Pass the OT Module 2 Test

An OTA is working with a 9-year-old boy who is relearning how to move his right arm following a head injury. The boy watches the OTA demonstrate the next exercise and immediately exclaims "I can't do that!" He appears to be nervous. The OTA responds to the boy's comment with a reflective response. Which response listed is a reflective response?

"New exercises can be scary because you don't know what's going to happen" [Reflective listening includes:Listen actively: Turn toward the child, sit or kneel at his level or hold him, and look directly at him.Listen for expressions of feeling: Words such as "scared," "happy," "excited," "sad," and "afraid." Try to identify and understand feelings rather than just words or facts.Reflect back: Restate the feelings the child has expressed and try to state the probable reason ("because") behind the feelings.]

What treatment techniques would you expect to utilize with a 7-year-old girl who has a diagnosis of autism spectrum disorder? (Select the 3 best choices).

1. Jumping or animal walks for proprioceptive input 2. Swinging for vestibular input 3. Use of a "first/then" schedule to encourage participation in classroom work [Treatment techniques that are used to treat children with autism include sensory integrative techniques, such as swinging or animal walks to provide specific types of sensory input, and visual structure to help compensate for deficits in other sensory areas, such as visual schedules and timers. Exposure to flashing lights or loud noises would likely exacerbate the girl's sensory dysfunction in visual or auditory processing, rather than help to provide appropriate input. These techniques are also likely to cause the girl discomfort and distress.]

Felisha is a normally developing 8-year-old girl. What skills would you expect to observe as Felisha participates in her daily activities? (Select the 3 best choices).

1. Mature grasp on pencils and crayons 2. Ties her own shoes 3. Rides a bicycle [Typical childhood milestones for an 8-year- old include a mature grasp on writing and drawing tools, the ability to tie shoes, the ability to ride a bicycle, and the ability to use a telephone to make a simple phone call to parents at home. The girl is too young to have reached the milestones of doing her own laundry or caring for a pet by herself.]

A COTA® works in a school-based setting with general supervision from an OTR® and has received training in the administration of certain standardized tests from the OTR®. The OTR® will periodically ask the COTA® to administer portions of these tests to students who have been referred for an occupational therapy evaluation or re-evaluation. Which tests would be appropriate for the COTA® to administer under this arrangement? (Select the 3 best choices).

1. Peabody Developmental Motor Scales 2. Bruininks-Oseretsky Test of Motor Proficiency 3. Motor-Free Visual Perception Test [The COTA® would be allowed to administer portions of tests that are standardized and have specific, objective instructions. The Peabody Developmental Motor Scales, Bruininks-Oseretsky Test of Motor Proficiency, and the Motor-Free Visual Perception Test. The Sensory Profile is a questionnaire style test that parents complete and the Transdisciplinary Play-Based Assessment is a non-standardized assessment that utilizes team observations, so these two tests do not meet the criteria.]

A 3-year-old boy is beginning school-based occupational therapy after transferring out of the local birth-to-three program. He has a diagnosis of Down syndrome. What characteristics would you expect to observe when you meet this boy? (Select the 3 best choices).

1. Poor fine motor skills 2. Difficulty with oral motor skills during eating 3. Low muscle tone [All children born with Down's syndrome have some degree of learning disability and delayed development, but this varies widely between individual children. The American Academy of Orthopedic Surgeons lists a number of issues affecting the muscles, bones, and joints of children with Down syndrome. The most common characteristics of Down's Syndrome include low muscle tone with resulting in joint hyper-mobility, poor oral motor skills with impaired lip closure and a strong tongue-thrust, poor core strength with impaired postural control,impaired balance, poor fine motor skills, and deficits in visual tracking and visual perceptual skills.]

What are some of the most common suspected causes of spina bifida? (Select the 3 best choices).

1. Poor maternal nutritional intake 2. Environmental factors, such as exposure to harmful substances 3. Insufficient intake of folic acid during pregnancy [his condition is not caused by trauma or injury during pregnancy or the birth process, or maternal age.The exact cause of spina bifida remains a mystery. No one knows what disrupts complete closure of the neural tube, causing this malformation to develop. Scientists suspect the factors that cause spina bifida are multiple: genetic, nutritional, and environmental factors all play a role. Research studies indicate that insufficient intake of folic acid—a common B vitamin—in the mother's diet is a key factor in causing spina bifida and other neural tube defects.]

Justin is a 9-month-old boy who is developing normally according to his pediatrician. What characteristics would you expect to see as Justin plays? (Select the 3 best choices}

1. Reciprocal creeping 2. Equilibrium reactions 3. Sitting without support while rotating upper body [A 9-month-old typically demonstrates equilibrium reactions while sitting, as well as the ability to sit without support while rotating the upper body, reciprocal creeping, and theability to engage in exploratory play. The Moro reflex disappears in normally developing infants by age 6 months. Walking without support does not typically develop before the age of tenmonths.]

A 5-year-old boy is attending an outpatient clinic for therapy services over the summer. He has a diagnosis of spastic quadriplegic cerebral palsy. He uses a manual wheelchair for mobility and wears bilateral neoprene wrist/thumb splints as well as bilateral ankle/foot orthoses. What treatment options would the OTA expect to utilize as she provides services to this boy? (Select the 3 best choices).

1. Review of splint fit and use with the family, including any needed adjustments to prevent pressure areas 2. Neurodevelopmental treatment activities 3. Visual tracking activities [Since the boy is attending an outpatient clinic for therapy services over the summer, treatment is likely to focus on the boy's development, including neurodevelopmental treatment activities and visual tracking activities. Range of motion and splint use and fit are also likely to be addressed. Handwriting and training in the use of assistive technology are activities that the boy participates in at school and would be addressed by the school-based occupational therapist rather than the therapist at the outpatient clinic.]

A 10-year-old boy with a diagnosis of severe hearing impairment receives occupational therapy. What techniques does the COTA® use while working with the boy? (Select the 3 best choices).

1. Sits directly across the table so the boy can see her face and hands 2. Makes eye contact with the boy before giving instructions 3. Signal to the boy to make sure his hearing aid is turned on [To ensure that the boy can understand the COTA® during treatment, she should sit directly across the table from him so that he can see her face and should make eye contact with him before giving instructions so that she knows he is paying attention. She should avoid sitting in an area that is back-lit by a window or bright light, as this can interfere with the boy's ability to see her clearly. She should also signal to the boy to check his hearing aid before the session. The COTA® should speak clearly, but at a normal pace and volume. The boy should be able to understand the COTA® if the COTA® follows these guidelines and should not need instructions to be written.]

Which primitive reflexes would you expect to observe while watching a typically developing 5-month-old infant? (Select the 3 best choices).

1. Suck swallow reflex 2. Palmar reflex 3. Moro reflex [The Galant and Rooting reflexes usually disappear at about age 3 months. The other reflexes tend to be present until 6 to 9 months.]

A 6-year-old girl displays deficits in kinesthesia that are directly affecting her ability to learn how to write letters and numbers. What treatment techniques could be used to address these deficits? (Select the 3 best choices).

1. Write letters in sand with eyes closed 2. Write letters on paper using a weighted pencil 3. Write letters on a wall-mounted chalkboard with chalk [Kinesthesia, also called proprioception, is the ability of a person to feel their body's position in relation to itself. This includes the ability to feel when the body is moving and how much force the body is exerting on objects or other people. Writing letters in the sand with eyes closed, vertical writing on a chalkboard, writing using a weighted pencil, and forming letters with the whole body all utilize kinesthetic activities to address handwriting. Typing is a separate skill from handwriting and it does not engage the same areas of the brain. Covering the pencil shaft with a fuzzy cover is an approach that uses tactile processing rather than kinesthesia.]

A 21-month-old child who is developmentally delayed has achieved the following milestones: using his fingers to eat Cheerios and peas, dipping his spoon into his food, and drinking from a cup. In order to plan the next stage of the child's intervention, what developmental age should the OTA use as a guideline to progress the child's self-feeding skills?

15-18 months [With developmental milestones, remember that there is a range of "average" and many milestones do overlap. In this scenario, the baby is functioning at an age level of 12-14 months. Typically, at this age, a toddler is able to dip their spoon in food, bring the spoon to their mouth, and drink from a cup.]

At what age should transition planning begin for a child receiving birth-to-three services?

2 years, 6 months [IDEA Part C states that transition planning should begin when a child is 2 years, 6 months of age, giving staff 6 months of planning time before birth-to-three services are discontinued at age 3.]

At what age can you expect a typically developing child to stab food with a fork?

24-36 months [Every child progresses differently with self-feeding, which is why there is such an age range regarding utensil use development. The consensus is that by 36 months, a child can use a fork to pierce soft foods and bring it to their mouth.]

An OTA asks a student to complete a three-step task of tracing her hand, coloring it in, and then cutting it out for a Thanksgiving project. At what age can you expect a child to be able to complete this type of task?

5-6 years old [Between the ages of 5-6 years, a child can complete a 3-step visual motor task of tracing her hand, coloring a picture, and cutting.]

By what age can a child use all of the utensils pictured independently?

6 [By age 6 a normally developing child will have acquired all of the skills needed to use the utensils pictured, including the ability to cut food with a knife.]

An OTA works with a child who has low tone in the classroom. The OTA suggests putting a balance disk on top of student's seat to the teacher. The teacher asks the OTA the reason for this. How should the OTA respond to this question?

A balance disk will improve dynamic sitting balance [Also called wiggle seats or move-n-sit cushions, this style of inflatable cushion is used to correct several issues with core stability and movement in classrooms. For a student with low tone, the balance disk would be used to help activate the muscles of the lateral trunk that are responsible for the small movements used to control dynamic sitting balance. The long-term result would be stronger trunk muscles and improved dynamic sitting balance during classroom work time.]

A fourth-grade student with cerebral palsy is unable to use his hands to access his computer keyboard. What assistive technology device could the OTA try with the student first to help him independently access the keyboard?

A head pointer [When using assistive technology devices to adapt an activity, best practice recommends trying the least invasive device first to minimize the amount of change and keep task performance as similar to peers as possible. If the student is able to use a head pointer to type on a regular computer keyboard, he will not require additional equipment or software to type assignments, just some practice in using the pointer and a little extra time to complete assignments. If the student cannot use the pointer or will not use the pointer because it looks different, then the OTA can progress to trying a switch with the student.]

A 10-month-old boy born with Tetra-amelia syndrome (absence of all four limbs) who is developing normally in the areas of his cognition, vision, and visual- perceptual skills is being seen by the OTA. Which type of sensorimotor play should the OTA use for this boy, at this stage of his development?

A mechanical toy with a chin-controlled on/off switch [An adaptive toy will encourage play and will allow the child to control the toy with his chin thus reinforcing cause and effect.]

While an OT is evaluating a 9-month-old infant's oral-motor skills, she observes that the infant is starting to chew bananas. What does this observation indicate?

An OT determines that the child's oral-motor skills are age appropriate [Oral Motor skills and feeding at 3-7 months: By 4 months of age, most infants have gained fair head control and are able to remain in an upright position with support, and parents are beginning to introduce puréed foods. By this time, the anatomical structure of their jaws and tongues have dropped forward to support munching patterns. They also may open their mouth when a spoon is presented and are able to manage thin purees with minimal difficulties.]

An OTA is working with a 5-year-old kindergarten student in the OT clinic of the local school. The student presents with tactile defensive behavior and poorly developed fine motor skill. What is the most appropriate intervention for the OTA to incorporate into this child's OT sessions?

Ask the student to place his hands in a large bowl filled with beans to find small objects that are hidden in the beans [Asking the student to place his hand in a large bowl of beans and grabbing various textured objects will work on fine motor skills.]

While examining a 2-month-old in supine position, an occupational therapist turns her head to the right. This results in extension of the right arm and leg and flexion of the left arm and leg. What are these movements known as?

Asymmetric tonic neck reflex (ATNR) [Refer to "Reflex Chart" in Study Materials. Asymmetric tonic neck reflex refers extension of extremities on the face side and flexion of extremities on the skull side when the infant's head is turned to one side while lying supine.]

At what age must the IEP include documentation addressing the transition from public school to post-secondary education/employment?

By age 16 [IDEA 2004 mandates that the IEP must include documentation addressing transition planning by the age of 16 at the latest. Individual states are allowed to set the age at which transition planning begins earlier, but not later than age 16.]

The persistence of childhood/teen emotional and behavioral problems beyond childhood such as defiant impulsive behavior, drug use, and criminal activity is indicative of what condition?

Conduct Disorder [Conduct disorder is a range of antisocial types of behavior displayed in childhood or adolescence. These behaviors can continue into adulthood and may result in consequences such as drug addiction or arrests for criminal acts.]

Charley is a 24-month-old toddler with hemiplegic cerebral palsy affecting his right side. The OT places a mitt on Charley's left hand while he is playing to encourage him to use his right hand. This is an example of what type of intervention?

Constraint-induced therapy [Also called forced-use therapy, this intervention constrains the normal limb to force the child to use the affected limb.]

A normally developing child sits up on his or her own before progressing to which skill?

Creeping on hands and knees [7-8 months of age]

In the classroom, a student in the 3rd grade has difficulty recognizing details in visual images and recognizing the likeness and differences of shapes/forms, colors and position of objects, people, and printed materials. Several strategies were recommended in the student's IEP, but after 4 months the strategies seem to no longer help the student. What should the OT do next?

Discuss new interventions with the special education teacher to be implemented in the classroom [If the student's progress has plateaued, then it is important to discuss new interventions with the special education teacher to be implemented in the classroom to yield more progress towards the student's goals.]

At a new mother baby group, an OT works with 10 infants between the ages of 7-13 months who have developmental delays. Many of the new mothers want to learn strategies that can promote oral motor development for their baby. After the OT suggests proper positioning in a high chair, what would be the next strategy to recommend?

Encourage hand to mouth patterns by bringing soft textured toys to the infants' mouths

An 8-year-old girl is walking on a balance beam. She shifts her upper trunk and arms in reaction to her steps on the beam in order to keep her balance. What are these movements called?

Equilibrium reactions [These reactions develop after righting reactions and allow children to maintain standing and walking posture.]

A 29-month-old boy swings on his stomach at a park. What muscles are being activated as he goes back and forth in order to achieve stability and balance?

Extensors [Swinging prone has many positive motor, sensory processing and psychological benefits, including:• Motor - different swinging positions can be used to target different muscle groups. Swinging prone strengthens the child's neck and back extensors, as well as his balance reactions.• Sensory processing/integration - swinging primarily targets the vestibular system, proprioception (by applying deep pressure), and gravitational insecurity. It also has an overall calming effect / soothing to overly stimulated senses.• Psychological effects - improves self-esteem and mood.]

A 7-year-old boy has an occupational therapy goal to improve in-hand manipulation skills. What intervention would help this student develop complex rotation?

Flipping a marker using one hand to put the cap on the end. [Flipping a marker using one hand to put the cap on the end. Rotation is the ability to turn an object around in the pads of the fingers and thumb (simple rotation) or turning an object from end-to-end (complex rotation) such as flipping a pencil from writing end to eraser.]

What should a COTA® do after witnessing his patient, an 8-year-old boy, being abused by his parents?

Follow the facility's policies regarding reporting abuse to child protective services

An OT has been requested to work with a 2-year-old boy who has delays in tongue control during feeding. Which of the following will most likely have the most impact?

Food textures [Posture is very important, but the question is about tongue control. If a child has an issue with tongue control, various food textures could be a choke hazard because they don't have the ability to maneuver the food properly within the mouth.]

When working with a child who has a sensory modulation disorder, which piece of equipment would be the best to use when focusing on providing vestibular input?

Hammock [This is the only piece of equipment that provides movement. Participation in movement experiences such as jumping, climbing and swinging games that allow the head to move in different ways will support the development of the vestibular system. Slow rhythmic movements such as rocking in a hammock tends to be calming and soothing whereas fast movements with changes in direction such as roller coasters, dancing, riding a bike along a winding path with bends and turns, tend to beactivating and alerting.The symptoms of SPD vary greatly depending upon the sense that is affected, how that sense is affected, and the severity of the condition. SPD may occur in each sensory system: Visual, Auditory, Tactile, Smell, Taste, Vestibular, Proprioception, Interoception and symptoms may vary depending on subtype.Sensory Modulation Disorder- 3 subtypes1. Sensory Over-Responsive2. Sensory Under-Responsive3. Sensory Craving]

A 4-year-old boy who has a global developmental delay is being seen by an OT for regular intervention. In order to focus on improving this boy's pincer grasp, which activity should the OT recommend for the boy to participate in at home?

Have him pick up small beans one at a time and place them in a bowl [This is a good intervention to promote pincer grasp. Simply placing his hands in a pile of rice or beans is usually used for sensory or dexterity-related development. Neither throwing a ball into a hoop or building towers out of legos requires the boy to use a pincer grasp.]

An OTA is working in a school setting with an 11-year-old girl who presents with a hearing loss. What approach should the OTA use when communicating with this child?

Make sure to have child's attention before speaking [It is best to make sure you have the child's attention before speaking with the child. It is not recommended to speak loudly or exaggerate mouth movements because that may confuse the child. It is recommended that you speak within 3 feet of the child; therefore, sitting 5 feet away may limit the child's ability to hear.]

Mason is a 3-years and 6-month-old boy who has been referred for evaluation to determine if he qualifies for Early Childhood services through his local school district. The OT observes that Mason uses a raking motion to obtain small objects and cannot unbutton buttons. He can build a block tower that falls when he attempts the 4th block. He runs, jumps and climbs on the therapy equipment with supervision. His mother reports that he is learning to use the toilet, but needs help with his clothing. What does the OT conclude based on her observations?

Mason has age-appropriate gross motor skills, but a mild fine motor delay. [By age 3-6, a child should be developing the ability to pick up small objects with tip and palmar prehension. Mason should be using his fingertips to pick up small objects and should be managing his own clothing with supervision when toileting. He should be able to build a 9-block tower. Mason demonstrates skills that are typical for a 2-3-year-old child, so his fine motor delays are mild.]

What reflex is integrated around 4 or 5 months of age when an infant feels that she is falling because she has a sudden loss of support?

Moro reflex [this reflex has three distinct components: spreading out the arms (abduction)retracting the arms (adduction)crying (usually)]

In response to having his head passively turned to one side, an infant turns his whole body to that same side. What reflex causes this response?

Neck-righting [Also referred to as Neck on Body Right Reaction (NOB)Onset age: 4-6 monthsStimulus: Place infant in supine and passively turn head to one side.Response: Body rotates as a whole to align the body with the head- Log rolling of the entire body towards the same side, to maintain alignment with head.Relevance: Maintains head/body alignment; initiates rolling]

A 7-year-old boy who has been diagnosed with a global developmental delay, has been referred for Occupational Therapy intervention. Currently, the child attends OT sessions, twice a week. The focus of today's session is on improving the child's eye-hand coordination and fine motor skills. You have selected to use a pegboard for this session, to achieve your goals, and the activity has been demonstrated to the child. However, when the colored pegs are presented to the child, he picks them all up at once and throws them onto the ground. How could this session be structured differently to help the child participate in this activity?

Only hand the child one peg at a time [It is important to make the environment free from distractions and to only hand him one peg at a time so that he can focus on one task at a time.]

A 5-month-old infant is held up by his adoring grandmother. While admiring him, the grandmother accidentally tilts the infant to one side. The infant's head aligns vertically, even though his body is tilted. What reflex causes this reaction?

Optic righting [Also called labyrinthine, this reflex automatically orients the head to a new optical or visual fixation point, depending on the body position change. The visual fixation point allows the head to correct its position to upright, regardless of the position of the body. This reflex is one of the reflexes the body uses to change positions.]

Todd is a 4 year old boy who is being evaluated for outpatient OT services. Todd was born with hearing impairment, deformities of the arms and legs, and vision abnormalities. Todd's growth rate is slower than his typically developing peers and he has had 5 bone fractures in the past that have required lengthy hospitalizations. Which disorder does Todd most likely have?

Osteogenesis Imperfecta [Osteogenesis Imperfecta (OI) is a group of rare disorders affecting the connective tissue and characterized by extremely fragile bones that break or fracture easily (brittle bones), often without apparent cause. It is the most common heritable disorder of connective tissue. Besides being associated with brittle bones, the following features are also linked to OI: Blue sclerae, dentinogenesis imperfecta (disorder of tooth development), increased joint mobility, short stature, and hearing loss. The visual system is also commonly affected in patients with OI. Ocular and visual pathway problems reported include corneal disorders, glaucoma, retinal detachment, optic neuropathy and others. Four main types of OI have been identified. OI type I is the most common and the mildest form of the disorder. OI type III is characterized by extremely fragile bones, multiple fractures, and malformed bones. Multiple fractures are often present at birth. This is the only disorder which would account for Todd's physical appearance, especially at birth.]

Between the ages of 5-6 years, a child can complete a 3-step visual motor task of tracing her hand, coloring a picture, and cutting.

Palmar supinate grasp [At 9 months, a child will develop an inferior pincer grasp. At 12-18 months a child develops palmar supinate grasp and can hold cookies, crackers, and objects. Can scribble on paper. Finger to palm translation.]

Third grade students in an elementary school eat lunch every Wednesday with the kindergarten through second grade special education students. What approach does this activity reflect?

Peer Mediated Approach [This approach is primarily used with children who have autism spectrum disorder but is also used with any children who have special needs. Normally developing peers are paired with students who have special needs so that those students may model their behaviors after the normally developing peers. The added benefit of this approach is that the normally developing peers gain an understanding and appreciation of who the students with special needs are and the obstacles they must deal with every day.]

Upon observation a 4-year-old boy with Down Syndrome appears to have difficulty walking in a circle and crawling through a tunnel. What treatment intervention would be best in order to help the boy with motor planning and gross motor coordination?

Playing Simon Says [this game will allow the child to work on motor planning and gross motor coordination at the same time. Walking on a balance beam and riding a bike with training wheels both work on gross motor coordination and balance, with less emphasis on motor planning because they use automatic actions. Playing an active board game works on motor planning, but not gross motor skills.]

An OTA is working with a 5-year-old child who has Spina Bifida Meningocele, in an outpatient setting. What is the most appropriate type of intervention for this child?

Playing a game of hopscotch [Children with spina bifida meningocele may have difficulty with instability, therefore, playing a game of hopscotch will offer opportunity to practice balance skills. Refer to "Spina Bifida" in Study Materials Module 2.]

In preparation for feeding a child, what does a COTA® do to prevent tongue-thrust?

Push the tongue down with the spoon [Tongue-thrust is the forward protrusion of the tongue which usually is an indication of improper tongue control and poor bolus control when moving food to the back of the mouth to swallow. Pressing down on the middle of the tongue can help suppress tongue-thrust and improve the child's ability to move food to the back of the mouth.]

A 2.5-year-old child is participating in occupational therapy for prosthetic training. The child's right upper extremity is absent at the proximal forearm level. What would be the most effective activity for the child to participate in first?

Pushing a large therapy ball toward a target with his right upper extremity. [This constitutes a "pre-positioning activity" in which the child practices limb positioning. This stage of pre-prosthetic training will be followed by prehension training, and finally the child will undergo functional training.]

What action should an OTA take when a 2-year-old child with sensory integration issues begins to cry on the floor after her mother leaves the room?

Redirect the child to an enjoyable activity [If the OTA can make sure the treatment session is client centered by involving the child in an activity that she enjoys, the child will most likely forget why she was crying and will participate in the activity. Children demonstrate more motivation to perform tasks during therapy sessions when they are presented with activities that interest them.]

A 5-year-old boy is constantly fiddling with jelly beans and candy canes on the OTA's desk when the OTA is talking to him. The OTA feels that the candy is becoming a distraction and is hindering their session. What should the OTA do next time?

Remove the items from the table [It is likely the student is distracted by all of the candy. It would be best to take the candy off of the table so the student can focus on what the OTA is saying to him during the session.]

A 6-year-old child has difficulty sequencing, maintaining prone extension, and maintaining oculo-motor control. What sensory activity addresses all of these skills?

Rolling down a ramp in prone on a scooter board and knocking over cones [Rolling down a ramp in prone on a scooter board and knocking over cones requires sequencing, maintaining prone extension, and oculo-motor control.]

This reflex is elicited in a newborn baby, when the corner of their mouth is touched or stroked, they automatically turn their head towards that stimulus, and at the same time they make sucking motions with their mouth. What is this reflex called?

Rooting [Rooting. This reflex begins when the corner of the baby's mouth is stroked or touched. The baby will turn his or her head and open his or her mouth to follow and "root" in the direction of the stroking. This helps the baby find the breast or bottle to begin feeding.]

A child with CP is being taught self -feeding skills using a spoon. As the child has a strong tonic bite reflex, what type of spoon is the MOST suitable for the child to use?

Rubber coated spoon [The definition of a tonic bite reflex is a reflexive, sustained jaw closure, accompanied by increased abnormal tone in the jaw muscles, in response to stimulation of the teeth or gums. It is difficult to release, and its force can damage the teeth or an object placed in the mouth.Rubber coated spoons provide a smoother surface than that of a regular stainless steel spoon and will protect the child's teeth from injury. Biting on a plastic spoon, could result in the plastic breaking and would therefore become a choking hazard.]

Ryan is a second-grade student with a diagnosis of seizure disorder with left frontal lobectomy at age 3. He has multiple physical and cognitive impairments. Ryan has just transferred to a new elementary school and his three-year reevaluation to determine eligibility for special education services is due. What assessment would be most useful in helping the IEP team to determine what Ryan's current skills are?

School Function Assessment [This assessment uses a criterion referenced questionnaire to evaluate a student's performance in many different activities and environments that are required in school. The assessment is usually completed using a team approach, as it is difficult for one staff member to evaluate all functional areas. By using this assessment, the IEP team would be able to assess how Ryan functions in all school environments and during most school activities. The Participation Scale is an assessment for students age 15 years or older with physical disabilities, so Ryan is too young for this assessment to apply. The Sensory Profile only assesses sensory processing so not all of Ryan's functional skills would be assessed. The Coping Inventory would assess Ryan's psychological and cognitive skills related to functional activities, but would not assess his physical abilities.]

A 17-month-old child with cognitive and gross motor delay is able to hold a spoon in his dominant hand and bang the spoon on his highchair. What would be the next appropriate activity to introduce to this child?

Scooping applesauce with a spoon [After a child can bang a spoon, the next appropriate activity would be to learn how to scoop food onto the spoon.]

A 3-year-old boy with Autism Spectrum Disorder (ASD) has mastered finger-feeding and drinking with a straw. The OT is working on self-feeding skills with the child, what may be the next appropriate intervention?

Scooping sand with a spoon [The next appropriate milestone based on the child's achievements is using a spoon therefore scooping with a spoon is the best choice.]

Sophia is a 16-year-old student who was initially diagnosed with ADHD at the age of 10. Despite being on prescribed medication, Sophia continues to display ADHD symptoms which are impacting on her school performance and ability to socialize with her peers. Her parents describe Sophia as being a daredevil and thrill seeker. Her teachers report that her behavior is disruptive in the classroom as she is very restless when sitting through a lesson and frequently tips her chair back. In addition, she fidgets and fiddles with anything within her reach and constantly chews on her pen. Based on this information, what behavior is Sophia most likely demonstrating?

Sensory Craving [Sensory CravingThe student is demonstrating a sensory modulation disorder. She is actively seeking/craving sensory stimulation.]

What type of toothbrush would be appropriate for a child with oral hypersensitivity?

Soft sponge-tipped toothette [Children with oral hypersensitivity are usually reluctant to use traditional manual or electric toothbrushes. The soft sponge on the toothette is more comfortable on the gums and not as threatening to children with this condition.Encouraging a child to use a soft sponge-tipped toothette is typically indicated in the child with oral hypersensitivity. We have sensory receptors in our mouths that allow us to recognize information about temperature, texture and taste. Children with healthy oral sensory systems can tolerate eating foods that have mixed textures like cereal and milk, spaghetti and mince or vegetable soup. They manage tooth brushing and visits to the dentist with minimal complaints. Some children struggle with processing and responding to the oral sensory information they encounter in everyday life. They may be over responsive or have increased sensitivity to oral input, causing them to be resistant to oral sensory experiences like trying new foods or brushing their teeth. A soft sponge-tipped toothette, is typically indicated in the child with oral hypersensitivity/defensiveness as the bristles of a regular toothbrush cause discomfort to those with sensory challenges.]

Steven is a 7 year old student with spina bifida. For the most part, Steven is able to walk to and from his classroom and his locker. However, he feels more stable walking outdoors with the use of his crutches. Given his current functional mobility, what type of spina bifida does Steven most likely have?

Spina bifida occulta [Often, individuals with spina bifida occulta do not present with obvious, outer symptoms but can experience slight instability or neuro impairments.]

This medical condition is a type of neural tube defect, where the spinal nerves usually aren't involved and typically there are no signs or symptoms but visible indications can sometimes be seen on the skin above the spinal defect, including an abnormal tuft of hair, or a small dimple or birthmark. What is the specific name of this medical condition?

Spina bifida occulta [Spina bifida, which literally means "cleft spine," is characterized by the incomplete development of the brain, spinal cord, and/or meninges. Occulta is the mildest and most common form in which one or more vertebrae are malformed. It is sometimes called "closed" spina bifida. In most cases, spina bifida occulta causes no problems. The name "occulta," which means "hidden," indicates that a layer of skin covers the malformation or opening in the vertebrae.]

An OT is assigned to work with a 6-year-old student and help him with handwriting adaptations. Currently the student has prone grasp and slight upper extremity weakness. Using the remedial approach, which work surface and position would be most useful in supporting this student?

Standing upright and writing on a chalkboard [In order to work on the student's prone grasp and upper extremities, the OT can have the student stand upright and write on a chalkboard. This will allow the student to raise his hand against gravity.]

An OTA wants to plan a vocational skills group for high school students with severe learning disabilities. The special education teacher informs the OTA that the students have already been taught job-seeking skills. In order to prepare the students for job placements, the OTA needs to expose the students to real-life job tasks, which they are likely to encounter once they are placed in a job. Which activity is the most appropriate for the OTA to plan for the group?

Stocking shelves at a local grocery store [Stocking shelves at a local grocery store. This task would allow the group members to experience an actual job task in the work setting where it is normally completed. The other tasks listed address job-seeking and work readiness.]

Sean is a 7-year-old first grade student with severe physical disabilities. He displays poor head and trunk control on most days. Which positioning device would be best to allow Sean to make eye contact with his peers, facilitating social interaction?

Supine stander [A supine stander will provide Sean with the head and trunk support that he needs to allow him to control his eye gaze. This will improve his ability to make eye contact with his peers. A prone stander would not be as effective due to Sean's poor head control. Prone on wedge will also not be effective due to Sean's poor head control. Side lying would place Sean on the floor, not up at eye level with his peers.]

A child is pretending to be a frog and her friend is pretending to be a prince. What type of play are these children exhibiting?

Symbolic play [Pretend play, also referred to as "fantasy play" is considered to be part of symbolic play. Play is an important element in Piaget's theory. It is a vehicle for the child to understand the world around him as well as an indicator of the child's cognitive development. Piaget determined that play is described in three stages: functional play (sensorimotor) such as an infant grasping a rattle; symbolic play (experience) which adds constructive concepts as well as pretend play activities; and games with rules which build social skills.]

Having a tendency to react negatively or with alarm to touch which is generally considered harmless or non-irritating is defined as: ______

Tactile Defensiveness [Progression of TX for tactile defensiveness: brushing firm consistent touch light moving touch as tolerated.‐ Don't apply: light touch, or light brushing provokes defensiveness.‐ Icing unpredictable results.]

An OT turns on a toy car for a 3-year-old boy. The car vibrates as it rolls. The boy is fascinated by the car but refuses to touch it. What condition does this behavior indicate?

Tactile defensiveness [children who have tactile defensiveness are sensitive to touch sensations and can be easily overwhelmed by, and fearful of, ordinary daily experiences and activities.]

A concerned school crossing guard asks the school OT to evaluate a 6-year-old student who has trouble getting in and out of his mom's car in the morning. How should the OT proceed with this new information?

The OT is unable to treat the student until a referral comes in from the physician

A 4-year-old girl wanders around a sensory integration clinic and begins playing with a bubble maker. The girl pushes the power button, the maker gently vibrates in her hands, and bubbles start to come out. Suddenly, the girl drops the bubble maker on the floor and runs away crying. What can the OT potentially conclude regarding the girl's reaction?

The OT should further assess tactile defensiveness. [Children who have tactile defensiveness are sensitive to touch sensations and can be easily overwhelmed by ordinary daily experiences and activities, such as touching a vibrating toy.]

An 8-year-old girl with Spina Bifida Myelomeningocele ( spinal level L1) has been referred for occupational therapy services to help her gain independence in her BADLs. After an initial evaluation, what ADL task would the OT most likely identify as needing the most remediation?

The OT would identify a need to develop the girl's dressing skills. [Myelomeningocele Spina Bifida (SBM) is the most severe form of spina bifida. The physical impairments in SBM include motor and sensory deficits of the lower limbs leading to difficulties with stance and locomotion, as well as urinary and bowel dysfunction. Upper limb function, as well as lower limb function, is impaired in two thirds of children with SBM. Upper limb motor deficits in SBM include motor weakness and impaired hand and finger dexterity, motor speed, motor planning, and bimanual coordination. This affects development of eye-hand co-ordination which may interfere with activities of daily living (ADLs), such as buttoning a shirt or opening a lunchbox. Difficulties with spatial relations, body image, and development of hand dominance may also be evident. A variety of cognitive impairments in perception and cognitive development have also been documented.Other common symptoms are: - Weakness or paralysis in the lower limbs- Urinary and bowel incontinence - Type 2 Arnold-Chiari malformation- an abnormal brain development involving the cerebellum.

When a 9-year-old boy is asked to write "green eggs and ham" from left to right, the student was able to write it adequately. However, when the same child is asked to write the sentence for a second time, he writes with increased sizing and minimum difficulty with letter formation. What can the OT conclude?

The child has a lack of attention for the task [The OT can conclude that the child has a lack of attention for the task. Since the student was able to complete the task the first time without any problems, the student should be able to complete the task correctly again. The student lacked attention or interest in the task.]

An OT is working with a 12 month old child in the family's home. Currently the child has goals to finger feed independently. In order to create the most effective intervention, what is most important for the OT to consider?

The food is in front of the child [It is important that food is in front of the child when teaching a child to finger feed.]

An OTA is working with a 1-year-old girl at home, as part of an early intervention program. The focus of the session is on self-feeding and the OTA is teaching the child how to finger feed herself "O" shaped cereal. What should the OTA consider as the most important factor when structuring this activity?

The food is placed in front of the child [It is important that food is in front of the child when teaching a child to finger feed.]

An OT has just evaluated an 8-year-old girl who has Spina Bifida Myelomeningocele. The OT has established both short-term and long-term goals to address grooming and dressing. What part of dressing is this girl likely to have the most difficulty completing?

The girl is likely to have the most difficulty with putting on pants [Myelomeningocele Spina Bifida (SBM) is the most severe form of spina bifida. The physical impairments in SBM include motor and sensory deficits of the lower limbs (weakness or paralysis) leading to difficulties with stance and locomotion, as well as urinary and bowel dysfunction.Other common symptoms:- Type 2 Arnold-Chiari malformation- an abnormal brain development involving the cerebellum.]

An OT has just evaluated an 8-year-old girl who has Spina Bifida Myelomeningocele and has established short and long-term goals to address grooming and dressing. What part of dressing is the girl most likely to have the most difficulty with?

The girl is likely to have the most difficulty with putting on pants [The girl is likely to have the most difficulty with dressing her lower extremities due to partial or complete paralysis of the legs as a result of Spina Bifida Myelomeningocele.]

A 5-year-old girl is asked to color a picture of a garden with a tree, sun, flower, and bunny. The OT directs the girl to color the tree green. As the girl begins coloring the tree, the girl picks up the color orange instead of the color green. What can the OT interpret from this?

The girl may have difficulty with visual perception [Visual perception is the ability to see and interpret (analyze and give meaning to) the visual information that surrounds us. The process of "taking in" one's environment is referred to as perception.]

The daughter of a 48-year-old man with a C3 spinal cord injury shows the OT a video that claims a cure for spinal cord injuries. She asks the OT if she should pursue this cure for her father. What should the OT tell the daughter?

There is no cure for spinal cord injury, so the claims on the video are not true. [Current medical science has not yet found a way to reverse spinal cord injury, even though many new treatments are available to compensate for it. The claims on the video may be for a way to compensate for spinal cord injury, but they cannot be for a cure and the OT should inform the daughter of this fact.]

A 4th grade teacher has 3 students diagnosed with ADHD in her classroom. She incorporates movement breaks into her lessons . This strategy is an example of ________?

Tier 1 intervention [Tier 1 intervention includes changes in the classroom that benefit all students, including those considered to be "at risk". Tier 1 intervention is the first step of the Response to Intervention, or RTI, process. RTI Tier 1 interventions are the "first line of defense" for supporting students. Response to Intervention (RTI) was designed to help prevent students from needing special education assistance. Tier 1 instruction is delivered to the whole class.]

What behavioral technique is being demonstrated when a teacher removes a young girl, who has Attention Deficit Disorder, from the classroom to the hall to sit by herself after she throws a temper tantrum?

Time-out is being demonstrated [Time out is a commonly used consequence for problem behavior. The timeout strategy involves removing the child from all sources of positive reinforcement as a consequence of a specified undesired behavior.]

An OTA is implementing a treatment plan which has been designed for a specific child who has been diagnosed with tactile defensiveness. During the session, the OTA rolls the child in a yoga mat. What is the reason for this?

To provide deep pressure and vestibular input [Tactile Defensiveness is a sensory processing issue, where the child's neurological system is "hypersensitive" to light touch sensation. Light touch tends to be alerting and arousing whereas deep tactile pressure is a firm, consistent touch which tends to be calming and organizing. The theory behind inhibition is that because multiple sensations and multiple pathways interact with each other in the CNS, by providing one kind of input, it may reduce/inhibit the sensation of the other.The vestibular and proprioceptive systems are interrelated and have some common functions. The proprioceptive system plays an important regulatory role in sensory processing as proprioceptive input can assist in controlling responses to sensory stimuli. Rolling in a yoga mat provides the child with both proprioceptive and vestibular input. Being encased in the mat, gives constant deep pressure (proprioception) and the act of rolling stimulates the vestibular system.]

An OT is working with a 4-year-old student at a local preschool and notices that the student got in a fight with her best friend and now looks sad and upset. What is the best way for the OT to help this student express herself?

Use hand puppets to tell a story [A student at this age will enjoy sharing a story through a puppet.]

An OT observes a 5th grade student in the classroom and then conducts the Sensory Profile assessment. The OT determines that the student does not pay attention to table-top activities due to hyperactivity. What suggestions can the OT provide?

Ways to balance free time and structure so the student can direct his own actions [A treatment strategy for a child with inattention and hyperactivity should include an environment that provides a balance between structure and freedom so the child can direct his own actions.ADD is the term commonly used to describe symptoms of inattention, distractibility, and poor working memory. With ADHD, the added feature is hyperactivity. Strategies to help students who easily become distracted include physical placement of the student in the classroom, increased movement, and breaking long stretches of work into shorter chunks. Chunk classwork into small manageable steps. Give the student a certain task to complete and then allow the student to choose a preferred activity, preferably one that includes movement.Giving them a 'brain break" can be very beneficial. According to research, brain breaks are simple physical and mental exercises that are designed to restore attention. The theory is that learning through movement increases oxygen into the bloodstream, which leads to improved concentration. Many studies have proven that brain breaks have a positive effect on students' academic performance.]

The parents of an 8 year old boy who is on the autism spectrum disorder have agreed to a goal of improving handwriting and visual motor skills. However, the parents inform the OT in the middle of the school year that they would like to change the boy's goal to be able to swing independently. How should the OT respond?

Work on swinging if it relates to an activity of improving visual motor skills [Work on swinging if it relates to an activity of improving visual motor skills. The parents are not able to change the goals in the middle of the school year. However, the OT can work on swinging if she combines visual motor skills with it.]

Katie, a 15-month-old child who acquired a hypoxic brain injury as a result of complications during childbirth, has been referred to an early intervention program. Katie presents with cortical blindness in the right visual field of both eyes. Which of the following observations reflect the impact that the child's diagnosis has on her gross motor abilities?

[Difficulty climbing over a pile of large foam blocks preferring to climb around [Due to difficulty with visual processing as a result of cortical blindness, the child will demonstrate difficulty with gross motor movements because of fear of movement requiring the need to seek the ground. Therefore, the child may demonstrate poor bilateral integration for reciprocal movements necessary to climb over uneven and unsteady surfaces.]

What is the best recommendation, you can give the parents of a child who is struggling to keep up with their written work at school due to an immature static tripod pencil grasp?

]Practice moving coins from their fingertips to palm and palm back to their fingertips [By improving the child's in-hand manipulation, you will ultimately encourage the use of a functional pencil grasp which facilitates legibility, letter formation, speed and endurance. An efficient pencil grip is one in which the writing tool is controlled only through finger movements. This occurs when the ulnar side of the hand supports the whole hand against the writing surface, allowing the other fingers to hold and move the pencil. Incorporation of finger-to-palm and palm-to-finger translations are in-hand manipulation skills that address the dynamic use of the fingers. These finger movements will help progress the child's static tripod grasp to a dynamic tripod grasp]

A 6-month-old baby who presents with a slight developmental delay is attending an early intervention therapy group. One of the group exercises involves having the parents place their babies on a therapy ball, in a seated position, and gently bouncing their baby up and down. In this scenario, is it safe for this 6-month-old baby to sit on a therapy ball?

]Yes, as long as the baby has good head control and the parent stabilizes the baby properly either at the baby's hips or around their trunk [A baby or child is only safe to sit on a therapy ball if they are stable and their joints are in alignment. Stability can be given to them externally by supporting their bodies with the therapist's/parent's hands. To place a baby in a seated position, it is essential for them to have full head control, as it is impossible to support their head and body at the same time, on such an unstable surface.]