OSC 605: OT Process: Older Adult PDF

OSC 605: OT PROCESS: OLDER ADULT CHAPTER 35 DEGENERATIVE DISEASES OF THE CENTRAL NERVOUS SYSTEM, P. 871 CHAPTER 37 DISORDERS OF THE MOTOR UNIT, P. 929 Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for...

OSC 605: OT PROCESS: OLDER ADULT CHAPTER 35 DEGENERATIVE DISEASES OF THE CENTRAL NERVOUS SYSTEM, P. 871 CHAPTER 37 DISORDERS OF THE MOTOR UNIT, P. 929 Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 PLAN  NBCOT prep questions  Degenerative diseases of the CNS- Chapter 35  Disorders of the Motor Unit- Chapter 37  Guest KEY TAKE AWAYS FROM GUEST?? CHAPTER 35 DEGENERATIVE DISEASES OF THE CENTRAL NERVOUS SYSTEM  In degenerative neurological disorders,  the disease progresses  occupational performance is often increasingly compromised  Occupational therapy aims to help the client compensate and adapt as function declines secondary to the disease process. Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 QUESTION  How has the disease progression affected Victoria? DEGENERATIVE DISEASES OF THE CENTRAL NERVOUS SYSTEM  Loss of self-efficacy in performing various tasks  OT’s role to help the individual with reframing the role of self despite decline in functional independence CHAPTER 35 DEGENERATIVE DISEASES OF THE CENTRAL NERVOUS SYSTEM  Amyotrophic Lateral Sclerosis (ALS)- review  Parkinson’s Disease (PD)  Alzheimer’s Disease (coming up in this course) Covered in OSC 602:  Amyotrophic Lateral Sclerosis (ALS)  Huntingdon’s Disease (HD)  Multiple Sclerosis (MS) https://fineartamerica.com/featured/2-central-nervous- system-springer-medizinscience-photo-library.html AMYOTROPHIC LATERAL SCLEROSIS  Used to identify a group of progressive, degenerative neuromuscular diseases.  Also known as “Lou Gehrig's” disease  Destruction of motor neurons within the spinal cord, brainstem and motor cortex  Combination of upper motor neuron and lower motor neuron deficits during disease process  Motor Neuron Disease: refers to a group of diseases that includes ALS, progressive bulbar palsy, progressive spinal muscular atrophy, primary lateral sclerosis, and an inherited form, https://med.emory.edu/departments/neurology/ and spinal muscular atrophy. programs_centers/emory_als_center/what_is_als/ index.html Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 TABLE 35-1 P. 875 Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 ALS Progressive Bulbar Palsy: Bulbar tracts and brainstem  Symptoms  Dysarthria  Dysphagia  Facial and tongue weakness  Wasting Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 ALS Progressive spinal muscular atrophy  Lower motor neurons in spinal cord and brainstem  Symptoms: Muscle wasting of limbs, trunk, and sometimes the bulbar muscles Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 ALS Primary Lateral Sclerosis  Corticospinal and corticobulbar regions  Symptoms: Progressive Spastic paresis  characterized by progressive weakness and spasticity (stiffness) of the legs. Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  CLASSIC ALS SYMPTOMS Recognizing early symptoms: https://www.youralsguide.com/early-als-symptoms-n ewly.html Fasciculations- https://www.youtube.com/watch?v=LD-2FfomZyU Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 ALS Clinical Picture  Typically a focal weakness in the arms, legs, or bulbar muscles  Poor balance, coordination, strength, slurred speech, fatigue, SOB  Weight loss, muscle atrophy, emotional lability  Prognosis: fatal and debilitating  New treatment: The U.S. Food and Drug Administration approved AMX0035 for the treatment of ALS in September 2022. AMX0035 is designed to slow disease progression by slowing or preventing motor neuron cell death. Motor neurons are the cells that die in ALS. Als.org Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 OT PROCESS FOR AMYOTROPHIC LATERAL SCLEROSIS- ALL TYPES  Focus on occupations most important to the individual  Adaptations - decline will happen  Family education and training  Listen to client and family needs- client centered Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 ALS  Assessments-specific to ALS  Amyotrophic Lateral Sclerosis Functional Rating Scale  https://www.sralab.org/sites/default/files/2017-07/PMandR_ALSRatingScale033111.pdf  Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS- R)  https://www.mdcalc.com/calc/10166/revised-amyotrophic-lateral-sclerosis-functional-r ating-scale-alsfrs-r  What other assessments can you think of? OT INTERVENTIONS:  DME  Caregiver training  Environmental modifications  Adaptive equipment including wheelchairs  ROM, light resistive exercises  Prevention of pressure sores Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 ALS PHASE ALS Phase I (Independent) Characteristics OT Intervention Stage I:  Mild weakness  Normal activities  Clumsiness  Energy conservation  Ambulatory  Provide opportunity for voice concerns  Independent with ADLs  Range of motion may be required  Gentle resistance exercise. Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  ALS PHASE ALS Phase I (Independent) Characteristics OT Interventions Stage II  Assess self-care , work, leisure  Moderate selective weakness  Adapt tasks  Slight decrease in ADLs  DME  Climbing stair becomes  Orthotics as needed difficult  Baseline dysphagia  Difficulty in raising arms and  Stretching buttoning clothing/ tying shoes  Cautious strength/resistance nothing over 3+/5 Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  Orthotics WHAT IS AN AFO? ANKLE FOOT ORTHOSIS (AFO, MAFO, TOE OFF) Types Diagnoses  https://www.youtube.com/watch?v=Ih-r20vbWR0  Foot Drop  Can be used for  Related to nerve injury  CVA, SCI, ALS, MS.  Foot Weakness  Can be diagnosis specific May need PT or Ortho Referral  ALS PHASE ALS Phase I (Independent) Characteristics OT Intervention  Manual or power wheelchair Stage III  Leg rests  Severe weakness in ankle, feet,  Trunk supports hands  Adapt or DME  Moderately decreased ADLS  Home modification  Easily fatigued especially with long  Education on bathroom equipment ambulation  Slightly increased respiratory effort  Keep patient as independent as possible  Encourage deep breathing exercises Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  Chest stretch  ALS PHASE: OT Intervention ALS Phase Ii (Partially Independent) Characteristics  Arm slings  Overhead slings Stage IV  Power wheelchair  Hanging arm syndrome  Assistive technology  Shoulder pain/edema in hand  Home modifications  Shower DME  Wheelchair dependent  Closure Activities  Severe LE weakness  Arm troughs  Able to perform some ADLs  Splints (testing hand splint, wrist cock up splint, thumb spica splint)  High fatigue  Anti-edema Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier.  ROM ISBN: 978-0-3233-3927-8 ALS PHASE: ALS Phase Ii (Partially Independent) Characteristics OT Intervention Stage V  Caregiver training for ADL assistance  Severe LE weakness  Mechanical lift  Moderate to severe UE weakness  Adaptations, DME  Wheelchair dependent  Skin protection techniques  Increasingly dependent in ADLs  Pressure relief  At risk for skin breakdown  Adapt wheelchair for possible need of respiratory unit  A/AAROM or PROM Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  ALS PHASE ALS Phase Iii (dependent) Characteristics OT Intervention Stage VI  Dysphagia referrals  Dependent with all positioning in  Feeding tube? bed or wheelchair  Speech devices  Completely dependent in ADLs  PROM  Extreme fatigue  Sensory stimulation  Massage  Skin care Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 ALS OT Intervention- team approach  Adaptation of functional activities as the disease progresses for client participation  Caregiver training as disease progresses  How to inform the client of the diagnosis and progression  When to consider noninvasive and invasive ventilator support  Evaluate for dysphagia and intervention with a feeding tube  Management of saliva and pain  Use of hospice services. Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 PREVENTION OF PRESSURE ULCERS Why?  Predisposing Factors  Pressure Injuries  Paralysis  Life threatening, but can be  Insensate skin prevented  Incontinence  Often interventions from OT are  Poor nutrition key to this  Anemia  Spasticity and joint contractures  Lack of education Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 COMPLICATIONS Pressure Ulcers: Common Sites  Acute phase: sacrum, heels  Subacute/chronic phase: ischial tuberosities, trochanters  Pressure Ulcers: Common Sites  Less common sites: occiput, scapula (Halo vest), malleoli, metatarsals https://www.merckmanuals.com/home/skin-disorders/ pressure-sores/pressure-sores ALS COMPLICATIONS Pressure Ulcers: Prevention  Pressure relief maneuvers  Heel reliefs/ankle foot orthotics  Specialty beds/wheelchair cushions  Bowel/bladder management strategies implemented early  Patient and family education Adam Stein, MD PREVENTION  Reposition  Friction and Shearing-avoid  30 min to 1 hour  Cushion use  Sometimes even more  Sliding board frequently  Commodes  Pressure relief  Wheelchairs  Weight shifts Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 HOW IS PD DIFFERENT FROM ALS? SYMPTOMS Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  PARKINSON’S DISEASE Resources for clients: https://www.parkinson.org/blog/awareness/new-parkinson-dot-org https://www.parkinson.org/understanding-parkinsons/10-early-signs PARKINSON'S DISEASE  Early Onset  3% 50 years of age or less  MJF Interview 11/4/2020  https://www.youtube.com/watch?v=jAxU8hnh-Wo Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 PARKINSON'S DISEASE  Stage I: Signs of PD are strictly one-sided, affecting one side of the body only.  Stage II: Signs of PD are bilateral and balance is not impaired.  Stage III: Signs of PD are bilateral and balance is impaired.  Stage IV: PD is functionally disabling.  Stage V: The person is confined to bed or a wheelchair. Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 THE SEVERITY OF THE DISEASE RATING SCALES  The Unified Parkinson’s Disease Rating Scale (UPDRS) https://www.theracycle.com/res  Follows the longitudinal course of the disease and made ources/links-and-additional-reso up of the following sections: urces/updrs-scale/  Part I: Evaluation of mentation, behavior and mood  Part II: Self-evaluation of ADLS including speech, swallowing, handwriting, dressing, hygiene, falling, salivating (drooling), bed mobility, self-feeding (cutting food), walking  Part III: Clinician-scored motor evaluation  Part IV: Complications  Hoehn and Yahr stating severity of Parkinson’s Disease  Schwab and England ADL scale THE UNIFIED PARKINSON’S DISEASE RATING SCALE (UPDRS) https://www.movementdisorders.org/MDS-Files1/PDFs/Ra ting-Scales/MDS-UPDRS_English_FINAL.pdf THE SEVERITY OF THE DISEASE RATING SCALES Modified Hoehn and Yahr Scale https://www.physio-pedi  Stage 0: No signs of disease a.com/Hoehn_and_Yahr  Stage 1.0: Symptoms are very mild; unilateral involvement _Scale only  Stage 1.5: Unilateral and axial involvement  Stage 2: Bilateral involvement without impairment of balance  Stage 2.5: Mild bilateral disease with recovery on pull test  Stage 3: Mild to moderate bilateral disease; some postural instability; physically independent  Stage 4: Severe disability; still able to walk or stand unassisted  Stage 5: Wheelchair bound or bedridden unless aided OT’S ROLE Depends on the client’s stage of PD, focus  Compensatory strategies  Client and family education  Environment and task modifications  Community involvement Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 EARLY STAGE PD- HOEHN AND YAHR 1-2.5 STAGES  Focus on promoting full participation in occupations, posture  Energy conservation  Sleep hygiene  Graded activities to improve ROM, strength, coordination, prevent contractures, improve posture and promote extension  Handwriting, computer skills  Safety  Wellness and health management Hall, C.A. (2018). Occupational therapy toolkit: Patient handouts and treatment guides (7th ed). Hallen House Publishing. ISBN: 9781948726009 MID STAGE PD-HOEHN AND YAHR STAGE 3-4  Use medication effectiveness time  Minimize distractions to increase focus of attention and concentration  Break down steps  Adaptive equipment, compensation  Safety  Graded TA/TE to improve ROM, strength coordination, prevent contractures, improve posture and promote extension  Functional balance  Pain management- positioning, modalities (superficial), deep breathing Hall, C.A. (2018). Occupational therapy toolkit: Patient handouts and treatment guides (7th ed). Hallen House Publishing. ISBN: LATE STAGE-HOEHN AND YAHR STAGE 5  Adaptive equipment for ADLs  Modify food textures and consistency  Sensory stimulation  Use of medication “on” times  Caregiver education:  PROM, positioning, body mechanics, fall prevention, use of DME Hall, C.A. (2018). Occupational therapy toolkit: Patient handouts and treatment guides (7th ed). Hallen House Publishing. ISBN: 9781948726009  OT ASSESSMENT – WHAT CAN YOU THINK OF?  COPM  Functional Assessments- ADL, IADL, functional mobility, balance, work  Depression  Cognition  Goniometrics  MMT  Parkinson's Disease Questionnaire  https://www.sralab.org/rehabilitation-measures/parkinsons-disease-questionnaire-39  Parkinson’s Disease Fatigue Scale (PFS-16)  https://www.sralab.org/rehabilitation-measures/parkinson-fatigue-scale  Executive performance test (EFPT)  https://www.ot.wustl.edu/about/resources/executive-function-performance-test-efpt-308  Fatigue impact scale Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice Hall, C.A.  (modified (2018). fatigue Occupational impacttoolkit: therapy scale:Patient https://www.sralab.org/sites/default/files/2017-06/mfis.pdf handouts and treatment guides (7th ed). Hallen House Publishing. ISBN: 9781948726009 skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 CASE EXAMPLE Open case example on Canvas  file:///C:/Users/montgomery.s/Downloads/PD%20case%20(1).pdf  Client’s symptoms?  How did the condition affect his occupations?  What assessments were used in this case?  What interventions were used in this case? Ott, K. & Kolodziejczak, S. Occupational Therapy Interventions for People With Parkinson’s Disease The American Journal of Occupational Therapy, 2022, Vol. 76(1), 7601390010. https://doi.org/10.5014/ajot.2022.049390 WHAT ASSESSMENTS WERE USED?  Occupational Profile  COPM  Activity card sort  Fatigue severity scale  9 item patient health questionnaire  39 Parkinson’s disease questionnaire  Timed up and go  Berg balance  9 hole peg test Ott, K. & Kolodziejczak, S. Occupational Therapy Interventions for People With Parkinson’s Disease The American Journal of Occupational Therapy, 2022, Vol. 76(1), 7601390010. https://doi.org/10.5014/ajot.2022.049390 OT INTERVENTION BASED UPON STAGES Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0- 3233-3927-8 PD STAGES https://www.parkinsonsnsw.org.au/understanding-the-five- stages-of-parkinsons/ PARKINSON’S DISEASE STAGE 1 Symptoms OT Management  Unilateral tremor  Exercise program (short) ROM and flexibility  Relaxation and breathing programs  Micrographia  Work evaluation  Poor endurance  Work simplification  Home modification and simplification  Fatigue  Habit training for breaks  Use of utensils  AE, DME, built up utensils Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 ADAPTIVE EQUIPMENT AND SET UP https://www.parkinson.org/living-with-par kinsons/management/activities-daily-livin g/assistive-tech-devices  PARKINSON’S DISEASE STAGE 2 Symptoms OT Management  Energy conservation  Bilateral motor disturbances  Daily flexibility exercises  Mild rigidity  Mobility exercises  Difficulty with simultaneous  Focus on trunk tasks  Difficulty with executive  Driving assessment function  Community mobility  Task analysis and adaptation Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice  AE and DME skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 PARKINSON’S DISEASE STAGE 3 Symptoms OT Management  Balance problems with delayed  Environmental modifications reactions  DME  Raised toilet seats  Difficulty with skilled sequential  Remove throw rugs tasks  Visual cues  Grab bars  External cues for speed and sequencing of new tasks Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 PARKINSON’S DISEASE STAGE 4 Symptoms OT Management  Fine motor control severely  Modifications to support compromised participation in self care tasks,  Oral motor deficits changes in food textures Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  PARKINSON’S DISEASE STAGE 5 OT Management Symptoms  Use of environment controls to  Client severely compromised allow access to environment in motor skills  Caregiver training  Dependent with ADLs Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  LSVT- BIG® AN EVIDENCE-BASED APPROACH TO THE TREATMENT OF PARKINSON’S DISEASE https://www.lsvtglobal.com/ FOCUS OF BIG®  AMPLITUDE  STABILIZATION  CALIBRATION- incorporating BIG movements into activities BIG® Comprehensive Program Rigid Protocol (4x week-4 weeks) Easy Modifications within the Protocol PWR!MOVES  Focus on Parkinson's-specific exercises that help maintain and restore skills that have deteriorated and can interfere with everyday movements.  More flexible program  Allows for individual adjustments based upon patient progress and needs  Focus on Anti gravity extension, weight shifting, axial mobility (trunk flexibility) and transitions (sit to stand) https://www.pwr4life.org/moves/ https://www.pwr4life.org/ More coming in lab today….. CHAPTER 37 DISORDERS OF THE MOTOR UNIT, P. 929 Disorders of the motor unit may be of neurogenic, neuromuscular, or myopathic origin and generally cause muscle weakness and atrophy of skeletal muscle. Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 NEUROGENIC DISORDERS Peripheral Neuropathy Distorts and interrupts messages between brain and the rest of the body Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  PERIPHERAL NEUROPATHIES  Associated with:  Trauma  Compression  Toxins  Infections  Neoplasms  Vascular disorders  Degenerative disorders  Congenital malformations Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice https://my.clevelandclinic.org/health/diseases/14737- skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 neuropathy ADDITIONAL CONSIDERATIONS IN ASSESSMENT Psychological Emotional Often overlooked as much as leisure We can take a holistic approach to the person and not just the physical aspects. Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8  ASSESSMENTS: https://www.mindgarden.com/158-ways-of-coping- questionnaire#horizontalTab2 Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 INTERVENTIONS  Positioning  Compensation for ADL, IADL and functional tasks  Sensory precautions  Pain management  Orthoses  Fall prevention  Footwear-Avoid going barefoot  Skin checks  TE- remediation  Leisure  Psychosocial Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s occupational therapy: Practice  Referrals skills for physical dysfunction (8th ed.). Elsevier. ISBN: 978-0-3233-3927-8 QUESTIONS ? NEXT WEEK AND BEYOND  Midterm 10/9/24 9 am-12noon; no in person labs- covering material through today! Lecture recording in place of lab.  After break, Wednesday 10/16/24: feeding/eating, role of SLP documentation lab 11:30-2:30