Module Five

B. A built-up handle spoon.
This patient is in the initial stage of Parkinson’s. Tremors are not severe during the early stages of PD, however, the OT practitioner should consider the amount of energy and time needed to perform a task. At this stage, poor endurance for previous occupations and fatigue impact on the patient’s participation in their ADLs. The use of built-up handles for eating and writing utensils should be introduced during the initial stages of PD as a lightweight utensil may facilitate smoother and higher-velocity arm movement.

– Fatigue is common early in the course of PD. Parkinson’s disease-related fatigue is often described as the sort of exhaustion that makes it feel impossible to move, as though one has no energy at all.
– Bradykinesia means slowness of movement and is one of the cardinal manifestations of Parkinson’s disease.
– Hand dysfunction is a common symptom in Parkinson’s disease and is characterized by poor manual dexterity, deficits in fine motor movements, and difficulty in performing movements with normal amplitude, speed, and coordination. Hand dysfunction leads to difficulties in activities of daily living (ADL), such as eating, dressing, washing, and writing.

– Pedretti’s Occupational Therapy – E-Book (p. 943).
– Occupational Therapy for Parkinsonian Patients: A Retrospective Study- http://www.hindawi.com
– http://www.hopkinsmedicine.org/health/conditions-and-diseases/parkinsons-disease/how-to-fight-parkinsons-diseaserelated-fatigue

D. Fall prevention and recovery with family, cognitive strategies, and patient and family education on patient’s awareness of deficits. Anosognosia related to a CVA is the lack of awareness or the underestimation of a specific deficit in sensory, perceptual, motor, affective or cognitive functioning due to a brain lesion. It is associated with a person’s lack of awareness of physical deficits. Hemiparesis and anosognosia raises fall risk. Therefore, caregivers should be educated on safety precautions and cognitive strategies to avoid injury.

A. Although balance and transfer training will be helpful, errorless approach (initiation, execution, & control) is an effective approach for addressing apraxia.
B. Fall prevention and recovery are helpful, however multi-modal cueing and scanning are more appropriate strategies for apraxia and neglect.
C. Endurance is not a primary deficit. However, positioning and stabilization would be a supportive strategy for weakness.

Gillen, Glen. (2009) Cognitive and Perceptual Rehabilitation. St Louis, MO: Mosby, Inc. [Kindle Cloud Library, Location 2797 – 2880 of 12366]. Retrieved from Amazon.com

C. Coordinate with the caregiver, to establish a schedule for her to participate in the patient’s therapy sessions.
Patients typically progress from relapse-remitting to secondary-progressive MS (SPMS). The relapses and remissions that used to come and go change into symptoms that steadily get worse over time. The overall expectation in this scenario is a further decline or deterioration in function. Since the patient is expected to decline in function over time, it is important to involve the primary caregiver early on during therapy sessions to maximize function for the patient and prevent secondary complications upon discharge home.
“http://www.neuropt.org/docs/default-source/csm-2016-handouts/ptnow-and-ms-edge-supplement-ptnow-severe-late-stage-ms-case.pdf?sfvrsn=2”
http://www.neuropt.org/docs/default-source/csm-2016-handouts/ptnow-and-ms-edge-supplement-ptnow-severe-late-stage-ms-case.pdf?sfvrsn=2

C. Complete the laundry task by having the patient sit all the way back on the chair.  By increasing her base of support, she would have more stability (proximal stability for distal functioning).

A. This facilitates anticipatory postural movements but does not change the stability.
B. By reducing the dynamic movement the patient needs to perform, she will have more stability but the goal of the session is to work on trunk rotation which the restructuring of the activity would not meet .
Introducing dynamic sitting would not provide the patient with the stability she needs.

Keogh, J., Sain, S.; and Roller, C. (2012). Kinesiology for the Occupational Therapy Assistant: Essential Components of Function and Movement. Thorofare, NJ: SLACK Incorporated, pp 96-98.

Individuals with Huntington’s chorea can experience choreiform movements such as involuntary jerking or writhing. Over time, symptoms may get worse and movements may affect the legs and the arms. This can impact walking and upper extremity coordination during functional activity.

C. Both clinicians position the patient upright and centered, with the front clinician blocking the patient’s knees and feet.
Max Assist: Patient does 25%, Caregivers do 75%. The question asks what part of the set-up is the “MOST IMPORTANT” in terms of ensuring a safe transfer, and keeping the clinicians out of harm’s way. By positioning the patient upright and centered, with the front clinician blocking the patient’s knees and feet, the clinicians are applying proper body mechanics which is the is the most important aspect for their safety. This step comes after positioning the wheelchair, locking the brakes, and securing the gait belt, then the clinicians should follow proper body mechanics to maintain the integrity of their spine, in order to safely support and move the patient. A gait belt should be used at all times if you have access to one. if you don’t have access to one, use the patient’s pants or belt.

A. The gait belt should fit snugly around the waist and not move up the trunk.
B. With a MMT of 3+, the patient will likely not have enough upper extremity strength to lift his hips. When the clinicians shift the patient’s weight forward, it will make it easier to passively lift his hips while the front clinician blocks his knees. The clinicians will direct and move the body towards the transfer surface.
D. Confusion and slow-processing is expected with anterior cerebral arterial stroke. Therefore, the team of clinicians should lead the count.

Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 316-317.
Pass the OT study material – Cerebral Vascular Accident,

B. Right below elbow amputation. A rocker knife allows a patient to cut food by rocking the knife, rather than using the knife to saw through food. This eliminates the need to use a fork to hold the food in place while cutting, so only one hand is needed to use a rocker knife. The design of the rocker knife makes it ideal for patients who only have the use of one hand, such as the patient with a right below elbow amputation.

D. Swivel. A swivel spoon is specially designed to allow the bowl to swing, keeping the bowl in a position to hold food no matter how the spoon is moved.

Swivel cutlery has a pivoting joint between the head and the handle of the utensil, helping to keep the head of the utensil horizontal as it is brought towards the mouth. The swivel mechanism of these utensils is engineered to stay level thus keeping the spoon bowl or fork tines level  which reduces spills. Built-in swivel limiters prevent excess rotation or swing allowing the utensil to scoop food.
This utensil is particularly helpful for people who have:
*hand tremors e.g. Parkinson’s
*weak hands/poor grasping abilities
*poor coordination

D. Reduce the resistance level of the ergometer hand bike to the previous level. Returning to the previous, tolerable exercise level will assist the patient in managing fatigue, a common symptom with multiple sclerosis.

B. Since the patient had reported fatigue, the clinician should discontinue the exercise at that level.
A and C. These are not consistent with the patient’s current functional abilities.

Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 518-519.

D. Measure the rate of perceived exertion during different types of tasks.
It is important to gather information about fatigue levels and the patient’s activity patterns to support a plan to develop strategies on managing fatigue. In terms of the difficulties experienced with reading, eye movement abnormalities are common in MS. Most eye movement abnormalities associated with MS are due to brainstem or cerebellar lesions and result in symptoms of visual fatigue, blurred vision, diplopia and oscillopsia. The predominant abnormalities of efferent ocular function encountered in MS include internuclear ophthalmoplegia (INO), saccadic abnormalities, nystagmus, abnormalities of the vestibulo-ocular reflex (VOR) and smooth pursuit abnormalities.

A. It is unlikely that the patient is exhibiting problems with executive functioning as she is able to comprehend what she is reading.
B. Addressing the patient’s concern is using a client-centered approach and validates the patient, therefore, education does not deal with the patient’s stated problem.
C. There is no indication of a problem with fine-motor skills.

Reed, Kathlyn. (2001) Quick Reference to Occupational Therapy. Gaithersburg, MD: Aspen Publishers, pp 314-319.
https://www.medscape.com/viewarticle/774939_4

B. The ability to stabilize the trunk laterally with some movement from the neck and shoulder.
A mobile arm support provides assistance for shoulder and elbow motions using gravitational forces and springs to compensate for decreased shoulder and elbow strength while maintaining joint range of motion. The criteria for using a MAS include adequate muscle power from neck, trunk, and shoulder girdle, and weakness in elbow flexion, external rotators, shoulder flexion and abduction, and elbow flexors.

A. The ability of the elbow to flex against gravity (3/5) may be best utilized with additional supports underneath the arm such as a table or lapboard for grooming and hygiene, not a MAS.
C. The criteria for shoulder flexion should be no more than 90 degrees of PROM.
D. There must be adequate strength for the patient to hold the head against gravity as the MAS does not support the head.

Hsu, J. D., Michael, J. W., & Fisk, J. R. (2008). Aaos atlas of orthoses and assistive devices (4th ed.). Philadelphia: Mosby/Elsevier, pp 186-187.

A. Bend the knees and keep the back straight, when unpacking new books from a box.
D. Maintain spinal alignment when holding the books.
E. Carry the books at chest height with elbows fully flexed.
All three techniques support proper body mechanics. These techniques support the following principles: maintaining the load close to the body, maintaining upright posture, and reducing joint stress by promoting equal distribution along the joints and muscles of the body.

Planning for Lifting and Carrying:
1. Test the weight of the object to be lifted. An easy way to determine if you can lift it without assistance is to try pushing the object with your foot. However, even lightweight objects that are large in size, or cumbersome, may best be handled with assistance.
2. Plan the best way to hold the object to keep it close to your body before lifting.
3. Position your body close to, and directly facing, the object. Place your feet flat on the floor, shoulder width apart, to provide a stable base for your body. To turn directions, use your feet to pivot. Do not twist!
4. Depending on the shape of the object, try to hold it at the sides and bottom, and keep it close to your body. If possible, keep your elbows bent while carrying an object.
5. Use the muscles in your legs as the power for lifting, not the back! Bend the knees, keep the back straight, and lift smoothly. Repeat the same movements for setting the object down.

https://www.spineuniverse.com/wellness/ergonomics/body-mechanics-your-spine-tips-1-3

Early, Mary Beth. (2006). Habits of Health and Wellness, Physical Dysfunction Practice Skills for the Occupational Therapy Assistant (3rd Edition, p 192). St. Louis, Missouri: Elsevier, Mosby Inc.

A. The patient’s ability to demonstrate carryover of and adherence to the home program instructions.
Adherence to and demonstrating carryover of the instructed program will ensure skill acquisition. This can be achieved via demonstration, practice, and feedback, specific to the skills of the task.

B. Although the patient’s understanding of the purpose of the home program is important, to connect the action to the outcome, knowledge of outcome measures is more pertinent to the reliability and success of the program as a whole.
C. As the patient is expected to continue towards independence at home, it is not expected that the patient will need assistance.
D. Visual deficits were not stated as a barrier to performance. However, demonstrated actions would be a more reliable determinant for patient adherence and follow-through with the home program.

Burgard, E. C., Sabata, D., & Wu, A. J. (2016). The meaning of context: Connecting the home environment and outpatient occupational therapy. SIS Quarterly Practice Connections. 1(2), 19–21.
Early, M.B. (2013). Physical Dysfunction Practice Skills for the Occupational Therapist Assistant (4th Ed.). St. Louise, MO: Elsevier Mosby, Inc. Pages 187-188.

C. Demonstrate active use of the equipment during a regular scheduled meal and allow the patient to return the demonstration.
Expressive or receptive aphasia, or global aphasia (both expressive and receptive) can occur after stroke and impairs one’s ability to express or understand language. Reading and writing can be affected as well. During OT intervention, it is best to have the patient perform the actual task in the appropriate environment and time of the day. In this way, the clinician can isolate other factors that will help determine the type of support the patient will need to perform the task successfully, based on the effects of aphasia on comprehension.

A. A combination of demonstration and return demonstration would be more effective.
B. It is more appropriate to start with a demonstration first.
D. This would be more appropriate if apraxia is suspected.

Gillen, Glen. (2009) Cognitive and Perceptual Rehabilitation. St Louis, MO: Mosby, Inc. (Kindle e-book, Location 4433 of 12336). Retrieved from Amazon.com

C. The patient’s understanding of the environmental barriers in her home
It is important to consider the patient’s understanding of the underlying risks that could lead to falls, including recognizing and having insight about the barriers that may potentially be unsafe. Although no major functional impairment is expected during Stage I Parkinson’s disease, it would be essential for the patient to be proactive and advocate for her own safety by acknowledging and recognizing the risks before the disease progresses.

B. This can be used during a home assessment.
A and D. This would be considered during and after an assessment of the patient’s performance.

https://parkinsonsmi.org/managing-pd/entry/living-alone-with-parkinsons-disease, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158465/

C. Have the patient repeatedly lift 10 pounds from the floor to the counter 3 times independently.
The selection of activity must be adaptable, gradable, and relate to the patient’s interest but in a way so that is geared towards maintenance or improvement of function and quality of life. A patient who has Guillain-Barre syndrome in the recovery stage needs to increase functional strength gradually to prevent relapse but be able to achieve his/her goal to effectively meet the demands of the roles the patient wishes to engage in.

A. Adding multiple elements that are too challenging does not provide opportunity for success without causing undue struggle.
B. Although this provides a gradation of challenge by including a distance of travel, it does not provide an element of lifting from the ground level.
D. Although pacing strategies are helpful to manage her condition, it does not provide a gradual challenge from his current level of function.

Ryan, S., and Sladyk, C. (2015). Ryan’s Occupational Therapy Assistant: Principles, Practice Issues, and Techniques. Thorofare, NJ: SLACK Incorporated, pp 58-59.
Thomas, Heather (2012). Occupation-Based Activity Analysis. Thorofare, NJ: SLACK Incorporated, pp 160-164.

B. They need a power wheelchair equipped with portable respirator with chin or breath controls.
C3-

A. Widen the doorway to 32 – 36″ clearance.
B. Remove the bathtub and create a wheel-in shower room with open access to the toilet and shower.
C. Install a shower curtain to shield the rest of the room from water spraying during showering and a floor drain to make cleaning the shower room easier.

A. Commonly, doorways are measured at about 23 to 27 inches; this would not be wide enough for a wheelchair user to fit through. Conventional doorways are not always accessible for either electric power chair or manual wheelchair use, so it’s generally necessary to modify or widen the bathroom doorway. Residential disabled bathrooms should be between 32 (min) to 36″ wide so that any size wheelchair or walker can easily move through the doorway.
B. A stand-alone shower area is generally best for those in a wheelchair. It is much easier to maneuver the wheelchair and is much safer than having to transfer to a tub and back again.
C. A movable shower curtain can shield the rest of the room from water spraying during showering and a floor drain makes it easy to clean his room.

D. Moving to a SNF is not appropriate as there are more suitable options for the patient had it been deemed necessary for him to relocate for safety reasons. For example, assisted living. A skilled nursing home is normally the highest level of care for older adults outside of a hospital. The Principle of Autonomy should also be considered. The patient has chosen to age at his home, and as this is his choice, it must be respected. Autonomy expresses the concept that practitioners have a duty to treat the patient according to the patient’s desires. Often, respect for Autonomy is referred to as the self-determination principle. However, respecting a person’s autonomy goes beyond acknowledging an individual as a mere agent and also acknowledges a person’s right “to hold views, to make choices, and to take actions based on [his or her] values and beliefs” (Beauchamp & Childress, 2013, p. 106). Individuals have the right to make a determination regarding care decisions that directly affect their lives. In the event that a person lacks decision-making capacity, his or her autonomy should be respected through involvement of an authorized agent or surrogate decision maker.
E. A caregiver is not considered a modification and will prevent the patient from being independent in his ADLs.
F. Countertops should be installed 34 to 36″ in height for those who are able to stand, and 30 to 32″ for full-time wheelchair users. Allow for a clear space underneath the countertop and handicap sink that is 29″ high x 32 to 36″ wide.
countertop and handicap sink that is 29″ high x 32 to 36″ wide.

** The American Disabilities Act website offers suggestions to make restrooms are handicapped-accessible, which also makes them elderly-accessible even if you never have specific mobility issues. Most of these apply to commercial spaces, but some are useful ideas for your home bathroom remodel. An “ADA-compliant” bathroom can ensure that you will have enough space around the toilet, under the vanity, and in and around the shower.

C. 18 inches.
The ADA-approved height for toilets is 17 to 19 inches from the floor to the seat, for handicapped, disabled, and elderly people. A toilet that is used by only one person or in a private residence can be exempted from ADA guidelines but the extra inches in height can make a positive difference when it comes to going to the bathroom by reducing the risk of injury or strain while getting up or down. A comfort height toilet is any toilet that meets the ADA comfort height requirement. These toilets are usually taller than standard toilets and are especially suitable for elderly people who may have trouble sitting down on and standing up from a standard toilet. Generally, their measurement of 17 to 19 inches from the floor to the seat, makes them about 2 to 3 inches taller than the standard toilet. Most senior members of the community prefer taller toilets because they do not put as much stress on their backs.

D. Teach the patient a variety of joint protection strategies for grooming. It is always important to deal with the patient’s pain first. Teaching the patient joint protection techniques and strategies will help eliminate the pain.

C. 35 lbs.
If the clinician is required to bear more than 35 lbs of the patient’s weight, and the patient is unable to use his or her UE to use a transfer board, the patient is a candidate for the use of a lift. The National Institute for Occupational Safety and Health (NIOSH) recommends the use of assistive technology including the use of a lift if it is likely that the caregiver/clinician will lift more than the maximum limit of 35 lbs of the patient’s weight for patient handling.

Module 5. Adaptive Equipment and Assistive Technology. https://passtheot.com/mechanical-lift/

C. Encouraging the family to carry out passive ROM exercise and pressure relief to prevent contractures and decubitus ulcers from developing.
As the ALS progresses to its final stages, almost all voluntary muscles will become paralyzed. The patient will most likely be bedridden and total assistance will be required.

A and B. ALS is a progressive disease. Already in the late stage, mobility is extremely limited and assistance is needed in carrying out most personal needs. Maintaining strength and AROM is not possible.
D. As the mouth and throat muscles become paralyzed, it becomes impossible to talk, eat, drink or swallow. Eating and drinking is therefore done via a feeding tube.

https://www.mda.org/disease/amyotrophic-lateral-sclerosis/signs-and-symptoms/stages-of-als

B. Sitting next to the sink and propping her elbow on the countertop during teeth hygiene tasks, while using a light-weight electric toothbrush.
This strategy addresses fatigue, poor proximal stability due to muscle weakness and enhancing oral hygiene. By propping her elbow on the countertop Rachel is using the environment for stability. Sitting will help to reduce her energy expenditure. The electric toothbrush will aid in better teeth brushing, in comparison to a manual toothbrush.

A. A weighted electric toothbrush may be helpful with controlling her tremor but it would be too heavy for Rachel as she presents with muscle weakness in her upper limbs and fatigue.
C. A universal cuff with a manual toothbrush attached is a strategy used with a patient who has a SCI. Rachel has the skill to brush her teeth.
D. Good oral hygiene is very important. There is a link between MS and periodontal disease as they have a similar inflammatory origin. A publication by the National Multiple Sclerosis Society (NMSS) titled “Dental Health: The Basic Facts” states that dental care may be neglected due to fatigue and focusing on MS-related needs. It stresses the importance of good dental hygiene to avoid infections that can increase MS symptoms.

https://multiplesclerosisnewstoday.com/2018/10/01/ms-neglecting-your-dental-hygiene/

B. The distinction between transitive and intransitive gestures is based on whether or not an action involves the use of an object.
Transitive gestures involve specific hand-object actions such as tool-use while, intransitive gestures are communicative in nature. A transitive gesture is tool-based (e.g. hammering in a nail) and it is in some way shaped by the nature of the object and by any knowledge possessed regarding its functions or potential uses.
Illustrators are the most common type of gesture and are used to illustrate the verbal message they accompany.
Adaptors are touching behaviors and movements that indicate internal states typically related to anxiety. Adaptors can be targeted toward the self, objects, or others. For example: many of us subconsciously click pens, shake our legs when anxious. Some self-adaptors manifest internally, as coughs or throat-clearing sounds. Smartphones have become common object adaptors, as people can fiddle with their phones to help ease anxiety.

D. Conceptual apraxia.
Conceptual apraxia is characterized by a difficulty in selecting adequate tool for that action. In this scenario, the patient is demonstrating poor knowledge of tool function and tool-object association, suggesting impaired conceptual knowledge of tool use.

A. Limb-kinetic apraxia is the inability to make fine, precise movements with an arm or leg.
B. Ideomotor apraxia is essentially an inability to perform gesturing and pantomime, on verbal command.
C. Functional movement disorder is a condition which may resemble any of the movement disorders but is not due to neurological disease.

C. Weighted pen and weighted wrist cuffs.
Some of the neurologic findings following TBI may be attributed to cerebellar damage, including ataxia, postural instability, tremor, impairments in balance and fine motor skills, and possibly even cognitive deficits. A patient with ataxia will have problems making fine, smooth and coordinated movements affecting the ability to write legibly. With trunk stability, the patient will have more control writing.

A. A universal cuff with a pen loop would be more appropriate for a patient with decreased strength and range of motion.
B. A keyboard is a more appropriate adaptation to compensate for limited range of motion or overall hand weakness to hold a writing tool.
D. This would be more appropriate for severe muscle weakness such as Guillain-Barré Syndrome.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734258/
Early, Mary Beth. (2013) Physical dysfunction practice skills for the Occupational Therapy Assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, 500-507.
http://www.oandplibrary.org/popup.asp?frmItemId=D7DBCBCE-122D-4718-80D3-15EBFC868690&frmType=image&frmId=19

C. Screen reading program.
A screen reader is a software application that enables people with severe visual impairments to use a computer. Screen readers work closely with the computer’s Operating System (OS) to provide information about icons, menus, dialogue boxes, files and folders. The device provides access to the entire OS that it works with, including many common applications.
There are two ways that this hardware can provide feedback to the user: Speech and Braille
A screen reader uses a Text-To-Speech (TTS) engine to translate on-screen information into speech, which can be heard through earphones or speakers.
In addition to speech feedback, screen readers are also capable of providing information in Braille. An external hardware device, known as a refreshable Braille display is needed for this. A refreshable Braille display contains one or more rows of cells. Each cell can be formed into the shape of a Braille character, a series of dots that are similar to domino dots in their layout. As the information on the computer screen changes, so does the Braille characters on the display change, providing refreshable information directly from the computer. Whilst it is possible to use either format independently, Braille output is commonly used in conjunction with speech output.

C. Constructional disorder.
This disorder is characterized by failing at tasks that require the manipulation of objects in space. i.e. The spatial part of the task is the problem.

A. Conceptual apraxia- There is a loss of knowledge of tools- object association. The patient would not understand the concept of a dishwasher and therefore not know what to do with the dishes.
B. Ideational apraxia- The patient would have difficulty sequencing the task and not with the spatial aspect of the task.
D. Functional movement disorder- This disorder may resemble any of the movement disorders but is not due to neurological disease.

B. Wheelchair-mounted mobile arm support.
A patient with a C5 spinal cord injury will have decreased strength with scapular protraction and limited horizontal adduction, and a mobile arm support would be beneficial to better support the weight of the arm and improve position of the arm for activities. Elbow flexion is the hallmark for this level.

D. At C6 SCI, an individual can actively extend their wrist to use a tenodesis splint. Presence of wrist extension provides potential for functional grasp through tenodesis.

C. Head pointer/wand. The Adjustable Head Pointer assists individuals who have limited use of their hands. It provides users an easy to use adapted pointing aid for writing, drawing, turning pages or activating controls. The Adjustable Head Pointer adaptive device can help people with limited verbal communication skills to use communication boards.

D. Manual wheelchair.
At the SCI level of T3, the patient typically uses a manual rigid or folding lightweight wheelchair for everyday living, with the ability to go over uneven ground for short distances. Individuals with T1-T12 paraplegia have innervation and function of all upper extremity muscles, including those for hand function. They can achieve functional independence in self-care, in bladder and bowel skills, and, at the wheelchair level, in all mobility needs. Individuals should receive advanced wheelchair training so that they can move over uneven surfaces, rough terrain, and ramps and curbs, as well as do “wheelies”. Can drive independently by using an adapted van or a car adapted with hand controls.

D. Pelvis.
The pelvis is the foundation for a good sitting posture as it dictates what happens to the body segments above and below. It is key to maintaining the correct posture as it dictates the position of the head, trunk and extremities. The pelvis is the base for sitting upright. To be strong and stable, a building needs a solid foundation. In the same way, to be stable when sitting the pelvis must be strong and stable. Any changes in the position of the pelvis will cause a change in the other parts of the body.

https://www.physio-pedia.com/Postural_Support_Devices

D. Standing at the cash register during the entire shift.
Spastic diplegia affects bilateral lower extremities more than the upper extremities. The patient may have difficulty with weight bearing, and maintaining postural control against gravity. He is therefore likely to become easily fatigued with static postures.
Reed, Kathlyn L. (2001). Developmental Disorders, Quick Reference to Occupational Therapy (2nd Edition, pp 27-33). Gaithersberg, Maryland: Aspen Publishers.
https://rarediseases.info.nih.gov/diseases/9637/spastic-diplegia-cerebral-palsy, https://www.youtube.com/watch?v=7fUGWKM32hE

A. Increased energy expenditure.
D. Dysphagia.
E. Poor postural control.

Huntington’s Disease (HD) is characterized by progressive disturbance in both voluntary and involuntary movement, in addition to a significant deterioration in cognitive and behavioral abilities.
Medications are available to help manage the symptoms of Huntington’s disease but treatments cannot prevent the physical, mental and behavioral decline associated with the condition. There is a wide spectrum of signs and symptoms. Which symptoms appear first varies greatly from person to person. Some symptoms appear more dominant or have a greater effect on functional ability, but that can change throughout the course of the disease. In addition to the movement, cognitive and psychiatric disorders, weight loss is common in people with Huntington’s disease, especially as the disease progresses.

Motor problems become more apparent during the middle stage of HD. In middle stage HD, individuals lose the ability to work or drive and may no longer be able to manage their own finances or perform their own household chores, but will be able to eat, dress, and attend to personal hygiene with assistance. Chorea may be prominent, and people with HD have increasing difficulty with voluntary motor tasks. There may be problems with swallowing, balance, falls, and weight loss. Problem solving becomes more difficult because individuals cannot sequence, organize, or prioritize information. Individuals with HD display higher energy expenditure than do individuals without HD and consequently have issues with weight loss and difficulty maintaining appropriate weight. Dysphagia, poor postural control, and inadequate fine motor coordination compromise the patient’s ability to eat.

http://www.mayoclinic.org/diseases-conditions/huntingtons-disease/symptoms-causes/syc-20356117
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction) (p. 934). Kindle Edition.

C. Shift upper body forward with the shoulder girdle over the quadriceps.
The patient is demonstrating retropulsion, the loss of balance in a backwards or posterior direction. He therefore, requires compensatory strategies for transfers. Moving his weight forward facilitates forward momentum as the hips lift off the chair, preventing a backwards motion.

A. Assistance with transfers is unnecessary as the patient is 1-person minimal assist and has adequate leg strength to stand and weight-bear through the lower extremities.
B and D. Scooting forward and hand placement are essential components for the initial steps of transferring, however, anterior weight shifting will correct and prevent a posterior loss of balance once the patient stands.

https://movementdisorders.ufhealth.org/2013/09/05/physical-therapy-tips-to-manage-retropulsion/

A. Corner chair with pelvic straps.
A corner chair has a V-shaped backrest that provides support at the back and sides of the user and is made specifically for users who cannot stabilize themselves against gravity. Corner chairs are perfect for children who may need head, trunk and pelvis support for attaining proper sitting alignment and posture. The corner chair will usually have a sturdy base so it can be the same height as a regular chair and be used at a table. Conversely, the base can be removed so the corner chair and child can both be placed on the floor for playing, allowing the child to interact more easily with their contemporaries at the same eye level either at a table setting, or on the floor during playtime. The pelvic straps help prevent the user from pushing or sliding out of the chair.

https://www.rehabmart.com/category/pediatric_corner_chairs.htm

A. Constructional apraxia.
Constructional apraxia is characterized by an inability or difficulty to build, assemble, or draw objects. Apraxia is a neurological disorder in which people are unable to perform tasks or movements even though they understand the task, are willing to complete it, and have the physical ability to perform the movements.

B. Flaccid paralysis.
Flaccidity is characterized by a complete loss of muscle tone.
Brunnstrom Stages of Stroke Recovery: The seven Brunnstrom stages were developed in the 1960s by Swedish physical therapist Signe Brunnstrom as a framework to understand how muscle control can be restored after stroke.
Stage 1: The first stage of the Brunnstrom approach is the period immediately after a stroke when the connection between the muscles and brain are so damaged that flaccid paralysis (flaccidity) sets in. The initial period of shock immediately after stroke where there is a complete loss of muscle tone. This means that the stroke survivor cannot initiate any muscle movements on their affected side. If the flaccidity lasts too long, the muscles will begin to atrophy.

Transitional Employment. Based on the evaluation results that show that Dustin has average intelligence, an ability to use adaptations to compensate for his problems with executive functions, and the ability to work independently once he has learned a job, Dustin may be able to hold a job on his own with some assistance to get started. A transitional employment program will provide Dustin with support at a pre-arranged job site on a temporary basis. Once Dustin has shown that he can perform the job on his own without the additional support, the transitional employment program will end and Dustin will maintain his employment on his own. Since Dustin should be able to hold a job without assistance at some point he will not require supported employment, which involves support at a pre-arranged job site on a permanent basis.

A. Constructional apraxia.
Constructional apraxia refers to the inability to accurately copy drawings or three-dimensional constructions. It is a common disorder after right parietal stroke, often persisting after initial problems such as visuospatial neglect have resolved. Constructional apraxia is characterized by an inability or difficulty to build, assemble, or draw objects. Apraxia is a neurological disorder in which people are unable to perform tasks or movements even though they understand the task, are willing to complete it, and have the physical ability to perform the movements.

B. Primary visual agnosia is a rare neurological disorder characterized by the total or partial loss of the ability to recognize and identify familiar objects and/or people by sight. This occurs without loss of the ability to actually see the object or person. The symptoms of visual agnosia occur as a result of damage to certain areas of the brain (primary) or in association with other disorders (secondary).
C. Ideational apraxia is a disturbance of voluntary movement in which a person misuses objects because they have difficulty identifying the concept (idea) or purpose behind the objects. Due to the conceptual loss, sequencing errors are common in this form of apraxia. Motor movement is not lost in ideational apraxia. However, the person’s movements appear confused because they cannot form a plan on how to sequence those movements when using an object.
D. Unilateral neglect is an attention disorder that arises as a result of injury to the cerebral cortex. Unilateral neglect is also commonly known as contralateral neglect, hemispatial neglect, visuospatial neglect, spatial neglect, or hemi-neglect.

D. Promote better positioning at work through modifications and weight belts.
It is important to think about modifications and equipment to help improve a person’s body position and body alignment at work. Providing workers with back support is controversial, but many believe that the use of such support has a preventative function. Rather than relying solely on back belts, companies should begin to implement a comprehensive ergonomics program that strives to protect all workers. When mechanical assist devices are not available, training in proper lifting technique and proper body mechanics is important to promote worker safety. The most effective way to prevent back injury is to redesign the work environment and work tasks to reduce the hazards of lifting. This would include training in identifying lifting hazards and using safe lifting techniques as well as implementing adaptations and modifications to jobs that require frequent lifting; twisted or bent postures; or pushing or pulling.
• The load is close to the body.
• Twisted lifts are eliminated.
• Gravity moves the load when possible.
• Slides, chutes, hoists, and hand trucks are used to move heavy loads.
• Weight is reduced to the lowest feasible level.

A weight belt is believed to reduce stress on the lower back by compressing the contents of the abdominal cavity. This increases the intra-abdominal pressure (IAP) which provides support. Wearing a belt also acts as a reminder of the position of the person’s back as the physical sensation of the belt against the skin prompts the person to consider their back position and what muscles must be activated to maintain good posture. The belt also prevents back hyperextension by forming a rigid wall around the lower torso, connecting the rib cage to the hip. This not only limits back movement, but it also prevents sideward bending and twisting.

D. 16” wide x 16” deep x 19.5” high.

Standard Dimensions for Wheelchairs

A. Bill for services under the medical insurance of employees. A company cannot bill a medical insurance company for hiring a ergonomic consultant. In this scenario the OT is an outside contractor therefore they do not need to bill for services. The management will have to pay the OT privately, what was negotiated before services were rendered.

At a work site:
OT Practitioners provide a wide range of workplace consultative services, such as helping employers to comply with the requirements of the American with Disabilities Act, evaluating and modifying tool and equipment design, and determining and reducing injury risk factors. For workers who have had an injury, occupational therapy practitioners can help them to return to work faster, increase their comfort, and suggest modifications to regain productivity.
Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. OSHA and the Wisconsin Occupational Therapists Association (WOTA) recognize the value of establishing a collaborative relationship to foster safer and more healthful American workplaces. OSHA and WOTA formed an alliance to provide WOTA members with information, guidance, and access to training resources that will help them protect employees’ health and safety.
Examples of services provided by occupational therapy include evaluating client performance and function; evaluating work demands; identifying injury risk factors; identifying job accommodations and modifications needed to return to work; and providing work transition services, ergonomic evaluation, and injury prevention services.

http://www.osha.gov
http://www.aota.org

B. Astereognosis.
Stereognosis is the ability to “understand” an object by touch. This understanding involves multiple functions, including perception, recognition, and identification of multiple object properties, such as size, texture, weight, and shape. Impairments in stereognosis (astereognosis) can only be diagnosed if the perception for touch and proprioception is intact. Astereognosis is defined as the general inability to recognize objects by touch in the absence of vision. In a typical neurological examination, astereognosis is assessed by asking the patient to identify an object through touch without visual input. Common objects used for identification can include coins, keys and paper clips. Astereognosis is a type of tactile agnosia.
Many authors of recent textbooks in clinical neuroscience use the terms astereognosis and tactile agnosia synonymously.

A. Apraxia is a neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement. Both the desire and the capacity to move are present but the person simply cannot execute the act.
C. Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write
D. Agraphesthesia is a disorder of directional cutaneous kinesthesia or a disorientation of the skin’s sensation across its space. It is a difficulty recognizing a written number or letter traced on the skin.

https://rarediseases.org/rare-diseases/apraxia/
http://www.acnr.co.uk/pdfs/volume4issue5/v4i5cognitive.pdf
The Parietal Lobe. Carsten M. Klingner, Otto W. Witte, in Handbook of Clinical Neurology, 2018

B. Dysmetria- undershooting or overshooting of a target.

A. Intention tremors – worsening of action tremor as the limb approaches a target in space.
C. Dyssynergia – breakdown/decomposition in movement resulting in joints being moved separately to reach a desired target.
D. Dysdiadochokinesia – impaired ability to perform rapid alternating movements.

C. 20 inches.

Standard W/C measurements for Proper Fit:
Seat Width
Measure the widest aspect of the user’s buttocks, hips or thighs and add 2 inches. This will provide space for bulky clothing, orthoses, or clearance of the trochanters from the armrest side panel.
This patient = 18 inches, therefore 18 + 2 = 20 inches

D. Weighted utensil.
Weighted utensils provide more control so that the utensil reaches the mouth more easily. The weight in the utensil handles helps to control tremor and lack of coordination. Ideal for persons with limited hand control, Parkinson’s disease or spasticity. 
One of the hallmark symptoms of PD is a resting tremor, often described as a pill-rolling tremor. Resting tremors occur at rest and subsides when voluntary movement is attempted. This type of tremor often diminishes with activity, but in some patients the tremor persists during performance of functional activities. When muscle weakness is not a major deficit for the patient, the use of weighted devices can help with stabilization of objects.

B. Dress while sitting in a chair with arms.
Dressing while sitting in a chair with arms is the best modification for this patient. The armchair will allow the patient to sit while dressing, compensating for his poor gross motor coordination and balance. The arms on the chair will add lateral support to compensate for the patient’s postural instability.

A. Adaptive strategies during graded outdoor gardening tasks.

Graded gardening tasks outdoors will allow the client to progress to performing this leisure activity, and working on outdoor gardening tasks will allow the client to gain skills in the natural context of the activity, as long as the practitioner has deemed the activity is safe for the client to perform.

C. Grilled cheese sandwich.
The activity analysis skill here is grading; the OT recognizes the success of a multi-step cold meal and appropriately upgrades the task to require more complex steps.  

A: The turkey and cheese sandwich is too similar to the original task and would likely not provide a sufficient challenge.

B: A microwavable dinner is typically a single-step process and therefore is not an appropriate upgrade.

D: A stir-fry dish is more complex and involves making two separate items to combine, which may be a desired task at a later time.

D. Constructional apraxia.
Constructional apraxia- Clinically, the patient has difficulty putting unattached pieces of an object together. The patient fails at tasks that require the manipulation of objects in space. The primary deficit in constructional disorder appears to involve the ability to perceive and imagine geometrical relations- the ability to organize and manually manipulate spatial information to make a design/whole. To perform such tasks successfully, an individual must have integrated visual perception, motor planning, and motor execution skills. A variety of tests have been utilized to identify constructional apraxia, including the copying of block designs, the copying of simple and complex figures, puzzle constructions, mental rotations, and 3D model building.

Ideomotor apraxia- Inability to execute the correct movements in response to a verbal command. Observed when a patient is asked to perform specific movements or imitate gestures. There is an inability to carry out a motor act on verbal command or imitation, but the patient can perform the task when using the actual object, in context.

https://www.sciencedirect.com/topics/medicine-and-dentistry/constructional-apraxia

D. Ask if the patient will don and doff larger clothing over her own clothing,
The OT needs to observe and provide strategies for dressing. The OT can ask the patient to don and doff larger clothing over her own clothing. This will allow her to complete the tasks and work on her goals.

B. Ask the patient to simulate dressing and bathing tasks.
Since the nursing staff have already assisted the patient in bathing and dressing, the OT can simulate dressing and bathing tasks to determine if the patient is able to complete those tasks.

B. Provide active listening in order to build a therapeutic relationship with the patient.
The best course of action for the OT to take, is to firstly provide the patient with active listening in order to build upon their therapeutic relationship.

A. Compensatory. When a patient has a progressive disease, it means the patient will not improve in function. Therefore, it is important to maintain function as much as possible and provide them with compensatory strategies.

B and C. Are the same. Goals are to improve function.

D. Due to ideational apraxia, the patient is not able to conceptualize the steps of the task.
The patient cannot perform the task correctly due to ideational apraxia as the patient has difficulty with sequencing the steps correctly of donning shoes/socks.
If dressing apraxia was an option, then that would be the correct answer but as it is not stated as an answer choice, ideational apraxia is correct. Dressing apraxia is seen as the inability to plan the effective motor actions required during the complex perceptual task of dressing one’s upper and lower body. The classification of dressing impairment as a form of apraxia can be seen as an extension of an ideational apraxia disorder. (Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 641). Kindle Edition.)

In more detail: Apraxia (called “dyspraxia” if mild) is a neurological disorder characterized by loss of the ability to execute or carry out skilled movements and gestures, despite having the desire and the physical ability to perform them. Apraxia results from dysfunction of the cerebral hemispheres of the brain, especially the parietal lobe, and can arise from many diseases or damage to the brain. There are several kinds of apraxia, which may occur alone or together.
The most common is buccofacial or orofacial apraxia, which causes the inability to carry out facial movements on command such as licking lips, whistling, coughing, or winking.
Other types of apraxia include:
• Limb-kinetic apraxia- the inability to make fine, precise movements with an arm or leg
• Ideomotor apraxia- the inability to make the proper movement in response to a verbal command
• Ideational apraxia- the inability to coordinate activities with multiple, sequential movements, such as dressing, eating, and bathing
• Verbal apraxia- difficulty coordinating mouth and speech movements
• Constructional apraxia- he inability to copy, draw, or construct simple figures
• Oculomotor apraxia (difficulty moving the eyes on command).
• Dressing apraxia (difficulty with the automatic and spontaneous capacity for dressing- donning and doffing clothes)

A. Refer the patient to his/her physician. If the OT detects the patient may need an ankle splint, then the OT needs to refer the patient to his/her physician first. The physician can then write an order for the patient to see a PT who can make a splint. Patient care always needs to follow the OT process of referral, screening, evaluation, intervention, and discharge.

D. Verbally explain techniques, then watch the nursing staff and caregivers implement them. To promote carry-through on interventions and ensure that the caregivers and nursing staff know exactly what to do, it would be optimal to verbally explain techniques and then watch them implement the strategies.

A. Identifies cognitive abilities and limitations of people with neurological disabilities, identifies learning potential and provides a starting point from which to begin intervention appropriate to the specific patient being tested.
The DLOTCA aims, first, to identify cognitive abilities and limitations of people with neurological disabilities in the primary cognitive areas related to function. Second, it aims to allow identification of learning potential and change as well as thinking strategies by means of analysis of the test’s mediation process. Third, it aims to provide a starting point from which to begin intervention appropriate to the specific person tested. The Dynamic Lowenstein Occupational Therapy Cognitive Assessment (DLOTCA) is a new version of the Lowenstein Occupational Therapy Cognitive Assessment battery (Itzkovich, Averbuch, Elazar, & Katz, 2000) used to assess basic cognitive skills in adult populations. The LOTCA batteries progressed from the LOTCA to the LOTCA Geriatric, to the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA–Ch), and then to the DLOTCA and DLOTCA Geriatric (DLOTCA–G). The LOTCA battery provides a cognitive profile along six cognitive areas: orientation, visual and spatial perception, praxis, visuomotor organization, and thinking operations. The LOTCA has been standardized, and its reliability and validity in various populations have been researched since 1989.

Updated: April 30, 2020. Dynamic Lowenstein Occupational Therapy Cognitive Assessment: Evaluation of Potential to Change in Cognitive Performance. American Journal of Occupational Therapy, March/April 2012, Vol. 66, 207-214.

D. Suspension sling or mobile arm support.
A suspension sling or mobile arm support allows hand activities to continue without fatigue to the shoulder and upper arm. A dycem mat and weighted utensils will increase the load and not be favorable for upper extremity weakness. A table tray lowered to the level of the patient’s abdomen will increase difficulty with the motions of hand to mouth.

D. Amputee axle. An amputee axle can be adjusted on the wheelchair to compensate for the person’s center of gravity, which tends to raise in height after a bilateral lower extremity amputation.

D. Catch and throw a ball into a hoop while seated.
Vertigo is a whirling or spinning movement in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system. A patient with vertigo may have an easier time participating in an activity that has a clear, stationary focal point. The patient should be seated to allow for participation in the activity without fear of falling.

D. Initiation and planning.
Executive function is an umbrella term that encompasses the set of higher-order processes. Executive functions are complex cognitive processes necessary to adapt effectively to the environment and to achieve goals. Executive functioning involves abilities and processes vital for daily life such as: Working memory, planning, reasoning, flexibility (the ability to adjust behavior to changing environmental circumstances), task initiation, inhibition, decision making, time estimation, and multitasking.

https://neuronup.us/areas-of-intervention/cognitive-functions/executive-functions/

D. The patient’s expected endurance. The endurance of patients with Guillain-Barre syndrome is usually poor and their ability to participate in evaluation tasks is therefore limited. The OT should plan to complete the evaluation over several sessions.

A. Dysmetria. Dysmetria is lack of coordination of movement typified by under- or over-shooting the intended position with the hand, arm, leg or eye. Dysmetria of a hand can make writing and picking things up difficult or even impossible.
B. Apraxia is a neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement. Both the desire and the capacity to move are present but the person simply cannot execute the act.
C. Astereognosis is the inability to recognize objects by touch alone even though the sense of touch and proprioception is intact.
D. Agnosia is basically a loss of the ability to identify objects or people. It is a perceptual disorder in which sensation
is preserved but the ability to recognize and interpret a stimulus or know its meaning is lost. Agnosia means “without knowledge”. Patients with agnosia cannot understand or recognize what they see, hear or feel. There are 3 main types of agnosia, based on the type of sensory input which has been affected. 1. Visual (vision). 2. Auditory (hearing). 3. Tactile (touch).

https://rarediseases.org/rare-diseases/apraxia/
http://www.acnr.co.uk/pdfs/volume4issue5/v4i5cognitive.pdf

A. PNF. Proprioceptive Neuromuscular Facilitation, abbreviated PNF, uses combinations of movements that follow diagonal or spiral patterns. These patterns work both agonists and antagonists, resulting in balanced movement throughout the pattern. PNF patterns are initiated with the distal part of the limb, so the movement sequence moves distal to proximal.

A. Body mechanics to use when lifting the new pets and their pet supplies. Since the group is a wellness group, the OT will want to teach the group how to prevent injury when lifting and carrying the cat or the cat’s supplies, such as cat food, from one place to another within the community center.

A. Tenodesis splints. If a patient has active wrist extension, the fingers will passively flex and the index finger will contact the thumb. This is called tenodesis action. Tenodesis splints support this action by bracing the thumb and providing a dynamic assist to the wrist, allowing the patient to use the tenodesis action to grasp objects.

D. Cerebellar lesion.
Intention tremor is the most common form of cerebellar tremor.

Kinetic tremor is evident during any voluntary movement. Kinetic tremor, which is exacerbated toward the end of a visually guided goal-directed movement, is called an intention tremor. It is characteristically seen in cerebellar disorders.

B. The tremor in PD typically occurs at rest and becomes less prominent with voluntary movement. It typically occurs initially in the distal upper extremity, and over time, moves proximally and then to the other upper extremity, again in a distal to proximal pattern.

A. Improving patient safety and providing caregiver education.
Since the patient has a degenerative disease and will not be improving abilities, the focus of the treatment plan should be adaptations to allow the patient to function safely at home. The patient’s caregiver should also be educated in techniques that will improve safety for both the patient and the caregiver.

A. Tilt-in-space. A tilt-in-space feature rotates the seat around a fixed axis, does not change the client’s position, and provides pressure relief for the buttocks. The nursing home staff would be able to provide pressure relief to the man by tilting the chair in different positions without having to reposition the man himself.

A. Left unilateral neglect. Since the patient was not aware that the food on the left side of the plate was there, the patient did not think to look to the left side or even consider that there was a left side. This is characteristic of left unilateral neglect.
Unilateral neglect is an attention disorder that arises as a result of injury to the cerebral cortex. Unilateral neglect is also commonly known as contralateral neglect, hemispatial neglect, visuospatial neglect, spatial neglect, or hemi-neglect. In unilateral neglect, patients fail to report, respond or orient to meaningful stimuli presented on the affected side. In most cases, the right parietal cortex has been injured and the left side of the body and/or space is/are ignored.

C. To work on internal rotation.
Internal rotation (also known as medial rotation) is an anatomical term referring to rotation towards the center of the body. These functional exercises will work on full range of internal rotation.