NBCOT Exam Prep

NBCOT Exam Prep

• The NBCOT exam prep guide includes a 6-week study schedule, NBCOT practice questions, and tips for testing strategies.

OTR Review

• The OTR review section includes over 600 OT terms and questions, covering topics such as:

Psycho Social and Neurological

• Psychotic disorders, brain injury, and dementia are populations that may use the Allen Cognitive Level Test (ACL)
• ACL measures cognitive level of function and is used as a screening tool
  • ACL 1: total assist, automatic actions/reflexive, attention span in seconds
  • ACL 2: max assist, postural actions/gross body movement, attention span in minutes
  • ACL 3: mod assist, repetitive actions, attention span in 30 minutes
  • ACL 4: min assist, goal-directed/familiar activities, attention span in hours
  • ACL 5: independent learning/exploratory, reasoning and problem-solving, attention span in weeks
  • ACL 6: planned action, conceptual, independent, absence of cognitive disability

Vision

• Age-related macular degeneration (ARMD or AMD): damage to macula, leading to vision loss
  • Dry: drusen deposits form in retina, increasing in number to form scotomas
  • Wet: abnormal vessel growth under retina, leading to fluid leak and damage
• Astigmatism: oval-shaped cornea, causing light rays to converge at multiple points
• Diabetic retinopathy: bleeding from small blood vessels in retina, leading to vision loss
• Fixation: focusing on an object, foundation of oculomotor control
• Fovea: center 10° of visual field, responsible for identifying details
• Visual acuity: ability to recognize small details, allows for speed and accuracy in processing
• Glaucoma: increased eye pressure, leading to vision loss
  • Acute narrow-angle glaucoma: acute episode, severe eye pain, headaches, nausea
  • Chronic open-angle glaucoma (COAG): chronic episode, decreased visual acuity and peripheral fields
• Hyperopia: farsightedness, difficulty seeing close objects
• Legal blindness: visual acuity of 20/200 or less in better eye with best optical correction, or visual field of 20° or less
• Macula: area of best vision
• Myopia: nearsightedness, difficulty seeing far objects
• Normal limits of visual field: superior 60°, inferior 75°, nasal 60°, temporal 100°
• Presbyopia: age-related loss of accommodation
• Retina: multilayer, sensory structure for the eye, initiates impulses to visual cortex via optic nerve
• Saccadic eye movement: quick eye movements that change fixation from one point to another
• Smooth pursuits/tracking: maintaining continued fixation on a moving target

Cranial Nerves and Vision

• Cranial nerves impacting vision:
  • Optic nerve (II)
  • Oculomotor nerve (III)
  • Trochlear nerve (IV)
  • Trigeminal nerve (V)
  • Abducens nerve (VI)

Visual Perceptual Hierarchy

• Foundational skills:
  • Oculomotor control
  • Visual field
  • Visual acuity
• Intermediate-level skills:
  • Attention
  • Scanning or visual search
  • Pattern recognition
• Advanced-level skills:
  • Visual memory
  • Visuo-cognition

Visual Field Assessments

• Confrontation testing: gross assessment of visual field
• Central field assessments:
  • Darnato 30-Point Campimeter: portable test card measuring central 30° of visual field
  • Pepper Visual Skills for Reading Test (VSRT): functional test indicating scotomas and their effects on function

Saccadic Eye Movements

• Assessed using:
  • biVABA
  • VSRT
  • Holding two different targets 16 inches from client's face, asking them to look from one to the other

Convergence and Divergence Assessments

• Convergence assessment: moving target towards client's nose, observing eye movements
• Divergence assessment: moving target away from client's nose, observing eye movements

Visual Attention Assessments

• Cancellation tests
• biVABA
• Figure and shape copying tests
• Line bisection test

Apraxia and Agnosia

• Apraxia (motor): inability to carry out a movement, despite intact sensory system, muscles, and coordination
• Ideational apraxia: difficulty with sequencing steps within a task
• Ideomotor apraxia: production error, using tools awkwardly or clumsily
• Agnosia: inability to recognize objects using only visual means
  • Color agnosia: inability to recognize specific colors
  • Color anomia: inability to name specific colors
  • Object agnosia: inability to recognize objects using only vision
  • Metamorphopsia: visual distortion of objects
  • Prosopagnosia (facial agnosia): inability to recognize a known face or individual
  • Simultanagnosia: inability to recognize and interpret an entire visual array at once

Visual Perception

• Visual spatial perception: ability to distinguish the space around one's body and objects in the environment
• Figure-ground: ability to recognize the foreground from the background based on differences in color, luminance, depth, texture, or motion
• Form constancy: ability to recognize a form, shape, or object despite changes in location, position, color, or size
• Spatial relations: ability to perceive the position of one's self in relation to objects in the environment
• Depth perception: ability to judge distances and depth
• Stereopsis: ability to see things in three dimensions, lack of which can affect depth perception and make the environment appear flat
• Topographical orientation: ability to navigate from one place to the next

Other

• Stereognosis: ability to identify everyday objects using tactile properties and no vision
• Graphesthesia: ability to identify forms, numbers, letters written on hand
• Autotopagnosia: inability to identify body parts on self or someone else or the relationship between parts
• Finger agnosia: inability to recognize which finger was touched or is being used
• Anosognosia: lack of recognition or awareness of one's deficits
• Right/left discrimination: ability to identify, discriminate, and understand the concept of right and left### Brain Functions and Cognitive Development
• The occipital lobe is responsible for scanning, identification of objects, awareness, and discrimination
• The frontal lobe is responsible for planning, problem-solving, organizing, attention, and initiation of movement
• The parietal and temporal lobes are involved in visual spatial relations, understanding spoken and written language, and verbal memory

Visual Inattention and Interventions

• Hemi-inattention: decreased search to left field due to right hemisphere deficit
• Interventions for hemi-inattention:
  • Provide bilateral activities
  • Guide the affected side through activities
  • Increase sensory stimulation to the affected side

Cognitive Assessments and Interventions

• Allen Cognitive Level test (ACL):
  • Evaluates cognitive functioning and capacity to learn
  • Scores range from 3.0 to 5.8 based on completion of stitches and method described by author
• Interventions for cognitive impairments:
  • Decrease external auditory stimuli
  • Give the individual increased response time
  • Use visual cues and gestures
  • Use concise sentences
  • Investigate the use of augmentative communication devices

Language and Communication Disorders

• Anomia: loss of ability to name objects or retrieve names of people
• Brocha's aphasia: loss of expressive language, resulting in decreased speech production
• Wernicke's aphasia: deficit in auditory comprehension, resulting in paraphasia or nonsensical syllables
• Global aphasia: combination of Brocha's and Wernicke's aphasia, resulting in severe impairment of spoken and written language

Visual Functioning and Development

• Erhardt Developmental Vision Assessment (EDVA) and Short Screening Form (EDVA-S): evaluates visuomotor development and identifies delays and gaps in skill sequences
• Brain Injury Visual Assessment Battery for Adults (biVABA): assesses visual skills, including acuity, color perception, depth, and visual fields

Cognitive and Behavioral Interventions

• Lowenstein Occupational Therapy Cognitive Assessment (LOTCA): measures basic cognitive functions prerequisite for managing everyday tasks
• Cognistat Neurobehavioral Cognitive Status Examination: explores, quantifies, and describes performance in central areas of brain-behavior relations

Orthopedic and Surgical Interventions

• Total Hip Arthroplasty (THA): replaces acetabulum and femoral head

• Minimally invasive technique: uses two 2-inch incisions, no detachment of muscles required

• Open reduction and internal fixation (ORIF): surgical alignment of fractured bones using screws, pins, wires, or nails### Hip Fractures & Hip Replacements

• Precautions: no hip flexion > 90 degrees, no internal rotation, no adduction (no crossing legs/feet)

• Intervention areas:

  • Client education (fall prevention, home modification, safe transfers, transportation)
  • Bed mobility & bedside ADL
  • UE strengthening
  • Functional ambulation & transfers with appropriate WBing status & ambulation device
  • Use of AD
  • Practice role activities using proper WBing status and ambulatory device
  • Caregiver training (educate precautions, transfers)

Low Back Pain

• Pathology:
  • Scoliosis (lateral curvature of spine)
  • Kyphosis (outward curvature of spine/hunch back)
  • Sciatica (nerve is entrapped by disc herniation)
  • Spinal Stenosis (narrowing of the intervertebral foramen)
  • Facet Joint Pain (inflammation or joint changes of spinal joints)
  • Spondylolysis (stress fracture of the dorsal to the transverse process)
  • Spondylolisthesis (slippage of one vertebra on another)
  • Herniated Nucleus Pulposus (stress may tear fibers of the disc, results in outward bulge of enclosed nucleus pulposus)
• Intervention areas:
  • Client education
  • Back stabilization & neutral spine
  • Body mechanics
  • Adaptive equipment
  • Ergonomics
  • Energy conservation
  • Stress reduction/coping techniques
• ADLs:
  • Bathing: shower not bath, keep items within easy reach, use long handled brushes/sponges
  • Dressing: sit while dressing, keep back straight or lie flat on bed, avoid bending forward
  • Functional mobility: logroll, maintain straight back and neutral spine, tighten abdominal muscles to support back

Amputations

• Classification system:
  • Transhumeral (short above-elbow amputation)
  • Transradial (radius ulna, BE)
  • Transfemoral (above knee, AK)
  • Transtibial (BK)
  • Syme's ankle (complete tarsal) disarticulation
• Precautions:
  • Joint complications: decrease ROM
  • Skin complications: delayed healing, extensive skin grafts, reduction of edema
  • Sensory complications: pain, body scheme/image
  • Psychological complications: severe depression, suicidal impulses
• Intervention areas:
  • Improve body image, self-image, psychosocial adjustment
  • Promote I fxn during ADLs and IADLs
  • Promote wound healing
  • Improve desensitization of the limb
  • Pain management
  • Residual limb shaping & shrinking
  • Promote proper skin hygiene
  • Maintain & restore passive & active ROM
  • Maintain & restore UE strength & end

Osteoarthritis (OA)

• Diagnostic criteria:
  • Hard tissue enlargement of 2+ of 10 selected joints
  • Hard tissue enlargement of 2+ distal IP joints
  • Fewer than 3 swollen metacarpal joints
  • Deformity of at least 1 of 10 selected joints
• Precautions:
  • Pain, fatigue
  • Inflamed or unstable joints
  • Perform resistive activity or exercise with caution
  • Possible sensory impairments
  • Fragile skin 2* disease or Rx side effects

Rheumatoid Arthritis (RA)

• Precautions:
  • Potential intolerance of thermal modalities
  • Respect pain as a signal to stop the activity
  • Reduce the force
  • Maintain muscle strength and joint ROM
  • Use each joint in its most stable anatomical and functional plane

OA and RA

• Principles of joint protection:
  • Respect pain as a signal to stop the activity
  • Reduce the force
  • Maintain muscle strength and joint ROM
  • Use each joint in its most stable anatomical and functional plane
  • Avoid positions of deformity & forces in their direction
  • Use the largest, strongest joints available for the job
  • Ensure correct patterns of movement
  • Avoid staying in one position for long periods
  • Avoid starting an activity that cannot be stopped immediately if it proves to be beyond capability
  • Balance rest and activity
• Home environmental modifications:
  • Remove doors of cabinets or attach loops to door handles
  • Lower the height of above counter cupboards
  • Use swivel or pull-out shelves
  • Replace standard oven with a microwave oven on a surface that accommodates available reach

Fibromyalgia

• Intervention areas:
  • Self management approaches
  • Patient education (fatigue management, energy conservation, body mechanics, pacing)
  • Lifestyle changes
  • Basic sleep hygiene measures
  • Fatigue management
  • Cognitive dysfunction
  • Pain & stress management

Cardiopulmonary Conditions

• Precautions:
  • Exercise intolerance
  • Chest pain or pain referred to teeth, jaw, ear, or mouth
  • Excessive fatigue, SOB
  • Lightheadedness or dizziness
  • Nausea or vomiting
  • Unusual weight gain of 3-5lbs in 1-3 days

Pulmonary Rehabilitation

• Intervention areas:
  • ADL evaluation and training
  • Breathing techniques
  • UE strengthening
  • Work simplification and energy conservation
  • Stress management

Breathing Techniques

• Pursed lip breathing:
  • Breathe in through your nose
  • With your lips pursed, exhale air slowly
  • Exhale twice as long as inhaling, if possible
• Diaphragmatic breathing:
  • Sit in a relaxed position (elevate feet preferably)
  • Place hand on your abdomen, feel stomach push out as you inhale through your nose
  • Feel your stomach go down as you slowly breathe out through pursed lips

Respiratory Diseases

• Precautions:
  • Oxygen saturation below 90%
  • Altered breathing patterns
  • SOB
  • Perspiration
  • Anxiety
  • Cough
  • Cyanosis (bluish discoloration of skin 2* decreased circulation, decreased O2 in blood)

OA & RA

• Splints:
  • Resting hand splints in the acute stage
  • Wrist splint only if arthritis specific to wrist
  • Ulnar drift splint to prevent deformity
  • Silver ring splints to prevent boutonniere & swan neck deformities
  • Dynamic MCP extension splint with radial pull for post-operative MCP arthroplasties
  • Hand base thumb splint for CMC arthritis
• Intervention areas:
  • ROM: focus on AROM, should be pain-free
  • Strengthening: avoid during inflammatory stage, avoid deformity positions
  • AE to prevent deformity, decrease stress on small joints, & extend reach

SPLINTS for Nerve Injuries

• Brachial plexus injury: flail arm splint
• Radial nerve palsy: dynamic wrist, finger, & thumb extension splint
• Median nerve injury: opponens splint, C-Bar or thumb post splint
• Ulnar nerve injury: dynamic/static splint to position MPs in flexion
• Combined median ulnar: figure-of-eight or dynamic MCP flexion splint
• Carpal tunnel syndrome: wrist splint positioned 0-15* extension

Prepare for the National Board for Certification in Occupational Therapy (NBCOT) exam with practice questions, a 6-week study schedule, and tips and testing strategies.