NBCOT Study Guide PDF

NBCOT Study Guide Table of Contents 1. Burn Rehabilitation 2. Cardiopulmonary 3. Musculoskeletal Conditions 4. Hands and UE 5. Amputations 6. PAMS 7. Work Rehabilitation 8. Low Vision 9. Neurodegenerative Conditions 10. Wheelchair and AT 11. Mental Health, Adult 12. Mental H...

NBCOT Study Guide Table of Contents 1. Burn Rehabilitation 2. Cardiopulmonary 3. Musculoskeletal Conditions 4. Hands and UE 5. Amputations 6. PAMS 7. Work Rehabilitation 8. Low Vision 9. Neurodegenerative Conditions 10. Wheelchair and AT 11. Mental Health, Adult 12. Mental Health, Pediatrics 13. Pediatrics 14. Dysphagia 15. OT Theory and Research 16. Ethics, Insurance, and COTA ______________________________________________________________________ 1. Burn Rehabilitation Burn Notes Evaluation/ Intervention Superficial Healing: 3-7 days Check ROM 72 hours post-op Superficial Partial Upper dermis Check strength/sensation once wound heals Healing: RA-> RV-> lungs-> LA-> LV-> body  - Systolic Pressure: pressure in heart during ventricular contraction - Diastolic Pressure: pressure in arteries between beats; ventricular relaxation; filling of blood - BP: 120/80 - High BP: >140/90 - Low BP: 4 weeks) Weight training Cardiovascular training Not covered by insurance, Physician referral after stress test MET Levels Stage 1: 1.0-1.5 MET Sitting: light BUE tasks seated for brief time: self-feeding, reading, washing face, playing cards, transfers, bed mobility, exercise all extremities in supine; only neck and lower extremities in sitting Stage 2: 1.5-2.0 MET No isometrics Sitting: dressing, sponge bathing, grooming, dressing, unlimited sitting, slow ambulation in room, crafts, exercises to all extremities Stage 3: 2.0-3.0 MET Sitting: showering, seated light IADLs, computer work Stage 4: 3.0-3.5 MET Mild resistance, treadmill, cycling, walking up stairs Standing: ambulation as tolerated, showering, light IADLs w/ energy conservation, driving, slow stairs Stage 5: 3.5-4.0 MET Standing: washing dishes, laundry, light home repairs, slow swimming/biking, hanging light clothes, making the bed,  golfing Stage 6: 4.0+ MET Home management, vacuuming, swimming, slow dancing, light yoga ______________________________________________________________________ 3. Musculoskeletal Conditions - Arthritis - Rheumatoid: inflammation of synovial lining; systemic, remissions/exacerbations, symmetrical - Deformities: boutonniere, swan neck, mallet finger (DIP), trigger finger, ulnar drift - Juvenile RA-> AROM exercises indicated - Inflammatory phase-> no hot packs, strengthening exercises, MMT, limit ADL participation - Intervention: system management, joint protection, energy conservation, assistive devices (built-up utensils, adjustable bowl tipper, and mountable electric can opener), ROM, strengthening, aerobic activity - Splint - Resting splint during acute stage - Ulnar deviation-> ulnar drift splint - Swan Neck-> block splint or dorsal splint in slight PIP, silver ring - Boutonniere-> silver ring, PIP ext splint - CMC arthritis-> hand based thumb splint - Osteoarthritis: larger joints, wear & tear of hyaline cartilage, pain/stiffness reduces with rest, local inflammation - Deformities: bouchard’s nodes (PIP), herberden’s nodes (DIP) - No PROM, No MMT if severe - Interventions: pain management, pain-free AROM, joint protection, energy conservation; ultrasound - Assessments: - ROM - Sphygmomanometer: grip strength  - Splinting (see below) - Osteoprosis: reversible; progressive; back pain, spinal deformities (kyphosis) - Assessments: home eval for fall risk, swallowing eval for kyphosis, low impact WB activities, environmental modification, energy conservation, joint protection, body mechanics - Milwaukee brace for kyphosis - Osteogenesis Imperfecta: dysfunction of genes responsible for producing collagen; brittle bone disease - Sxs: malformed bones, loose joints, blue/purple sclera, brittle teeth, hearing loss, respiratory problems - Interventions: safe ADL participation, environmental modification, preventative positioning and protective splinting/padding, AROM to improve muscle strength, weight bearing activities to improve bone strength - Ostopenia: bone loss, reversible - Intervention: diet, exercise, medication, environmental modification - Hip Replacement - Total Hip (THR): replaced acetabulum and femoral head - Partial Hip: replaced femoral head - Precautions - Anterolateral: no extension, no ER, no adduction - Posterolateral: no hip flexion >90, no IR, no adduction - WBS - Partial Weight Bearing (PWB): affected LE 50% of weight - Toe Touch Weight Bearing (TTWB): toe of affected LE, 90% weight on unaffected LE - DME: long-handled equipment, tub bench, raised toilet seat - Fibromyalgia: paina affecting musculoskeletal system; soft tissue pain, parasthesias, joint swelling, inability to think clearly, nonresotrative sleep, fatigue, depression, anxiety - Interventions: pain/stress management, gentle stretching, strengthening activities, CBT, alternative medicine (acupuncture, hypnosis), sleep hygiene, myofascial release, trigger point tx, massage, biofeedback, fatigue management, work simplification, energy conservation, memory aids, activity/environemntal modfiication - Contractures: fixed posture due to shortening of skin, ligaments, joint capsule, tendons, or muscles; 2/2 burns, wound healing, increased muscle tone from peripheral nerve injury, SCI, head injury (stroke, TBI), CP - Soft tissue-> therapy  - Boney block-> surgery - Evaluation: AROM/PROM - Intervention: superficial and deep heat to increase tissue extensibility, slow stretch, static splinting - Cancer - Stage 1: tumor present, no spread - Stage 2: localized spread of tumor - Stage 3: tumor spread to other organs - Stage 4: inoperable primary lesion - Post-op/Convalescence: rehab of motor, sensory, cognitive, neurobehavioral, psychological impairment, occupational role/body image, social support, health supporting behaviors - Palliative Care: prevent and relieve suffering, enhance QoL, family collaboration, caregiver training - End-of-life Care (Hospice): support QoL (i.e. empower life celebration, journaling,scrapbooks, phone call contact, letter writing, spirituality) - Open Kinetic Movement - Closed Kinetic Movement ______________________________________________________________________  4. Hands and Upper Extremity - Hands - Evaluation - Pain-> interview - ROM-> goniometer - Strength-> MMT, dynamometer, and pinch - Edema-> volumeter and measuring tape - Vascular-> Allen’s, color, trophic changes, pulse, and skin temp - Sensation-> semmes-weinstein for nerve compression, 2 point discrimination, nerve laceration and recovery - ADL checklist - Coordination - O’Conner Dexterity Tweezer Test-> hand eye coordination - Nine-hole Peg Test - Jebsen–Taylor Hand Function Test-> test of hand fx in writing, page turning, picking up objects, feeding, stacking, lifting objects - Minnesota Rate of Manipulation Test-> gross hand/arm movement; eye hand coordination and speed - Crawford Small Parts Dexterity Test-> motor dexterity test using tweezers and screw driver - Purdue Pegboard Test - Before/After tx: Quick DASH Disorder Symptoms Intervention Dupuytren’s Thick fascia, flexion Surgical release, A/PROM, deformities in involved strengthening when digits wounds healed, grasp and release Splint: extension splint at all times except bathing DeQuervain’s: Cumulative Finkelstein’s Test: pain w/ Keep thumb immobilized, Trauma Disorder (CTD); ulnar deviation of wrist and ice massage over radial tenosynovitis of abductor thumb in flexion wrist, activity/work mod, policis longus and extensor gentle AROM of policis brevis wrist/thumb to prevent stiffness, grip & pinch strengthening after 2 wks Splint: thumb spica splint (0-2 wks) Trigger Finger: CTD; 0-3/6 wks splinting, scar tenosynovitis of finger massage, edema control, flexors; non-operable tendon gliding activities, avoid repetitive gripping w/ tools and handles far apart Splint: finger-based trigger finger splint (MCP extended, IP joints free) Charcot-Marie-Tooth: Splint: compensate for neurological disorder that hand weakness and impacts voluntary muscle promote function control and muscle strength. As the condition progresses Carpal Fractures: fx to Scaphoid fx: FOOSH; most Do not assess PROM or individual carpal bones common MMT until ordered by physician Lunate fx: Keinbock’s disease; necrosis of lunate after loss of blood supply Proximal Fracture: Boxer’s fx: ⅘ MC fx Splint: ulnar gutter splint metacarpal fx Do not assess PROM or MMT until ordered by physician Wrist Fractures Colles fx: fx of distal radius Do not assess PROM or with dorsal displacement; MMT until ordered by most common; hand down physician Smith’s fx: fx of distal radius with palmar displacement; palm up  Bennet’s fx: fx of 1st MCP base CRPS (see below) Extensor Mallet Finger: flexion in DIP Tendon/Avulsion Inuries: Splint: DIP extension splint (0-6 wks) tendons separate from Intervention: splint in full ext for 6 weeks, tendon gliding bone and removes bone exercises matter Boutonniere Deformity: flexion of PIP and hyperextension of DIP Splint: PIP ext splint (0-6 wks); DIP AROM Intervention: splint PIP in extension and isolated DIP flexion exercises Wrist-> volar wrist splint Swan Neck Deformity: injury to MCP, PIP, or DIP; hyperextension of PIP and flexion of DIP Intervention: splinting of PIP in slight flexion Complex Regional Pain STAMP Contracture-> pain-free Syndrome (CRPS) AROM for short periods S: Sensory Type 1: after noxious event - Alloydnia: sensation Edema-> elevation (Stage Type 2: after nerve injury misinterpreted as 1) massage, contrast bath, pain compression, AROM, - Hyeralgia: increased gloves response to pain - Hyperpathia: pain Activity-> joint protection, after stimuli is energy conservation removed Pain-> TENS, splinting T: Trophic: discoloration, (static, then dynamic as hair/nail growth tolerated A: Autonomic: swelling, Stress-loading-> WB edema, sweating, activities within small range vasomotor instability and gradually increasing M: Motor: weakness, Desensitization-> contractures, atrophy, fluidotherapy muscle spasms, low activity tolerance No PROM, passive stretching, joint  P: Pain mobilization, dynamic splinting, casting Flexor Tendon Injuries: Duran Protocol: passive flex and ext of fingers in splint surgery needed; early mobilization Splint: dorsal block splint (0-4 wks); tendon gliding Kleinert Protocol: - Early (0-4 wks): dorsal block splint (wrist 20-30 flex, MCP 50-60 flex, IP ext) - Intermediate (6-8 wks): dorsal block splint w/ wrist in neutral Intervention: tendon gliding, AROM Tendon Hand Zones Extensor Tendon Zones Flexor Tendon Zone - Hand Nerve Innervations Nerve Injuries Radial Nerve Radial Nerve Injury: Radial Tunnel Radial Nerve Palsy: wrist drop, lack of Syndrome: burning wrist drop, Incomplete: nerve finger and thumb pain in lateral weakness, compression/entrap ext forearm d/t paralysis ment entrapment Low Level-> wrist Splint: dynamic Complete: drop Splint: long arm wrist and MCP ext laceration or splint w/ elbow splint avulsion High Level-> lost of flexed, forearm triceps supinated, wrist Interventions: neutral; wrist cock Strengthening wrist up splint and finger Splint: wrist cock up extensors splints; static wrist Interventions: ext splint 30 TENS, massage, degrees nerve gliding Interventions: Isotonic strengthening Median Nerve Median Nerve Carpal Tunnel Pronator Teres Injury: ape hand Syndrome: Syndrome: deep deformity; palm numbness & pain proximal numbness and tingling in 1-3 & forearm w/ activity, numbness to 1st radial same as CTS but and ½ of 4th digit, half of 4th, no pain when generalized especially at night sleeping weakness and pain, loss of pinch/thumb Tinel’s Sign: tap Positive Tinel’s-> at opp/palmar median n to elicit sx forearm abduction, decreased Phalen’s Test: elicit Splint: elbow pronation changes in 90-100 degrees w/ sensation forearm neutral Low Lesion-> flattening of thenar Moberg Pickup Intervention: TENS eminence, loss of Test: test median for pain thumb opp, thumb nerve function add Semmes-Weistein: High Lesion-> hand test loss of of benediction sensation (attempting to make a fist w/ digits 2 and  3) Splint: carpal tunnel splint or wrist cock-up at 0-10 degrees ext to relieve pressure and control edema; worn at night; median nerve gliding Ulnar Nerve Ulnar claw Cubital Tunnel Guyon’s Canal: deformity and Snydrome: Ulnar: nerve numbness of ulnar proximal ulnar n compression at the side and 4th and ½ compression at wrist; numbness of 4th digit, elbow b/t medial and tingling in ular generalized epicondyle & nerve distribution of weakness and pain olecranon process; hand of ulnar side; sensation appears at rest; decreased in 5th Tinel’s Sign: tap MCP hyperxtend, and ulnar half of Guyon’s to elicit sx IPS flex 4th; numbness/tingling Splint: wrist splint in Froment’s Sign: in ulnar side of neutral flexion of thumb IP forearm; d/t elbow when lateral pinch fx/dislocation, attempted arthritis, diabetes, assembly line work Wartenberg’s Sign: Intervention: passively abduct maintain elbow at fingers and ask to 90 degrees; avoid bring back to 3rd, if repetitive 5th held abducted movements from 4th then (+) Tinel’s Sign: tap Jeanne’s Sign: cubital tunnel to hyperextension of elicit sx thumb MCP Froment’s Sign: flex Semmes-Weinstein of thumb IP when : test loss of doing lateral pinch sensation Wartenberg’s Sign: Splint: dorsal 5th held abducted blocking splint w/ to from 4th maintain wrist 20-30 degrees flex Elbow Flexion Test:  and MCP 30-40 holding elbow in degrees flex while felx for 5 min w/ allowing IP joint wrist neutral to elicit motion sx Splint: splint elbow at 70-90 degrees flex - DR. CUMA - Drop wrist - Radial nerve - Claw - Ulnar nerve - Median nerve - Ape hand *Generally: Radial-> finger extensions, Median-> thumb flexion/opposition, ⅔ flexion, Ulnar-> ⅘ flexion, pinky opposition - Splinting: rest, prevent deformite/contractures, increase joint ROM, protect bone/tissue/joint, increase functional use, decrease pain Splinting Resting Hand Wrist 20-30° ext, MCP 45-60° flx, PIP & DIP slight flexion, thumb abducted/opposition  Dorsal or volar; rest or protect structures Tx: RA, dupuytren’s, CRPS, trauma, burns, pain/deformity Antideformity (intrinsic plus) Wrist 20-30° ext, MCP 70-90° flx, PIP & DIP extended, thumb abducted Maintain length of ligaments Tx: burns Wrist Cock Up/Extension Wrist 45° ext (worn during the day) Tx: radial nerve injury, radial tunnel syndrome, carpal tunnel syndrome Thumb Abduction/Thumb SPICA C bar b/t thumb & index web space to prevent thumb ADD Tx: de quervain Lumbrical Bar Reduce MCP hyperextension/IP flexion, MCPs splinted to block Resting Ball/Cone Antispasticity Decrease tone in hand & UE Tx: pain/deformity Soft Neoprene Position thumb & forearm Tx: RA or CP to increase functional use of hand Serial Casting Fiberglass Static: immobolizes Tx: positions clients with increased tone and gradually stretches out soft tissue Progressive: static splint that is contractures remodeled to address changes in joint motion Dynamic Splinting: includes elastic, Angle pull at 90° to be most effective rubber, band, spring to increase PROM or augment AROM - Upper Extremity - Epicondylitis: CTD; non-operable - Lateral Epicondylitis/Tennis Elbow: overuse of wrist extensors - Mill’s Test: elbow flexion-> pronate forearm-> flex wrist-> elbow extension - Cozen’s Test: radially deviate wrist - Medial Epicondylitis/Golfers Elbow: overuse of wrist flexors - Intervention: ice/deep massage; strengthening; isometric to isotonic exercises; activity/work modification - Splints: elbow strap, wrist splint - Rotator Cuff Tendonitis: d/t over use, scapular weakness, ligament/capsule tightness, or trauma - Drop Arm Test: hold arm out at 90 degrees then slowly lower arm down to side - SITS - S: Supraspinatus (abd, flex) - I: Infraspinatus (ER) - T: Teres minor (ER) - S: Subscapularis (IR) - Intervention: activity modficiation, sleeping postures, reduce pain (positioning, modalities, rest), pain-free ROM - Adhesive Capsulitis/Frozen Shoulder: inflammation and immobility of glenohumeral ligaments/joints; greatest limitation: ER, abduction, IR, and flexion - Intervention: PROM, modalities, encourage active use in ADLs - Shoulder Disolocation: from trauma or overuse - Intervention: regain ROM, pain-free ADL, rotator cuff strengthening, avoid combined abd + ER - Fracture - Forearm fx: (elbow/radial head fx most common-> FOOA) - Type 1: Nondisplaced - Intervention: long arm sling - Type 2: Displaced w/ Single Fragment - Intervention: lnon-operative; immobilization for 2-3 weeks and ROM w/ medical clearance - Type 3: Commented - Intervention: lsurgery w/ immobilization; ROM within 1st week if cleared - Proximal Humeral fx: most common; non-operative; immobilization w/ sling; ROM early as 2 weeks w/ medical clearanace  - Intervention: lhumeral fx brace; sling for immobilization/comfort - Brachial Plexus Disorder - Erb-Duchenne’s Palsy: paralysis of upper brachial plexus (C5-6; sometimes C7); arm cannot be raised; weak elbow flexors and scapular retraction/protraction; Median/Ulnar nerve - Arm straight and wrist fully bent - Contractures develop after 6 mo-> adduction and IR, supination deformity of forearm - Klumpke’s Palsy: paralysis of lower brachial plexus (C7-8, T1); rare; paralysis of hand and wrist; Radial Nerve - Rostral Injuries-> shoulder dysfunction - Caudal Injuries-> hand dysfunction - Splint-> shoulder ER, abduction, and flexion ______________________________________________________________________ 5. Amputations - Prosthetics - Pre-prosthetic Phase: pain, edema of residual limb, contracutres, phantom limb/pain, infection, skin complication (breakdown/necrosis) - Evaluation: self-care (with/without prosthetic), sensation (phantom), pain, self identity, strength, ROM, endurance, skin integrity, motor skills, functional mobility/balance, driving, vocational/recreational interests - Intervention: change dominance, rom/strength of uninvolved joints, denssensitizaiton, wrapping (distral to proximal), shaping, skin care, physical/psychological adjustment - Prosthetic Phase: ill fitting prosthesis/torque can cause skin ulcers, seavetous cysts, edema, sensory changes (hyperesthesia or hypoesthesia [loss of sensation]) - Intervention:  - LE Treatment: shaping residual limb, decrease swelling, desensitization, strengthen UEs (focus on triceps), transfer training (stand pivot), LB dressing, standing tolerance, WC mobility (back wheels should be adjusted farther back to counterbalance w/ anti-tippers) - UE Treatment: ADL/IADLs, vocational/leisure activities, home eval/intervention, emotional/psych support - Prosthesis control training → operating each component of the prosthesis - Prosthesis use training → integrating prosthesis components for efficient functional use - Prepositioning training → identifying optimal position of each unit (wrist, elbow) - Prehension training → TD control during grasp - Functional training → control/use during functional activities - Prosthetic Terminal Devices (TD) - Body-Operated: use scapula and shoulder movement to open/close TD (i.e. hook or prosthetic hand) (See below) - Myoelectric: muscle contractions detected by electrode to open/close TD (i.e. wrist flexors/extensors, elbow extension/flexion, pectoralis major/infrapsinatus) Body Operated Prosthesis Component Movement Intervention Terminal Device Humeral flexion and Teach TD before elbow scapular abduction unit Passive: non-functional (protraction) For transhumeral Active: may have EMG but protheses, keep elbow locked at 90 degrees needs 2 sites Wrist Unit Rotate hook using other Simulate best position for hand, stable service, specific activities between knees, or contralateral TD Hook position: neutral, supination, pronation Elbow Unit Lock/unlock elbow unit by Flex elbow & lock in depressing arm while different planes; extend extending & abducting and adduct humerus Use mirrors Flex arm to flex elbow Turntable Rotate elbow turntable Teach best position for to/away from body for specific activities optimal positioning using other hand or stable surface ______________________________________________________________________ 6. PAMS - Preparatory methods for occupational performance - 240 hours of supervision - Heat transfers - Conduction: superficial up to 1 cm; heat transfers (i.e. hot pack, paraffin) - Convection: heat to tissue through fluid (i.e. whirlpool, fluidotherapy) - Radiation: laser - Conversion: heat from internal friction; up to 4-5 cms (i.e. ultrasound) - For contractures, scarring, pain, and muscle spasms (not generalized weakness) PAM Method Effects Contraindicators Cryotherapy: cools Ice, towels, cold Decreases edema, Impaired tissue to 1-2 cm packs (decrease pain, muscle circulation, Paraffin, Hot Packs, swelling and acute spasms, abnormal peripheral vascular Fluidotherapy, pain), immersion tone, inflammation, disease, Whirlpool baths, whirlpools metabolic activity of hypersensitivity to (increase tissue cold, impaired debridement and sensation, open healing), wounds, infections compression units Thermotherapy: Hot packs (increase Increases: blood Acute inflammation, heats tissue 1-2 cm blood flow and flow, muscle edema, sensory healing), whirlpools, contraction velocity, impairment, cancer, fluidotherapy capillary blood clot, infection, (decrease pain and permeability, tissue cardiac problems, increase mobility), extensibility/ROM impaired cognition contrast baths, paraffin baths Decreases: fluid (decrease stiffness viscosity, muscle and pain) spasms, pain Mechanotherapy: Ultrasound, Thermal: increases Pregnancy, high frequency phonophoresis tissue pacemaker, waves, 4-5 cm, (ultrasound + extensibility/ROM infections, cancer, good for acute topical medication and blood flow; blood clots, growth injuries to give to increase healing decreases pain, plate bones of oxygen to tissues and decrease joint stiffness, children, fractures, faster inflammation) muscle spasms, cognitive/sensory chronic impairments, breast inflammation implants Non-Thermal: increases bone healing E-Stim NMES: promotes wound healing, Pregnancy, maintains muscle mass, increase ROM, pacemaker, facilitates voluntary motor control, epilepsy, cancer, decreases spasms/edema infection, decreased TENS: pain sensation, cardiac disease, stroke Ionotophoresis: Saline-> scar management Dexamethasone-> inflammation Lidocaine-> pain High Volt Galvonic Stimulation (HVGS): reduce pain and increase ROM, circulation, healing, and muscle spasms relief Low-Level Laser & Light emitting, Decreases pain, Not for general Light Therapy super luminous, edema, weakness, low-level laser inflammation, and pregnancies, diodes scar tissue; infections,  increases wound oncology; do not healing place over vagus nerve, carotid sinus, eyes, or endocrine glands *In general, no PAMS with cancer, pacemaker, pregnant, cog/sensory/vascular impairments ______________________________________________________________________ 7. Work Rehabilitation - Common workplace injuries: back/neck injuries, carpal tunnel, de quervain’s, tenosynovitis, & lateral epicondylitis - Functional pain (McGill, Pain Disability Index, Functional Interference Estimate) - Symptom magnification: - Unconscious: - Catastrophizing: client believes, contrary to evidence, that the situation is far worse than it actually is - Refugee: escapes unresolved conflict - Symptom Misinterpreter: responds to physical changes in an extreme manner 2/2 difficulties with processing sensory input - Conscious - Malingering: falsification or exaggeration of illness (physical or mental) to gain external benefits (i.e., avoiding work, seeking attention) - Game Player: convince symptoms are real for personal gain - Identified Patient: assumes patient role as a lifestyle - Symptom Minimizer: keeps symptoms hidden so they can return to normal activity - Work Injury Prevention Program - Primary Prevention Goal: identify/reduce risk BEFORE INJURY occurs; promote health/wellness - Secondary Prevention Goal: early identification of symptoms to REDUCE duration, severity, cost of injury  - Tertiary Prevention: treating the injury and restoring worker role AFTER INJURY - Objective Workplace Data - Occupational Requirements Survey (US Bureau of Labor Statistics): create occupational profiles for various occupations according to categories - Education, training, and experience - Cognitive and mental demands - Physical demands - Environmental conditions - Dictionary of Occupational Titles - Sedentary Work: 10 lb seldom or occasionally, or a negligible amount of weight (less than 1 lb) frequently. Involves standing less than or equal to one third of the time. - Light: 11–25 lb seldom or occasionally, up to 10 lb frequently, or a negligible amount of weight constantly. More than one third of the day is spent standing. - Medium: 26–50 lb seldom or occasionally, 11–25 lb frequently, and 1–10 lb constantly. - Heavy: 50-100 lb seldom or occasionally, 26–50 lb frequently, or 11– 25 lb constantly. - Very Heavy: More than 100 lb seldom or occasionally, more than 50 lb frequently, or more than 25 lb constantly. - Frequency - Seldom: Activity occurs for up to 2% of a job’s workday schedule. - Occasionally: Activity occurs for 2% to 1/3 of a job’s workday schedule. - Frequently: Activity occurs for one-third to two-thirds of a job’s workday schedule. - Constantly: Activity occurs for two-thirds or more of a job’s workday schedule. - Five-Level Grip Test: determining maximum effort as a biomarker of health status - Jamar Dyanometer - Max effort on 5 grips (one trial per handle setting) - Strongest grip is expected on the second (standard setting) and third settings - Rapid exchange grip testing-> 10 trials for each hand  - When graphed, results can be compared to normative data by age - Work Place Evaluations - Pre-Job - Vocational Evaluation: capacity and interest for work if they have not worked before or looking for new job; can be completed by vocational counselors - General Vocational Eval: comprehensive; determine the person’s aptitudes, abilities, and interests to work - Specific Vocational Eval: for a particular job - Self-Directed Search: measures client's vocational interests. - Cognitive Status Exam: measures neurological behaviors (e.g., attention, speech, memory for work activity), which should be assessed after determining the client's vocational interests. - Box and Block Test: addresses performance skills, which should be assessed after determining the client's vocational interests. - Job Demands Analysis - Objective information of job - Used in hiring, determining compensation, and worker rehab - Based on questionnaires, interviews, observations, and formal assessments completed in real work environment - Work Place Screening - Assess a client’s physical and cognitive abilities to meet the general or specific demands of the essential functions of a job. - Focus is on the worker and specific job - Work Tolerance/Pre-Work Screening - Conducted after the client has received an offer of employment conditional on the client passing the screening - If the client does not pass, he or she is evaluated for a disability, and the employer then determines whether reasonable accommodations will allow the client to carry out the duties of the job - Return-to-work - Worksite Evaluation: on-the-job assessment to determine safety and ability to work after onset of disability - Essential job functions - Assets/limitations of the client - Physical environment - Reasonable accommodations?  - Functional Capacity Evaluation (FCE): objective assessment of person’s physical ability to perform work-related tasks; *GOLD STANDARD - Includes interviews, medical record review, ROM/Strength, pain assessments, physical performance using standardized tests - Completed by many disciplines (i.e. physicians, case managers, attorneys) - Helps physicians determine disability status - Work Rehabilitation - Work Hardening: relies on task replication; interdisciplinary team; length/duration depends on the client’s abilities but gradually increases up to 5-8 hours/5 days per week - Work Conditioning: restores client’s systematic/neuromuscular function; usually one discipline. - Work Readiness: help identify goals for work and a plan to return to work after serious illness or injury - Accommodations Ideas - Advance notice of topics to be discussed - Work requests in writing - Assignments broken into smaller tasks - Written checklist - Structured breaks w/ opportunity for physical activity - Work from home - Private workspace w/ adequate room and reduced distractions - Lighting (i.e. desk lamp) - Establish employee policies (no perfume) - Use of timer or handheld organizers/calendar (paper, computer, or phone-based) - Provide a written checklist of assignments - Lift types: - Semisquat: safest lift for the back; ideal for heavy loads - Squat: alternative to the semisquat when space is limited - Stoop lift: used only for light loads ( on and off resistance - Lead pipe-> uniform resistance - Seen in Parkinson’s - Akinesia: inability to initiate movement - Athetosis: dyskinetic condition including inadequate timing, force, and accuracy of movement in trunk/limbs writhing and worm-like movement; fluctuations from low to normal w/ no spasticity - Dystonia: involuntary sustained distorted movement or posture involving contraction of groups of muscles - Chorea: involuntary movements of face and extremities; spasmodic and short duration - Seen in Huntington’s  - Hemiballismus: unilateral chorea; violent, forceful movements of proximal muscles - Feedforward Praxis: enables a person to compare previous motor plans and sensory information to detect potential errors and correct the plan before attempting it again. - Executional Praxis: ability to perform the motor action with precision - Premotor Preservation: repetition of movements and difficulty transitioning from one activity to another - Seizures - Simple Focal (Partial): sudden movement of a single body part with no change in vital signs - Petit-Mal/Absence Seizure: abruptly stopping motor activity with a blank stare or rapid blinking; “pill-rolling” tremor of one hand, resting tremor, bradykinesia (slowed movement), postural instability - Secondary sxs-> resistance to passive motion that is not velocity dependent, akinesia, festinating (shuffling) gait, falling backwards (retropulsion), falling forwards (propulsion), mask face, micrographia, FM or bimanual deficits, communication impairment, swallowing/feeding issues, moody/behavioral disturbances, cognitive deficits (impaired EF, memory loss, visuospatial deficits, possible dementia later) - Stage 1: unilateral tremor, rigidity, akinesia, min or no functional impairment - Stage 2: b/l tremor, rigidity or akinesia, with or without axial signs, Indep w/ ADL, no balance impairment - Stage 3: worsening of symptoms, postural instability, onset of disability in ADL, can still lead indep life - Stage 4: requires help with some/all ADL, unable to live alone, walker use, poor fine motor/dexterity - Stage 5: confined to w/c or bed, Max A, possible hallucinations - Intervention: avoid crowds, rhythmic movement, external cues, bowel/bladder schedule, heat for pain, antispasticity splint - TBI - Open/Focal: penetration of skull - Hemiplegia, monoplegia, abnormal reflexes - Decorticate: UE in spastic flexion with IR and add; LE in spastic ext, IR, abd - Decerebrate: UE and LE in spastic ext, add, IR; wrist and fingers flexed, plantar portions of feet flexed and inverted; head retracted - Glasgow Coma Scale: eye, verbal motor - Coma: 3 - Severe: 13 - Conscious: 15 - Side-laying preferred w/ abnormal tone - Inhibition technique-> applying firm, prolonged pressure - Splinting - Resting Splint-> every 2 hrs - Cone Splints-> prevent fingers digging into palm - Antispasticity Splints-> functional position and abd fingers - Elbow Casts-> loss of PROM in elbow flexors - Spinal Cord Injury - ASIA Scale - ASIA A: No sensation and motor - ASIA B: Incomplete; sensory but no motor - ASIA C: Incomplete; >50% of motor is unilateral neglect, spatial dysfunction - Visual spatial processing - Left motor praxis  - Nonverbal memory - Attention - Emotion - Processing nonverbal auditory - Interpretation of abstract information - Interpretation of tonal inflections - Internal Carotid Artery (ICA): similar to MCA - Anterior Cerebral Artery (ACA) - Contralateral hemiplegia - Sxs-> Grasp reflex, incontinence, confusion, apathy - Posterior Cerebral Artery (PCA) - Homonymous hemiaopsia, hemisensory loss, alexia (inability to see words or read), thalamic pain - Vertebrobasilar - Dysarthria, dysphasia, emotional instability, tetraplegia - Interventions - Unilateral neglect-> Top-Down Approach-> determine compensatory options the client can use in the home environment - Flexor synergy-> low-load, submaximal stretch - Spasticity-> WB, ROM, splinting - No overhead pulleys d/t impingement - Assessments - Barthel index - FIM Scores: for d/c - 18-30: Level 1: Total Assist - 31-53: Level 2: Max Assist - 54-71: Level 3: Mod Assist - 72-89: Level 4: Min Assist - 90-107: Level 5: Supervision/Set up - 108-119: Level 6: Mod I - 120-126: Level 7: I - COPM: 7+ years old - Assessments of Motor & Processing Skills (AMPS): needs training; 3+ years; assesses functional competence at 2-3 chosen BADL or IADL tasks; observes & documents motor processing skills that interfere w/ task performance - 1: deficit - 4= competent - Behavioral Inattention Test: adults w/ unilateral neglect; looks at the presence of neglect and its impact on functional task performance  - 9 activity-based subsets-> picture scanning, menu reading, map navigation - 6 pen/paper subtests-> line crossing, star cancellation, letter cancellation - Catherine Bergego Scale: detect presence and severity of unilateral neglect, self-awareness, and behavioral neglect through observation of everyday life situations - Stroke Impact Scale - Line Bisection Test: detects unilateral spatial neglect; place mark through center of a series of horizontal lines - Single Letter Cancellation Test (SLCT): presence and severity of visual scanning; includes a visual target anchor to direct voluntary gaze control while scanning - Brunnstrom: 7 stages to improve movement from a reflexive pattern to voluntary control (specific sequence); reflexivive to volition - Modified Ashworth Scale - 0: no increase in muscle tone - 4: affected part is rigid in flex/ext - Lowenstein Occupational Therapy Cognitive Assessment (LOTCA): for stroke, TBI, tumor; measures basic cognitive functions that are prerequisite for managing everyday tasks - 5 areas-> orientation, visual, spatial perception, VM organization, thinking operations - 1: low ability - 4: high ability - Splints - Bobath Finger Spreader-> thumb and fingers in abduction - Rood Cone-> sustained deep pressure to ↓ spasticity of hand - Orthokinetic Splints-> tactile input to facilitate/inhibit muscle groups - Spasticity Reduction Splint-> places spastic distal extremity on submaximal stretch to ↓ spasticity - Overhead Suspension Sling-> arm supported by sling w/overhead rod - Balanced Forearm Orthoses-> arm trough, proximal and distal arms, support bracket; allows pt with weak proximal musculature to use available control of trunk/shoulder - Shoulder Sling-> support flaccid arm, soft-tissue contracture, edema, pain - Functional Neurological System Disorder/Conversion Disorder: impaired sensation/motor; paralysis, numbness, blindness, deafness or seizures wl no underlying neurologic pathology - Rancho Los Amigos - 1. No Response - 2. Generalized 3. Localized - 4. Confused/Agitated 5. Confused/Non-Ag/Inapprop 6. Confused/App - 7. Automatic - 8. Purposeful 9. Purposeful 10. Purposeful (Mod I) - Interventions - Level 1: No Response; Total Assist - PROM, splinting to prevent contractures - Level 2: Generalized Response: Total Assist - PROM, splinting/positioning, sensory stimulation - Level 3: Localized Response; Total Assist - PROM, sensory stim, visual/auditory tracking, pictures of friends/fam, simple commands (i.e. squeeze my hand/blink) - Level 4: Confused, Agitated; Max A - Simple movement/reaching, calm voice w/ clear instructions, simple cognitive activities, simple ADLs, simple routines, limit distractions - Level 5: Confused, Inappropriate; Max A - Wanders - AROM, single step fine motor, simple cognitive tasks, tasks using familiar objects, repetition in activities - One step instructions and hand-over-hand cueing; highly structured - Level 6: Confused, Appropriate; Mod A - Attention span ~30 min - Tasks w/ repeated instructions/reminders, simple sequencing, grooming w/ supervision, cold food prep, familiar and simple housekeeping tasks, labels and visual reminders - Level 7: Automatic; Min A - Simple problem solving, ADLs with set up, simple cooking w/ supervision, basic home maintenance - Level 8: Purposeful; SBA - Executive functioning, metacognition, problem solving, decision making, work simplication/modfication, home exercise program  - Level 9: Purposeful; SBA upon request - Money management, medication management, relaxation/coping techniques, may drive - Level 10: Purposeful; Mod I - Safety in IADLs, recommendations in AT/driving aids - Allen Cognitive Scale - Level 0: Coma: Total Assist; 24-H supervision -.8: Generalized reflexive actions - Level 1: Automatic Actions: Total Assist; 24-H supervision -.0: Withdrawing from noxious stimuli -.2: Responding to stimuli with one sensory system -.4: Locating stimuli -.6: Rolling in bed -.8: Rasing body part - Level 2: Postural Actions: Max A; 24-H supervision -.0: Overcoming gravity and sitting -.2: Righting reactions/standing -.4: Aimless walking -.5: Directed walking -.6: Using grab bars - Level 3: Manual Actions: Mod A; 24-H supervision -.0: Grasping objects -.2: Distinguishing objects - Cues to sequence dressing -.4: Sustaining actions on objects - Supported living -.6: Noting effects on objects - Trained to initiate dressing at certain times -.8: Using all objects - Level 4: Goal-Directed Actions: Min A/S; visual cues -.0: Sequencing familiar actions -.2: Differentiating features of objects -.4: Completing a goal -.6: Personalizing features of objects - Independent living -.8: Learning by rote memorization - Level 5: Exploratory Actions: SBA; trial and error through problem solving -.0: Comparing and changing variations in actions and objects -.2: Discriminating among sets of actions and objects -.4: Self-directed learning  -.6: Considering social standards -.8: Consulting with others - Level 6: Planned Actions: I - Muscular Dystrophies - Duchenne’s Muscular Dystrophy: weakness of all voluntary muscles includes heart and diaphragm; rarely survive past early 20s; behavioral and learning difficulties may occur - Becker Muscular Dystrophy: slower to progress; less severe; loss of motor function in LB/shoulders, cardiac problems, enlarged calves; survival to late adulthood - Arhrogyroposis Multiplex Congenita: loss of anterior horn cells; weakness, deformities, and contracutres; UE shoulder IR, elbow ext, wrist flex; LE hip IR/flex and clubfeet - Limb-Girdle Muscular Dystrophy: proximal muscles of pelvis and shoulder affected initially; slow progression - Fascioscapulohumeral Muscular Dystrophy: occurs in early adolescence; involves face, upper arm, scapular region; progresses to abdominal and hips; slow progression; does not affect cardiac; normal life span - Spinal Muscular Atrophy: decrease in motor neuron proton-> weakness of voluntary muscles including breathing and swallowing - Type 1: birth or infancy; life expectancy is 2 yrs - Type 2: children; progresses rapidly; life expectancy early childhood - Type 3: older children; late onset; less severe - Type 4: adolescent/adult; late onset; less severe - Huntington’s: progressive physical, intellectual, psychiatric conditions; onset mid-life - Early Stage: movement deficits; difficulty maintaining work - Middle Stage: disturbance in EF (memory and decision-making), decrease in motor coordination and balance - Late Stage: chorea becomes dyskinesia, hypertonicity, akinesia; max assist - Involuntary movements-> chorea (rapid, involuntary movements), akithesia (motor restlessness), dystonia (abnormal posture) - Voluntary movements-> bradykinesia, akinesia (delayed initiation or loss of movement), incoordination - Cognition-> sequencing, memory, decision making, problem solving, EF - Behavioral/emotional deterioration - Dysphagia and dysarthria - Assessment-> Unified Huntington’s Disease Scale - Spinocerebellar - Fredrich’s Ataxia: autsomoal recessive inheritance; onset in childhood; gait unsteadiness; UE ataxia; dysarthria; minor tremor; areflexia; progresses towards scoliosis and cardiac issues - Cerebellar Cortical Degeneration: onset 30-50 yrs old - ALS: progressive degeneration of corticospinal tracts and anterior horns; life expectancy 2-5 yrs after dx (death d/t respiratory failure) - Sxs: muscle weakness/atrophy (begins distally and symmetrically); cramps precede weakness - LMN signs-> spasticity, hyperactive tendon reflexes, twitching, cramping, muscle atrophy - Corticobulbar-> dysphagia, dysarthria - Corticospinal (UMN)-> spasticity, hyperreactive reflexes - Flail/Hanging Arm Syndrome (FAS)/Man-In-Barrel Syndrome: slowl progressive sporadic motor neuron disorder, severe flaccid paralysis and muscle wasting in both arms symmetrically - Sensory systems, cognition, eye movements, and bladder intact - Stage 1: can walk, independent w/ ADLs, min weakness - Stage 2: can walk, mod weakness - Stage 3: can walk, max weakness - Stage 4: WC, some assistance w/ ADLs, severe weakness in LE - Stage 5: WC for mobility, dependent for ADLs, severe weakness in UE/LE - Stage 6: bed bound, dependent for ADLs & self care - Assessments - ALS Functional Rating Scale - Purdue Pegboard, - Multidimensional Fatigue Inventory - Dysphagia Screening - Guillain Barre: demyelination of peripheral nerves; rapid progression - ANS involvement-> may result in postural hypotension, arrhythmias, facial flushing, diarrhea, impotence, urinary retention, increased sweating - Acute/Inflammatory Stage (2-4 wks): symmetrical muscle weakness in at least 2 extremities; edema, fatigue, muscle weakness or paralysis, sensory loss, bladder incontinence, pain, risk for skin breakdown - Intervention: preventing skin breakdown and contractures, decreasing anxiety, having items close by; make sure hemodynamically stable - Plateau Phase: most severe, skin break down, pain, edema, muscle weakness, paralysis, bladder incontinence; can include facial palsy,  respiratory failure, dysphasia, cognitive difficulties (executive functioning, short term memory, decision making) - Intervention: communication tools, environmental modifications, positioning - Recovery (up to 2 yrs): remyelination and axonal regeneration; starts at head/neck to distally - Intervention: functional and community mobility, fatigue management, energy conservation, splinting, coordination, strength, sensation, home assessment - Longterm prognosis - 50% mild neurological deficits/full recovery - 15% residual functional deficits - 80% ambulatory in 6 mos - 5% die d/t complications - Multiple Sclerosis: life span 5-10 yrs less than avg - - Motor-> ataxia, weakness, gait instability, fatigue, dysphagia, spasticity, LE paralysis, intention tremors, bladder dysfunction - Sensory-> parasthesia, impaired proprioception, touch, pain, temp, vertigo, heat intolerance  - Vision-> diplopia, blurred, partial/sudden loss - Communication-> slurred speech - Cognitive-> ST memory loss, apathy, poor judgement, inattention, impaired processing - Interventions: compensatory - No heat - Vision, sensory, bladder training, exercises and strengthening, pain/fatigue management, cognitive retraining, stress management, memory aids, hips at 90 degrees to reduce LE extensor tone - Assessments: when most energized - Occupational Profile - FIM - Modified Fatigue Impact Scale - Beck Depression Inventory - Nine Hole/Purdue Pegboard - Semmes Weinstein - Modified Ashworth Scale - Dementia - Memory-> ST/LT memory, personal episodic memory, semantic memory, procedural memory - Cognitive-> aphasia, apraxia, agnosia, executive functioning deficits, topographical disorientation, spatial tasks, poor judgment, anxiety/defensiveness, disinhibited behavior, psychotic symptoms - Motor-> gait disturbances, hyperflexia (overflexion of limb), paratonia (involuntary resistance to passive movement) - Alzheimer’s Disease: atrophy of frontal, parietal, and temporal lobes and hippocampus d/t protein accumulation; 9-10 life expectancy after dx - Early Stage: ADLs in tact, ↓ IADL performance (shopping, financial mgmt, meal prep, driving skills), social ↓, work ↓, leisure ↓ - Middle Stage: impairment in all occupations; cannot live alone; ADL impactedl eating problems, IADL neglected; dependent in community mobility, financial mgmt, shopping; cleaning/cooking with supervision, ↓ leisure, ↓ social participation, ↓ orientation to day - Late Stage: dependent in ADLs; cannot ambulate safely; communication is lost - Vascular Dementia: cerebrovascular disease (small mini-strokes); similar to AD but less severe memory deficitl gait disturbance; abrupt decline rather than continuous - Frontotemporal Dementia: neuronal, intranuclear inclusions; progressive aphasia; corticobasal syndrome (asymmetric involuntary movements, tremors, rigidity); similar to AD or Parkinson’s - Dementia with Lewy Body Proteins: usually in limbic areas d/t reduced acetylcholine and dopamine - Progressive deficits in executive function, visuospatial abilities, attention, memory, aphasia, apraxia, and spatial disorientation - Intervention - Informed consent-> assess decision-making skills - Eye contact - Positive/friendly expression - Do not give orders - Use short/simple words & sentences - Do not speak about the person as if they are not there - Create a routine of enjoyable activities - Use nonverbal communication - Attend to safety issues at all times - Assessments: depending on cog ability-> interview/observational - Functional Cognitive Screening-> ACLS, AMPS, Cognitive Performance Test, Executive Function Performance Test, Independent Living Scales, Kitchen Task Assessment, Aradottir OT-ADL, MMSE - Activity Card Sort (ACS): level and involvement w/ IADL, leisure, and social activities - Memory Assessments-> Contextual Memory Test, Hopkins Verbal Learning Test-Revised, Prospective Memory Screening, Rivermead Behavioral MemoryTest - Resiberg’s Stages/Global Deterioration Scale - 1. No Cognitive Decline - No EF and cog deficits - 2. Very Mild Cog Decline - Reports of memory problems-> small bliips - No evidence of issues at work or social situations - 3. Mild Cog Decline - Impaired concentration - Difficulty at work - Denial and anxiety of deficits - 4. Mod Cog Decline - Trouble remembering personal history - Difficulties w/ IADLs  - Reduced expressions/emotions - Withdrawal from activities - 5. Mod Severe Cog Decline - Some assistance for ADLs - ST memory loss - Lack of orientation to time, place, or date - 6. Severe Cog Decline - Lack of awareness to activities/surroundings - ADLs require assistance - Incontinence/bowel issues - 7. Very Severe Cog Decline - Personality/behavioral changes - Loss of speech and ability to hold conversation - Difficulty moving, eating, and swallowing - Cranial Nerves: Oh Oh Oh To Touch And Feel Very Good Vagina, Ah Heaven - I: Olfactory: Sensory - II: Optic: Sensory - III: Oculomotor: Motor/Sensory - IV: Trochlear: Motor/Sensory - V: Trigeminal: Motor/Sensory - VI: Abducens: Motor/Sensory - VII: Facial: Motor/Sensory - VIII: Vestibulocochlear: Sensory - IX: Glossopharyngeal: Motor/Sensory - X: Vagus: Motor/Sensory - XI: Accessory: Motor/Sensory - XII: Hypoglossal: Motor/Sensory ______________________________________________________________________ 10. Wheelchair and AT - Pressure sores-> position ever 15-30 min/hr - Tilt-in-space: hip contractures, need to recline to reduce pressure or manage fatigue, cannot reposition themselves independently, or unable to maintain an upright seated position; prevents shear  - Recline: seat-to-back angle changes to greater than 90°, ranging from upright to nearly horizontal; appropriate for clients who are unable to sit upright (e.g., because of hip restrictions, such as limited hip ROM/tight hips) or who spend considerable time in a wheelchair and need to rest during the day; eases personal care activities - Contoured: for mod assist w/ positioning, prevents skin breakdown, for scoliosis, kyphosis, pelvic obliquity - Planar - Modular - CVA w/ flaccid arms-> lapboards and arm troughs - ADA Accessibility - Accessible door width (32 inches wide) - Curb ramp must have no more than a 1:12 ratio, or no greater than 8.33% slope - Measure with measuring tape, spirit level, and string line - Plate Switch: responds to minimal force; allows independent access to channels on TV - Pneumonic Switch: air - Phonation Switch: sound/voice - AAC systems-> based on curriculum goals - Teachers, principals, SE teachers, parents, siblings involved to use system - Ataxia/dysmetria-> suction plate and cupholder ______________________________________________________________________ 11. Mental Health, Adult - Cognitive/Behavioral challenges - Flight of ideas - Concrete thinking - Confabulation: makes fake thought/idea - Hallucinations - Distraction free environment - Highly structured, tangible activities - Redirection - Delusions  - Do not deny delusion - Redirect to reality-based thinking/actions - Avoid discussions that reinforce delusions - Akathisia: movementt disorder that makes it difficult to sit still - Allow person to move around as needed - Select gross activities over fine motor/sedentary ones - Offensive behavior: physical or verbal - Set limits and immediately address the behavior - Clearly present the reasons why the behaviors are not acceptable in a nonjudgmental way - Clearly communicate the consequences of the behavior - Protect all patients from the threat of harm/abuse - Keep needs of entire unit it mind - Lack of initiation/Participation - ID reasons for lack of participation - Find activities that address pts interests - Positive feedback and rewards, motivate - Offer choices - Manic/ Monopolizing - Highly structured activities that require a shift of focus from person to person - Thank client for participation and and redirect attention to another member - Escalating Behavior - Avoid challenging behavior - Maintain a comfortable distance - Actively listen - Use calm but not patronizing tone - Avoid positions where anyone feels trapped - If person continues to escalate, remove other members & call for help - Acting out Behavior (in children) - Depending on situation options are: - Interpretation: put words to observed behavior-> enables child to appropriately express their feelings - Redirection: refocuses the child on the activity - Limit-Setting: inform child of what is acceptable/unacceptable - Tme-Out: remove child from problematic situation to a specific area  - Dangerous Behavior - Locations where additional help is accessible if emergency arises - Aware of objects that can be dangerous to themselves or others (sharp objects etc) - Personality Disorders - Cluster A - Paranoid - Schizoid: social withdrawal, discomfort w/ human interaction, avoid relationships, lack of emotions - Schizotypal: magical thinking, peculiar ideas, illusions, derealization - Cluster B - Antisocial - Borderline - Histrionic - Narcissistic - Cluster C - Avoidant - Dependent - Obsessive Compulsive: orderliness, perseverance, stubbornness, indecisiveness, pattern of inflexibility/perfectionism; not OCD - Group Leadership Styles - Directive-> provide more directions and structure, more prescriptive in directing the group activities - For low cog abilities - Facilitative-> allow participants to take responsibility for group activities while still maintaining control over goals/decision-making - For fair-Good insight and motivation - Advisory-> work alongside group in coaching capacity; enables members to perform at highest capacity - For Mature (group is able to work together and resolve conflicts) and high verbal abilities - CBT - Shaping-> approximations of desired behavior are reinforced/rewarded - Chaining-> one step in a sequence is learned, which sparks next step - Reinforcement-> positive feedback about desired behavior - Practice-> repetition of behavior - Intentional Relationship Model - 1. Advocating - 2. Collaborating - 3. Empathizing  - 4. Encouraging - 5. Instructing - 6. Problem-solving - Depression - Medications - SSRIs-> nausea, headache, sexual dysfunction, insomnia - Tricyclics-> dry mouth, blurred vision, sedation, postural hypotension - SNRIs-> HTN, anxiety, dizziness, sedation, nervousness, weight gain, nausea, sweating - MAOIs-> weight gain, hypotension, insomnia, liver damage - Avoid foods with amino acid tyramine as it will increase BP (severe headache or palpitations) - Aged cheeses, pickled foods (sauerkraut, herring), cured/smoked meats (salami, sausage, pepperoni, hot dogs), yogurt, sour cream, fruits that need to ripen, fava beans, peapods, chocolate, beer/red wine, soy, yeast extracts - Bipolar - Ignore comments about inflated behavior/superiority - Allow autonomy - Simple/structured tasks - Promote self esteem and self-concept exploration - Addictions - Recovery Model: self-direction, individualized/person-centered tx, empowerment, holistic, nonlinear, strength-based, peer support, respect, responsibility, hope, family, community - Interventions - Wellness Recovery Plan (WRAP); storytelling to decrease stigma - Assessments - Allen Cognitive Level Screening Tool (ACLS-5): letter lacing tasks - Level 1: Awareness - No benefit from group - Level 2: Gross Body Movement - Focus on movements and copyign modeled movements - Level 3: Manual Actions; running stitch - Focus on elements of repetition and manipulation - Level 4: Familiar Activity; whipstitch - Goal-directed activities such as craft projects - Level 5: Learning New Activity; cordovan stitch  - Activities w/ graded structure, requires control of medium and impulses - Routine Task Inventory: ADL performance informed by caregiver - Beck Depression Inventory (BDI-II): adolescents and adults w/ depression; presence and depth of depression; interview or questionnaire; 0-3 (3 being severe) - Hamilton Depression Rating Scale: severity of illness; interview of informed individuals - QoL Interview - Oregon QoL Questionnaire - Empowerment Scale - Executive Function Performance Test (EFPT): executive function during tasks (cooking oatmeal, making a phone call, managing - medications, paying a bill); assesses initiation, organization, safety, task completion - Mini-Mental State Exam (MMSE): primarily for dementia; questionnaire to measure cognitive function for orientation, memory, attention, and multi-step directions - The Short Portable Mental: adults w/ psychiatric disorders; questionnaire on orientation to measure intellectual function - Milwaukee Evaluation of Daily Living Skills: 18+ yrs w/ chronic illness and resided at least 5 mos in psychiatric hospital or group home, or 2 yrs at outpatient day program; screening form of assessment of actual/simulated performance of BADLs - Comprehensive Occupational Therapy Evaluation Scale (COTE Scale): for adults w/ acute psychiatric dx; observing and rating bxs - Occupational Performance History Interview-II (OPHI-II): adolescents and adults; semi structure interview - Occupational Self Assessment: 18+ years; 2-part self-report checklist - Montreal Cognitive Assessment (MOCA): for mild cognitive dysfunction; measures attention, concentration, executive functions, memory, language visuoconstructional skills - Kohlman Evaluation of Living Skills (KELS): adolescents and adults in acute psychiatric hospitals; standardized assessment w/ observation in basic living skills (self-care, safety & health, money management, community mobility, telephone, employment & leisure participation) - SLUMS (St Louis): mild cog impairment and dementia; measures attention, recall, orientation, calculation, memory w/ interference, registration and digit span, visual spatial, executive function) - Adolescent Role Assessment: 12-17 yrs; interview and discussion ______________________________________________________________________ 12. Mental Health, Pediatrics - ADHD - Play-based interventions for intrinsic motivation - Rett’s: genetic metabolic disorder; 6 mos-2 yrs; deterioration of language (receptive and expressive); motor deterioration (repetitive movements and loss of purposeful head movements); irregular breathing patterns; seizures common - Hypotonic-> spastic-> rigid - Reactive Attachment diosrder (RAD) - Inhibited-> failure to initiate or respond appropriately to social interactions; interactions are inhibited, hypervigilant, or highly ambivalent - Disinhibited-> indiscriminate sociability;inability toe xhibit appropriate selective attachments; excessive familiarity with relative strangers - Oppositional Defiance Disorder (ODD): - Interventions-> role playing, modeling - Assessments - Pediatric Interests Profile: MOHO-based; best; self-report - Short Child Occupational Profile: MOHO-based; occupation-focused assessment that determines whether volition, habituation, skills, and environment facilitate or restrict occupational participation - Child Occupational Self-Assessment: MOHO-based; client-directed assessment that covers everyday activities, including self-care, school tasks, social activities, and family-related activities - Pediatric Volitional Questionnaire: MOHO-based; observational assessment to understand volition - School Setting Interview: MOHO-based; collaborative interview that describes student–environment fit in multiple school settings - Intellectual Disorders - Dx  - Genetic-> Down Syndrome, Fragile X, Prader-Willi (constant hunger), Klinefelter’s (poor muscle/bone strength d/t less testosterone)-> reduced tone/strength - Metabolic-> Phenylketonuria, Hypothyroidism, Tay-Sachs (muscle twitching, dysphagia, seizures, vision/hearing loss; lifespan to age 4) - Prenatal-> Rubella, Toxoplasmosis, AIDS - Maternal Substance Abuse - Acquired-> Encephalitis, Meningitis - Stages - Mild: 55-59 iq - Min support - Focus on acquiring social and vocational skills - Moderate: 40-54 IQ - Focus on acquiring independence in routine, ADLs, client factors to perform roles w/ supports and structure (i.e. vocational rehab) - Severe: 25-39 IQ - Asisstance required for most tasks - Supervised living required - Significant impairment in motor functional and physical development - Focus on acquiring communication and basic health habits - Profound ID: gravitational insecurity and hypersensitivity - Galant Grasp (32 weeks gestation-2 mos): hip movement and ROM for crawling/walking; from prone, stroke spine on one side from top to bottom, infant will lateral trunk flex to that side - Palmar Grasp (32 weeks gestation-4 to 6 mos): finger flexion when placing finger on palm - Not integrated-> reduced FM integration, object release, and object manipulation - Asymmetric Tonic Neck Reflex (ATNR) (37 weeks gestation-4 to 6 mos): supine, turn head laterally, extension of arm on face side and flexion of arm on alternate side - If retained-> poor reading comprehension, midline crossing, visual tracking/eye pursuit, hand writing (arms cannot accommodate for head movement), hand-eye coordination, bimanual coordination - Eyes will stop at midline, child will lose place of where they are reading, poor visual tracking/eye pursuit - Tonic Labryinthine Reflex (TLR) (37 weeks gestation-6 mos): - Supine-> body in extensor tone-> difficult to flex neck to sit up - Prone-> body in flexor tone - If retained-> poor posture, motor coordination, difficult to extend head in prone and lift head from supine  - - Phase 2: - Right Reactions (3-6 mos): maintains alignment of head in space; helps w/ head control, initiating rolling, crawling, and standing - If not integrated-> difficulties with ambulation, standing up, kneeling - Neck Righting: in supine, turn head to one side, entire body turns towards head to bring body in alignment; log rolling towards head; precursor to rolling by transitioning from supine to side lying - Non-Segmental Rolling: whole body moves in one unit; no trunk rotation - Body Righting: in supine, bend hip/leg to one side and infant will segmentally roll to keep head and body aligned; facilitates rolling from supine to side lying through spinal/trunk rotation - Symmetrical Tonic Neck Reflex (STNR) (4-12 mos): precursor to crawling - Neck flexion-> hip/leg extension-> resists movement to sit up - Testing - 1. Place in crawling position w/ flexed head-> UE flex, LE extend - 2. Place baby in crawling position w/ extended head-> UE extend, LE flex - If retained-> sitting up from supine becomes difficult, poor muscle tone and sitting posture  - - Landau Reflex/Superman Pose (3/4-12/24 mos): horizontally in prone suspension-> extension of BUE/LEs and head; breaks flexor tone - Phase 3: lifetime reflexes, reactions, and responses - Optical Head Righting (birth/2 mos-lifetime): suspended vertically then tilt (forward, backwards, laterally), baby will orient head to body - Uses vision/visual cues to maintain head in upright position - Labryinthine Head Righting (birth/2 mos-lifetime): same as above but eyes are covered - Uses ‘Labyrinthine’ structure within inner ear to sense vestibular stimuli and change in orientation - Protective Reactions - Downward Parachute (4 mos-lifetime): lower baby towards surface while suspended vertically, BLEs extend - Forward Parachute (6 mos-lifetime): quickly tip baby forward towards surface while vertically suspended, response will be BUE and head extension w/ hands open - Sideward Parachute (7 mos-lifetime): tip baby to side while in sitting, arm will extend and abduct to the side - Backward Parachute (9/10 mos-lifetime): tip baby backwards while sitting, response will be BUE extension or 1 side spinal rotation with arm extension  - Equillibrium Reactions: spine will curve on raised sides; UE/LE extends and abducts; ability to maintain equilibrium w/o arm support and make postural adjustments; 1st line of defense against falling - Prone Tilting (5 mos-lifetime): in prone on tilt board, raise one side of surface - Supine Tilting (7/8 mos-lifetime): in supine or sitting - Quadruped Tilting (9/12 mos-lifetime): on all fours - Standing Tilting (12/21 mos-lifetime): standing - Pediatric Developmental Milestones - 2 Months - Holds head up - Turn towards sound - 4 Months - Holds head steady - Pushes up to elbows - Brings hand to mouth - Reaches for toy - Tracks with eyes - Smile spontaenously - 6 Months - Rolls over - Pass hand to hand - Thing to mouth - Sits with support - Support weight on legs - 9 Months - Get into sitting from lying - Sit w/o support - Pushup in prone - Crawls - Stand holding on - Tracks falling/moving objects - Pinch - 12 Months - Can take few steps unsupported - Walks well steadying self on environment - Puts object into container - Relases objects w/o help - Sits in chair  - Holds crayons and makes marks - Stacks blocks - Attempts puzzles - Obens/shuts containers - Points w/ index - Uses two hands-> one to hold and one to manipulate - 18 Months - Walks alone, rarely falls - Uses cup/spoon and simple tools - Begins to run - Plays in stand - Pushes/pulls large objects on floor - Completes 4-5 piece puzzle - Builds 4 block towers - Draws simple figures (lines, circular shapes) - String beads - Turns book pages - 2 Years - Climbing up/down furniture - Up/down stairs holding on - Stand tiptoe - Begin to run - Throws/kicks ball - Jumps w/ both feet - Runs and squats - Hold one object and act with another - 3 Years - Climbs well - Up/down stars 1 foot at a time - Runs easily - Catches large balls - Begins to hop - Likes rough/tumble play - Pedal tricycle - Copy shapes (3-4 yrs) and traces forms - Colors large forms - Draws circles accurately - Putting on a shirt - Object manipulation and bimanula coordination - Builds towers and lines up objects  - Plays with toys and moving parts - Snips scissors - 3.5-> buttoning - 4 Years - Hops/stand on 1 foot for 2 sec - Catches bounced ball most of the time - Pours liquids with SPV - Write name (4-5 yrs) - Copy shapes - Washing hands (4-5 yrs) - 4.5-> buckling shoes, belt - 5 Years - Toilets independently - Tying/untying knots - 5-6-> drawing triangle, write name, write letters w/ model - 6 Years - Shoe tying - Torticollis/Wry Neck: rare condition in which the neck muscles contract, causing the head to twist to one side - Cerebral Palsy (CP) - Dyskinetic/Atheoid CP: lesion in basal ganglia; fluctuations in muscle tone - Dystonia - Athetosis: writhing involuntary movements more distal than proximal - Chorea: spasmodic involuntary movements more proximal than distal - Ataxic CP: lesion in cerebellum - Hypotonia - Ataxic movements - Spastic CP: lesion of motor cortex - Hypertonia - Hyperreflexia - Assessments - Diplegic CP - Screen visual perceptual skills - Handwriting-> positioning first (slight extension and forearm 45 degrees pronation) - Positioning - 4 Point-> maintain position-> rocking on hands/knees-> push up on one leg-> stand up  - Spina Bifida - Spina Bifida Oculta: bony malformation w/ separation of vertebral arches w/ no external malformations; no functional deficits - OSD: when an external marker is present - Spina Bifida Cystica: exposed pouch comprised of the spinal cord & meninges - Meningocele-> protrusion of CSF & meninges but not SC; no functional deficits - Myelomeningocele-> protrusion including spinal nerve roots often in lumbar; sensory/motor deficits; deformities; incontinence - Tethered Cord Syndrome: difficulties w/ bowel, bladder, gait; may go undiagnosed - Sensory Processing Disorder - Sensory Modulation Disorder - Sensory Overresponsivity - Sensory Underresponsivity - Sensory Seeking/Craving Dunn’s Model Neurological Threshold Behavioral Response Continuum Passive Active High Low Registration Sensory Seeking Low Sensory Sensitive Sensory Avoiding - Sensory-based Motor Disorder-> dyspraxia and sensory-based postural disorders - Sensory Dscirmination Diosrder - Autism - Toileting-> modeling and visual aids - Developmental Coordination Disorder - Assessments: BOT-2; Cognitive Orientation to daily Occupational Performance (CO-OP) - Prematurity Ages - Gestational Age: period to birth - Chronological Age: premature birth to present - Corrected Age: actual birth date to present - Play Stages - Unoccupied Play (0-3 mos) - Solitary Play (0-2 yrs) - Spectator/Onlooker Behavior (2 yrs)  - Parallel Play (2+ yrs) - Associate Play (3-4 yrs) - Cooperative Play (4+ yrs) - Levels of Play - Exploratory Play (birth-1 yrs) - I.e. dipping hands in rice - Relational (10-18 mos) - Functional/Manipulative (12-18 mos) - I.e. stacking colored rings - Symbolic (18-30 mos) - I.e. pretending - Role Play (30-36 mos) - School - Students w/ physical disabilities are eligible for ongoing OT only if they have difficulty w/ curriculum-based tasks - IDEA - Part A: outlines the general provisions of the law - Part B: covers assistance for providing a free appropriate public education in the least restrictive environment for children with disabilities ages 3–21 - Individualized Education Plan (IEP) - Must be submitted annually - 13 qualifying categories of disability - Transition plan begins at age 16 - Includes location of OT services and beginning/end dates of service - Part C: early intervention services for children with disabilities from birth through age 2. A child does not have to be enrolled in school to participate in IDEA Part C - Individualized Family Service Plan (IFSP) - Considers family resources and strengths - Transition plan developed before the child’s 3rd birthday - Reviewed every 6 months - Section 504 of the Vocational Rehabilitation Act: provision of reasonable accommodations for a student with a disability to have equal access to academic programs and to fully participate in sports, after-school care, and extracurricular activities - Emphasizes equal access to education - Does not need team review to modify  - Does not need parent participation - Does not need annual review - Prohibits discrimination based on disability - Positive Behavioral Intervention and Supports (PBIS): - Response to Intervention Approach (RTI) - Tier 1: interventions promote positive behaviors within the classroom and address most students’ needs; school-wide approach - i.e. organizing the classroom to promote student focus during activities and establishing clear routines - Tier 2: focuses on children who are demonstrating or are at risk for challenging behaviors - i.e. check-in/check-out sessions, in which children receive feedback on their behavior throughout the day; group social skills training; mentoring - Tier 3: focuses on students who are not responding to Tier 1 or Tier 2 strategies - I.e. individual and family counseling; individual behavior support plan. - SETT (Student, Environment, Task, Tools) Framework: develop school-based teams to create Student-centered, Environmentally useful, and Tasks-focused Tool systems. - Service delivery - Integrated Service Delivery Model-> intervention in child’s natural classroom environment and instruction to staff members to meet child’s outcomes - Consultation-> implementing a specific program for a student or educating the teacher to enhance knowledge and skills to facilitate the child’s performance in class - Pull-Out Services-> remove the child from the classroom setting and should only be used if the child is working on a skill at a level far below classroom peers or when the intervention that is being provided is distracting to others in the classroom - Handwriting - Rubberband sling: supinated to pronated forearm - Formal Handwriting Assessments  - Children’s Handwriting Evaluation Scale - Denver Handwriting Analysis - Minnesota Handwriting Assessment: norm-referenced, standardized - Evaluation Tool of Children’s Handwriting - Test of Handwriting Skills - Print Tool: not standardized, norm-referenced; ability to produce handwriting - Legibility Formula: number of readable words divided by the total number of words written - Pediatric Assessments: no reassessments within 6 mos - Miller Function and Participation Scales (M-FUN): 2 yrs 6 mos-7 yrs 11 mos; standardized; measures child's fine, visual, and gross-motor skills and attempts to determine the impact of skills on participation in home and school activities - Peabody Developmental Motor Scales: birth-5 yrs; norm-referenced - CAPE/PAC: 6-21 yrs; for rec and leisure, not school activities; 55-item questionnaire to examine how children and youth participate in everyday activities outside of school classes - Sensory Integration and Praxis Tests: best for SI and praxis; standardized; shows underlying neurological functions that affect sensory integration; 90-120 min to administer; requires specialized training to administ