity required to survive on the street. Occupations of the homeless include: Collecting cans for recycling money Finding/building shelters Begging
Role Acquisition and Social skills training
The learning of all daily life, work, and leisure skills that enable one to participate in social and productive roles ( student, workers, family members, leisure participant )
Allows the observer to rate 10 functions in 3 categories of physical capabilities, self-care, and social interaction
The parachek Geriatric rating scale
Reason a person is discharged from a group
The person has been discharged from the treatment setting The person displays uncontrollable assultive or suicidal behavior The person fails to attend group
Illness
The presence of disease
Purposes and Uses of Medical Records
The purposes of medical recording in psychiatric OT are: To explain why occupational therapy services were needed and how these services contributed to the outcomes for the person To show the professional clinical reasoning behind the therapy plan To communicate an occupational therapy perspective on the client To provide a chronological record of the services provided and the outcomes. Users of these medical records include other OT staff, physicians, and third-party payers (such as health insurance companies)
What does validity mean regarding tests?
The test or instruments test what they are supposed to.
5.Intervention implementation
The treatment plan is carried out OTAs are responsible for this aspect of the treatment process
Wheelchair Seating and Positioning- COTA must understand
The use of wheelchairs at home, in the community, or in institutions improves the clients' mobility, level of independence, and participation in their chosen occupations. One size does not fit all. Joint replacements, osteoarthritis, osteoporosis, CVA, Alzheimer's disease, Parkinson's disease, dementia, diabetes, heart failure, and hypertension can all influence the type, size, and fit of the wheelchair. Outcome of wheelchair fitting done by OTR Proper positioning, independence, prevention of skin breakdown, improved quality of life
Myth #1: Chronological age determines the way an elder acts and feels.
The way elders are perceived significantly affects the way they are treated. Stereotypes may affect the way you treat elders and the way they will respond to you. Treat elders as individuals within their own particular contexts, history, and circumstances.
Intrinsic muscles of the Hand (Thumb) are known as the...
Thenar Group
Ending the Therapeutic Relationship
Therapeutic relationships end for many reasons: Patient discharge Client accomplishment of goals Change of job or living situation Recognition that current therapy is not working Make time to acknowledge the end of the relationship. Ask patients to explore feelings associated with ending the relationship. Reinforce gains made during the therapeutic relationship.
Do schools and fieldwork programs fall under "business associate" status?
There has been much discussion as to whether a fieldwork contract requires schools to become "business associates" and therefore fall under the HIPAA requirements for each contract. The decision of whether or not to become a business associate lies with each school. But the argument can be made that the occupational therapy and occupational therapy assistant students and the schools are not business associates using the following information: A Business Associate Agreement is required by HIPAA where a person or entity provides services for a covered entity that involve access to patient health information. An exception to that is a person who performs "in the capacity of a member of the workforce of [a] ...covered entity". 45 CFR Sec. 160.103 defines members of the "workforce" as "employees, volunteers, trainees, and other persons whose conduct, in the performance of work for a covered entity, is under the direct control of such entity, whether or not they are paid by the covered entity. There is a specific exception indicating that a Business Associate Agreement is not required for persons or entities involved in a patient's treatment. 45 CFR 164.502(e)(1).
Established functional roles:
There is clearly a leader in the group (the OTA or other staff), and there are distinct roles group members can fulfill.
What is the purpose of ascending nerves?
They are also known as sensory nerves and they carry afferent signals to the CNS.
Every medical record needs to incorporate the billing "treatment records" These should cross-walk with the progress notes and clarification orders.
They may include: treatment time (45 minutes), start and end of treatment times, CPTs and units of therapy delivered per visit. Therapists need to review for accuracy and sign as an attestation that billing was complete and accurate.
Code of Ethics outlines principles for OT practitioners.
They must: Demonstrate concern for the well-being of their clients and respect their clients' rights. Be competent. Comply with laws and rules that apply to their practice. Provide accurate information about services. Be fair and discreet and demonstrate integrity with colleagues and other professionals.
Myth #6: Elders prefer quiet and tranquil daily lives.
This varies with the individual. Don't make assumptions that all older adults want a quiet lifestyle. Continuing a vibrant lifestyle and staying active are key to healthy psychological aging.
Thriving: a holistic lifespan theory
Three interacting factors Person Human environment Nonhuman environment Failure to thrive Sharp decline in physical health with no real physical or illness-related reason Critical elements of thriving Social connectedness Ability to find meaning in life Attachment to one's environment Adaptation to physical patterns Positive cognitive or affective function
Ethical conflict action: What will I do professional boards
Three major bodies with jurisdiction over professional behavior: AOTA Ethics Commission Responsible for writing the profession's ethics standards and for imposing sanctions on AOTA members who do not comply National Board for Certification in Occupational Therapy (NBCOT) Responsible for certifying OTRs and COTAs Can permanently deny or revoke certification if necessary State licensing board
Internal Organization of the Human Being (Model of Human Occupation)
Three subsystems Volition Habituation (habits)
OT approaches for Cognitive Disorders
Time Management leisure Relapse prevention Perceptual and cognitive functions social interaction social skills communication skills
Erickson's theory of human development
Time Period Stage Early infancy Trust vs. distrust Later infancy Autonomy vs. shame and doubt Early childhood Initiative vs. guilt Childhood Industry vs. inferiority Adolescence Ego integrity vs. role confusion Early adulthood Intimacy vs. isolation Middle adulthood Generativity vs. stagnation Late adulthood Ego integrity vs. ego despair
Peck's stages of psychological development in the second half of life
Time Period Stage Middle age—1st Wisdom vs. physical powers Middle age—2nd Socializing vs. sexualizing Middle age—3rd Cathectic flexibility vs. impoverishment Old age—1st Ego differentiation vs. work-role preoccupation Old age—2nd Body transcendence vs. body preoccupation Old age—3rd Ego transcendence vs. ego preoccupation
Requires that one recognizes one's values and priorities, structure a daily routine, schedule one's time and organize task efficiently
Time management
allows clients to make the most of each day
Time management
Why Study Aging?
To clarify misperceptions of aging and elders To understand where the demographics in the United States are leading our profession To learn what is normal aging and what is not normal aging To learn strategies for working with older adults that lead them to optimal health
3 Objectives of Promotion
To present information to consumers as well as others. To increase demand. To differentiate a product. Kurtz, D. (2010). Contemporary Marketing
Techniques to promote interaction in a group- Leader Behaviors
Tolerate silence Avoid responding directly to members question or comment- instead redirect to anotehr group member When member is talking for long time- scan group/break eye contact to encourage other members to respond
Cost-control strategies can create ethical challenges for practitioners.
Traditionally, services are based on clinical need. Increasingly financial constraints may impede care. Cost-driven practices may include "creative" documentation. Creative documentation refers to the practice of exaggerating a problem, altering a diagnosis, or implying better prognosis so more client visits can be approved. When fraud exists, such practices are also liable to legal inquiry and punishment. Informed consent hinges on respect for client autonomy and the practitioner's ability to effectively communicate potential outcomes. The higher the risk, the more thorough the informed consent process should be. Autonomy necessitates that they be allowed to accept or refuse the intervention. Respect for autonomy does not include offering interventions that are not clinically indicated.
Coping with physical disability can have a negative effect on mental well-being. For example:
Traumatic brain injury (TBI) may result in loss of cognitive function, leading to impulsiveness or anger. Disfiguring conditions can cause patients to withdraw, becoming isolated and depressed. Chronic pain can result in fatalistic thinking, fatigue, and loss of valued occupations. OT approaches for secondary mental illness mirror those used for primary mental illness.
Refer to medical care for disease, injury, other medically treatable conditions
Treatment
Strategies in tertiary prevention
Treatment of a homebound elder who is experiencing limitations because of arthritis pain Providing education about self-care activities such as joint protection and energy conservation to prevent deterioration of arthritic joints
The importance of evidence-Based Practice
Treatment plans should be based on approaches that are scientifically sound and proven to achieve the desired goals Evidence comes from: Meta-analysis Systematic reviews Randomized controlled trials Other research studies Expert opinion OTAs should carefully document patient outcomes in order to help expand the literature of evidence-based OT approaches
Milieu Therapy
Treatment units/day cares are social systems Rules, hierarchies, and roles must be established Patients given all the responsibility they can handle
Categorize the intervention:
Treatment, or functional restoration Maintenance of function Rehabilitation Prevention
How is the glenohumeral (GH) joint classified?
Triaxial
What are the extensors of the elbow named?
Triceps brachii Anconeus
Antigroup ( Egocentric) roles- Help seeker
Tries to get sympathy of group by acting helpless, victimized or insecure
T/F According to Role acquisition, client awareness- clients should be made aware of the effects of their actions
True
T/F Activities used for assessment will have different criteria than those used to help clients reach goals.
True
T/F All the disorders first seen in childhood and adolescence shape how the individual grows and develops
True
T/F Both the OT and the OTA are involved in the selection of activities
True
T/F Children born to opioid-addicted mothers have withdrawal symptoms and my die of them
True
T/F Documentation is a necessary part of the OTA's job.
True
T/F Family caregivers tend to be female.
True
T/F Homicide is the leading cause of death for African Americans age 10-24
True
T/F In many states mental illness cannot be forced to accept treatment unless they are danger to themselves
True
T/F It is common for patients to experience sexual feelings toward staff.
True
T/F Occurs at all levels of socioeconomic status.
True
T/F Patients with severe mental illness rarely seek out treatment.
True
T/F People with more serious and persistent mental illness often do not seek treatment
True
T/F State laws require OT or OTA to act on reported abuse
True
T/F Symptoms are not the illness itself
True
T/F Unless the activity is going to help provide assessment data or help the client reach treatment goals, there is no reason to consider it further
True
T/F newly sober alcoholics preferred activities associated with alcohol, whereas alcoholics with longer recovery preferred activities associated with sobriety
True
t/f Both transference and countertransference happen unconsciously
True
What movement does the Middle Deltoid of the shoulder joint do?
True abduction
OT approaches homeless include:
Trust-building outreach activities Assistance with enrollment in health service programs and shelter access Education (sex education, HIV awareness, substance-abuse treatment) BADL skills development (grocery shopping, grooming, hygiene)
Bathroom modifications for Fall prevention
Tub or shower bench with armrests and back Handheld shower hose, grab bars Raised toilet Floor mats should have nonskid backing and be in good condition. Heat-sensitive safety valves should be installed to prevent scalding. Bedside commode Good handrails may need to be installed in showers, near toilets, and so on for balance.
Some tips for making the most of electronic device use:
Turn off or silence cell phones or pagers, as they are distracting to staff and patients. Consider replacing paper subscriptions to professional journals and catalogs with online-only versions. Curtail email distractions. Set a timer of 5 to 10 minutes to check on work email. Delete all spam or non-work-related messages. Reply to messages quickly and succinctly
How does a lodge work
Typically lodges are small groups of 4 to 8 people who share a house and own a small business. Each group must select a business to operate, for which they will develop and implement a business plan. Lodge groups' businesses have included lawn care, custodial or laundry services, printing, furniture building, shoe repair, catering, and other services. Lodge members assume specific positions of responsibility within the household and the business-for example, the business may have a manager and a crew chief; the household, a cook and a medication supervisor. There are no live-in staff members at any Lodge, although each lodge has access to a professional who is available for training and consultation whenever the group requests his or her help. Staff members are also on call 24 hours a day for emergencies. In addition, Lodge members hire professional consultants-such as accountants and lawyers-to assist with Lodge business operation. Responsibility for the house and business improves the member's self-confidence and helps them become more independent by giving them a stable roll in the community. (Retrieved from http://www.theccl.org/Fairweather.htm)
Complete and Accurate All clinical documentation must be legible. Of course, EMRs (electronic medical records) and printed entries are easier to read than long hand.
Ultimately, electronic medical records minimize misinformation and reduce room for it.. Documentation forms vary, but it is helpful to use nationally recognized forms such the CMS 700 form for therapy initial evaluations and plans of care. This promotes documentation consistency and familiarity for the documenter. All forms need to be thoroughly completed. Do not leave blanks. Incomplete documentation reflects incomplete knowledge.
Somatic mutation theory
Unexpected chromosomal changes occur and result in replication mistakes. Mistakes result in progressive loss of function.
Aging and Physical Illness
Unexpected illness is a catastrophic stressor. Unexpected illness can be debilitating in terms of independence and self-care. Chronic illness is no less stressful, but the elder may have adapted to the illness more gradually. Elders who view a physical illness as a challenge cope better than those who view it as a punishment.
Activity theory
Unless constrained by poor health or disability, elders have the same psychological and social needs as middle-aged persons. Theory excludes elders' physical well-being, past lifestyle, and personality attributes.
Myth #3: As you age, you naturally become older and wiser.
Unrealistic expectations of elders (good or bad) may cause the elder to feel like a failure. Forgetfulness or memory loss may occur. Intelligence does not decline with age; IQ scores increase until the late 20s and then level off and remain unchanged until late in life. Continued intellectual stimulation promotes successful aging.
I know you're thinking "This is Documentation 101,"but it's not. The above principles and documentation form sections are the "cornerstones" for sound therapy clinical documentation.
Use clinical resources when and where available: peer reviews, chart audits and continuing education are invaluable resources.
Steps to insure reliability page 2
Use consistent, well defined positions, Use consistent, well defined, and carefully palpated anatomical landmarks to align the goniometer, Use the same amount of manual force to move subject's body part during successive measurements of passive ROM, Urge subject to exert the same effort to move the body part during successive measurements of active ROM
Asian
Use family name when addressing avoid direct eye contact ask open ended questions never mention Japan or US war Idioms may be taken literally Smiling and nodding does not necessarily signal agreement Keep greater physical distance Never touch the head! non-therapeutic touch is not easily accepted Cleanliness extremely important do not wear street shoes in house gift giving a cultural requirement
Unskilled service examples
Use of heat as a "palliative and comfort measure" Routine assistance in dressing, eating, or going to the toilet Positioning in bed
Steps to ensure reliability
Use the same device to take measurements with, use goniometer size appropriate to joint size, record mean of measurement if examiner is less experienced, have same examiner rather than new examiner take several measurements
Psychotropic Drugs and their Side Effects- Antianxiety Drugs
Used to control anxiety in non-psychotic disorders. Sometimes called "minor tranquilizers." Some drugs in this class, such as the benzodiazepines, can be addicting.
Psychotropic Drugs and their Side Effects- Antidepressant Drugs
Used to treat depressive disorders and social withdrawal. Divided into three classes: nonselective cyclics, selective cyclics (including SSRIs), and monoamine oxidase inhibitors (MAOIs) Side effects include: Cyclics: dry mouth, blurred vision, constipation MAOIs: hypertensive crisis after consumption of tyramine
Who is involved in ethical decision/problem solving
Usually the COTA Likely the COTA's client The client's family often needs to be involved in medical decision making. Family involvement may result in an ethical dilemma for the COTA.
an approach to helping individuals and groups understand their own values
Value clarification
Levels of Culture
Values and beliefs are shared at a variety of levels. Individual Sense of humor, personal space, coping style, role choices Family Economic factors, ethnicity, housing Community Language, geography, industry Region Shared with community and includes language, geography
Self variables
Verbal- tone, volume word choice Nonverbal- distance from the pt, arm/leg position
Facilitating Growth and Development Model
Views the OT's role as one "concerned with facilitating or promoting optimal growth and development in all ages of man" (p. 88). Illness, disability, and trauma threaten an individual's growth and development. The COTA must understand: Developmental tasks and adaptive skills mastered at different ages Ways illness, disease, trauma, and disability threaten that development The environmental variables necessary to support the development and maintenance of adaptive skills
3 Subsystems of human occupation
Volition- motivation which initiates action Habituation- organizes actions into predictable routines and patterns Performance Capacity- objective physical and mental capacity for action and the subjective experience of this capacity
Medicare Part B
Voluntary benefit that is paid for by monthly premiums (beneficiaries pay 20% of their costs under Part B). Currently Part B coverage has a therapy cap. Cap is a set financial amount per year for all outpatient rehabilitation costs except hospital outpatient costs. AOTA is working to eliminate the cap.
Sense of friendliness,interest, enthusiasm the therapist conveys
Warmth
Why is stabilization important?
We stabilize the proximal joint segment in order to obtain an accurate goniometric reading and to make sure the proximal bones and joints are not moving affecting our reading.
Nongenetic theory
Wear and tear theory Cumulative damage to vital parts of the body leads to death of cells, tissues, organs, and finally the organism.
Occupational alienation:
When people are unable to meet basic occupational needs or use their particular capacities because of intervening sociocultural factors
Ethical conflicts Action: Reporting healthcare professionals
When reporting other health care professionals, the state regulatory board should be contacted. State boards have the power to intervene if they determine the public to be at risk because of a practitioner's incompetence, lack of qualifications, or unlawful behavior. State boards can publicly reprimand a practitioner or may even prohibit someone from practicing in that state.
Hand Washing- the first defense against infection
When to wash hands: Before starting work Before and after treatment Before donning and removing gloves During performance of duties Before and after handle food After personal use of toilet or toileting a pt After sneezing, coughing or contact with oral and nasal areas Before leaving the room of pt on isolation or precautions On completion of duty
Acts on feelings
Will go on "gut instinct"; will make a decision based on what feels right instead of facts These clients need to feel comfortable with the COTA before following therapy recommendations.
Acts on fact
Will want evidence to support the COTA's treatment recommendations Will want to know risks and benefits; will ask questions
The most basic guiding principle to inclusive documentation is, "If it wasn't documented, it didn't happen." But even that is no longer sufficient.
With greater insurer scrutiny on provider fraud and expense management, therapists need a revised documentation mantra: "If the services were not well documented, the services were not well performed."
Where are the cranial nerves located?
Within the brain
Includes all activites through which humans provide for their own welfare and contribute to welfare of the social groups which they belong
Work
Myth #4: Elders are not productive, especially at work.
Work assists in regulating life activities and providing meaningful life experiences associated with identity, financial security, status, and opportunities for socialization. Retirement changes this, and elders must find other activities to replace work life. Many seniors continue to work past age 65 years.
Changes in Occupation over the Life Span-Later Adulthood
Work time drops off considerably in retirement. Loss of work role has both positive and negative consequences. Self-worth may be dependent on cultivating new interests and challenges.
Changes in Occupation over the Life Span-Adulthood
Work time exceeds play time. (Work does not necessarily mean "paid employment.") Competence at work satisfies the urge to achieve
How free writing can be used for ethical reflection
Write for 10 minutes without stopping. Key is to suspend the usual breaks in writing and let uncensored thoughts pour onto the page. Technique is useful in uncovering deep moral and ethical feelings. Technique may reveal previously unrealized opinions or persuasive reasons for a stance.
Task Role- Recorder
Writs down and maintain points of discussion
After a______of practice as an OTA, you will be eligible, under the standards of the Accreditation Council for Occupational Therapy
Year
Medicaid
a combined federal and state insurance program that addresses the health care needs of the indigent, was enacted in 1966.
What does soft-end feel mean?
a joint can not bend any farther due to soft tissue on both sides of the joint
define cognitive skill
ability to perceive, represent and organize sensory information for thinking and problem solving
define sensory integration skill
ability to receive, select, combine and use information from the vestivular, tactile, proprioceptive senses to perform functional activities
efine self identify skill
ability to recognize ones own strengths and weaknesses, and to perceive ones self as worthwhile, reliable, consisted and self directed
Mindful practices teach-
acceptance and self-restraint
what does Role Acquisition method of treatment address?
acquiring specific skills required for the clients chosen role and occupation
What are the major ligments of the shoulder girdle?
acromioclavicular , sternoclavicular
What are the boney landmarks of the scapula?
acromion process, corocoid process, glenoid fossa, subscapulare fossa, axillary border, superior angle, vertebral border, inferior angle, supraspinous fossa, infraspinous fossa, spinous process
Similar to muscular strength, cognitive strength varies
across individuals based on their habitual level and types of activity
Where is the supinator of the forearm and radioulnar joints located?
across the wrist from lateral epicondyle of humerus to proximal end of radius on the lateral surface
Grading social conduct and interpersonal skills ( disregards the needs or rights of other people)
activities that require interaction with other people include opportunities to discuss and analyze what happens grade on involvement of other people and nature of involvement interaction skills take a long time to develop improve only when the person is reasonably comfortable
Therapy groups are formed around many different goals. As an OTA, you are most likely to lead
activity groups. Characteristics of leader behavior include: Consistency Autonomy Nurturing Interpersonal Learning
Adoption of a classroom setting and an educational framework encourages clients to
adopt the role of the student, aa valued and functional social role
Loss of neurons, dendritic changes, and impaired nerve conduction velocity
affect nerve communication.
Both men and women experience age-related changes in bone density, but change is most pronounced in women
after menopause; it is associated with a decrease in estrogen.
Treatment focus for children with Psychosocial problems
age appropriate roles Mutual collaborative goal setting- include family and teacher Group programming for development of social skills and play behaviors Special interventions- applied behavior, sensory integration Child centered positive support Education of and consultation with parents Scheduling compatible with school schedule and needs of family
Fear of being strange places
agoraphobia
Self-control
allows clients to contain and manage emotions Anger management
Cognitive disabilities
also based on neuroscience foundation
Giving to others
altruism
Depression may develop in response to
an anxiety disorder
Depression may exist along with
an anxiety disorder
Psychoeducation believes that deficits can be remedied and skills taught via
an educational program that includes instruction and opportunity to practice skills
Clients may find sustained participation in leisure activities challenging. The OTA can assist by:
analyzing the source of difficulty helping to choose activities that can be managed more easliy initiating a search for new leisure activities guiding clients to maintain a work-life balance that allows them to recognize the value of leisure time helping the client obtain and maintain supplies related to enjoying the leisure activity
Where are the ankle and foot Extensors?
anterior aspect of the ankle and foot
Where are the pronator muscles of the elbow and radioulnar joints found.
anterior surface of forearm and lateral and medial aspects of the forearm
How does the frontal plane divide the body?
anteriorly and posteriorly (front and back)
Cluster B disorders- personality
antisocial borderline histrionic narcissistic
Often, the primary psychiatric symptom a patient experiences is
anxiety
Abnormal gait patterns occur when:
any of the subphases within the stance or swing phase are not occurring or functioning appropriately due to muscular or neurogenic problems.
The framework can be applied to the care of
any person needing OT services.
Negative symptoms of schizophrenia
apathy flat mood deterioration of hygiene social isolation psychomotor slowing
Skills must be practiced repeatedly and then
applied to new situation
Activities for social situations
asking for help from others learning what to say learning what not to say what to say to others social experiences in parties, topical discussions community excursions
which social skill group category? making request, disagreeing, setting limits
assertive skills
Domain of concern:
assisting people to engage in everyday life activities that they find meaningful and purposeful
Psychoeducation
assumes that skill deficits can be remedied by direct teaching and training
What is the most typical hallucination for schizophrenia
auditory
Inaappropriate approaches to anxiety
avoid be drawn into extended discussion of physical symptoms
Inappropriate approaches to depression
avoid being overprotective and helpful
Inappropriate approaches
avoid sarcasm refrain from arguing with the patient about reality
Cluster C disorders- personality
avoidance dependent OCD
General rule of relapse preventation
avoidance of people, places, and things associated with the abused substance
Activities suitable for sensory integration-Increase ROM
ball games housework- sweeping
Role acquisitions
based on developmental and behavioral concepts used together with social skills training which is based primarily on behavioral concepts
Development of adaptive skills-
based on developmental concepts
Psychoeducation
based on educational principles and techniques
Sensory integration
based on neuroscience foundations
Games of Strategy can used to teach the follow skills
basic social skills following rules staying in one's roles beware of roles of others negotiations cooperations
Hindu
bathing is performed as part of the morning ritual may take time between morning ritual and eating showers are preferred to baths religious items close to them at hospital bed majority of prayer is in the morning dietary restrictions are rooted in pacifism fasting is important aspect of religious practice family obligation to care for the elderly and the sick
Social skills training and role play can help illustrate the difference between
behavior that is appropriate and likely to succeed and that which is not
Many who have severe mental illness only seek out treatment after
being incarcerated- 10% prison population has a mental illness
Where are the extrinsic muscles of the hand located?
bellies in the forearm
Where are the midpalm or deep palm muscle group located?
between the thenar and hypothenar muscle groups
Where is the Hypothenar muscle group located?
between the wrist and the digiti minimi
Skeletal system changes result in declining
bone density, lowered skeletal resistance to stress, and loss of skeletal flexibility and mobility.
Why would an end-feel be hard?
bone on bone
Cognition is influenced
by genetic makeup, lifestyle choices, health status, and external environments. . with good health and good sensory function.
Elders may compensate in lost of Proprioceptive LE function
by reducing the amplitude speed of movement to maintain balance.
Approaches for hallucinations- Environement
calm and quiet not isolated
The four major parts of the brain are:
cerebrum, diencephalon, brainstem, and cerebellum
Developing a group session plan can help you define group goals as well as anticipate ?
challenges that may arise during group.
When HIPPA does not apply
charitable providers who pay for the healthcare provided to patients solely through charitable donations. These providers do not bill electronically for the care provided and do not use HIPAA transaction codes. Consequently, they are not covered entities. Similarly, many therapists are not subject to HIPAA's requirements because they are not covered entities. Instead, they are subject to HIPAA's requirements by virtue of being a member of the workforce of a covered entity. The covered entity is required by HIPAA to ensure that members of its workforce adhere to HIPAA's privacy requirements. HIPAA's requirements attach to most therapists relevant to protected healthcare information they use and disclose as a result of their employment with a hospital, HMO, outpatient facility, home health agency, etc. Most therapists do not bill for the healthcare services they provide, and they certainly don't use HIPAA transaction codes. Therefore, if a neighbor at a party or soccer game discusses a health issue with you (that is not related to information you also gleaned through employment with a covered entity), it is not a HIPAA issue because you are not a covered entity. Of course, this is not to state that you do not have to uphold and adhere to other ethical or licensure rules involving patient confidentiality; it simply means that HIPAA is not implicated.
Cleanup gives members time to
chat informally.
What is a neurotransmitter?
chemicals needed to activate action potentials in a neuron.
Symptoms of OCD may appear in Middle childhood
child may be fearful, anxious and may use ritual behavior
The work of an adolescence, like a work of a child, consists of school and
chores
Medicare and Medicaid were enacted when
civil rights were a focus. The focus was reflected in government acts that passed around that time such as the Developmental Disabilities Act and the Vocational Rehabilitation Act.
The COTA can use Cognitive Disabilities model to describe
client performance and to guide selection of activities or tasks that permit the client to function consistently at the greatest possible level.
Leisure planning and leisure counseling activities must take into account
client's ability to make decisions and follow through on them.
The OTA's role may be any of the following:
coach, supervisor, role model, problem solver, group member.
Leaders redirect group energies toward
common goals.
which social skill group category? controlling voice tone and quality, articulating appropriately, using appropriate word choices
communication skills
Young siblings may feel
confused, afraid, angry, or resentful.
The first of the behaviors of the leader, _____, is the foundation of successful groups
consistency
What is the primary role of the cerebrum?
control of voluntary movement.
What does the autonomic nervous system do?
controls involuntary muscles, such as smooth and cardiac. Also known as the involuntary system
What is the function of the somatic nervous system?
controls skeletal muscle and sensory organs such as skin, also known as the voluntary system
_____, _______________, _______________, help one balance one's own need and feelings with the demands of life and time
coping skills time management self-control
Name three ligaments of the shoulder girdle
coracoclavicular ligament acromioclavicular ligament coracocromial ligament
A symptom associated with psychotic illness in which movement requires conscious effort and deliberate planning rather that being automatic or involuntary
corticalization of movement
Learns family norms so that can be incorporated in the plan of care
culture layer
What are dermatomes?
cutaneous branches of specific spinal nerves, located throughout the body and are responsible for how touch feels at a given point of the body
Coping skills help clients
deal with common life stressors Stress management Managing grief and loss
Proprioceptive function in LE
declines with age and affects sensorimotor performance (i.e., balance).
When climbing a flight a stairs a person with schizophrenia may have to lift his/her foot deliberately to each step- this phenomenon is known as
decomposition of movement ( movement broken up in patterns)
How much opportunity for Independence and decision making does the group leader give the group
degree of autonomy
The second stage ( skills training)in the cycle of skills training, in which the target behavior is demonstrated to the person via role play, videotape, or other example
demonstration
which social skill training phase: clinician shows the client how the behavior is performed
demonstration
Cognitive Disabilities Model- 6 cognitive levels
describe the way an individual relates matter, behavior, and mind demonstrated by his or her voluntary motor actions Level 1: greatest degree of impairment Level 6: normal performance
The most important task is adolescence is to
develop an identity separate from one's parents
Match the goal statements to the category of intervention. Use action terms such as
develop, restore, improve, maintain, or prevent
The most important psychosocial task of older adults is believed by many experts to be the
development of an understanding and appreciation for what they have accomplished during their lives
In addition to emotional and social deficits, it seems that children with mental health problems are more likely to have
developmental motor delay
Observable symptoms in proprioceptive disturbances
difficulties in perception problems with body image motor incoordination
Allen identified 6 levels of cognitive ability- levels 1-4 have ______ living in unassisted in the community
difficulty- they can not perform routine task such as paying bills
Arthritis, the most common cause of
disability, limits activity for 19 million U.S. adults
In schools, interventions must be
educationally relevant
During play, the child also learns the joy of having an
effect on the world and on other people
Where are the Humeroulnar and Humeroradial joints locate?
elbow
OBRA focuses on
elders' rights, quality of care, and quality of life in the nursing home setting.
Running away from an inpatient treatment facility without being discharged
elopement
Mindfulness opens a path to complete
engagement in occupation
In MOHO what impacts the engagement of occupations?
environmental demands, constraints and opportunities
Screening or assessing the cognitive status of elders is useful in
establishing treatment plans based on the ability to function, determining the type and extent of assistance needed, and addressing safety issues.
Symptoms can arise in response to
events or conditions in the environement
The best activities are those that will enable the person to handle the
everyday demands of life
What does ext. mean?
extension
What does ER mean?
external rotation
examples of poor social skills are:
failure to make eye contact failure to respond to questions speaking too loudly standing too close making bizarre statements failure to read others body language/ behavior
Reactive attachment disorder can lead to
failure to thrive
Medical emergencies include:
fainting; seizures; minor cuts, burns, and contusions; serious wounds; fractures; poisoning; choking; cardiac arrest; and strokes
T/F Pt with psychiatric disorders of childhood grow out of it and usually do not suffer into adulthood
false- disorders of childhood are at increased risk for mental illness throughout life
T/F The experience of flow is restricted to leisure activities.
false- many find their greatest experience of flow in work
T/F Generalization and evaluation in psychoeducation should be stated as a goal
false- post program should be included since they are not in the goals p. 73
T/F major brain disorders such as schizophrenia, Affective disorder, ADHD, are caused by upbringing
false- they are biological and not caused by upbringing
T/F An OTA can evaluate an person's cognitive ability
false-must be done by OT but OTA can help perform some parts
Public policy develops from legislation at the
federal and state levels and represents society's values.
What does flex. mean?
flexion
The knee is a uniaxial joint which means it can only do two movements which are:
flexion extension
Many problems of people with psychiatric disorders are caused by deficits in skills needed
for living
Practicing a skill in a variety of situation helps the client see that what works in one situation can work in others- this is called
generalization
The ability to recognize what behavior is appropriate or not for a given situation is called
generalization
Differentiating between normal alterations in cognition and abnormal changes in cognitive function is crucial in
geriatric rehabilitation.
Even though it is possible and sometimes necessary to counsel clients individually, ________ is probably more effective because members can get ideas and support from each other
group counseling
The ability to participate effectively in the occupations of ones choice is affected by
habits and roles, communications skills and in particular by the ability to assert and express oneself
Positive symptoms of schizophrenia
hallucinations delusions disorganized speech and behavior
Programmed aging
he genetic "clock" Cells may lose the ability to replicate. Segments of DNA become depleted with advancing age. 75% of variation in lifespan can be explained by nongenetic factors
The person may feel hopeless because
he or she seems to have no control over the anxiety
What occurs in the temporal lobe of the brain?
hearing, memory processes (both short and long-term)
What is another name for a uniaxial joint and where are two place this type of joint are located in the body.
hinge joint, elbow and knee.
The Elderly may be seen at
home, in assisted-living facilities, or in inpatient programs.
Activities suitable for sensory integration- balance
hopping skipping standing on one foot bicycle cross county skiing rollar skating
What does horiz. ab mean?
horizontal abduction
what does horiz. add. mean?
horizontal adduction
Medicare Part A =
hospital insurance
Grading independence and self-direction
how much the client must rely on the OT practitioner or other people for help activity begins an activity which the client require instruction from the therapist initiate discussion of what the client is able to do without assistance allow for increase mastery with practice complex enough that activity include opportunities to develop new skills and to make multiple decisions
Human action in the environment is called
human occupation
Name boney landmarks of the elbow and forearm.
humerus Lateral and Medial epicondyles of the humerus Olecranon process of the Ulna Radial head Ulna Radius Radial and Ulnar Styloid processes
The major landmarks of the pelvis are:
iliac crest posterior superior iliac Acetabulm (socket for hip joint)
Abstract thinkers deal with new information through ?
imagination.
The practice of giving feedback right after the event it relates
immediacy
Adaptive skills are acquired
in a series of stages that follows a developmental sequence
Almost every aspect of our sensory systems experiences a change
in functioning with age.
Helplessness, anger, or depression can arise
in mental healthcare workers. Despite hard work, some patients still do not achieve wellness, or may even deteriorate. Students may become overwhelmed by the number of people with mental health needs or by the severity of a particular patient's illness. Students may become frustrated with patients who seem to sabotage their own success. Healthcare providers may themselves need therapy to manage these difficult, overwhelming feelings.
Elders with chemosensory impairments report changes
in mood and functional impairments.
Consider developing monthly, weekly, and daily schedules
in order to keep both large and small goals within reach.
Although instruction/education occurs in groups, each student has an
individualized educational plan and objectives
Allen level six
individuals can understand abstract ideas Written directions and diagrams can be used and demonstrations may be required Possible range of activities is unlimited
Reduction in sweat glands leads to
inefficient temperature regulation; loss of fatty tissue increases the risk of heat stroke in the aged.
The components of a normal gait Swing phase are:
initial swing, midswing, terminal swing
The changing face of the health care economy demands
innovative and progressive responses from individuals. OTs and COTAs must be strong advocates for their profession and the clients that benefit from OT intervention by adjusting to change and adapting to new ways to deliver intervention.
External continuity
interacting with familiar people. Using this theory, elders would be kept in their primary residences as long as possible.
What does IR mean?
internal rotation
Consist of all processes or relationships among individuals that result in a change in behavior, knowledge or attitude
interpersonal learning
What does the parietal lobe do?
interprets sensory perception
Depression
is a lasting feeling of sadness or hopelessness that interferes with life
T cells and B cells have a diminished ability to respond to the threat of foreign bodies; risk of acquiring infections
is increased.
Sensory intergration
is the smooth working together of all the senses to provide information needed for accurate perception and motor action
Purpose of evaluation
is to identify client goals and abilities in key areas: Activities of daily living (ADLs) Education Work Play and leisure Social participation
The health care industry has become fragmented. Current trend, especially for elders,
is toward comprehensive, cost-effective health care.
Diabetes is the leading cause of
kidney failure, nontraumatic lower extremity amputations, and new cases of blindness each year among U.S. adults aged 20-74 years.
Role acquisition is based at least in part on the idea that all behavior is
learned
Behavioral approach has been used in OT with the developmentally disabled and cognitivelyy impaired, it focuses on
learning as a consequence of external rewards
What methods may OT use for Psychoeducational application?
lecturing, guiding role playing, discussions, social modeling,use of films, group exercises, simulation or real life experiences,designing & providing feedback for homework assignments, creating & assessing pre and post-testing
Self-actualization is gratified through individuals chosen
leisure, expressive and value driven activities
the psychoeducational model can be used to address what areas of dysfunction?
life skills and role acquisition
The personal experience of living and doing through a particular human body
lived body
Care:
long-term mental health assistance for patients who require continued supervision
The completion of group allows members to reflect on their activity and .
look ahead to future groups
Maslow's hierarchy of needs
lower levels must be met first Low to high Physiological needs Safety needs Love and Belongingness needs Esteem needs Self-actualization needs
Factors to consider for attention span
make the task meaningful client should be capable of doing an activity that requires constant attention over time - should not be a short activity such as making coffee -should not be an activity that is approached casually su ch as knitting and other crafts
Aging has suppressant effect on vaccines;
makes them less effective.
What are the boney landmarks of the sternum?
manubrium, body of the sterum, xiphod process
How does the sagittal plane divide the body?
medially and laterally (left and right)
Service:
mental health assistance that is managed and controlled by the client
Comorbidity in substance abuse
mental ill substance abusers 35-60 % of abusers have other mental illness
Most adolescent impaiteint services use _____
milieu therapy- attempts to give pt as much responsibly as they can handle and enable them to take charge of their own bad decisions and day to day environement
A single incident of disturbed mood
mood episode
Why would an end-feel be firm?
muscular stretch, capsular stretch, Ligamentous stretch
Activities suitable for sensory integration-Spontaneity of movement
non predictable activities chance follow the leader surprise
Access to Medical Records
nother common myth is that physicians are being denied access to their patients' medical records on the grounds that the patient has not authorized the disclosure. In other instances, physicians are being denied access to laboratory test results performed for their patients without a patient's authorization. Under HIPAA, a patient's medical record and lab test results are necessary for the physician and other members of the healthcare team to render healthcare. The use and disclosure of this health information would be from one covered entity to another (hospital to physician or laboratory to physician) for the purpose of providing treatment. As such, absolutely no authorization from the patient is needed. Conversely, many physicians are refusing to treat patients unless the patients sign a consent permitting the physician to use and disclose their health information. HIPAA as adopted in its final form does not require any such consent, and, in fact, HIPAA precludes providers from conditioning treatment on the signing of such a consent. HIPAA does not require children to sign releases before their parents or guardians are permitted to have access to their medical records. In a town in Georgia, a social worker wrote an editorial in the local paper that gave this erroneous information, which caused quite a stir in that town. In fact, HIPAA defers to state law when it comes to a parent's or guardian's access to a minor's healthcare information. HIPAA does not supercede or preempt state law governing minors. That means in most states, and in most instances, parents or guardians can access the medical records of minor children without the minor's permission.
origin and insertion bones for trapezius - upper
o: head, vertebrae i: acromion process
origin and insertion for middle trapezius
o: thoracic vertebrae I: scapula
The work of the adult centers on the occupational role selected through the process of
occupational choice
Aging marked by physiological, cognitive, and psychosocial changes that impact a person's
occupational performance and quality of life.
Transference
occurs when a patient relates to the therapist as if he/she were another person of importance Make conscious effort to observe patient behavior related to the transference
Countertransference
occurs when the therapist assumes the role transferred onto him or her. . Speak to a supervisor or mentor about the countertransference role and seek guidance.
Leaders assign official roles, and must be aware
of how these role designations will affect the individual and the group dynamic.
The framework is used by OTs as a way
of organizing and substantiating their work.
If new members are present or group meets infrequently, introductions can foster a sense
of welcoming.
+/- 25% of adults 50 years and older experience impaired
olfaction.
Where are the flexors of the forearm and wrist located?
on the anterior side of the forearm and wrist
Because MOHO is an ______ system, the system of human occupation is vulnerable the effects from the human and nonhuman environment, which may damage or impair the function of any subsystem
open
Activities suitable for sensory integration-abnormal adduction, flexion, and internal rotation
opposite motions are needed parachute lifted over the head shaking out bedclothes throwing a beach ball
Actions can be regarded as either assets
or deficits depending on context
What are the origin and insertion of the Biceps Brachii?
origins: coracoid process of scapula and supraglenoid tubercle Insertion: Radial tuberosity of the radius and bicipital aponeurosis
Degenerative changes in the joints are frequently caused by
osteoarthritis (OA), a condition that affects about 50% of the population 65 years and older. .
People learn to do things by imitating
other people
which social skill group category? complementing, expressing interest
other-enhancing skills
Where mental illness pt seek treatment
outpatient hospitals community health centers
Medicare Part D
outpatient prescription drug coverage
Adolescents may be seen in school, in
outpatient programs, or in inpatient settings.
Where are cells of the PNS located
outside of the CNS
Drug side effects and recommended OT treatment
p. 228-229
Repeated and unexpected panic attacks characterized by such symptoms as shortness of breath, racing pulse, dizziness nausa
panic disorders
The ability to work and play in the presence of others, comfortably and with the awareness of their presence
parallel level
Avoid a protective attitude that prevents elders from active
participation in their care and decisions
What can Goniometry determine
particular joint position and total ROM
Epithelial barriers of the skin, lungs, and digestive tract break down; makes us more susceptible to
pathogens.
The Sacral plexus overlaps the lumbar plexus and its roots are L4-S4. What does this plexus innervate?
pelvis, buttocks, perineum, and contributes to innervation of LE's
Obesity has become a major health concern for
people of all ages. 1 in every 3 adults and nearly 1 in every 5 young people aged 6-19 are obese.
Allen Level five
perform most activities that can be demonstrated can include up to 3 steps at a time aware of space and depth and the relation between objects verbal directions can include prepositions and terms about spatial relationship all hand tools new learning may be self initiated
The individual sense of his or her own competence and ability to be effective
personal causation
Environment variable
physical space- classroom, hospital room, outdoors; as well as occupants of the space ( other pts)
Explain and the importance of testing positions.
place the joint in a starting position of 0, permit complete ROM, provide stabilization for the proximal joint segment.
This is to measure the extent to which students actually learn and apply everyday environments the skills taught in the psychoeducation course
post program test or post test
Where are the Flexors of the ankle and foot?
posterior aspect of ankle and foot
Where are the elbow extensors located?
posterior of humerus and ulna
Where are the extrinsic muscles of the forearm and wrist located?
posterior side of forearm and wrist
Where are the intrinsic muscles of the hand located?
posterior surface of the forearm
The third stage in skills-training, in which the person attempts the target behavior and repeats it until he or she become comfortablle
practice
which social skill training phase: where client is asked to rehearse and talk throughout the behavior
practice
Mastery needs are best met through experiences that permit
practices, repetitions and experimentations
Consumers want simplified access to a range of services with
predictable costs.
Occupation is a _______________ to health.
prerequisite
Choose goals and activities that provide a realistic challenge but are consistent with the client's
present level of ability
Antigroup ( Egocentric) roles- Special interest pleader-
pretends to speak on behalf of a particular group
checklist, questionnaires, discussions are examples of which principle of Role Acquisition
principle 1 : client participation
OTA demonstrates confidence in a group on confidence. learn from positive role models. these are examples of which principle of Role Acquisition?
principle 10: imitation - people learn how to do things by imitating others
interest check list, family member, medical record are examples of which principle of Role Acquisition?
principle 2 :personalized goals
explain the purpose of the activity presented and how it is related to the clients goals and current needs are examples of which principle of Role Acquisition?
principle 3: ability based goals
increase demands as skill level increases is example of which principle of Role Acquisition?
principle 4: increasing challenge
client is unable to tolerate social skills training in a group, you provide social skill training one on one, then move the client to a social skills group. which principle of role acquisition is this?
principle 5: Natural Progression
role playing a social situation and the goals of being able to go out to the movies w/o having anxiety about interaction with others which principle of role acquisition is this?
principle 6 : Client Knowledge - client know what they are suppose to be learning and why they are learning it
provide feedback on clients performance and how they can continue to make improvements is example of which principle of Role Acquisition?
principle 7 : Client awareness - client is aware of impact and effects of their actions
OTAs may encounter the homeless in various settings:
prisons, emergency shelters, nonprofit outreach organizations.
What are the names of the two Pronator muscles of the elbow and radioulnar joints
pronator quadratus pronator terres
Medicare Part A Therapy is reimbursed under a
prospective payment system (PPS).
what population is most affected by lack of appropriate social skills?
psychiatric population
Once the decision is made, the adolescent begins to work towards it ( ex enrolling in a training program or looking for a job), this begins the
realistic period
the creation (again) of laboring capacity
recreaction
Define Goniometry
refers to the measurements of angles of human joints by the bones of the body. It
Although there is no magic formula or minimum weekly requirement that we can apply equally to all individuals,, it appears that each person should spend enough time
relaxing to feel restored and refreshed and able to work again
Changes that occur through childhood and young adulthood are the
result of maturation and development rather than aging. -Others caution against the differentiation because of its implications as to the perceived potential of older individuals to continue to grow and develop throughout the lifespan.
A feeling that one's role are in conflict
role conflict
Internalized images and sets of direction that belong in a given role
role script
A feeling that one cannot meet expectations of one's role
role stress
What axis does the frontal plane revolve around?
sagittal axis which divides the body into medial and lateral halves
Position and goni alignment for forearm supination:
seated Fulcrum: medially and just proximally to the ulnar styloid process proximal arm: parallel to the anterior midline of the humerus distal arm: across ventral aspect of the forearm, just proximal to the styloid processes at the least bulky part. The distal arm of the goniometer should be parallel to the styloid processes of the radius and ulna
Positioning and goni alignment for forearm pronation
seated fulcrum: laterally and proximally to ulnar styloid process proximal arm: parallel to anterior midline of humerus distal arm: across dorsal aspect of forearm at least dense area just proximal to styloid processes of radius and ulna. the distal arm should should be parallel to the styloid processes of the radius and ulna
positioning and goni alignment for Horiz AB.
seated fulcrum: on superior anterior portion of acromion process proximal arm ?????? get rest later
Body position to test shoulder complex flexion.
seated on edge of chair
Positioning and goni alignment for elbow flexion.
seated on edge of chair fulcrum: over lateral epicondyle proximal arm: with lateral midline of the humerus, using center of acromion process as ref distal arm: lateral midline of the radius, using radial head and radial styloid process for ref
position and goni alignment for wrist extension.
seated with arm resting on surface, 90 shoulder abduction, 90 elbow flexion, hand hanging over edge of surface fulcrum: lateral aspect of the wrist over the triquetrum Proximal arm: with the lateral midline of the ulna, using the olecranon and ulnar styloid process for ref distal arm: lateral midline of the 5th metacarpal
positioning and goni alignment for wrist flexion.
seated, arm resting on supporting surface with should abducted to 90 and elbow flexed to 90 with hand hanging over the edge fulcrum: on the lateral aspect of the wrist over the triquetrum proximal arm: with the lateral midline of the ulna, using the olecranon and ulnar styloid processes for ref. distal arm: lateral midline of the 5th metacarpal
positioning and goni placement for wrist radial deviation.
seated, shoulder AB 90, elbow Flex 90, palm flat on surface fulcrum: dorsal aspect of the wrist over the capitate proximal arm: with the dorsal midline of the forearm with lateral epicondyle as reference if arm is lying down distal arm: with dorsal midline of the 3rd metacarpal
positioning and goni alignment for wrist ulnar deviation.
seated, shoulder AB 90, elbow flex 90, palm flat on surface fulcrum: dorsal aspect of the wrist over the capitate proximal arm: align with dorsal midline of the forearm, use the lateral epicondyle as ref if arm postioned at shoulder AB 90 and elbow flex 90. distal arm: with dorsal midline of the 3rd metacarpal
Biochemical, structural, and metabolic alterations effect
sensory and motor function, coordination, reaction time, gait, and proprioception.
activities that provide increased vestibular, tactile and proprioceptive input would be used for which OT practice model?
sensory integration
Value Systems
separates wrong and good from evil.
Identifying the day's activity and goal can give the group a sense of
shared direction.
What action does the Coracobrachialis help the shoulder joint with?
shoulder flexion
The five senses that are commonly recognized
sight hearing taste smell touch
All skills are developed in predictable direction from
simple and complex
Body positioning for shoulder complex extension and goniometric alignment
sitting on edge of chair Fulcrum: over lateral aspect of greater tubercle Proximal arm: parallel to the midaxillary line of the thorax distal arm: lateral midline of the humerus with lateral epicondyle as reference
Stigma is
social disapproval. Many in the general population look down on those with mental illness. Mental health patients are aware of this stigma. Never shun or shame a patient. Remember that patients are people first. Be honest about feelings toward the mentally ill; share those feelings with a supervisor or a trusted colleague. Move beyond the feeling that the mentally ill are "others."
Family members are respected, treated as collaborator in intervention planning
social layer
Sensory changes can negatively impact
social participation, occupational engagement, physical health, and overall quality of life.
identifiable, learned behaviors that individuals use in interpersonal situations to obtain or to maintain reinforcement from their environment
social skills
which model refers to teaching of interpersonal skills needed to relate to others?
social skills training
Expected normal end-feel of elbow and forearm
soft
How do soft and hard end-feels differ?
soft - soft tissue not allowing more joint movement hard - bones not allowing for more moint movement
Why would an end-feel be soft?
soft tissue approximation.
What is osteokinematics?
specific joint motion occurring at a joint such as flexion, abduction, etc.
OTAs can interpret symptoms as requests for
specific services or assistance
What are the boney landmarks of the clavicle?
sternal end, acromial end
What are the two main joints of the shoulder girdle?
sternoclavicular acromioclavicular
Activities suitable for sensory integration-Posture
straighten the back lifting the head- holding a parachute throwing a ball in the air
Structural and physiologicl changes in muscles contribute to a loss in
strength.
What is the positioning and goni alignment for shoulder complex lateral (external) rotation?
supine fulcrum: over the olecranon proximal arm: either parallel or perpendicular to the floor distal arm: align with ulna, using olecranon and ulnar styloid for ref.
Positioning and goniometric alignment for shoulder complex ABduction
supine Fulcrum: close to anterior aspect of the acromial process Proximal arm: parallel to the midline of the anterior aspect of the sternum Distal arm: anterior midline of the humerus with medial epicondyle for reference
Medications can make aging skin
susceptible to the effects of sun exposure, more prone to bleed, and less able to heal
OTAs can encourage positive leisure-time activities by:
taking a leisure evaluation involving a client in group leisure activities guiding client to explore whether or not he/she enjoyed the activity, and why
The new behavior to be learned in the immediate treatment situation
target behavior
The directions of the task are reduce from one to two steps
task layer
Approaches to mania- Activities
task that permit movement are ideal
The process that began in the fantasy period of childhood enters a new stage, known as
tentative period
Define Plane
the 3D space body movements occur in
What area of the body is innervated by the brachial plexus?
the UE
Children may recognize
the absence of nurture from the ill parent. They may take on the role of custodian, even at a young age.
Where do the cranial nerves exit the brain?
the brainstem
Depressive Disorders-are distinguished from the Bipolar Episodes by
the fact that there is no history of ever having had a Manic, Mixed or Hypomanic Episode.
What does "end feels" mean
the feel at the end of a joint once it has moved as far as it is able
Caregivers can easily become overwhelmed and may benefit from
the guidance, support, and advice of the OTA.
Children with psychotic disorders may be in
the home or hospitalized.
Define Role Acquisition
the learning of all daily life, work, leisure skills that enable one to participate in social and productive roles
What is arthrokinematics?
the movement of bone surfaces within a joint
A synapse is:
the place where neurons join to form a junction and it serves as a pathway for information
What is action potential and what is its purpose?
the transmission of electrical impulses that enables the nerve to transmit messages for movement or other functions to occur within the body.
Wrap-up discussions let members share
their feelings and discoveries made during group.
When making health care decisions, some clients make ___?
their own decisions, others need the collective consensus of a group (family or extended community).
According to Kelly social skills are
those identifiable, learned behaviors that individuals use in interpersonal situations to obtain or maintain reinforcement from the environment
Assertiveness is taught in
through structured set of exercises defining assertiveness help client identify own assertiveness next obstacles to it are identify and tackled strategies are taught and practiced in hypothetical roles
What is the name of the main ankle joint?
tibiotalar
Factors to considered before using any crafts as leisure
time money traditional sexual orientation of the craft level of expertise required in manual and cognitive skkils likelihood of success manual dexterity
Rates are paid based on
time, case, or episode patient classification systems:
What is the purpose of descending, motor nerves
to carry efferent impulses to the periphery of the body.
What is the purpose of cranial nerves?
to carry impulses to and from the brain
What is the purpose of spinal nerves?
to carry impulses to and from the spinal cord
Secondary symptoms to anxiety
to lesson anxiety- pt may act out or withdraw
The purpose of the sodium potassium pump is:
to maintain the resting membrane potential of a cell
A well-developed schedule will keep you on task and will allow others
to predict when you will be available to assist them.
Develop intervention according
to resident needs relative to complexity and intensity of required intervention. Intervention plans should be based on function and must integrate the plan of care. Intervention should be reinforced by other disciplines, such as skilled nursing. Resident's prior level of function, mobility, and safety in addition to self-care deficits must be reflected in assessments.
Mindfulness practices are another avenue
to self-control
What is the main function of a neuron
to transmit signals or impulses through the body for regulating movement, organ function and sensory information
Pay particular attention to the beginning and completion of each group session, as these set the?
tone for present and future group sessions.
Name specialized function of the nervous tissue.
transmission of afferent and efferent impulses.
Changes can preclude prompt intervention and
treatment.
Parents often feel
tremendous guilt and responsibility for their child's mental illness
The GH joint is the same type of joint as the hip joint which is:
triaxial
The hip joint is the same type of joint as the shoulder GH joint. What type of joint is this?
triaxial
T/F A program to help someone to improve the ability to make decision must include opportunities to face real choice
true
T/F improvements gained in Sensory integration treatment are permanent because they involve a change in the CNS
true
Impairments in olfaction may also be a source of
uncertainty or vulnerability.
PPS rates are based on anticipated resource
usage; rates are fixed
OT for anxiety disorders usually involve learning to recognize and
use activities that are relaxing
Diagnostic Related Groups (DRGs)
used in inpatient hospitals
Resource Utilization Groups (RUGs)
used in skilled nursing facilities
OT approaches to Personality disorders
vary widely and must be tailored to specific needs and goals of the pt
Dependence occurs
when a patient is reliant on the therapist for any reason. Detrimental: Excessive dependence on the therapist. Patient is capable of doing more, but is overreliant on therapist to overcome challenges. Constructive: Dependent on therapist only for things the patient truly cannot manage. Self: Synonymous with independence. Can become problematic if patients overestimate their abilities to be self-reliant.
when does sensory dysfunction occur?
when person is unable to properly process sensory information , which results in inappropriate adaptive response.
The Medicare Act,
which resulted in a national health insurance plan for elders, was enacted in 1965.
Maintaining good intellectual functioning has been associated
with good health and good sensory function.
Some argue that aging begins at 30 years
with onset of decrements in physiological function and efficiency.
Aging is inherent in the individual and occurs
within biological and genetic parameters.
The adult spends many hours in ______, leaving little time for _____
work play
What movements occur in the forearm and wrist?
wrist flexion/extension ulnar deviation(adduction) radial deviation (abduction) supination (forearm) pronation (forearm)
Rheumatoid arthritis (RA) is a progressive autoimmune disease with onset in
young adulthood or midlife
Avoid treating elders like children
—they are not.
African American
• Most African Americans believe that God has a great influence over health. Traditional concepts of health, rooted in African Beliefs, emphasize harmony (with the social and natural worlds) and do not distinguish between mind, body and spirit. • Children may avoid direct eye contact with adults out of respect • In traditional Black culture, family bonds and respect for elders are extremely important • Close family friends may be referred to as cousin, sister, brother, aunt and uncle despite actual familial relation and be considered extended family support may be through friends • Large numbers of family members & friends may gather to support the patient • The Black female has become the head of household in many families Important to take the time to explain diagnoses, sickness, and treatments as fully as possible. • The cultural value placed on being "strong" may hinder some African Americans from seeking mental health services • Many African Americans have a strong sense of obligation to gather at the time of death. Family members will often gather for a prayer vigil to assist the dying person to transition into the next life. The terms "transition", "passing" or "passed away "are typically used to describe death. • Among deeply religious African Americans, discussing end-of-life issues can be seen as inappropriate or bad luck. Due to a strong belief that God controls life and death, many African Americans do not have existing healthcare directives (older generation). • More likely than other groups to report depression and other psychological disorders as a physical problem; common complaints include: headache, abdominal pain, muscle pain, neck and lower back and fatigue. Likely to say "I have bad nerves"
Development of adaptive skills model, Expected Outcome
•Short term goal- learn skill components •Long term goal- Pt. will participate fully in social roles and environment.