The Process of Occupational Therapy

Cognitive-behavioral groups

- requires intact cognition - contraindicated for dementia patients; too high

Group Leadership Styles

-Directive -Facilitative -Advisory

B192. An adolescent with Duchenne muscular dystrophy refuses to use mobile arm supports (MAS) because "they look so big and stupid." Which action should the OTA take first in response to the client's statement? Answer Choices: A. Collaborate with a rehabilitation engineer to design a more compact device. B. Explore other options with the client to perform activities that do not use the MAS. C. Provide several logical reasons for using the MAS to enhance functional performance. D. Discharge the client and follow up with them after one month to re-assess their interest in the MAS

B. Explore other options with the client to perform activities that do not use the MAS. Rationale: The most effective first action is exploring ways the client can do activities without requiring the use of the MAS. This response is an example of therapeutic use of self and a client-centered approach. Developing a different design for a MAS is a long-term option that may not be feasible. Providing logical reasons for using the MAS is not the best initial response, as it ignores the client's feelings of frustration and is not a client-centered approach. There is no need to discharge the client from treatment. The issue needs to be addressed now, not in one month.

B9. An adult with obsessive-compulsive disorder is hospitalized due to the exacerbation of symptoms. During the patient's first occupational therapy group, which is the most beneficial activity for the OTA to employ with this person? Answer Choices: A. Sanding a cutting board. B. Repotting plants. C. Stringing small beads into a necklace. D. Lacing a wallet with the double cordovan stitch.

B. Repotting plants. Persons with obsessive-compulsive disorders exhibit behaviors that are characterized by orderliness, persever-ance, and driven by a pursuit for perfection. Repotting plants is the activity choice that offers an opportunity to break away from the repetitive behavioral patterns of obsessive-compulsive disorder. The other activities all have elements that could reinforce the repetitive behavioral components of the disorder; that is, sanding back and forth, stringing bead after bead, and lacing the stitch over and over. In addition, these activities could be held to a standard of perfection; that is, a perfectly smooth surface, the perfect bead pattern, a complex stitch with no twists.

A21. The members of a clubhouse attain a level of cohesion that enables them to perform at a cooperative/ supportive cooperative level. Two members disagree with the others on the details of a group project. How should the OTA leading this group respond to this conflic? Answer Choices: A. Listen to all viewpoints and suggest that members vote to determine the project details. B. Mediate only when the members have reached a deadlocked situation. C. Encourage the members to explore alternative methods to resolve the conflict.

C. Encourage the members to explore alternative methods to resolve the conflict. Rationale: In a cooperative/supportive cooperative group, the OTA acts as an advisor. Group members are mutually responsible for giving feedback and meeting group needs. The OTA's interventions should facilitate group problem solving rather than direct the course of actions or decisions. Waiting until a group is deadlocked would not be beneficial to group cohesion.

B29. A young adult recently diagnosed with schizophrenia is referred to an OT day treatment program. Which should the OTA do first with the client? Answer Choices: A. Determine short-term and long-term goals for program participation. B. Model desired behaviors during OT and therapeutic recreation groups. C. Have the person complete an occupational interest inventory. D. Encourage the client to maintain a daily log of medication intake.

C. Have the person complete an occupational interest inventory. Rationale: Upon referral, the first step in the OT process is screening. The OTA can contribute to this process by having the person complete a screening tool. Determining the person's occupational interest can help identify areas equiring further evaluation. One cannot establish short-term and long-term goals with the client until an evaluation is completed. It is unknown if the client has deficits in medication management. Modeling behavor is a component of the intervention process.

Co-leadership

Occurs when there is sharing of group leadership between two or more therapists

Therapeutic use of self

The practitioner's conscious, planned interaction with the individual, family members, significant others, and/or caregivers. The conscious, planned use of one's personality, unique characteristics, perceptions and insights during the therapeutic process

Instrumental groups.

concerned w/ meeting health needs & maintaining function

task-oriented group

purpose/focus: Increase awareness of needs, values, ideas, and feelings and behaviors as they engage in a group task. to improve intra- and inter- psychic functioning by focusing on problems that emerge in the process of choosing, planning, and implementing a group activity. assumptions: activities elicit feelings, thoughts, and behaviors and are the means by which members can explore and experience these thoughts, feeling, and actions. through activities, members can increase their self-awareness and practice new behaviors. type of client: individuals who primary dysfunction is in the cognitive and socioemotional areas due to psychological or physical trauma. clients with fair verbal skills who can interact with others.

Topical Group

purpose/focus: to discuss specific activities that members engage in outside of group to enable them to engage in activities in a more effective, need-satisfying manner a. concurrent-concerned with activities already engaged in outside of group b. anticipatory-concerned with activity that is expected to be done in future assumptions: improvement of ability to engage in specific activities outside of group results from discussion of these activities. type of client: individuals who share similar current or anticipatory problems in functioning members must be at least at an egocentric-cooperative/basic cooperative group skill level.

Parallel groups.

use individual tasks with minimal interaction required

Reality orientation groups

useful for those with early dementia or those with delirium who are confused, or persons who are institutionalized or unable to leave immediate surroundings. May use calendars, clocks, pictures. Reality is reinforced when not in group.

Cooperative/supportive cooperative

- To enable members to engage in a group activity which facilitates the free expression of ideas and feelings - to develop sense of trust, love and belonging, and cohesion - to enable members to identify and meet socioemotional needs leadership role: - act as a non authoritarian advisor, not as a direct leader - leader and members are mutually responsible for giving feedback. identifying and meeting needs, and reinforcing behavior.

Mature Group

- enable members to assume all functional socio-emotional and task roles within a group, - enable members to reinforce behaviors which result in need satisfaction and task completion leadership roles: - acts as a peer, an equal, a group member - members assume all roles, with OT group leader filling in only if and when needed to maintain group - all members satisfy needs and reinforce behavior while maintaining a balance between need satisfaction and task completion,

Parallel Group

- enable members to perform individual tasks in presence of others. - Minimally interact verbally and non-verbal with others. - Develop basic awareness of trust, and comfort with others. leadership role: - provide unconditional positive regard to develop trust - actively fill all leadership functions and meet all members needs - reinforce all behaviors appropriate to group, no matter how small - provide structure - facilitate interaction

Project /Associative Group

- to develop the ability to perform a shared, short-term activity with another member in a comfortable, cooperative manner - To develop interactions beyond those that the activity requires - Enables members to give and seek assistance leadership role: - select and structure activities that can be shared by 2 or more members - fulfill all of members needs while encouraging members to give and seek assistance and interact beyond activity requirements - reinforce cooperation, mild competition, trail-and-error learning, sharing, and interactions

Egocentric-cooperative/basic cooperative

- to enable members to select and implement a long-range activity that requires group interaction to complete. - to develop an understanding of group goals and group interaction norms. - to enable members to identify. and meet the needs of themselves and others (safety, esteem) leadership role: - less of an active, direct leader - facilitate and allow members to fulfill functional leadership roles to function independently - provide guidelines and assistance as needed - reinforce members meeting needs of self and others - serve as a role model

instrumental group

- to help members function at their highest level possible for as long as possible. - meet mental health needs leadership role: - provide unconditional positive regard, support, and structure to create a comfortable, safe environment for patients.

Types of Interventions

1. prevention (primary, secondary, tertiary) 2. meeting health needs (psychophysical, temporal balance, safety, love and acceptance, group association, mastery, esteem, sexual, pleasure, self-actualization. 3. the change process (establish/restore/remediation/restoration) 4. management 5. maintenance

C67. An OTA accepts a job in an after-school program. The program provides services for adolescents at risk for mental health problems due to their history of being survivors of child abuse. The OTA collaborates with the occupational therapist to plan an intervention program. They decide that an activity group to elicit the adolescents' thoughts and feelings in a safe atmosphere would be instrumental to their recovery. Which group would be most relevant for the therapist and OTA to design? Answer Choices: A. A task-oriented group. B. An instrumental group. C. A topical group. D.A thematic group.

A. A task-oriented group. ationale: The purpose of a task-oriented group is to increase members' awareness of feelings, thoughts, needs, values, and behaviors through the process of choosing, planning, and implementing a group activity. Activities are selected for their expressive characteristics so that participants can project their feelings and study their behav-iors. A topical group is a verbal group that focuses on the discussion of activities members are engaged in (concurrent) or will be engaged in (anticipatory) outside of the group. The purpose is to improve activity performance through problem-solving. An instrumental group is designed for individuals with chronic disabilities who are functioning at their highest level with no anticipation for improvement. The aim of this group is to provide a supportive, safe, structured environment that maintains function, prevents regression, and promotes quality of life. A thematic group assists members in acquiring the knowledge, skills, and/or attitudes to perform a specific set of skills independently.

A139. An adult with schizophrenia has been experiencing negative symptoms of restricted emotion, decreased engagement, and a lack of energy. Which group is the best for the OTA to include in the client's intervention plan? Answer Choices: A. An arts and crafts group in which each client works on a self-selected individual project. B. A meal planning and preparation group in which clients works collaboratively with others. C. A stress management group that includes biofeedback and visualization. D.A support group for persons with schizophrenia in which all clients share their stories.

A. An arts and crafts group in which each client works on a self-selected individual project. Rationale: Experiencing negative symptoms associated with schizophrenia can have a significant impact on a person's ability to attain life goals, live independently, maintain a job, and nurture healthy personal and social rela-tionships. Given the person's presenting negative symptoms of restricted emotion, decreased engagement, and a lack of energy, it is best to include the person in a group with minimal expectations to share or socialize with others. According to Mosey's developmental groups, this is called a parallel group. The use of Moseys developmental groups can assist clients in acquiring and developing group interaction skills. An arts and crafts group in which each client works on a self-selected individual project meets the criteria of a parallel group. Enabling a client to choose an individual activity to complete will assist the client in developing a comfort level in the presence of others. Providing the client with a choice of activity and a means to express feelings through media is an effective approach to develop self-efficacy and group interaction skills. The OTA can structure a parallel group to allow graded expression and interactions with others in a safe environment as the client develops trust and comfort in the presence of others. As the client's comfort level increases in social situations, they can work collaboratively on a joint project, share life stories, and offer support to oth-ers. The concentrated focus that is required to effectively engage in biofeedback and visualization would make these approaches difficult for a person with negative symptoms.

A150. An OTA reviews the positioning protocol for a premature infant with severe spastic cerebral palsy with the infant's parents. The protocol is in a written format. During the review, the OTA notices that the parents do not seem able to follow along with the protocol's text. Which action is best for the OTA to take initially in response to this observation? Answer Choices: A. Ask the parents if they have any concerns about positioning their infant. B. Ask the parents if they can read and understand English. C. Include pictures of proper positioning in the protocol. D. Demonstrate proper positioning techniques.

A. Ask the parents if they have any concerns about positioning their infant. Rationale: This is an open-ended question that enables the parents to express any concerns that they may have about positioning their infant. These concerns may be comprehension related and/or task related. The realities of caring for a premature infant with severe physical disabilities can be overwhelming. The parents' perceived difficulties in following the written protocol may be due to emotional stress, not limitations in literacy. The parents may welcome the opportunity to express their concerns. The other choices are close-ended and do no facilitate an open dialogue. If the parents have difficulty understanding English or if they could benefit from pictures and/or demonstrated positions, they can express this in response to the OTA's open invitation to express concerns.

A178. A carpenter recovering from injuries incurred during a fall from a ladder has decreased strength in the triceps, bilaterally. The most recent manual muscle test indicated that the triceps' muscle strength is 3. The OTA provides the client with a tabletop wood project to complete. To develop triceps' muscle strength, how should the OTA position the tabletop when the person sands the project? Answer Choices: A. At a 45-degree incline angled so that the individual's hands are above the elbows when the elbows are flexed. B. At the individual's waist height so that the individual's hands and elbows are on the same plane when the elbows flex. C. At a 45-degree incline angled so that the individual's hands are below the elbows when the elbows are flexed.

A. At a 45-degree incline angled so that the individual's hands are above the elbows when the elbows are flexed. Correct Answer: A.Rationale: This position requires the triceps to perform movement against gravity, which is possible at a muscle strength of 3 (fair). The sanding activity will provide slight resistance, which is the next level of muscle strength (3+, fair plus). Sanding wood placed on a table at waist height, or inclined so that the hand is below the elbow when it is flexed, respectively, uses gravity-eliminated or gravity-assisted positions. These positions are too low for a person with fair muscle strength who can perform complete range of motion against gravity, and they will not increase strength.

A125. An OTA with established service competence completes a standardized early intervention screening of an 8-month-old child. The results indicate that the child can sit independently by propping forward on both arms. The OTA collaborates with the occupational therapist to determine the next step to take in working with this child. Which is the best action for the OTA to complete next?An OTA with established service competence completes a standardized early intervention screening of an 8-month-old child. The results indicate that the child can sit independently by propping forward on both arms. The OTA collaborates with the occupational therapist to determine the next step to take in working with this child. Which is the best action for the OTA to complete next? Answer Choices: A. Evaluate the child's sensorimotor skills using a standardized assessment. B. Inform the parents that the child exhibits typical behavior. C. Develop goals to improve sitting balance. D. Provide play activities to develop dynamic sitting balance.

A. Evaluate the child's sensorimotor skills using a standardized assessment. Rationale: The screening indicated a sensorimotor delay, which requires further evaluation. Sitting with arms propped forward is typical of a 5- to 6-month-old. At 8 months, a child typically sits without support; therefore, further evaluation of the child's sensorimotor status is indicated. The occupational therapist and OTA cannot collaborate to set goals or prescribe activities prior to the completion of a full evaluation. OTAs are able to perform standardized assessments with the supervision of an occupational therapist.

A124 A young adult with a 10-year history of serious mental illness is being discharged home in 2 days. The client collaborates with the care coordination team to plan discharge with the client's primary family members. The team consists of a psychiatrist, a registered nurse, a social worker, an occupational therapist, and an OTA. The team conducts a pre-discharge family meeting to provide family members with information to assist them in supporting the client's recovery. What is the most relevant information for the occupational therapist and OTA to provide to the client's primary family members in this meeting? Answer Choices: A. Family role activity suggestions and potential adaptations. B. The therapeutic effects and potential side effects of medications. C. Advocacy strategies and consumer/family resources. D. Information on family dynamics and family support groups.

A. Family role activity suggestions and potential adaptations. Rationale: The occupational therapist and OTA are the members on the identified care coordination team who are most qualified to provide information about role activities and potential activity adaptations. The ability of a client to engage in meaningful activities in the home and resume relevant role activities can facilitate positive family functioning and support recovery. The other choices are all relevant foci for discharge planning, but the other members of the team can provide this information.

B74. An OTA provides community mobility training for a resident in a group home for individuals with develop mental disabilities. A resident successfully completes the intervention activity the OTA had designed with the occupational therapy supervisor. The OTA needs to plan the next day's intervention session, but the superving occupational therapist is on a two-week vacation. Which is the best action for the OTA to take in respo to this situation? Answer Choices: A. Grade the activity that the client successfully completed to its next level of difficulty. B. Use the same activity that the resident successfully completed during the next session. C. Delay the next treatment session until the supervisor returns and is able to provide guidance. D.Ask the residential program director to assign another supervisor for the duration of the current supervi sor's vacation.

A. Grade the activity that the client successfully completed to its next level of difficulty. Rationale: OTAs are trained in activity gradation and the implementation of OT intervention; therefore, the OTA can independently plan the next treatment activity. Using the same activity would not enable the resident to progress toward goal attainment. There is no need to delay the treatment session or obtain another supervisor. In this scenario, the OTA had designed the intervention activity with the supervising occupational therapist. This intervention planning would have involved collaboration between the two professionals and provided the OTA with a solid basis for designing the next level of activity needed to meet the established goals.

An OTA is working with an occupational therapist to develop a discharge planning group for clients being discharged within the next month from a long-term facility for adults with serious mental illness. Which initial action is best for the OTA and therapist to take when implementing this program? Answer Choices: A. Obtain prospective group members' occupational profile and post-discharge goals and options. B. Identify community resources to develop a community re-integration program and enhance post-discharge participation. C. Develop a self-medication management teaching module to increase post-discharge medication compliance. D. Complete an evidence-based search to identify best practices in community-based mental health occupational therapy.

A. Obtain prospective group members' occupational profile and post-discharge goals and options. When developing any therapeutic group, it is imperative that the OTA and occupational therapist obtain each prospective group member's occupational profile. Completing these profiles will provide information about group members' occupational history, patterns of daily living, areas of occupation, perceived strengths and limitations, priorities, and expected outcomes. This information will influence the type, focus, structure, and activities of the group that the OTA and therapist will develop. For a discharge planning group, it is important to determine members' post-discharge goals prior to the group. A thorough occupational profile should include the identification of post-discharge goals. Before the OTA and therapist can identify commnunity resources to develop a community re-integration program and enhance post-discharge participaion, they would first need to know the group members status and discharge goals and options. Identifying areas of occupation that the group members are successful with or having trouble with will determine if a self-medication module is necessary or not. While completing an evidence-based search can increase the OT practitioner's knowledge about best practices in community-based mental health occupational therapy, this option does not address the item's focus on developing a discharge planning group.

A.176 An elementary school student with autism spectrum disorder is referred to occupational therapy. One of the student's goals is to self-initiate goal-directed play to decrease the frequency of self-stimulating behaviors of hand waving and rocking. The student's verbal communication is impaired, but the student compensates by using picture cards to let others know what is wanted or needed. Which of the following approaches to initiate self-play in the home environment is best for the OTA to suggest to the student's parents?An elementary school student with autism spectrum disorder is referred to occupational therapy. One of the student's goals is to self-initiate goal-directed play to decrease the frequency of self-stimulating behaviors of hand waving and rocking. The student's verbal communication is impaired, but the student compensates by using picture cards to let others know what is wanted or needed. Which of the following approaches to initiate self-play in the home environment is best for the OTA to suggest to the student's parents? Answer Choices: A. Provide limited play choices using picture cards, encourage choosing, and give verbal praise when the child chooses an activity

A. Provide limited play choices using picture cards, encourage choosing, and give verbal praise when the child chooses an activity. Rationale: Autism often presents as impaired development of social interactions and communication and a limited repertoire of activities of interest. Symptoms can include repetitive movements or self-stimulating behaviors. Persons with autism may not speak. They may have a limited vocabulary and may typically not ask for help or request things. Children with autism often prefer to play alone and have difficulty sharing experiences with others. The goal of therapy is to encourage engagement in purposeful activity, self-direction, imitation, and social interaction. Using the child's form of communication of picture cards, the parents can provide a choice between a limited number of play activities at home to encourage the self-directed activity of choosing a play activity. Providing verbal praise immediately after a decision is made will reinforce a positive behavior and support continued decision making over time. As the child makes decisions more readily, verbal praise can be reduced. When decision making is difficult, providing several options to choose from can be overstimulating and cause stress. The resultant stress typically increases repetitive or self-stimulating behaviors. Including the child in after-school programs can be an option when the child is able to participate in purposeful activities and benefit from learning through imitation. At this point, an after-school program will likely be too stressful, which may result in social isolation or lost opportunity for self-directed decision making. In addition, this scenario specifically asked for an intervention strategy for the parents to use in the home environment, not within the school environment.

B163. An adult incurred a fracture of the right proximal humerus and is using a shoulder immobilizer for the first two weeks to aid healing and help control pain. The patient is right-hand dominant. They are referred to occupational therapy for interventions to enable independent ADL performance. Which activity will be the most difficult for the patient? Answer Choices: A. Putting on a pullover top. B. Washing their hair. C. Taking off a heavy coat. D. Brushing their teeth.

A. Putting on a pullover top. Rationale: Treatment of a proximal fracture of the humerus includes non-operative treatment using a sling or shoulder immobilizer with no shoulder mobility for the first two weeks, followed by either exercises to slowly increase the range of motion or surgery. Because there is a period of immobilization, patients need to learn how to complete ADL using modified techniques. While the person could use a one-handed technique to don a pullover top, this would put too much strain on the upper extremity and may cause increased pain. A safer alternative to dressing the upper body is to wear tops with front opening closures (i.e., zippers, buttons, or snaps). Because coats have front openings, taking off a winter coat would not pose the greatest difficulty. The patient can learn one-handed techniques to brush their teeth and wash their hair.

A187. An adult who incurred a severe traumatic brain injury (TBI) is entering the second week of care at a longten TBI rehabilitation center. The patient's family visits regularly and frequently asks multiple questions of the treatment team. With the patient's permission, a team and family conference is planned to address family concerns. Which is the most important information for the team to share with the family? Answer Choices: A. Realistic and clear information about the individual's current status and care plan. B. Each team member's expert opinion about the expected prognosis and discharge recommendations. C. Reimbursement information about each professional service to help determine treatment choices. D. Community resources for family support and respite care.

A. Realistic and clear information about the individual's current status and care plan. The family needs to understand the individual's current status and what is being done in treatment to facili ate recovery. This information can help the family support the team's care plan. Since the individual has been in rehabilitation for only two weeks, it is not possible for the team to know the prognosis or discharge plan. Reimbursement is always pertinent to the provision of care, but it is not the primary basis for determining intervention. Providing the family with community resources is important, but it is premature at this time.Community-based support programs are focused on individuals with TBI who have completed the acute habilitation phase. Most (if not all) TBI rehabilitation centers offer on-site support programs for families, which would be more relevant to this family's current needs. Respite services may or may not be needed by he family, depending upon the individual's level of recovery, and cannot be determined at this point.

B159. An individual with borderline personality disorder is admitted to the hospital following a suicide attempt. After attending an OT orientation group, the patient tells the OTA, "You are the only therapist who has ever been really helpful." The patient asks to meet with the OTA privately on a regular basis instead of the assigned primary individual therapist. Which action is best for the OTA to take in response to the patient's request? Answer Choices: A. Refer the patient to the assigned primary individual therapist. B. Agree to meet with the patient since a positive therapeutic connection has been expressed. C. Tell the patient that an OTA provides only occupation-based group treatment. D. Explain that this type of manipulative behavior is not acceptable.

A. Refer the patient to the assigned primary individual therapist. Rationale: The patient must be referred to the primary individual therapist assigned to their case. Although the patient has responded favorably to the initial OT group session, this does not preclude the patient's need for indi- upon patients' requests. Labeling the individual's behavior as manipulative is judgmental and can be considered antagonistic.

B121. A patient who is recovering from recent coronary artery bypass surgery is preparing for discharge. To ensure the person's safety while traveling in a car, which is best for the OTA to recommend? Answer Choices: A. Ride in the backseat. B. Do not use a seatbelt. C. Disable the airbag. D. Resume driving in eight weeks.

A. Ride in the backseat. Rationale: Riding in the backseat of a vehicle following open heart surgery is the safest location in a car. Front seats have airbags which if deployed can harm the person. If a postcardiac surgery patient must sit in the front seat, the airbag should not be disabled. This would increase the potential for injury if an accident occurs. A seatbelt should always be used for safety. A pillow placed between the person and the seatbelt can increase comfort and safety. The patient's physician will determine when it is safe for the patient to resume driving.

B150. Several residents of a skilled nursing facility report that they are bored with their individual daily range-of-motion exercise programs. The OTA collaborates with the occupational therapist to design a group to attain the goals of the individual exercise programs. Which would be most beneficial for the OTA to recommend incorporating into the proposed group? Answer Choices: A. Several exercise videos with diverse exercise styles and music. B. The residents performing gentle range of motion on each other. C. Exercises in rhythm to a marching band video. D. The provision of coffee and cake after the group.

A. Several exercise videos with diverse exercise styles and music. Rationale:Adding variety can stimulate interest and socialization. Group members can select videos that are of personal interest. Clients should not do hands-on treatment with each other. Moreover, passive range of motion is contraindicated for many diagnoses. A marching band video may be at a tempo that is too vigorous for some residents. Providing coffee and cake does not address the need to increase interest in performing daily ROM exercises.

C90. An individual who is acutely psychotic has been brought to the hospital by a legal guardian. The individual neither responds to questions nor attends to visual stimuli in the room. Who should the OTA collaborate with to determine the individual's short-term goals? Answer Choices: A. The guardian. B. The individual. C. The psychiatrist.

A. The guardian. Rationale: An individual decides goals in conjunction with occupational therapy practitioners except when the person is unable to take care of self, is a danger to self or others, or is unable to participate in the process. Since the person cannot respond, it would be in the individual's best interest to have the guardian take the place of the individual. The psychiatrist is an important member of the team with whom the OTA will collaborate, but they cannot set goals for the individual. Goal setting must take into account the individual's perspective and the psychiatrist will not have this personal awareness. The guardian would be the person most informed about the individual's life situation, roles, values, needs, and desires, all of which are critical to the formulation of relevant goals.

B6. In a school setting, a 6-year-old child is referred to occupational therapy for interventions to develop skills for handwriting and engagement in other fine motor activities. During an individualized education plan meeting, the OTA explains how upper extremity hypotonicity can influence handwriting and other fine motor activities. The OTA recommends having the child engage in home exercises prior to completing homework that requires handwriting. Which is the best method for the OTA to use when discussing the relationship between muscle tone and handwriting with the child's parents? A. Use common, everyday language to explain this functional relationship. B. Use medical terminology to emphasize the importance of the recommendations. C. Use the Occupational Therapy Practice Framework language to support OT's focus.

A. Use common, everyday language to explain this functional relationship. Rationale: Using common, everyday language to describe how home exercises (e.g., weight bearing activities such as chair push-ups) may decrease hand fatigue and improve handwriting tasks can help the parents understand this relationship. Relating the description to an observable functional outcome can lead to better comprehension and follow-through in the home. An OT practitioner cannot assume that the family is familiar with medical terminology and knows how it is related to function. The Practice Framework is a document that defines and guides the OT process. This document likely contains terms that are unfamiliar to the parents.

A165. An OTA provides occupational therapy services at a homeless shelter that includes residents who are HIV positive. Which procedure should the OTA follow when conducting several therapeutic groups to develop participants' ADL and IADL skills? Answer Choices: A. Wash hands before and after each group session. B. Always wear latex gloves during groups. C. Wear latex gloves during meal preparation activities. D. Implement transmission-based precautions.

A. Wash hands before and after each group session. Rationale: Health professionals should use standard precautions at all times, regardless of clients' diagnoses. Washing hands is a basic precautionary step all individuals should take to prevent the spread of infections and diseases (even in their own homes). The diagnosis of HIV is irrelevant to the question's correct answer because HIV is transmitted only through the exchange of body fluids. Wearing gloves during meal preparation activities complies with health department regulations abut handling food. However, this option only addresses group sessions that involve food. One must still wash one's hands before and after glove use. In addition, due to potential latex allergies, health care environments must be latex-free. Transmission-based precautions are used when the route(s) of transmission is (are) not completely interrupted using standard precautions alone. For some diseases that have multiple routes of transmission (e.g., SARS), more than one transmission-based precaution category may be used. Transmission-based precautions have three categories: contact precautions droplet precautions, and airborne precautions. None of these are indicated for HIV. See Chapter 9.

A.119 An OTA working in a skilled nursing facility conducts an initial therapeutic feeding session with an old adult with dysphagia. During the session the resident consistently expresses a desire to return home. W the OTA's best response? Answer Choices: A. Redirect the conversation to the texture and taste of the food. B. Acknowledge the resident's desire to return home. C. End the session and report the resident's desire. D. Offer to contact the resident's family to convey this desire.

B. Acknowledge the resident's desire to return home. Rationale: It is natural and normal for a new resident in a skilled nursing facility to express a desire to return home. This wish must be acknowledged and validated in order to establish therapeutic rapport. Ending the session or immediately redirecting the resident to the feeding activity ignores the validity of the resident's genuine feel-ings. This is counter-therapeutic. Once a person feels that they have been heard, they are often able to refocus on the activity. Because the OTA does not know the resident's relationship with their family, it is inappropriate for the OTA to offer to contact the family.

B144. An OTA provides home-based services to a neonate with significant developmental delays. Two hours before the next scheduled home visit, the child's parent informs the OTA that one of three older children has developed chickenpox. While the other children do not show signs of chickenpox, the parent expresses concern that they are contagious. Which is the OTA's best response to this situation? Answer Choices: A. Cancel the scheduled session and reschedule after two weeks have passed. B. Complete the scheduled session using airborne precautions. C. Complete the scheduled session using standard precautions. D.Complete the scheduled session using droplet precautions.

B. Complete the scheduled session using airborne precautions. Rationale: There is no need to cancel the scheduled session. Standard precautions are used in all clinical situations. Chickenpox is a disease transmitted by airborne droplet nuclei that remain suspended in the air; therefore, airborne precautions are warranted. Wearing respiratory protection (i.e., a mask) provides sufficient protection. Droplet precautions are used with individuals known or suspected to be infected with serious illness microorganisms transmitted by large particle droplets that can be generated by the person during talking. sneezing, coughing (e.g., rubella, mumps, pertussis, influenza).

A79. A school-based OTA receives a referral for a student who has illegible handwriting, poor attending behaviors, questionable visual skills, and problems with pencil management. After speaking with the teacher, reviewing classroom work samples, and collaborating with the occupational therapist, which action should the OTA take next? Answer Choices: A. Provide pencil grips and specialized paper as a trial to determine interventions. B. Directly observe the student during a naturally occurring writing time. C. Administer a standardized visual perceptual and visual motor assessment. D.Administer a standardized handwriting assessment.

B. Directly observe the student during a naturally occurring writing time. Rationale: Skilled observation during a writing activity is an essential part of the evaluation process. Noting the student's performance in the classroom should precede standardized testing of performance components. These observations, review of the student's work and history, and the teacher interview can then be reviewed by the occupational therapist and OTA to determine the need for further evaluation and the most appropriate standardized measures to use to evaluate the child, if needed.

C134. An OTA leads a work group at a vocational rehabilitation program for persons with traumatic brain injuries.One member begins to make sexually suggestive comments to other group members. The OTA redirects the client to the work in progress, but the member continues to make sexually suggestive statements. Which is the OTA's best initial response to this situation? Answer Choices: A. Explain to the client that such statements are not tolerated at work and call security to have the client removed from the group. B. Explain to the client that such statements are not tolerated at work and the client must stop or leave the group. C. End the group before the situation escalates and reschedule the group to meet without the disruptive client. D.Set the client up at a different workstation so the client is not in contact with other group members and cannot disrupt the group's work.

B. Explain to the client that such statements are not tolerated at work and the client must stop or leave the group. Rationale: This response reinforces the norms of a work environment and gives the individual the opportunity to practice making a decision about the most effective course of action. An important aspect of vocational rehabilitation for persons with traumatic brain injuries is the development of effective social interaction skills which comply with workplace norms. Ending the group, removing the client from the group, or decreasing contact with others does not address the client's need to develop the interaction skills required for work. In addition, the role of the OTA in a vocational rehabilitation program is to act as a work supervisor, which included enforcing the expectations of a workplace. Inappropriate sexual remarks are not tolerated in a work setting. If the client cannot comply with work norms in a vocational program, they may need to be referred to a prevocational program for basic social skills and work habit training. These basic skills are not the focus of vocational rehabilitation.

a97. Several adolescents with behavior problems attend a school-based after-school program. They work at an egocentric-cooperative/basic cooperative level in a group which is focused on developing the skills needed to enable successful school performance and respond effectively to peer pressure. Which of the following should the OTA focus on helping the group members do in the group to facilitate the attainment of group goals? Answer Choices: A. Actively take on roles such as energizer, coordinator, or opinion giver. B. Focus on the group tasks related to the completion of a long-range activity. C. Make decisions with minimal to no input or guidance from the group leader. D. Perform group skills consistent with the developmental level of adolescents.

B. Focus on the group tasks related to the completion of a long-range activity. The goals of an egocentric-cooperative/basic cooperative group are to enable members to select and implement a long-range activity that requires group interaction to complete (eg., constructing the set for a school play), develop an understanding of group goals and group interaction norms (eg., do not interrupt others when they are speaking), and enable members to identify and meet the needs of themselves and others safety, esteem). At this level, members do not actively assume diverse group roles and they are not able t make decisions without the group leader's input or guidance. While the clients are adolescents, an egocentric cooperative/basic cooperative group performs at the 5- to 7-year developmental level. The age range of adolescence is from 10-19. A cooperative/supportive cooperative group is at the 9- to12-year-old development level. A mature group is at the 15- to 18-year-old developmental level.

C41. A cooking group meets for 1½ hours each week at a partial hospitalization program. During the group, members do not smoke, they wait for everyone to be served before eating, and they clean up after the meal. When reporting these observations, which of the following is the most accurate statement for the OTA to make? Answer Choices: A. The group protocol is clear. B. Group norms are being followed. C. Group sanctions are effective. D.A diversity of group roles is evident.

B. Group norms are being followed. Rationale: Group norms are the expected and accepted behaviors in a group. These norms establish an atmosphere of mutual respect, safety, and support. Sanctions are implemented only in a group if members' behaviors fall outside of the group's norms and are considered deviant. The scenario does not provide sufficient information to determine members' group roles. A group protocol outlines the group's membership criteria, goals, and activities.

a113. A non-English-speaking family attends a discharge planning session. The assigned OTA does not sha language of the family. Which action should the OTA take first?A non-English-speaking family attends a discharge planning session. The assigned OTA does language of the family. Which action should the OTA take first? Answer Choices: A. Make a referral for a home care therapist to visit the family to provide in-home education. B. Obtain an interpreter to communicate with the family during the session. C. Attempt to communicate with the family through nonverbal communication. D.Consult with the occupational therapist to develop a discharge plan.

B. Obtain an interpreter to communicate with the family during the session. Rationale: The best choice to ensure the family involvement in the discharge planning process is to seek out a way to communicate directly and verbally with the family via an interpreter. The family is not included in these processes without an interpreter. Nonverbal communication does not transcend a language barrier for abstract concepts such as incorporating the individual's needs, values, and they have already been assigned this case. The OTA can independently get an interpreter to help communicate with the family. In addition, the OTA and occupational therapist should not develop a discharge plan without the familys input.

B32. An OTA conducts a communication group in a wellness program for a large corporation. In this mature group, what should the OTA do? Answer Choices: A. Help to develop the group norms of conduct. B. Participate as a member. C. Actively resolve group conflicts. D. Maintain a leader role.

B. Participate as a member. In a mature group, the group leader participates at the level of a member and does not act as a designated leader except in special circumstances such as a member becoming destructive to the group process. The members decide formally and informally the norms for behavior. The group leader does not usually participate in conflict resolution except to facilitate the member's participation in serious situations, such as deadlocked conflicts. The group leader functions in a variety

B158. A child is referred to occupational therapy because of hand fatigue during handwriting and difficulty managing clothing fasteners, such as buttons and zippers. Upon evaluation, the occupational therapist determined that the child has undeveloped hand arches and a closed web space. Which activity is best for the OTA to use to facilitate an open web space? Answer Choices: A. Walking across the floor like a crab and a bear. B. Playing on the monkey bars in the school playground. C. Using both hands to roll cookie dough into snake shapes. D. Coloring a vertically mounted picture using finger paint.

B. Playing on the monkey bars in the school playground. An open web space is created when the thumb opposes the index finger and creates a space between both. A child compensates for a closed web space by grasping objects harder than necessary, which leads to hand fatigue and poor hand dexterity. Grasping the round monkey bars on playground equipment inherently opens the web space while developing hand arches and strength. The other activity choices are completed using a flat palm and do not facilitate arch development.

a47. An individual attends a community day treatment program to assist in recovery from major depression. The client has good eye contact and responds verbally to interactions initiated by others. Cognition is intact. Which group level is best for the OTA to recommend this client attend? A. Parallel. B. Project/associative. C. Cooperative/supportive cooperative. D. Mature.

B. Project/associative. A project/associative group utilizes short-term activities that require the participation of two or more people. Tasks are shared, and the focus is on interaction rather than task completion. This level is appropriate for someone who is socially responsive to others with intact cognition. A parallel group does not require any interaction for task completion. This group is too low-level for this individual because it would not provide the opportunity to use and build existing social skills. Cooperative/supportive cooperative and mature groups require members to be self-expressive and meet socioemotional roles. These groups are too high-level for the individual at this point.

C152. An OTA works in a subacute rehabilitation center that is experiencing significant staffing shortages. As a result, the director of rehabilitation has temporarily suspended all pre-discharge in-home evaluations to ensure all essential direct services are provided to clients. The OTA is working with an older adult who requires a wheelchair for mobility due to hemiplegia and a lower extremity amputation. The client will be discharged to live with an adult child who will provide supportive care to the client. During an initial intervention planning meeting with the client and the family caregiver, the client and caregiver express concern that the caregiver's home is not wheelchair accessible. Which is the best action for the OTA to take in response to the client's and caregiver's expressed concerns? Answer Choices: A. Inform the director of rehabilitation that a home evaluation is an essential service and that the OTA will collaborate with the occupational therapist to complete a pre-discharge in home evaluation. B. Provide the caregiver with a home accessibility checklist and guidelines for videotaping key aspects of the home which the OTA will review with the client and caregiver du

B. Provide the caregiver with a home accessibility checklist and guidelines for videotaping key aspects of the home which the OTA will review with the client and caregiver during family care plan meetings. Rationale: Providing the caregiver with a home accessibility checklist and guidelines for videotaping key aspects of the home will provide the OTA with specific information about the home's level of accessibility (e.g., width of doorways, presence and number of stairs). The completion of a written checklist will ensure all key accessibility issues are reported. The videotaping can supplement this written report in lieu of the OTAs on-site evaluation. Upon reviewing this information with the client and caregiver, the OTA can ask for additional information (if needed) and make relevant recommendations for needed accommodations (e.g., offset hinges, ramp and/or grab bar installation). These recommendations can be made prior to the client's discharge home. Informing the director of rehabilitation that a home evaluation is an essential service ignores the reality that the setting has a significant shortage of staff and that the established priority is the provision of essential direct services to clients. One cannot assume that a caregiver has knowledge of accessibility standards and how to evaluate typical areas of difficult in-home accessibility. Thus, providing the caregiver with a handout and a list of recommended modifications to be made, if the caregiver determines difficulties exist, is not the best choice. There is no need to meet with the occupational therapist and recommend the client be discharged to a skilled nursing facility for supportive care. The client and caregiver have a discharge plan for the client to live with the caregiver and the OTA should work with them to implement this plan. Accessibility problems and safety risks can be determined via the completion of the home accessibility checklist and vide otaping key aspects of the home. Based on the results of this evaluation, the OTA can make recommendations to the client and caregiver to increase the home's accessibility and safety. Caregiver training can also be incorporated into pre-discharge intervention sessions to ensure the client's sa

C65. An OTA meets with a patient with fibromyalgia who has had difficulty meeting intervention goals. The patient complains of being hurt and frustrated in attempts to resolve pain and fatigue issues. Which is the most effective technique for the OTA to use to help the patient increase insight into this situation? Answer Choices: A. Consult with the occupational therapist about pain management options. B. Reflect the patient's verbal expressions back to the patient. C. Refer the patient to a specialized pain management center. D. Repeat the patient's exact words back to the patient.

B. Reflect the patient's verbal expressions back to the patient. Rationale: Reflection involves expressing the feeling behind the patient's words and is an effective technique to facilitate self-reflection and develop insight. Repeating the exact words or parroting is not effective because this means merely stating the words without a focus on the emotions behind the words. Exploring options for pain treatment and a referral to a pain management center can be helpful for managing the patient's pain, but these options do not address the question's stated focus on increasing the client's insight

C133. An OTA initiates a lifestyle redesign group at an assisted living facility for new residents. Which approach is best for the OTA to use during the group's initial session? Answer Choices: A. Encourage the members to share their feelings about moving to an assisted living facility to facilitate adaptive adjustment. B. Review written handouts about the group's purpose, norms, and goals in an environment that minimizes auditory distractions. C. Describe environmental modifications that can be made to the residents' apartments to compensate for low vision. D. Provide specific recommendations for doing activities at a slower pace to accommodate for decreased reaction time.

B. Review written handouts about the group's purpose, norms, and goals in an environment that minimizes auditory distractions. Rationale: The first session of a group should focus on orienting group members to the group's purpose, norms, and goals.Most persons who live in assisted living facilities are older adults. Therefore, it is important for the OTA to consider the impact of age-related sensory changes on the residents' ability to participate in the group orientation. Age-related sensory changes typically include hearing loss. Thus, it is best for the OTA to orient the group members by orally reviewing written handouts in an environment that minimizes auditory distractions. Providing written materials that the members can take with them can also facilitate a positive orientation to the group because the residents will have this information readily available to review as needed. Encouraging the members to share their feelings about moving to an assisted living facility is not appropriate for an initial group meet-ing. Revealing personal feelings about a major life change requires a cohesive group of members who trust each other. Because the members are new residents, they will likely not know each other well and may be uncomfortable with sharing personal information. Doing activities at a slower pace and modifying the environment are effective interventions for age-related sensory changes; however, they are not the most relevant focus for an initial session of a newly formed group. New members first require an orientation to the group.

A60. An adult diagnosed with multiple sclerosis over 10 years ago experiences an exacerbation of symptoms. The individual's principle complaint is decreased strength and endurance. The person can ambulate short dis tances with a cane in the home and uses a wheelchair outside of the home. The client asks for suggestions to enable independent home maintenance. Which is the best positioning recommendation for the OTA to sug gest the person use during meal preparation? Answer Choices: A. Sitting in the wheelchair with a tray table. B. Sitting at the kitchen table. C. Leaning against the counter while standing D. Leaning against a tall stool while standing

B. Sitting at the kitchen table. Rationale: Multiple sclerosis is characterized by fluctuations in abilities. The best choice for an activity that will be performed frequently is to perform the activity in an adequately supported position. The avoidance of fatigue is important in the management of MS. Doing meal preparation while sitting at the kitchen table achieves these aims and uses the person's natural context. There is no need indicated in this scenario for the use of a wheel. chair and a tray; the client can do meal preparation activities with readily available supports. Standing might require using too much energy and does not provide good support or stability for performing the fine motor aspects of meal preparation. Leaning against the counter or a stool requires more energy, does not provide good support or stability for performing the fine motor aspects of meal preparation, and may not be safe.

B65. An OTA works with adolescents who are survivors of child abuse. OT interventions can be provided in groups or on an individual basis. Which of the following would indicate to the OTA that an intervention should be provided to an adolescent on an individual basis rather than in a group? Answer Choices: A. The adolescent wants more socialization experiences. B. The adolescent desires greater control over the environment. C. The adolescent needs an opportunity to gain situational perspective.

B. The adolescent desires greater control over the environment. Rationale: The person who wants to have more control over the environment would benefit from working on an individual basis. Groups are unpredictable and effective group process requires the development of trust and the sharing of control among all members. This may be difficult for an adolescent who has survived child abuse and needs to develop a sense of personal control. Someone who wants increased socialization would benefit from group interventions. A group is also the best intervention format to put one's own personal situation into perspective.

C30. An OTA conducts an activity group on an acute inpatient psychiatric facility. The group members are individuals who have poor orientation to reality. Which is the best activity for the OTA to include in this group? Answer Choices: A. A discussion of the effects of hospitalization on occupational roles. B. The assembly of wooden toys for a children's unit. C. Guided imagery for stress management. D. Structured verbalizations about personal assets and limitations.

B. The assembly of wooden toys for a children's unit. Rationale: A group on an acute inpatient psychiatric unit for persons with poor orientation to reality should include activities that are structured, easily completed in one session, and provide a concrete result to reinforce reality. Wooden toy kits meet these criteria and donating them to the children's unit facilitates Yalom's curative factor of altruism. Discussions and verbal activities are abstract, and even if presented in a structured format, they would be difficult for persons with poor orientation to reality to follow. They also involve personal issues that require time to process feelings, effective verbal skills, and an adequate level of insight. This time allotment and client capabilities are typically not available in a setting with a short length of stay. Guided imagery can be difficult for a disoriented person to focus on and can be frightening to an acutely ill person.

C20. A client receives occupational therapy services following a right below elbow amputation. The client works as a carpenter and plans to return to work. The client has been fitted with a body-powered prosthesis. The current focus of prosthetic training is the development of dressing skills. What strategy is best for the OTA to teach the client for donning work pants? Answer Choices: A. Substitute elastic waist pants for pants with fasteners to eliminate the need to zipper and snap. B. Use the terminal device to hold the waistband while the left hand zips the zipper and fastens the snap. C. Use the left hand to hold the waistband while the terminal device zips the zipper and fastens the snap. D. Dress in a supine position while in bed by rolling side to side and using the left hand to pull the pants up.

B. Use the terminal device to hold the waistband while the left hand zips the zipper and fastens the snap. Rationale: When a client utilizes a unilateral body-powered prosthesis to complete bilateral activities, the prosthesis completes the stabilizing component of the activity and the intact hand completes the fine motor compo-nent. When an individual dons pants, holding the pants in place by gripping the waist band (or belt loop) is done utilizing the prosthesis. The intact hand then completes the fine motor component of the task (in this case, zippering the zipper and fastening the snap). The client can be taught to complete the task as described in choice B. There is no need for the client to change the style of work pants to elastic waist pants. Typically, carpenters wear work pants that have multiple pockets and/or tabs to hold tools. This pant type is not typically available with an elastic waist. The fine motor skill that is required to operate a fastener is beyond the capabilities of the terminal device of a body-powered prosthesis. Dressing supine in bed while rolling side to side and pulling up the pants is not indicated in this case. This technique is utilized by clients who are not able to stand (e.g., a person living with an SCI).

C69. Ten members of a community reintegration group are not working well together and show decreased levels of trust. The occupational therapist and OTA establish a goal to enhance the level of cohesiveness in the group. To begin the next group session, which is the best action for the OTA to take? Answer Choices: A. Read inspirational phrases to increase motivation. B. Verbally review the goals and purposes of the group. C. Have each person contribute a line about childhood memories to a group poem. D.Ask each person to talk about silly mistakes to provide some levity.

B. Verbally review the goals and purposes of the group. Rationale: The best choice is for the OTA to verbally review the goals and purpose of the group. This helps to direct the focus of the members onto the reason(s) that they are participating in the group. This reinforcement of a shared purpose can help develop cohesion. The OTA and therapist can then design and provide activities that build on this commonality. Inspirational phrases can help instill a positive attitude, but they do not address the need to develop group cohesion. Using individual members' input to compile a group poem can be an activity that could increase cohesiveness. However, some group members may have had less than wonderful childhood experiences and may be reticent to share a childhood memory with persons with whom they are not close. Consequently, this activity may be more detrimental than helpful. One way to decrease cohesiveness is to require self-disclosure in a group with decreased levels of trust. As a result, the topic of silly mistakes is also not a good group discussion focus. It is not likely to facilitate trust, openness, and willingness to share.

B190. An older adult experienced a fall that resulted in a Colles' fracture of the right wrist. This required external fixation to stabilize the wrist. The client had the external fixator removed 24 hours ago and is experiencing limited wrist flexion and extension. Which intervention is best for the OTA to use to facilitate the most improvement in wrist flexion and extension in the shortest amount of time? Answer Choices: A. Repeating wrist flexion and extension exercises. B. Watering plants in the rehabilitation facility's greenhouse. C. Hand washing dishes using warm soapy water. D. Writing thank-you cards on a slanted surface.

B. Watering plants in the rehabilitation facility's greenhouse. Rationale: A core premise of occupational therapy is the use of purposeful activities to attain desired goals. Studies indicate that using purposeful activities is associated with higher levels of motivation and engagement, which leads to greater improvement in movement in comparison to rote exercises devoid of any meaning. The purposeful activity of watering plants requires the most active wrist flexion and extension. Writing thank-you notes on a slanted surface requires minimal active wrist flexion and extension. Hand washing dishes is contraindicated as it will prevent proper wound healing, which is an important consideration when an external fixator is removed one day prior to a treatment session.

C128. An OTA collaborates with an occupational therapist to develop the preadmission screening procedures for a supported housing program with several levels of care. The population served by this program include persons with serious mental illness who are actively engaged in their recovery. Which tool is best for the therapist and OTA to include in the recommended screening procedures? Answer Choices: A. A semi-structured interview. B. An activities of daily living checklist. C. A structured cooking task. D.A weekly activity schedule.

C. A structured cooking task. ationale: The purpose of screening is to determine the need for further evaluation. A structured cooking task can be used to screen for a diversity of cognitive skills (eg., ability to follow directions and problem solve, awareness of safety) and home management abilities (e.g., use of kitchen equipment, level of cleanliness) that can help determine the need for further evaluation. This information will be necessary to select the level of supported housing that would be most effective for each person referred to the program. A semi-structured interview can be helpful in determining interests and goals, but it is not an effective screening for functional skill level. An ADL checklist can assess knowledge of an activity/skill, but it does not assess performance; therefore, its usefulness is limited. A weekly activity schedule can provide information about time use and ability to complete a structured task, but it is a paper-and-pen task that has limited applicability to screening for housing placement recommendations.

C13. An older adult with severe rheumatoid arthritis lives independently and receives occupational therapy services at an outpatient clinic. During an intervention session, the client expresses concern about the ability to assist a 3-year-old grandchild with donning and doffing clothing during a planned weekend visit. During prior visits, the client's spouse had assisted the child, but the spouse is now deceased. The client reports that the child has abilities that are typical of their age. After providing support to the client, which action is best for the OTA to take in response to these stated concerns? Answer Choices: A. Teach the client how to use a zipper pull to open and close the zippers on the child's clothing. 3. Teach the client how to use a button hook to open and close buttons on the child's clothing. C. Advise the client to ask the child's parents to provide elastic waist pants and pull-on tops for the visit. D.Advise the client to ask a friend or family member to stay over to provide assistance and ensure the child's safety.

C. Advise the client to ask the child's parents to provide elastic waist pants and pull-on tops for the visit. Rationale: A person with severe rheumatoid arthritis in the hands will have joint pain, stiffness, and limited range of motion. This will make the opening and closing of clothing fasteners and the use of a button hook and zipper pull difficult to impossible. Boutonniere and swan neck deformities are also associated with severe rheumatoid arthritis and further limit functional hand use. The provision of pullover shirts and elastic waist pants for the child to wear will enable the caregiver to help the child, if needed. At the age of 3, typically developing children can independently put on pullover shirts with minimal assistance, button large front buttons, and zip and unzip a jacket once on track. Assistance may be needed to remove a pullover shirt, get zippers on track, and button small buttons. Thus, it is best for the parents to provide clothing for the weekend visit that do not require the fastening of buttons or zippers. The client lives independently and there is no information in the scenario indicating that outside assistance is needed to ensure the child's safety.

C166. During an initial evaluation session, an OTA completes a standardized assessment with an older adult to determine the person's functional abilities. The assessment includes multiple timed subtests. The client successfully completes several components of the first subtest but runs out of time to complete the remaining subtest tasks. Which action is best for the OTA to take in response to the client's performance? Answer Choices: A. Record the client's performance and proceed to the next timed subtest according to the established protocol. B. Record the client's performance and end the evaluation session because the assessment is too difficult. C. Ask the client to complete the remaining subtest's tasks and continue the assessment in an untimed manner. D. End the evaluation session and collaborate with the occupational therapist to determine an alternative assessment.

C. Ask the client to complete the remaining subtest's tasks and continue the assessment in an untimed manner. Rationale: Because the reaction time of older adults is typically diminished, it can be expected that an older adult would run out of time during the completion of a timed task. The norms for most timed tests are established with younger adults. Adhering to the timing of tasks makes it more difficult for older adults to demonstrate their functional capabilities. Since the aim of the OTA's evaluation is to determine the person's functional abilities, it would be best for the OTA to continue the assessment in an untimed manner. Allowing the older adult to complete the assessment subtests at their own speed will provide an accurate representation of the person's functional level. In documenting the results of the evaluation, the OTA should note that the timed aspects of the assessment were not followed. While this will make it impossible to compare the client's performance with established norms, the information that is acquired about the person's functional level can help inform intervention planning. There is no need to end the evaluation session as the desired outcome of this evaluation session is attainable.

C103. A new resident of a skilled nursing facility begins occupational therapy to improve grooming and dressing skills. The person refuses to work with the female OTA assigned to the client. The department's sole male OTA has limited experience working with individuals with traumatic brain injury (TBI). Which action is best for the supervising therapist and department OTAs to take in response to this client's stated preference?Answer Choices: A. Encourage the individual to work with the assigned female OTA and assure the client of the OTA's skill and competence. B. Contract with a per diem male OTA to work with the client and provide the needed interventions. C. Assign the male OTA to work with the individual and have the supervising therapist provide close supervision to the OTA. D. Modify the intervention goals to include activities that the individual will feel more comfortable with when working with a female OTA.

C. Assign the male OTA to work with the individual and have the supervising therapist provide close supervision to the OTA. Rationale: This is the choice that respects the person's autonomy. The client's preference for working only with a male practitioner can be due to a cultural, religious, and/or personal reason(s), all of which should be honored. Therefore, this is a request that should be granted. While the male OTA has little direct experience working with persons with TBI, the evaluation and intervention of personal ADL is an area of entry-level OT practice that does not typically require specialized training. However, it would be helpful to provide the OTA with close supervision regarding the application of these fundamental skills to persons with TBI. The supervisor is responsible to help the OTA develop the skills needed for best practice. Encouraging the client to do something that is uncomfortable violates the person's rights. Modifying the goals is not appropriate, as goal modification must be based on an assessment of the client's abilities. In addition, the established goals are relevant and should be addressed.

B179. An older adult is admitted to a skilled nursing facility following a fall that resulted in a fractured hip with open reduction, internal fixation. The resident lived alone in a second floor apartment and was unable to return home. The resident is extremely agitated over being in a nursing facility. During the first OT session, the resident angrily yells, "Leave me alone, I just want to get out of here!" Which is the OTA's best initial response? Answer Choices: A. Explain the benefits of active engagement in occupational therapy. B. Console the resident by stating it is likely that this placement is temporary. C. Calmly and supportively acknowledge the resident's feelings. D.Advise their supervisor that the resident's mental status should be assessed

C. Calmly and supportively acknowledge the resident's feelings. Rationale: This resident has just incurred an injury that has resulted in the loss of their home. It is natural for the resident to be angry and upset over the unanticipated placement in an institution. The OTA should not be surprised by this outburst and should respond in a calm and supportive manner to acknowledge the resident's feelings. This is an effective use of interactive reasoning and can effectively assist with building rapport. While it is important to explain the benefits of active engagement in occupational therapy, the resident's ability to adequately process this information may be diminished by their distraught state. Therefore, calmly supporting the person is the best initial response. Once rapport has been attained, the OTA can more effectively explain the OT process to the resident. Consoling the resident by stating that the skilled nursing facility placement is likely only temporary is not truthful since the OTA cannot know what the residential outcome will be for this person. Advising the OT supervisor that the resident's mental status should be assessed is not appropriate. There is no information provided in the item scenario to indicate a need for a mental status evaluation.

A40. An OTA administers a standardized cognitive-perceptual assessment to a client. The client demonst culty performing the first two tasks included in this assessment tool. Which is the next best action for the OTA to take? Answer Choices: A. Continue the assessment and provide additional verbal cues during task performance. B. Continue the assessment and demonstrate each task for the client. C. Continue the assessment according to the established administration protocol. D. Discontinue the assessment to avoid frustrating the client.

C. Continue the assessment according to the established administration protocol. A standardized assessment must be administered according to its established protocol to be reliable. Providing additional cues or demonstration would compromise the reliability of the assessment tool. Discontinuing the assessment would not enable the OTA to obtain needed information about the person's cognitive-perceptual status. Since most cognitive-perceptual assessments measure several skills, one cannot assume that poor performance on the first two tasks will mean poor performance on the other tasks. OTAs are able to administer standardized assessments with the supervision of the occupational therapist. For specialized evaluations, the OTA must establish service competence. The occupational therapist is responsible for the interpretation of the evaluation.

An OTA is implementing a community mobility group with individuals attending a traumatic brain injury day-treatment program who live in an urban area. Which activity should the OTA plan for the group members to complete during the first group session? Answer Choices: A. Reading bus and subway maps. B. Taking a subway or a bus as a group. C. Determining a desired destination. D. Purchasing a public mass transportation fare card.

C. Determining a desired destination. Rationale: The best first group activity is to have the group members determine a desired destination. Once a destination is decided, members can review bus and subway maps to identify the public transportation route(s) that they can take to their desired destination. These maps and specific route directions are available on several websites and phone apps. Purchasing a public mass transportation fare card and taking a subway or a bus as a group would be the next community mobility activities after a route is planned.

C29. An older adult with a diagnosis of osteoarthritis in both knees is referred to inpatient occupational therapy. During screening, the patient expresses a desire to return home to live alone independently. The occupational therapist and OTA collaborate to determine their next action. Which should the therapist and the OTA do next in response to the patient's stated goal? A. Recommend adaptations to the patient's home environment to increase safety. B. Teach the patient energy conservation techniques to use during IADL tasks. C. Evaluate the patient's BADL and IADL using a standardized measure. D.Train the patient in a home resistive exercise program to build strength and ROM.

C. Evaluate the patient's BADL and IADL using a standardized measure. Rationale: The patient has just been screened for OT services, so the next step in the OT process is to evaluate the person's functional abilities. OTAs can contribute to the evaluation process using standardized measures. Osteoarthritis is isolated to specific joints and is not systemic in nature. By evaluating the patient's BADL and IADL, the OTA can collaborate with the occupational therapist to determine the activity demands of the BADL and IADL the patient performs while keeping in mind the specific joints that are affected. Once this information is obtained, then the OTA and occupational therapist can make informed recommendations based upon their observations and clinical reasoning to decrease excessive loading and repetitive use of these joints. Simple adaptations, such as moving items higher (onto counters, etc.) can be recommended and energy conservation techniques can be taught based upon the evaluation results. Resistive exercise programs are contraindicated for persons with osteoarthritis.

B91. An older adult is referred to occupational therapy with a diagnosis of osteoarthritis in both knees and elbows. The OTA contributes to the screening process by interviewing the patient. The OTA learns that the patient desires to return home to live alone independently in a two-level home. The OTA collaborates with the occupational therapist to determine the best response to this patient's stated goal. Which action should the therapist and OTA take next? Answer Choices: A. Provide suggestions for adaptations to the patient's bathroom to increase safety. B. Train the patient in energy conservation techniques to use during IADL tasks. C. Evaluate the patient's performance of daily activities in a simulated setting. D. Provide the patient with a home exercise program to build strength and ROM.

C. Evaluate the patient's performance of daily activities in a simulated setting. Rationale: The person has just been referred to occupational therapy and the screening has indicated a need for further evaluation. By observing the person perform daily activities within a simulated setting, the OTA can assess the demands of the activities the patient performs and the patient's capabilities. Because osteoarthritis is isolated to specific joints and not systemic in nature, the OTA can assess how the specific affected joints impact occupational performance. Once this information is obtained, the OTA can collaborate with the occupational therapist and use clinical reasoning to make recommendations to improve occupational performance. The resulting intervention plan may include bathroom adaptations, training in energy conservation techniques, and/or a home exercise program. However, interventions cannot be planned until after an evaluation has been completed.

a20. A client with a persistent depressive disorder and their spouse attend a discharge meeting with the OTA following the client's four day hospitalization for a major depressive episode. They express concern they have few shared activity interests and spend little time together. The client retired four months ago. The spouse continues to work full time. Which of the following should the OTA encourage this couple to do first to address this concern? Answer Choices: A. Immediately participate in one activity together. B. Engage in their individual activities of interest during the week. C. Explore activities they have enjoyed together and alone. D. Delay planning activities until the depression is totally resolved.

C. Explore activities they have enjoyed together and alone. Rationale: Assistance with an exploration of activities is a priority given the client's recent hospitalization for depression. The client's life has changed significantly with the loss of the worker role due to retirement and the resultant change in the amount of time spent alone. It will be important for the client to explore activities they have enjoyed alone so that retirement and time separated from their spouse will be enjoyable and meaningful. Exploring activities that the couple has enjoyed together will assist both in the maintenance of their relationship and in the establishment of a new post-retirement activities pattern. Immediate participation in one activity together is premature for there has been no determination of shared interests. Involvement in their own individual activities of interest during the week may be helpful but it does not address their expressed concerns about having few shared interests and spending little time together. A delay in planning activities until the depression is totally resolved ignores the client's expressed concerns.

a109. A child with spinal muscle atrophy can no longer reach beyond 90 degrees of shoulder abduction and 90 degrees of shoulder flexion. The parents state that the child can no longer independently don or doff a T-shirt. Which is the best approach for the OTA to recommend the child use to don a T-shirt? Answer Choices: A. Place the T-shirt directly on the child's lap, have the child don the arms first, then don the head of the T-shirt. B. Have the child wear front-opening shirts instead of T-shirts to eliminate the need to don shirts over the head. C. Have the child support the elbows on a table at chest height to don the T-shirt over the arms, then don over the head. D. Have the child lean to the right and don the right arm, repeat with the left arm, and then don the head of the T-shirt.

C. Have the child support the elbows on a table at chest height to don the T-shirt over the arms, then don over the head. Spinal muscle atrophy is a progressive disorder and the OTA needs to prepare the child and family for progressive loss of skills. The best technique, as shoulder ROM decreases, is to use a table for support to don the arms then use elbow and neck flexion to don the T-shirt over the head. Wearing front-opening shirts instead of T-shirts is an effective compensatory technique to eliminate the need to don shirts over the head. How-ever, the exam item specifically asked for an approach to help the child don a T-shirt. When the child can no longer don a T-shirt using adaptive strategies such as the use of front-opening shirts can effectively maintain the child's independence in dressing.

C100. A young adult admitted to a locked inpatient psychiatric unit is referred to occupational therapy. The referral states that the client is exhibiting symptoms of bipolar disorder, manic episode, with anxiety. Which approach is best for the OTA to use to engage the client in the occupational therapy program? Answer Choices: A. In a scrapbooking group, encourage the client to make a page using shared decorative paper, stickers, and pens to create a unique design. B. Ask the client to help decorate the unit for an upcoming holiday using supplies from a storage box of last year's decorations. C. In a cooking group, have the client cut shapes to construct a gingerbread house using templates and written directions.

C. In a cooking group, have the client cut shapes to construct a gingerbread house using templates and written directions. Rationale: Choosing a structured activity with clearly defined task steps is a good choice. Because bipolar disorder interferes with executive functions of the brain, structuring the activity with directions and patterns would lessen information processing demands and lend itself to greater potential for success. Additionally, this activity can be individualized so the client works on the task alone in a parallel group or in an assembly line fashion in a project group. This action would allow for the activity to be meaningful, graded for task demands and social interaction, and organized to minimize stress. A client in a manic phase of bipolar disorder would typically approach the tasks of scrapbooking and decorating the unit in a disorganized manner. During scrapbook-ing, the client would likely have difficulty negotiating for shared materials and supplies, making the task difficult for other group members. The resulting psychosocial reactions would present a challenging group dynamic for the OTA to manage using therapeutic use of self. This would not be helpful to the client or group members. The task of decorating the unit has not been structured to facilitate goal attainment for this client. Instead, it can contribute to the client's mania by its lack of structure, unclear definition of roles for client par-ticipation, and laissez-faire leadership approach. The aim of inpatient hospitalization is to facilitate symptom management, so this is not an effective action.

a83. A single parent with rheumatoid arthritis and two school-aged children reports difficulty completing a home exercise program. The parent states that multiple familial, work, and home management responsibilities fill the day and additional activities cannot fit into the day. Which is the best action for the OTA to take in response to these realities? Answer Choices: A. Explain and reinforce the importance of active range-of-motion exercises for remediation of dysfunction. B. Provide interventions to improve time management skills and temporal adaptation. C. Incorporate the parent's engagement in a diversity of role activities into the home program. D. Increase the frequency of OT sessions to compensate for lack of follow-through on the home program.

C. Incorporate the parent's engagement in a diversity of role activities into the home program. Rationale: The performance of role activities requires the individual to actively range joints, which is the purpose of an exercise program. Incorporating AROM into one's daily routines can be more easily implemented than adding a specific exercise regimen. Some people find pure rote exercise uninteresting. In addition, since activity and the pursuit of occupational roles is the foundation of OT, this choice provides the most theoretically consistent action. Reminding the individual of the importance of AROM, providing intervention to improve time management skills and temporal adaptation, and/or increasing the frequency of the OT sessions ignore the reality of a single parent's busy life. The person has reported nothing to indicate a lack of understanding of the importance of AROM, poor time management skills, or temporal dysfunction. Increasing the frequency of OT sessions would just add further demands to the parent's already busy schedule and is not indicated.

B122. An OTA is working with a preschool student who was born with congenital cytomegalovirus (C.MV) infection.As a result, the child has difficulty seeing. The child enjoys playing with classmates but has difficulty when the play activity is highly dependent on vision. Which of the following are best for the OTA to recommend to the child's teacher to improve the child's play experiences with classmates? Select the three BEST responses. Answer Choices: A. Have the child read books in Braille aloud to the classmates. B. Train a classmate to guide the child during play activities. C. Incorporate three-dimensional objects into play activities. D. Train a personal assistant to provide verbal cues during play activities. E. Introduce tactile matching games using different shapes and textures to the class. F. Provide the child and classmates with toy musical instruments to form a class 'band!

C. Incorporate three-dimensional objects into play activities. E. Introduce tactile matching games using different shapes and textures to the class. F. Provide the child and classmates with toy musical instruments to form a class 'band! Correct Answers: C, E, and F.Activities which employ the use of senses other than vision (i.e., touch, hearing, smell, and taste) are effective interventions to compensate for low vision. This vision see, to approach can enhance play for a child with limited vision and improve the child's ability to learn. Children depend on touch for learning abor the world including the qualities of temperature, texture, shape, softness, sharpness, elasticity, and resilience. Incorporating three-dimensional objects into play activities and introducing tactile matching games can help a child with low vision participate in play through touch without having to rely on others for information. Providing the child and classmates with toy musical instruments to form a class 'band' can effectively use the child s intact hearing to play with peers. Having 1:1 assistance from an aide or a classmate is not a practical or effective option when the goal is to improve the child's play experiences with peers. Typically, preschoolers do not have someone to help them play with each other. Reading books in Braille aloud does not have components of active play and would not provide developmentally appropriate preschool play opportunities.

C92. A young adult recently diagnosed with depression and anorexia nervosa is a consumer of services at a psychosocial clubhouse. The client attends individual occupational therapy sessions once a week and several evening and weekend groups. During an individual session with the OTA, the client states, "I don't know what I want to work on. I don't really know what my goals are." Which is the most effective action for the OTA to take in response to this client's statement? Answer Choices: A. Advise the client to discuss these concerns with the supervising occupational therapist. B. Establish a short-term goal related to improving the individual's goal setting skills. C. Initiate a discussion with the individual about what is personally important. D. Contact the individual's psychiatrist to request a medication evaluation.

C. Initiate a discussion with the individual about what is personally important. It is best for the OTA to engage the person by exploring their values and priorities as soon as concerns are expressed. This choice provides the person with the opportunity to explore and articulate personal preferences. Actively engaging the person in a dialogue is client-centered, employs therapeutic use of self, and incorporates consumer rights. Advising the client to discuss concerns with the supervising occupational therapist does not provide the client with the opportunity to expand on concerns in the here and now. This could be perceived by the person as a disregard for their concerns by the OTA. The OTA can directly respond to the person's concerns, which can help establish rapport with the individual. Setting up a short-term goal to improve goal setting skills without the direct input of the individual would not contribute to a client-directed intervention plan. This is a violation of the ethical principle of autonomy. There is nothing in the scenario to indicate the need for a medication evaluation.

A.144 A caregiver support group meets weekly at a senior center. A new member attends the group for the third time and listens intently. The person nods in agreement when others speak but does not participate vebally Which action is most effective for the OTA to take to facilitate the individual's engagement in the group? Answer Choices: A. Reiterate the group's norm that active participation is expected from all group members. B. Ask the individual several questions to encourage verbal participation. C. Invite the individual to join in the discussion, if the person would like. D. Refer the individual to the center's social worker for individual, non-group counseling.

C. Invite the individual to join in the discussion, if the person would like. Rationale: Inviting the individual to join the discussion acknowledges their membership and supports attention and active listening, but it does not pressure the person to speak before ready. It can take time for an individual to feel comfortable sharing personal thoughts with a group of people who may have been just acquaintances (or even strangers) prior to this group membership. It is inappropriate to pressure for verbal participation before a person is ready. Individual counseling can be helpful, but it is no substitute for the therapeutic benefits of a group. In addition, group members can benefit from a group discussion without verbally participating. These benefits can include many of Yalom's curative factors including universality, instillation of hope, and the gaining of specific information.

B157. An OTA conducts a caregiver education workshop on positioning techniques for family caregivers. At the conclusion of the class, the caregivers will be expected to utilize the skills taught. Which is the most effective method for the OTA to use when teaching these techniques? Answer Choices: A. OTA demonstration of general techniques followed by individualized discussion with each caregiver. B. An oral multimedia presentation including PowerPoint slides and handouts of positioning techniques for diverse disorders. C. OTA demonstration of techniques followed by a lab with caregivers practicing positioning on each other. D.A question and answer session to address the specific individual positioning concerns of the caregivers.

C. OTA demonstration of techniques followed by a lab with caregivers practicing positioning on each other. Rationale: A variety of teaching methods including demonstration, practice, and discussion has the best chance of reinforcing learning in a diverse group. Using only oral teaching methods will likely not enable the participants to develop the needed positioning skills. Psychomotor skills are best learned by practice, not lecture or question and answer. Feedback should include both knowledge of performance and knowledge of results.

C182. A 5-year-old child with cerebral palsy has right side upper extremity weakness. As a result, the child predominantly uses the left upper extremity during all functional tasks. The OTA collaborates with the occupational therapist to design intervention activities that will facilitate the child's use of both upper extremities and improve the child's fine and gross motor coordination. Which of the following activities is the best for the OTA to use during intervention to promote symmetrical bilateral integration? Answer Choices: A. Walking, wheelbarrow walking, walking like a crab, and walking like a bear. B. Cutting, stringing beads, tracing stencils, and getting dressed. C. Popping beads, rolling clay or dough, clapping, and catching a beach ball. D. Typing, making a tie-dyed T-shirt, playing poker, and lifting weights.

C. Popping beads, rolling clay or dough, clapping, and catching a beach ball. Rationale: Bilateral integration is the ability to use both sides of the body together in a coordinated manner. Fine and gross motor coordination is necessary to facilitate independence in ADL and IADL. Symmetrical bilateral integration occurs when both sides of the body perform the same action. Popping beads, rolling clay, clap-ping, and catching a beach ball are all age-appropriate symmetrical bilateral activities that address both fine and gross motor coordination. Walking, wheelbarrow walking, walking like a crab, and walking like a bear are reciprocal bilateral activities. Cutting stringing beads, tracing stencils, and getting dressed are asymmetrical bilateral activities. Typing, making a tie-dyed T-shirt, playing poker, and lifting weights are not age-appropriate activities for a 5-year-old child.

C46. An individual with Parkinson's disease exhibits difficulty moving from sitting in a chair to standing. Which technique is best for the OTA to recommend the person use to help successfully complete this functional mobility activity? Answer Choices: A. Rise from the chair while sitting with buttocks against the back of the chair. B. Extend both legs so that both feet are in front of the chair while rising. C. Sit at the edge of the chair and rock back and forth before rising. D. Rise while weight bearing on one foot and pushing up with both arms.

C. Sit at the edge of the chair and rock back and forth before rising. Rationale: One of the most common problems that persons with Parkinson's disease have is difficulty with the initiation of movement. Rocking back and forth prior to moving from sit to stand provides the person with vestibular and proprioceptive input that can help facilitate movement. Rising from the chair while sitting with buttocks against the back of the chair increases the difficulty of the activity, so it is not effective. Rising with extended legs or while weight bearing on one foot are incorrect; both employ poor body mechanics and may be unsafe.

A155. An OTA works at a community-based vocational rehabilitation program. Right before a discussion group about effective work habits is scheduled to begin, the OTA is asked to assist another OTA with this group. Which is the best action for the OTA to take? Answer Choices: A. Split the group in two and have each OTA work with their own group. B. Participate as a member of the group and model desired responses. C. Support the leader with comments and questions that keep the group on focus. D.Act as an observer and take notes for documentation.

C. Support the leader with comments and questions that keep the group on focus. Rationale: The role of assisting a group leader is to facilitate participation of the members and the achievement of the goals of the group. Splitting members into two groups would result in the assisting OTA having no knowledge of the group's history, process, or goals. In addition, the existing leader would receive no input from a co-leader. The benefit of receiving feedback from a co-leader is likely the precipitant for the group leader asking the OTA to participate. Participating as a member, an observer, and/or a recorder also do not provide any co-leadership benefits.

B187. A school-based OTA is teaching orientation and mobility skills to an adolescent with a degenerative visual disorder. Which is the most effective motivational technique for the OTA to use with this student? Answer Choices: A. Provide concrete structure and frequent feedback to ensure accurate orientation and safe functional mobility. B. Keep sessions short to allow time for emotional adjustment to orientation and mobility challenges. C. Treat the student as an adult and incorporate the student's orientation and mobility goals into intervention sessions. D. Limit anxiety by practicing the techniques in a quiet and self-contained environment; e.g., an empty classroom.

C. Treat the student as an adult and incorporate the student's orientation and mobility goals into intervention sessions. Rationale: Adolescents prefer to be treated as adults. The most important (and most effective) motivational technique is to incorporate the student's goals into the intervention sessions. Too much structure will limit the student's trial and error learning, which is vital to learning and retaining orientation and functional mobility skills. The length of intervention sessions should be determined by the student's established goals, the methods identified to attain these goals, and the student's progress toward goal attainment. Throughout the orientation and mobility training sessions, the OTA can incorporate the therapeutic use of self to help the student emotionally adjust to the challenges of the situation and effectively deal with any anxiety they may be experiencing. Using a quiet, self-contained environment can be a helpful intervention approach when first introducing orientation and mobility techniques, but it is not a motivational strategy.

A66. A parent recovering from brain cancer receives home based occupational therapy services. The client has residual problem solving deficits. Sensorimotor abilities are within functional limits. The client identifies a desire to resume the role of home maintainer. To develop the requisite problem-solving skills needed these roles, which is best for the OTA to work on with the client during OT intervention? Answer Choices: A. Performing routine morning self-care. B. Dusting the home's living room. C. Washing the family's laundry.

C. Washing the family's laundry. Rationale: Problem solving is the ability to recognize and define a problem, identify alternative plans for solving the problem, select a plan, organize steps in the plan, implement the plan, and evaluate the plan's outcome. Doing laundry can present several potential problems that must be solved (i.e., stain removal, appropriate care for different textured and/or colored fabrics). The other task choices are more structured and have less of a problem-solving component.

C61. A 4-year-old child with a complete myelomeningocele at the T12 level is referred for outpatient occupational and physical therapy. In setting goals with the parents, the occupational therapist established a goal to increase independence in dressing skills and the physical therapist established a goal to improve ambulation. When the OTA begins the initial intervention session, the parents state they want their child to only work on ambulation. They do not want the OTA to provide interventions to develop their child's dressing skills. Which action is best for the OTA to take first to address the family's stated preference? Answer Choices: A. Concur with the family that the child does not need to receive occupational therapy services. B. Refer the family to counseling to assist them in accepting the child's functional limitations. C. Work with the occupational therapist and parents to determine a desired focus for intervention. D. Reinforce the importance of independence in dressing for the child to the family.

C. Work with the occupational therapist and parents to determine a desired focus for intervention. Rationale: Working with the occupational therapist and parents to determine a desired focus for intervention addresses the child's and family's rights. This action allows the OTA and occupational therapist to apply therapeutic use of self. The family refuses intervention to work on the child's dressing skills and the OTA should respect their decision. The OTA can use this opportunity to collaborate with the family to help them determine a focus for occupational therapy services that meets their child's needs. A 4-year-old with a complete myelomeningocele at the T12 level will have needs in other areas of occupation besides dressing (e.g., play). There is no information provided in the item scenario to indicate that the family needs a counseling referral. Reinforcing the importance of dressing does not respect the family's stated preference.

C184. An OTA works in a subacute rehabilitation facility with an older adult who incurred a Colles' fracture and a hip fracture during a fall. The patient has osteoarthritis, age-related sensory changes, and cognitive deficits consistent with a mild neurocognitive disorder. The patient's adult child has been given durable power of attorney by the patient. During a treatment session, the patient states all therapy must stop because it is too painful. After ending the treatment session in response to the patient's reported pain, which action is best for the OTA to take next? Answer Choices: A. Contact the patient's adult child to request permission to continue with the established intervention plan and procedures. B. Revise the intervention plan to include the application of hot packs to painful areas to reduce pain during intervention. C. Collaborate with the patient to modify the intervention plan to meet the patient's goals in a pain-free manner. D. Collaborate with the occupational therapist to determine the most effective ways to meet the patient's goals in a pain-free manner.

Collaborate with the occupational therapist to determine the most effective ways to meet the patient's goals in a pain-free manner. Rationale: The client is complaining of pain during therapy; therefore, the OTA has an ethical responsibility to collaborate with the occupational therapist to determine the most effective ways to meet the patient's goals in a pain-free manner. Although the patient has given durable power of attorney to an adult child, it would be unethical to request permission to continue services that are causing distress to the individual. Hot packs can effectively decrease pain. However, the client in this scenario is recovering from acute injuries and has age-related sensory changes; thus, the use of a hot pack is contraindicated. The ability to collaborate with the patient to modify the intervention plan will be constrained by the patient's reported cognitive deficits.

C3. An occupational therapist is supervising an OTA to establish service competence in the administration of a standardized pediatric assessment. Which of the following guidelines should the therapist highlight as important for the OTA to follow during assessment administration? Answer Choices: A. Review each child's referral and screening information to identify expectations for a child's assessment performance. B. Exclude parents from the area in which the assessment is being conducted so a parent does not influence the child. C. Adhere strictly to the planned pacing of the assessment and do not adjust timing to accommodate a child's reactions. D. Be prepared to respond to any unexpected behavioral or physical responses a child may have during the assessment.

D. Be prepared to respond to any unexpected behavioral or physical responses a child may have during the assessment. Rationale: During a standardized pediatric assessment, a child may have unanticipated difficulties that could impede the child's performance. Thus, the OTA must be prepared to respond to any unexpected behavioral or physical responses the child may have during the assessment to maximize the child's performance. This choice is consistent with best practice in pediatrics, which uses a strengths-based approach; the other answer choices are not consistent with a strengths-based approach. The pacing of the assessment can be adjusted to accommodate the child and maximize the child's opportunity to demonstrate strengths. When reporting the assessment results, the OTA should document this accommodation. The action of reviewing each child's referral and screening information to identify assessment expectations is incorrect because all assessments should be unbiased and not based on preconceived expectations. In pediatric practice, parents should not be excluded from the area in which the assessment is being conducted. The OTA will not be familiar to the child; not having a parent present while a stranger is present could expectedly contribute to a child's anxiety. This could diminish performance.

B146. An OTA constructs a splint for a middle-school aged child who fractured the radius and ulna. The child becomes angry and pushes the OTA as the OTA attempts to mold the splint onto the child's arm. What should the OTA initially do in response to the child's behavior? Answer Choices: A. Ignore the behavior and continue with the splint construction. B. End the session and document the child's behavior. C. End the session and notify the parents of the child's behavior. D. Calmly remind the child of acceptable behaviors within a clinical setting.

D. Calmly remind the child of acceptable behaviors within a clinical setting. Rationale: The most appropriate initial response is for the OTA to help the child regain control so that they can receive needed services. Providing information to the child on the appropriate behavioral limits of a clinical setting enables the OTA to establish a professional relationship with the child. The child is of sufficient age to understand limit setting. Ending the session is premature because this does not provide the child with the opportunity to modify their behavior and be fitted for the needed splint. Ignoring the behavior would be inappropriate. The child's anger and loss of control must be handled in a direct, non-threatening manner.

B135. In an outpatient rehabilitation clinic, an OTA is working with a high school student with a spinal cord injury at the L1 spinal cord level. The client is a competitive swimmer and is able to transfer independently from the wheelchair to the pool without an assistive device. The client's goal is to learn how to mount and ride a horse. Which is best initial action for the OTA to take to help the client attain this goal? Answer Choices: 1. Provide transfer training to the client's family members to help them learn how to effectively assist the client in mounting a horse. B. Develop an upper extremity exercise program for the client to complete each day to develop the strength needed for independent horse mounting. C. Recommend the client increase their scheduled swimming sessions to include time to practice mounting large inflatable tubes in the pool. D. Consult with an adaptive riding specialist to discuss alternative methods for persons with disabilities to use when independently mounting a horse.

D. Consult with an adaptive riding specialist to discuss alternative methods for persons with disabilities to use when independently mounting a horse. Rationale: Consulting with an adaptive riding specialist would be the best option initially to determine ways in which a person with a disability can mount a horse. Based upon this information, the OTA can collaborate with the client and the occupational therapist to develop an effective intervention plan. This may include interventions to improve balance and strength and/or a direct referral to an adaptive riding program. At this stage of the rehabilitation process, a person with a L1 spinal cord injury will be independent in transfers. Thus, implementing a transfer training program for the family members is not needed. It would also not be an effective approach since mounting a horse has different activity demands than transferring. Since the client is a competitive swimmer upper extremity strength is not a needed focus for intervention. The activity demands of mounting large inflatable tubes in a pool are not the same as the activity demands of mounting a horse. The ability to mount tubes in a pool would not generalize to mounting a horse.

B12.A person with a diagnosis of major depressive disorder is receiving treatment in an acute psychiatric inpatie unit. The patient was recently placed on suicide precautions. The OTA has scheduled 30-minute individual sessions in the patient's room to begin intervention. Which is the most beneficial activity for the first intervention session? Answer Choices: A. Tooling a leather wallet. B. Writing in a personal journal. C. Building a sand terrarium in a plastic globe. D. Decorating cookies to contribute to the patients' lounge.

D. Decorating cookies to contribute to the patients' lounge. Rationale: Decorating cookies is a safe, 'no-fail' project. The end product fosters the curative factor of altruism, which can be therapeutic. Also, the end product is not dangerous or potentially harmful to the patient. Tooling a wallet uses tools that can be used to harm oneself. The OTA can be careful to account for all tools but having tools available that can cause harm is an unacceptable risk on an acute inpatient psychiatric unit. While writing in a journal can be therapeutic, it may reinforce negative feelings and poor self-esteem. The globe of the sand terrarium can be broken and sharpened into an object that one can use to harm oneself.

A16. An OTA working on an acute psychiatric inpatient unit conducts a series of groups for clients newly admitted to the unit. Which group leadership style is most effective for the OTA to assume when leading these groups? Answer Choices: A. Advisory. B. Facilitative. C. Laissez faire. D. Directive.

D. Directive. Directive leadership involves the provision of structure, clear directions, and immediate and consistent feel back. These qualities are needed in a group whose members are acutely ill with psychiatric disorders. The other choices do not provide the structure or organization needed for individuals whose symptoms often nclude decreased attention span, distractibility, poor social skills, and/or thought disorders.

B57. During an individual session with an OTA, a client states, "I don't know what I want to work on. I don't really know what my goals are." Which is the best action for the OTA to take in response to the client's concerns? Answer Choices: A. Defer the development of an intervention plan until the individual has self-determined goals. B. Establish a short-term goal related to improving goal-setting skills. C. Contact the client's psychiatrist to request a medication evaluation. D. Initiate a discussion with the individual about what is personally important.

D. Initiate a discussion with the individual about what is personally important. rational: It is best for the OTA to employ therapeutic use of self to establish rapport with the individual and engage them in the goal-setting process by exploring personal priorities. This answer choice is client-centered and orporates the patient's rights. Deferring the development of an intervention plan does not provide the client with the opportunity to participate in this planning process nor does it provide the opportunity for the OTA to facilitate client's ability to articulate their preferences. Setting up a short-term goal to improve goal setting skills without the input of the individual is vague and would not contribute to a client-directed intervention plan. This is a violation of the ethical principle of autonomy. There is nothing in the scenario to indicate need for a medication evaluation.

C14. An OTA and occupational therapist collaborate with a local office for the aging to design a new community-based day treatment program for individuals with neurocognitive disorders. Which groups are best for the OTA and therapist to recommend the program include? Answer Choices: A. Reality orientation groups. B. Cognitive-behavioral groups. C. Parallel groups. D. Instrumental groups.

D. Instrumental groups. Rationale: According to Mosey's taxonomy of groups, instrumental groups help individuals function at their highest possible level for as long as possible. They provide supportive, structured environments and activities that prevent regression, maintain function, and meet mental health needs. Activities can include reminiscence, arts and crafts, music, exercise, dance, and any other activity that is interesting and enjoyable to the members. Reality orientation groups are contraindicated for persons with neurocognitive disorders who cannot remember basic facts like dates, people, or places. Groups that focus on the use of memory can be very frustrating and countertherapeutic for persons with neurocognitive disorders. Cognitive-behavioral groups require intact cognition and are at too high a level for persons with neurocognitive disorders. Parallel groups can be indicated for individuals with neurocognitive disorders, but a schedule should not be comprised primarily of parallel groups for they are limiting in their potential for social interactions.

C149. An OTA works at a psychosocial clubhouse. The OTA is leading a closed group on stress management that has been meeting for several months. One of the members shares some concerns about personal safety at home. Which is the OTA's best response to the member's expressed concerns? Answer Choices: A. Tell the individual you will privately talk about the concerns after the group. B. Immediately send the individual to see the clubhouse's occupational therapist. C. Assure the individual that the concerns reflect normal anxieties. D. Invite the individual to share more details about the concerns

D. Invite the individual to share more details about the concerns Rationale: It can be very difficult for an individual to share concerns about personal safety. This person clearly felt safe in this group and sufficiently comfortable with the OTA and members to be able to voice these concerns. Therefore, the OTA should seize the opportunity to obtain more information about the nature of the person's concerns. Delaying the attainment of this information until after the group is not necessary and can have the risk that the person will change their mind. Even the minute delay caused by having the person go see the occupational therapist can be long enough for the person to decide that they do not want to disclose any further information. In addition, the person may have formed a positive therapeutic relationship with the OTA and the group members based on their shared experience in an ongoing closed group. It cannot be assumed that the person will have the same rapport or therapeutic relationship with the occupational therapist. Thus, the person may not be comfortable sharing personal information with the therapist. Assuring the person that these anxieties are normal minimizes their feelings and can be dangerous if the individual is truly unsafe at home.

B155. A client is admitted to a skilled nursing facility (SNF) following a fall that resulted in a concussion. Upon evaluation, the occupational therapist noted cognitive changes resulting in difficulty sequencing tasks and short-term memory impairment. The therapist and OTA decide that an analysis of the client's current activity performance based on an occupation-based approach would help guide the intervention plan. Which method is best for the OTA to use when completing this activity analysis? Answer Choices: A. Interview the client about how routine tasks are typically completed. B. Assess the client's performance components using a standardized measure. C. Provide the client with a structured task that is broken down into subtasks. D. Observe the client complete a typical ADL morning routine in the client's room.

D. Observe the client complete a typical ADL morning routine in the client's room. Rationale: An occupation-based approach to activity analysis involves observing people as they complete desired occupations within their natural environment. Because it is not always possible to observe clients in their homes, OT practitioners should simulate the natural environment as close as possible. Since the client was admitted to an SNE, observing the client complete a typical morning ADL routine is acceptable, despite it not being at home. Information gathered upon completion of an occupation-based activity analysis can then be used to decide how the identified strengths can be used to support performance and how the identified limitations can be remediated through skill development, compensation, and/or modifications to the activity or its context/environment. Interviewing the client about how routine tasks are typically completed can provide helpful insights to the client's habits and routines, but it is not a method of activity analysis. Likewise, the assessment of the client's performance components using a standardized measure will provide useful information about the client's assets and deficits, but it is not a method of activity analysis. Providing the client with a structured task that is broken down into subtasks can be a helpful form of intervention, which can be based on the information gained from an occupation-based activity analysis.

C124. A middle school-aged child with a sensory processing disorder participates in weekly occupational therapy sessions at a private pediatric clinic. Initial evaluation had identified the presence of symptoms consistent with a sensory-based motor disorder. The child has shown no improvement in coordination, equilibrium, and motor planning for the past two months. The parents report that the child continues to exhibit difficulties with play, learning, and social participation. Based on these observations and parental report, which is most important for the OTA to discuss with the occupational therapist? Answer Choices: A. Providing the parents with a home program and discharging the child from therapy. B. Referring the child to a pediatric social worker to explore potential resistance to therapy. C. Increasing the frequency of therapy to two sessions per week to increase the child's engagement. D. Re-evaluating the child to determine deficit areas that are contributing to dysfunction

D. Re-evaluating the child to determine deficit areas that are contributing to dysfunction Rationale: The child is not making gains in occupational therapy with the current approach to address coordination, equilibrium, and motor planning, and the parents are reporting ongoing dysfunction. Therefore, the OTA should discuss the need for re-evaluation of the child with the occupational therapist. This re-evaluation by the occupational therapist would obtain information that can help revise the current intervention plan to more effectively meet the child's needs. The OTA would contribute to the re-evaluation process with supervision from the occupational therapist. Intervention focused on other performance skills and client factors may be effective and should be implemented before discharging the child. The OTA should not continue to treat the child in areas that show no progress. The child has not made gains. Increasing the frequency of occupational therapy without a revised intervention plan will not facilitate functional improvements. The identified deficits are within the domain of practice of occupational therapy, so a referral to a social worker is not neces-sary. There is no information provided in the scenario to indicate that the child is resistant to therapy.

B130. A person experiencing an acute manic episode is completing the admission process to an inpatient psychiatric unit. The intake coordinator has to unexpectedly complete an emergency admission. The admissions coordinator asks the OTA to spend some one-to-one time with this individual until the coordinator can return to complete the intake process. Which is the best way for the OTA to use this time with the client? Answer Choices: A. Discuss the precipitants to the hospitalization with the person. B. Ask the person to make positive statements about them self. C. Have the person do a craft activity requiring attention to detail. D. Take a walk around the unit with the person to orient them.

D. Take a walk around the unit with the person to orient them. Rationale: Walking with the person can allow for some energy release, which is important for a person experiencing a manic episode. It is a non-threatening activity that can facilitate interaction. Providing the person with an orientation may decrease the stress of admission and foster rapport. Upon admission, the person may be uncomfortable discussing precipitants to hospitalization and may have difficulty making positive statements about them self. Activities requiring concentration and attention can also be difficult for a person experiencing an acute manic episode.

B89. A 2-month-old infant with bilateral hip dislocations is being discharged home from an acute pediatric facility. The occupational therapist and OTA have developed a home program for the parents of this first-born child. Which is most important for the occupational therapist and OTA to assess before instructing the parents the details of this home program? Answer Choices: A. The family's insurance reimbursement plan. B. The parent's level of formal education. C. The family's home environment. D. The parents degree of anxiety.

D. The parents degree of anxiety. Rationale: Prior to providing the parents with details about the home program, the occupational therapist and OTA should assess the parents' level of anxiety since excess anxiety could impact their comprehension and retention of the instructions given. This is an effective use of interactive reasoning and can help build rapport with the parents. This can contribute to increased compliance with the prescribed home program. While the other factors may also be considered, they do not represent immediate priorities for hospital-based instruction.

A189. An individual with myasthenia gravis is being discharged home after a hospitalization for the treatment of pneumonia. The person's spouse has expressed concern about caregiving responsibilities and the clients a ability to function in the home. The OTA collaborates with the occupational therapist to address the spouse's concerns and the client's needs. Which is the most beneficial recommendation for the OTA and occupational therapist to make? Answer Choices: A. The extension of client's length of stay to allow for caregiver training. B. The extension of client's length of stay to provide intervention to develop ADL skills. C. A referral for the client to an adult day care program to relieve caregiver stress and develop functional s D.A referral to a home care agency for a functional evaluation and home assessment.

D.A referral to a home care agency for a functional evaluation and home assessment. Rationale: A functional evaluation in the client's home and an assessment of the home environment is the most beneficial choice listed to provide accurate information about the client's functional status and caregiver needs. This information will enable the home care team to collaborate with the family to develop an appropriate intervention plan to address their identified needs. An extension of length of stay is very difficult to justify because the individual was hospitalized for the medical treatment of pneumonia. Once this illness is effectively treated, discharge must occur. In addition, it is more effective to provide caregiver and ADL training in the person's home environment. A referral to adult day care may be determined based on the home care evaluation.

B185. An OTA conducts a task-oriented activity group for adolescents recently diagnosed with anorexia nervosa. Which is the best activity for the OTA to include in the initial session of this group? Answer Choices: A. Making cards to send to veterans in a local hospital. B. Baking cookies for the residents in a homeless shelter. C. Performing low-impact aerobic exercises. D.Composing lyrics and melody for a group song.

D.Composing lyrics and melody for a group song. Rationale: A task-oriented group utilizes a psychodynamic approach to increase participants' understanding of their s, values, ideas, feelings, and behaviors. Activities are selected and designed to facilitate self-expression he exploration of feelings, thoughts, and behaviors. Composing a song is a self-expressive activity that s each member to contribute their thoughts and feelings. It is an activity that can be stopped to discuss viors, feelings, and issues that arise during the group. The other activity choices do not provide this self-ession opportunity. In addition, because persons with anorexia nervosa have a complex relationship with that takes time to address, baking would not be an appropriate activity for an initial session. Similarly, use persons with eating disorders often engage in exercise in an excessive (sometimes self-abusive) manner, aerobic exercising is not an appropriate activity for an initial session.

A78. A tool and die designer develops bilateral carpal tunnel syndrome. The local work hardening program does not have the exact equipment that the designer uses in the job setting. Which action is best for the OTA to take in response to this situation? Answer Choices: A. Refer the client to another work hardening program that has the equipment. B. Inform the occupational therapist about the need for equipment to duplicate the work setting C. Perform some necessary aspects of rehabilitation in the client's work setting. D.Duplicate the job task components as closely as possible.

D.Duplicate the job task components as closely as possible. Rationale: Work hardening programs can use real or simulated tasks that duplicate, as closely as possible, the components of each client's job tasks. It is not realistic for all programs to have every possible piece of equipment related to clients' iob tasks. Consequently, OT practitioners become skilled at activity analysis and adept at simulating job tasks with the equipment that they have available. An OTA who is experienced in work hardening can provide effective intervention without equipment that exactly matches the client's work. Therefore, there is no reason to refer the client to another facility. A reason to refer a client to another facility is the therapy staff's lack of experience and inability to provide effective intervention. It may be helpful to perform some aspects of rehabilitation during a site visit, but the logistics of this can be difficult The OTA's ability to provide intensive therapy in a work environment would likely be limited. Therefore, the best answer is to duplicate the job tasks in the clinic

A146. An OTA works with an individual with chest and upper extremity burns. During the intervention session, the client expresses vague fears about personal safety at home and asks the OTA to advocate for an extension in the discharge date. According to the medical record, the client had incurred the burns during a cooking accident. Which is the OTA's best initial response to the client's stated concerns? Answer Choices: A. Encourage the client to speak to the occupational therapist about discharge plans. B. Assure the client that pre-discharge fears are normal and expected. C. Document the client's concerns and recommend an extension of the length of stay.

D.Invite the client to expand upon the nature of these concerns. Rationale: The OTA needs more information to determine the basis for the client's fears and an appropriate response. Referring the client to the occupational therapist can be helpful, but it will not address their concerns at this moment. A delay may result in the client deciding that their concerns are not worth mentioning. Many clients find it difficult to express fears, so it is important to respond immediately when they do. This is of particular importance in cases of domestic violence, which this case and any case) can have as a contributing and complicating factor. In addition, the client's fears may be functionally based, and the OTA can address these immediately in the current intervention session. Assurance that fears are normal and expected does not address the issue at hand. A request to extend a client's length of stay requires a documented need for inpatient services. Client's stated concerns about home safety are not sufficient justification for a length of stay extension.

B198. A six-week-old infant born prematurely is being discharged from the hospital. The infant has spastic diplegia as a result of cerebral palsy. The OTA collaborates with the occupational therapist and the family to develop a home exercise and positioning program that can be incorporated into the family's natural daily routine. The infant's parents speak limited English. Which is most important for the occupational therapist and the OTA to determine prior to discharge? Answer Choices: A. The parents' degree of anxiety about program implementation. B. The parents' ability to purchase positioning equipment. C. Characteristics and accessibility of the home environment. D. The parents' comprehension of the instructions.

D.The parents' comprehension of the instructions. Rationale: To ensure the home exercise and positioning program will be successfully implemented by the parents, the occupational therapist and the OTA must determine their comprehension of the instructions prior to discharge. Cultural competency requires occupational therapy practitioners to minimize potential barriers to service, including any language barriers. Effective communication is essential when sharing important information. Because spasticity can result in contractures, the correct implementation of a home exercise and positioning program is critical to the infant's well-being. Addressing the parents' anxiety about program implementation and determining the parents' financial resources and the characteristics and accessibility of the home should be considered in the development and implementation of a home program. However, they are not the primary pre-discharge concerns in this scenario. Any potential communication barrier needs to be addressed initially to ensure ethical practice. It is important to recognize that the positioning needs of a six weeks old infant can be met by the use of common household items (e.g., rolled towels). Expensive equipment would not be needed at this point.

Evaluation Group

Purpose/focus: to enable client and the therapist to assess client's skills, assets, and limitations regarding group interaction. assumption: to accurately evaluate an individuals functional abilities, one must observe the person in a setting where the skills can be demonstrated. type of client: all individuals who will be involved in groups or who lack group interaction skills.

B17.An adolescent incurred a C4 spinal cord injury. During the initial session, the patient refuses to speak to the OTA. The OTA supportively acknowledges the client's response. Which action should the OTA take next? Answer Choices: A. Set up a chin-operated bedside environmental control unit (ECU). B. Provide passive range of motion to prevent contractures. C. Explain what OT can offer the adolescent to adjust to decreased abilities. D. Ask the adolescent to tell nursing staff when personally ready for OT.

Rationale: the individual immediately needs a method to access the environment. Being able to call staff, operate a TV and/or radio, answer the phone, turn on/off lights, and other basic ECU functions are important tasks for the adolescent to self-control. It is not necessary to explain what OT can offer. Some of the benefits of OT will likely become self-evident as the adolescent learns to use the ECU. This explanation can be expanded on as adolescent begins to engage in intervention. Providing PROM ignores the patient's feelings. PROM can be provided by direct care staff. The individual may not be ready for quite a while to collaborate with the OTA to the need to adjust to disability. While this is occurring, the OTA can still provide meaningful support interventions and work on developing a therapeutic relationship.

Advisory leadership

Takes place when the therapist functions as a resource to the members, who set the agenda and structure the group's functioning --1. this style is assumed when members shills and engagement are high (cooperative/supportive cooperative, mature groups) --2. members select and complete the groups activity with leaders advice, if needed. --3. group maintenance roles are independently assumed by group members --4. feedback occurs as a natural part of the groups self-directed process. --5. the advisory leaders goal is to have members understand and self-direct the process

directive leadership

Takes place when the therapist is responsible for the planning and structuring of much of what takes place in the group --1. needed when the members cognitive, social, and verbal skills, as well as engagement, are limited. (parallel or project/associative level groups) --2. leaders select the activates to be used in the group --3. they provide clear verbal and demonstrated instruction to complete tasks --4. group maintenance roles and feedback is predominately provided by the directive leader --5. the directive leaders goal is task accomplishment

developmental group

a continuum of groups consisting of parallel, project, egocentric cooperative, cooperative, and mature groups. Purpose to teach and develop members' group interaction skills purpose/focus is to teach and develop members group interaction skills

A81. An OTA is working with the parents of a 5-year-old child with developmental delay. This child is not self-feeding. The occupational therapist's evaluation of the child indicated that the child has potential to participate in this ADL. When talking to the parents about this possible goal, they indicate this is not a priority for them. Which action is best for the OTA to take in response to the parents' statement? a. Ask the parents about their intervention priorities for their child. b. Work on utensil use with the child without using food items. c. Explain the importance of self-feeding to the child's independence. d. Refer the parents to online sources about the typical development of feeding.

a. Ask the parents about their intervention priorities for their child. When differing values occur between OT practitioners and family members, open-ended questions should be used to help the practitioner understand the family's context. The OTA should ask the parents about their intervention priorities for their child. Based on this information, the OTA can collaborate with the OTR and the parents to develop goals that honor the parents' wishes. The parents' preferences are likely founded on their personal and cultural values. Family centered care and cultural competence are important aspects of OT service delivery. Practitioners must respect family preferences and cultural differences. The other options in this scenario ignores the parents' stated priority and do not consider cultural diversity; therefore, they are incorrect.

A150. An OTA reviews the positioning protocol for a premature infant with severe spastic cerebral palsy with the infant's parents. The protocol is in a written format. During the review, the OTA notices that the parents do not seem able to follow along with the protocol's text. Which action is best for the OTA to take initially in response to this observation? a. Ask the parents if they have any concerns about positioning their infant. b. Ask the parents if they can read and understand English. c. Include pictures of proper positioning in the protocol. d. Demonstrate proper positioning techniques.

a. Ask the parents if they have any concerns about positioning their infant. This is an open-ended question that enables the parents to express any concerns that they may have about positioning their infant. These concerns may be comprehension related and/or task related. The realities of caring for a premature infant with severe physical disabilities can be overwhelming. The parents' perceived difficulties in following the written protocol may be due to emotional stress, not limitations in literacy. The parents may welcome the opportunity to express their concerns. The other choices are closed-ended and do not facilitate an open dialogue. If the parents have difficulty understanding English or if they could benefit from pictures and/or demonstrated positions, they can express this in response to the OTA's open invitation to express concerns.

B74. An OTA provides community mobility training for a resident in a group home for individuals with developmental disabilities. A resident successfully completes the intervention activity the OTA had designed with the occupational therapy supervisor. The OTA needs to plan the next day's intervention session, but the supervising occupational therapist is on a two-week vacation. Which is the best action for the OTA to take in response to this situation? a. Grade the activity that the client successfully completed to its next level of difficulty. b. Use the same activity that the resident successfully completed during the next session. c. Delay the next treatment session until the supervisor returns from vacation and is able to provide guidance. d. Ask the residential program director to assign another supervisor for the duration of the current supervisor's vacation.

a. Grade the activity that the client successfully completed to its next level of difficulty. OTAs are trained in activity gradation and the implementation of OT intervention; therefore, the OTA can independently plan the next treatment activity. Using the same activity would not enable the resident to progress toward goal attainment. There is no need delay the treatment session or obtain another supervisor. In this scenario, the OTA had designed the intervention activity with the supervision OTR. this intervention planning would have involved collaboration between the 2 professionals and provided the OTA with a solid basis for designing the next level of activity needed to meet the established goals.

B159. An individual with borderline personality disorder is admitted to the hospital following a suicide attempt. After attending an OT orientation group, the patient tells the OTA, "You are the only therapist who has ever been really helpful." The patient asks to meet with the OTA privately on a regular basis instead of the assigned primary individual therapist. Which action is best for the OTA to take in response to the patient's request? a. Refer the patient to the assigned primary individual therapist. b. Agree to meet with the patient since a positive therapeutic connection has been expressed. c. Tell the patient that an OTA provides only occupation-based group treatment. d. Explain that this type of manipulative behavior is not acceptable.

a. Refer the patient to the assigned primary individual therapist. the pt must be referred to the primary therapist assigned to their case. Although the patient has responded favorably to the initial OT group session, this does not preclude the pts need for individual therapy. on inpatient psychiatric units, OT practitioners often serve as primary individual therapists in addition to their group therapist role. However, the assignment of caseloads is not (and cannot be) based upon to request. labeling the individuals behavior as manipulative is judgmental and can be considered antagonistic.

Types of Interventions: management (interventions designed to reduce or minimize disruptive or undesirable behavior that interfere with therapeutic activities or procedures needed to change areas of dysfunction that are the main focus of intervention (an individual becomes excessively anxious during there first use of a wheelchair in an environment outside of the hospitial. Supportive interventions are needed to decrease anxiety, thereby enabling the person to work on essential community mobility skills)

a. in the AOTA practice framework, the terms 'modify/compensation/ adaptation' are used to distinguish interventions that alter the context or demands of an activity to reduce distracting features. --1. compensation and adaptation techniques are also used to alter the context or demands of an activity to support the person's ability to engage in areas of occupation (the provision of cues)

Types of Interventions: maintenance: interventions designed to support and preserve the individuals current functional level (a reminiscence group to maintain the cognitive and social skills of individuals with early to mid-stage neurocognitive disorders)

a. no improvement in function is planned due to the chronicity of the disorder or the progression of the disease. b. a decline in function is prevented, as much and for as long as possible c. maintenance programs include familial, environmental, and social supports and consistent and regularly scheduled follow-ups. d. while maintenance is not often reimbursed by third0party payers, it is a major type of OT intervention b/c OT practitioners often work with people who have chronic and/or progressive disorders. e. in the AOTA practice framework, the term 'maintain' is used to designate these interventions.

Types of Interventions; prevention (interventions designed to promote wellness, prevent disabilities and illness, and maintain health)

a. primary (aka: create/promote and health promotion): the reduction of the incidence or occurrence of a disease or disorder within a population that is currently well or considered to be potentially at risk (parenting skills classes for teen parents to prevent child neglect) b. secondary: the early detection of problems in a population at risk to reduce the duration of a disorder/disease and/or minimize its effects through early detection/diagnosis, early appropriate referral, and early/effective intervention (the screening of infants born prematurely for developmental delays and the immediate implementation of intervention for identified delays) c. tertiary: the elimination or reduction of the impact of dysfunction on an individual (the provision of rehab services to maximize community integration)

Types of Interventions: meeting the health needs (interventions designed to satisfy inherent, universal human needs. These needs are not automatically met)

a. psychophysical: the need for adequate shelter, food, material goods, sensory stimulation, physical activity, and rest (institutionalized orphans confined to cribs require sensorimotor interventions to counter environmental deprivation) b. temporal balance and regularity: the need for a satisfying balance between work/productive activities, leisure/play, and rest (forced leisure due to involuntary unemployment requires intervention to achieve temporal balance) c. safety: the need to be in an environment free from hazards or threats (living in a chaotic, abusive home does not meet this need, and interventions are needed to ensure safety) d. love and acceptance: the need to be accepted and loved for one's personal attributes and uniqueness, not for ones accomplishments (the barriers caused by aphasia and ataxia can hinder meeting this need; therefore, supportive interventions are indicated) e. group association: the need to feel connected to others who share similar interests and goals (the stigma and symptoms of mental illness can prevent regular interactions with a group; therefore, interventions to develop social interaction skills and provide community supports are indicated) f. mastery: the need to successfully complete an activity or meet a goal b/c it is interesting and challenging (deficits in performance components can hinder successful performance and block interventions to develop performance skills and/or adapt activities are needed) g. esteem: the need to be recognized for ones accomplishments (lack of opportunity to do activities perceived as worthwhile by others requires interventions to facilitate recognized contributions) h. sexual: the need for recognition of ones sexuality and the satisfaction of sexual drives ( institutional rules against adult consensual sex prohibit meeting this need and require review and revision) also, physical impairments to sexuality may require adaptations and environmental modifications. i. pleasure: the need to do things just for fun (the child on an intensive school and home physical rehab program needs an intervention plan to supportive of spontaneous play) j. self- actualization: the need to engage in activities just for oneself and for personal sati

Types of Interventions: the change process (interventions designed to achieve behavioral changes and functional outcomes)

a. this is the most commonly used in OT and is most reimbursed b. this process if often the only form of intervention discussed or documented c. guidelines for intervention planning and implementation relate directly to this process d. in the APTA framework, the terms 'establish /restore/remediation/restoration' are used to distinguish interventions that change a person in some manner. --1. intervention focus on establishing a skill or ability that a person had never developed and/or restoring a skill or ability that the person lost due to impairment.

A45. A 3-year-old with recurring headaches and decreased gross and fine motor skills is hospitalized for a diagnostic workup. The occupational therapist completed a screening of the child and determined that the OTA should complete a standardized developmental assessment. Just prior to the scheduled OT evaluation, the parents have been told that the child has brain cancer. The parents are upset when they bring the child to OT. The OTA provides support. Which is the next best action for the OTA to take in response to this situation? a. Cancel the evaluation session and refer the parents to their spiritual advisor or the social worker. b. Advise the parents to speak to their spiritual advisor or the social worker after the evaluation session. c. Ask the supervising occupational therapist to participate in the session and spend it addressing the parents' acceptance of the diagnosis. d. Reschedule the evaluation for later in the day so that the parents can speak with their spiritual advisor or the social worker.

b. Advise the parents to speak to their spiritual advisor or the social worker after the evaluation session. The best actions are to advise the family to seek a source of help and comfort and process with the eval session. the OTA can provide this advice in a supportive and empathetic manner and then complete the scheduled assessment. The Child needs the OT eval as part of the diagnostic workup. The OTA can respond supportively to the family without direct supervision from the OTR. The provision of consulting is best provided by pastoral care and/or social work practitioners. Canceling or rescheduling the eval session is not necessary, and in a busy hospital setting it is unlikely that make-up re-appointments would be readily available. Given the nature of the child's diagnosis, the timely completion of a developmental assessment is essential.

B129. An OTA implements a transitional program for a 15-year-old high school student with a history of numerous school-related failures. Which is the most important principle of intervention for the OTA to use with this student? a. Utilize activities that are typically at the developmental level of a 12-year-old to ensure successful completion. b. Grade an activity of interest into achievable steps to facilitate successful completion. c. Introduce several activities during each session and change them frequently to decrease boredom. d. Terminate the activity during a treatment session when there is difficulty with activity completion to eliminate frustration.

b. Grade an activity of interest into achievable steps to facilitate successful completion. grading an activity to be presented in achievable steps is the most appropriate intervention principle for a person with a history of diminished successful experiences. Employing activities appropriate for a younger child and terminating activity when difficult will not address the teens need for transitional services. Introducing several activities during one session can be overwhelming and decrease the ability to work in a focused manner on the attainment of transitional goals. -characteristics of transitional programs Ch 4

B32. An OTA conducts a communication group in a wellness program for a large corporation. In this mature level group, what should the OTA do? a. Help to develop the group norms of conduct. b. Participate as a member. c. Actively resolve group conflicts. d. Maintain a leader role.

b. Participate as a member. in a mature group, the group leader participates at the level of a member and does not act as a designed leader except in special circumstances such as a member becoming destructive to the group process. The members decide formally and informally the norms for behavior. The group leader does not usually participate in conflict resolution except to facilitate the members participation in serious situations, such as deadlock conflicts. the group leader functions in a variety of task, maintenance, or egocentric roles as needed to show members how these roles function in the group.

C133. An OTA initiates a lifestyle redesign group at an assisted living facility for new residents. Which approach is best for the OTA to use during the group's initial session? a. Encourage the members to share their feelings about moving to an assisted living facility to facilitate adaptive adjustment. b. Review written handouts about the group's purpose, norms, and goals in an environment that minimizes auditory distractions. c. Describe environmental modifications that can be made to the residents' apartments to compensate for low vision. d. Provide specific recommendations for doing activities at a slower pace to accommodate for decreased reaction time.

b. Review written handouts about the group's purpose, norms, and goals in an environment that minimizes auditory distractions. the first session of. a group should focus on orienting group members to the groups purpose, norms, and goals. most persons who live in ALFs are older adults. therefore, it is important for the OTA to consider the impact of age-related sensory changes on the residents ability to participate in the group orientation. Age-related sensory changes typically include hearing loss. thus, it is best for the OTA to orient the group members by orally reviewing written handouts in an environment that minimizes auditory distractions. Providing written materials that the members can take with them can also facilitate a positive orientation to the group b/c the residents will have this information readily available to review as needed. Encouraging the members to share feelings about moving to an ALF is not appropriate fro an initial group meeting. Revealing personal feelings about major life change required a cohesive group of members who trust each other. B/C the members are new residents, they will likely not know each other will and may be uncomfortable with sharing personal information. doing activities at a slower pace and modifying the environment are effective interventions for aggregated sensory changes; however, they are not the most relevant focus for an initial session of a newly formed group. New members first require an orientation to the group. -group process and stages of group development Ch 3

C69. Ten members of a community reintegration group are not working well together and show decreased levels of trust. The occupational therapist and OTA establish a goal to enhance the level of cohesiveness in the group. To begin the next group session, which is the best action for the OTA to take? a. Read inspirational phrases to increase motivation. b. Verbally review the goals and purposes of the group. c. Have each person contribute a line about childhood memories to a group poem. d. Ask each person to talk about silly mistakes to provide some levity.

b. Verbally review the goals and purposes of the group. the best choice is for the OTA to verbally review the goals and purpose of the group. this helps to direct the focus of the members onto the reason(s) that they are participating in the group. This reinforcement of a shared purpose can help develop cohesion. The OTA and therapist can then design and provide activities that build on this commonality. Inspirational phrases can help instill a positive attitude, but they do not address the need to develop group cohesion. Using individual members' input to compile a group poem can be an activity that increases cohesiveness. However, some group members may have had less than wonderful childhood experiences and may be reticent to share childhood memory with persons with whom they are not close. Consequently, this activity may be more detrimental than helpful. One way to decrease cohesiveness is to require self-disclosure in a group with decreased levels of trust. As a result, the topic of silly mistakes is also not a good group discussion focus. It is not likely to facilitate trust, openness, and willingness to share. --charateristics of cohesive groups and group facilitation techniques, Ch 3

B70. To develop the social interaction skills of adolescents with autism spectrum disorder (ASD) an occupational therapist and an OTA develop a community-based after school program. Which group is best for the therapist and the OTA to include in this program? a. A directive group. b. A topical group. c. A developmental group. d. A task-oriented group.

c. A developmental group. A developmental group focus is to teach the social interaction skills needed for group participation in a sequential manner. it provides group structure and activities along a continuum that is consistent with how interaction skills typically develop. individuals with ASD often have significant deficits in social interaction skills. however, they typically have normal intelligence and do not need interventions to address cognitive skills. A directive group- uses a highly structured five-step approach to help low-functioning patients (persons with neurocognitive disorders or serious mental illness) develop basic skills. A topical group - is a discussion group focus on activities performed outside of the group (vocational planning) A task-oriented group - focus is to increase members awareness of their values, ideas, and feelings as revealed through group activity. this emphasis on intra-psychic functioning would be appropriate for individuals with ASD -Ch 10 and 13

C128. An OTA collaborates with an occupational therapist to develop the preadmission screening procedures for a supported housing program with several levels of care. The population served by this program include persons with serious mental illness who are actively engaged in their recovery. Which tool is best for the therapist and OTA to include in the recommended screening procedures? a. A semistructured interview. b. An activities of daily living checklist. c. A structured cooking task. d. A weekly activity schedule.

c. A structured cooking task. the purpose of screening is to determine the need for further evaluation. A structured cooking task can be used to screen for a diversity of cognitive skills (ability to follow directions and problem solve, awareness of safety) and home management abilities (use of kitchen equipment, level of cleaniness) that can help determine the need for further evaluation . This information will be necessary to select the level of supported housing that would be most effective for each person referred to the program. A semi-structured interview can be helpful in determining interest and goals, but it does not assess performance, therefore, its usefulness is limited. A weekly activity schedule can provide information about time use and ability to complete a structured task, but it is a paper-and-pen task that has limited applicability to screening for housing placement recommendation,

B8. A child with attention deficit with hyperactivity disorder (ADHD) and conduct disorder attends an afterschool program that utilizes sensory-integrative and behavioral management approaches to achieve intervention goals. Snacks are provided and occasionally used as rewards. A parent insists that a child not be given any foods containing sugar. Which is the OTA's best response to this request? a. Discontinue providing sugary snacks but continue their use as rewards in the behavioral management program. b. Provide the parent with recent research that refutes the link between sugar and problem behaviors. c. Comply with the parent's request and discontinue providing sugary snacks. d. Inform the parent that the OTA will discuss the issue with the occupational therapist to determine the best course of action.

c. Comply with the parent's request and discontinue providing sugary snacks. the parents request must be respected and honored. The OTA may provide a parent with research information related to a child's condition, it is not the OTAs role to attempt to prove the parent wrong in their beliefs. The OTA can directly address the issue with the parent and does not need to discuss the issue with the OTR before responding. Behavioral rewards and appropriate snacks that do not contain sugar can be used in the program. The use of non-sugar items can also be beneficial for children at risk with a secondary diagnosis of diabetes or other medical conditions. -cliennt-centered practice, ch. 3

C19. An occupational therapist and an OTA co-lead a work adjustment group. One member has become progressively more dependent on the OTA for directions, praise, and input throughout the group activities. Which action should the group leaders initially take in response to these behaviors? a. Schedule several individual sessions with the OTA and group member to examine the issues of dependency and transference. b. Inform the attending psychiatrist that the group member is exhibiting signs of dependency and transference. c. Have the OTA work with the person during group sessions to develop independence in task completion. d. Have another therapist co-lead the group with the occupational therapist and reassign the OTA to another group.

c. Have the OTA work with the person during group sessions to develop independence in task completion. the development dependency is not uncommon in therapeutic relationships. the best approach is to use the situation and have the OTA function as a change agent. it is not necessary to devote individual sessions to this issue. Moreover, this individualized attention could foster increased dependency. dependency needs are best addressed in the group setting during activities. one can notify the psychiatrist, but this does not address the potential to modify behavior in the group setting. Removing the OTA is not a good choice because the member does not have a chance to work through the dependency issues. This action does not give an opportunity for the OTA to use themself therapeutically. --review group facilitation guidelines and principles of therapeutic use of self, ch. 3

A155. An OTA works at a community-based vocational rehabilitation program. Right before a discussion group about effective work habits is scheduled to begin, the OTA is asked to assist another OTA with this group. Which is the best action for the OTA to take? a. Split the group in two and have each OTA work with their own group. b. Participate as a member of the group and model desired responses. c. Support the leader with comments and questions that keep the group on focus. d. Act as an observer and take notes for documentation.

c. Support the leader with comments and questions that keep the group on focus. the role of assisting a group leader is to facilitate participation of the members and the achievement of the goals of the group. splitting members into 2 groups would result in the assisting OTA having no knowledge of the groups history, process, or goals. IN addition, the existing leader would receive no input from a co-leader. the benefit of receiving feedback from a co-leader is likely the precipitant for the group leader asking the OTA to participate. Participating as a member, an observer and/or recorder also do not provide any leadership benefits. -effective group co-leadership Strats. Ch. 3

B187. A school-based OTA is teaching orientation and mobility skills to an adolescent with a degenerative visual disorder. Which is the most effective motivational technique for the OTA to use with this student? a. Provide concrete structure and frequent feedback to ensure accurate orientation and safe functional mobility. b. Keep sessions short to allow time for emotional adjustment to orientation and mobility challenges. c. Treat the student as an adult and incorporate the student's orientation and mobility goals into intervention sessions. d. Limit anxiety by practicing the techniques in a quiet and self-contained environment; e.g., an empty classroom.

c. Treat the student as an adult and incorporate the student's orientation and mobility goals into intervention sessions. adolescents prefer to be treated as adults. The most important (and effective) motivational technique is to incorporate the students goals into the intervention session. Too much structure will limit the students trail and error learning, which is vital to learning and retaining orientation and functional mobility. The length of intervention sessions should be determined by the student's established goals, the methods identified to attain these goals, and the students progress toward goal attainment. Throughout the orientation and mobility training sessions, the OTA can incorporate the therapeutic use of self to help the student emotionally adjust to the challenges of the situation and effectively deal with any aniexty they may be experiencing. Using a quiet, self-contained environment can be a helpful intervention approach when first introducing orientation and mobility techniques, but it is not a motivational strategy.

A71. An OTA works in a school setting with adolescents with autism spectrum disorder (ASD). The need for a social skills training group is identified. One activity that the OTA plans to use in the group is role playing. Which is the most effective way for the OTA to determine relevant scenarios for the role-play activities? a. Survey the teachers on social difficulties displayed in class. b. Survey parents on social difficulties they have observed in the adolescents. c. Review literature on adolescent social skill development. d. Ask the group members about their social concerns.

d. Ask the group members about their social concerns. directly asking members about their concerns will enable the OTA to identify areas of common concern that can serve as the basis of relevant role-play scenarios. This will foster Yalom's curative factor of universality. the ability to express ones concerns and needs is especially important to adolescents since their main developmental task is to separate from parents and develop their own self-identity. Surveying others provides information on their perceptions of the adolescents' needs. This may or may not be an accurate reflection of members needs. Reviewing developmental literature can be helpful to understand adolescent concerns, but it cannot be used to plan role-play scenarios for a specific group of adolescents with unique needs. -Ch 3 and 10

C14. An OTA and occupational therapist collaborate with a local office for the aging to design a new community-based day treatment program for individuals with neurocognitive disorders. Which groups are best for the OTA and therapist to recommend the program include? a. Reality orientation groups. b. Cognitive-behavioral groups. c. Parallel groups. d. Instrumental groups.

d. Instrumental groups. according to Mosey's taxonomy of groups, instrumental groups help individuals function at their highest possible level for as long as possible. they provide supportive, strutted environments and activities that prevent regression, maintain function, and meet mental health needs. Activities can include reminiscence, arts and crafts, music, exercise, dance, and any other activity that is interesting and enjoyable to the members. Reality orientation groups - are contraindicated for persons with neurocognitive disorders who cannot remember basic facts like dates, people, or places. Cognitive-behavioral groups - require intact cognition and are at too high a level for persons with neurocognitive disorders. Parallel groups - can be indicated for individuals with neurocognitive disorders, but a schedule should not be comprised primarily of parallel groups for they are limiting in their potential for social interaction. - mosey's taxonomy groups ch.3

A14. An OTA provides occupational therapy services in a program for survivors of domestic violence. The OTA uses a client-centered approach. Which should the OTA do during intervention sessions? a. Offer specific suggestions for more effectively dealing with confrontations. b. Respond to self-deprecating comments with positive feedback on personal characteristics. c. Reinforce only the consumers' neutral comments about themselves and their skills. d. Paraphrase the consumers' statements to help clarify expressed feelings and plans.

d. Paraphrase the consumers' statements to help clarify expressed feelings and plans. the focus of client-centered therapy is to be directed by the consumer. a goal is to encourage self-awareness of feelings and the exploration of possible desired options for future actions. Offering specific suggestions and behavioral reinforcement are not consistent with client-centered therapy. the OTA should use techniques to encourage the consumers to generate their own ideas. In the client-centered approach, the OTA should withhold judgment on self0deprecating comments and accept the consumer unconditionally. -ch 3 and 13

C124. A middle school-aged child with a sensory processing disorder participates in weekly occupational therapy sessions at a private pediatric clinic. Initial evaluation had identified the presence of symptoms consistent with a sensory-based motor disorder. The child has shown no improvement in coordination, equilibrium, and motor planning for the past 2 months. The parents report that the child continues to exhibit difficulties with play, learning, and social participation. Based on these observations and parental report, which is most important for the OTA to discuss with the occupational therapist? a. Providing the parents with a home program and discharging the child from therapy. b. Referring the child to a pediatric social worker to explore potential resistance to therapy. c. Increasing the frequency of therapy to two sessions per week to increase the child's engagement. d. Re-evaluating the child to determine deficit areas that are contributing to dysfunction.

d. Re-evaluating the child to determine deficit areas that are contributing to dysfunction. the child is not making gains in OT with the current approach to address coordination, equilibrium , and motor planning, and the parents are reporting ongoing dysfunction. therefore, the OTA should discuss the need for re-eval of the child with the OTR. the re-eval by the OTR would obtain information that can help revise the current intervention plant to more effectively meet the child's needs. The OTA would contribute to the re-eval process with SV from OTR. intervention focused on other performance skills and client factors may be effective and should be implemented before discharging the child. The OTA should not continue to treat the child in areas that show no progress. the child has not made gains. increasing the frequency of OT w/o a revised intervention plan will not facilitate improvements. the identified deficits are within the domain of practice of OT, so a referral to a social worker is not necessary. there is no information provided in the scenario to indicate that the child is resistant to therapy. - treatment planning guidelines , Ch 3

facilitated leadership

occurs when the OT practitioner shares responsibilities for the group and for group process with the members --1. this style is advised when members skill levels and engagement are moderate (egocentric - cooperative/basic cooperative or cooperative/supportive cooperative) --2. facilitated leaders collaborate with group members to select the activities to be used in a group --3. members and leaders share instruction throughout the groups process. --4. group maintenance roles and feedback are provided by members with the leader facilitating the process. --5. the facilitative leaders goal is to have members acquire skills through experience.

Types of Clinical Reasoning

procedural/scientific (identify problems, set goals, create & implement tx) interactive (how it affects person, therapeutic relationship) narrative (occupational story & process of change) pragmatic (considers context & tx possibilities within setting) conditional (ongoing revision of tx)

Thematic Group

purpose/ focus: to assist members in acquiring the knowledge, skills, and/or attitudes needed to perform a specific activity assumptions: improvement of ability to engage in activities outside of group can result from teaching these activities within group. type of client: determined by the specific goals of the group. members needs, concerns, and goals must match the objectives of the group. members must have a minimal group interaction skill level equal to a parallel group skill level.