Module One

A. Maintaining range of motion for a spastic hemiplegic arm of a patient who had a stroke several years ago.
The term “maintain” is already a red flag because denial of payment happens frequently with therapy that is viewed as “maintenance”. In the case of a patient post-stroke with hemiplegia that he has lived with for years, providing interventions to maintain range of motion for a spastic hemiplegic arm now will not produce quantifiable results in the eyes of third party payers. If a patient has been pre-determined for a certain number of sessions by a third party payer for a rotator cuff tear, then the patient is not had high risk for payment denial unless OT services goes over that number without seeking approval for additional days. For the patient with schizophrenia, the OT is not specifically providing mental health treatment but rather addressing the hip. E-stimulation to the lower back extensors is quantifiable and skilled treatment for postural stability and alignment, thus is not a high-risk treatment for denial.

A. Retraining a woman with a traumatic brain injury in self feeding skills.
B. Incorporating bowling into the treatment plan of a man with a fracture of the right radius.
F. Setting up an activity of building a birdhouse for a man recovering from Guillain Barre Syndrome.
Purposeful activities are meaningful to the client and goals are written to specifically address these activities. Self-feeding, bowling, housekeeping, and participating in the hobby of building birdhouses are all activities that have meaning for these clients. Goals should be written in the treatment plan addressing these activities, as these are activities the clients want to resume. Providing a sock aid to a woman recovering from a hip fracture is an enabling activity, as the woman may not need the sock aid to dress herself once she has recovered. Applying the hot pack is an adjunctive activity, as it will help prepare the man for participation in therapeutic exercise.

C. Medicare Part A.
Medicaid provides health coverage for children, pregnant women, parents, seniors, and individuals with disabilities.  Blue Cross/Blue Shield PPO is private insurance. Medicare Part A covers patients that are in the acute care setting and need a minimum of 5d/wk of therapy.
Medicare Part B covers patients in the outpatient setting that need therapy 3d/wk.

C. Primary prevention.
Primary Prevention is aimed at reducing the risk of disease or disability in a healthy population. It begins before the onset of a disease.

Secondary Prevention seeks to prevent the early stages of a disease advancing through early diagnosis and treatment. It attempts to prevent the disease from progressing by detecting it early.
Tertiary prevention focuses not only on restoring health after the occurrence of a disease or disability, but also on preventing any damaging after-effects and complications setting in. Attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability, the objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient. Goals of tertiary prevention include preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease.

D. Introduce the patients and hand out supplies. Regardless in which state the clinician is practicing, a COTA® can help lead mental health groups, but is prohibited from setting goals and interpreting results from a standardized assessment any patient.
The OT initiates and directs a patient’s evaluation, interprets the data, and develops the intervention plan. In terms of goals, the OTA is responsible for being knowledgeable about the client’s occupational therapy goals, not setting them.

B. “The patient has learnt the technique of a depression transfer and is progressing towards his long-term goal for dressing”.
Low-Cervical Nerves (C5 – C8). The “A” portion of the SOAP note represents the assessment which reflects the patient’s progress, functional limitations, and expected benefits from skilled OT interventions and to justify continuation in rehabilitation. The assessment describes the clinician’s interpretation of the “S” and “O” of the SOAP note and reflects the clinician’s clinical judgement.

SOAP note:

Ask yourself:
• Should the treatment plan be changed? How?
• Does a new referral need to be made?
• Are any accommodations or modifications recommended?

A. Altruism.
Altruism is the unselfish concern for the welfare of others. This concept is reflected in actions and attitudes of commitment, caring, dedication, responsiveness, and understanding. It is characterized by acts with no apparent benefits for the individual who performs them but that are beneficial to other individuals. Often, people behave altruistically when they feel empathy and a desire to help. For the patient participating in the card making activity will address certain OT intervention goals. Receiving candy from the OTA, is however not relevant in terms of the patient’s intervention plan but it will help the patient feel less confined to the hospital and it’s restrictions.

B. Routine supervision.
Intermediate OTA
Supervision: Routine/general supervision by all level OT or advanced OTA
Supervises: Aides, technicians, volunteers, Level 1 OT students, Level 1 + 2 OTA students

B. Report the information to the physician.
It is important to report this information to the physician so that the physician can do further testing. The physician needs to be made aware of the patient’s deficits, so that he/she can assess further assess the patient and discuss the matter with the patient. Besides the patient possibly needing further testing, it is typically the physician’s legal responsibility to report impaired drivers. It is not within the scope of practice, for an OT to make recommendations for driver training in this scenario, or to report the driver to the authorities.

C. Nonmaleficence.
Nonmaleficence. Principle 2. Occupational therapy personnel shall refrain from actions that cause harm. Nonmaleficence “obligates us to abstain from causing harm to others” (Beauchamp & Childress, 2013, p.150). The Principle of Nonmaleficence also includes an obligation to not impose risks of harm even if the potential risk is without malicious or harmful intent.Nonmaleficence relates to avoiding actions that may cause harm.

A. When it is indicated to meet the needs of the patient.
Interventions do not always go as planned. They should be modified as needed. They should be modified based on the patients needs. The COTA® is responsible for being knowledgeable about the patient’s occupational therapy goals. The OTA selects, implements, and makes modifications to therapeutic activities and interventions that are consistent with demonstrated competency levels, client goals, and the requirements of the practice setting.

A. Narrative reasoning.
Narrative reasoning is a central mode of clinical reasoning in occupational therapy. Clinicians reason narratively when they are concerned with disability as an illness experience, that is, with how a physiological condition is affecting a person’s life. In this paper, narrative reasoning is contrasted with propositional reasoning, and two kinds of narrative thinking are examined. The first is the use of narrative as a mode of speech that can be contrasted with biomedical discourse, in which disability is framed as physical pathology. The second involves the creation rather than the telling of stories. Clinicians try to “emplot” therapeutic encounters with patients, that is, to help create a therapeutic story that becomes a meaningful short story in the larger life story of the patient.

B. Complete a simulated bathing task. In order to be discharged, the OTA needs to see certain skills, even if the patient completed them in advance with the nursing staff.

A. The demonstrated ability to use an identified intervention task in a safe and effective manner with a similar outcome as the OT.
Service competency does not mean that the OTA will perform the task in exactly the same manner as the OT, only that the outcomes will be similar. The supervising OT’s view of the OTA’s performance is subjective, whereas the OTA’s ability to achieve a similar outcome as the OT is objective. The amount of continuing education the OTA has had can influence service competency, but does not define it. Similarly, an OTA may only require general supervision but may not demonstrate the same types of outcomes as the OT in certain areas.

B. Use a goniometer to measure the patient’s current range of motion.
D. Write a progress summary that includes objective information.
F. Administer a standardized test that the COTA® has been trained to administer by the OTR®.
Using a goniometer to measure the patient’s current range of motion; writing a summary about the patient’s progress that includes objective information, and administering a standardized test which the COTA® has been trained to administer by the OTR®, are within the COTA®’s scope of practice.

A. Revising the patient’s treatment goals, and making changes as necessary – only the OT® is permitted to establish the patient’s treatment goals.
B. Using a goniometer to measure the patient’s current range of motion can be performed by the COTA®. The OTR® determines which assessment tasks can be implemented by the COTA®.
C. It is the OT®’s responsibility to establish the plan of care and treatment goals. The OT® is responsible for making modifications to the intervention plan throughout the intervention process. It is not within the COTA®’s scope of practice to modify an existing plan of care.
D. If the COTA® is the primary therapist treating the patient, she is able to write a progress summary for the care plan meeting, as long as the summary is approved and co-signed by the OTR®. The COTA® is allowed to give recommendations to the OTR® regarding changes to the patient’s treatment goals and frequency, but the final decision regarding changes to the treatment plan can only be made by the OTR®. I.e. The COTA® can collaborate with the OTR® to come up with an intervention plan by giving input and recommendations for the patient’s intervention.
E. Decreasing the patient’s treatment frequency based on his/her progress can only be established by the OTR®. She is solely responsible for determining the patient’s need for continuing, modifying, or discontinuing OT services.
F. Administering a standardized test that the COTA® has been trained to administer by the OTR®.
The role of the OTA is described as contributing to the process through implementing assessments delegated by the OT and providing reports of the patient’s abilities and the OTA’s observations in a manner consistent with state and federal law, regulatory requirements, and AOTA official documents.
Practice acts may differ from state to state, and they supersede AOTA official documents, so occupational therapy practitioners should check their state practice act for what role the OTA may take in the evaluation process in their state. In addition, OTA involvement in the evaluation process is limited when using assessments which require training to administer that is available only to OTs e.g. Sensory Integration Praxis Test or the Assessment of Motor and Process Skills. Evaluating the patient is the primary responsibility of the OT, and analyzing and interpreting all evaluation data must be carried out by the OT. However, if permitted by the relevant state practice act, the OTA may administer some standardized assessments, once service competency has been demonstrated.

https://www.oregon.gov/otlb/Documents/OTA%27s%20role%20in%20the%20Evaluation%20Process%20by%20Mashelle%20Painter.pdf
https://ot.unm.edu/common/docs/fieldwork/articles/Guidelines%20for%20OT%20supervision.pdf

C. Behavioral and mental status leading to decreased social participation.
It is essential to consider the patient’s motivation as it may affect goal-directed behavior especially if the patient has had a recent change in condition or when dealing with a chronic condition. The value of social participation at meal times should be considered prior to treating for positional adaptations and supports that target the underlying deficit associated with the symptoms of Supranuclear Palsy (rigidity, stiffness, eye gaze, swallowing).

Progressive supranuclear palsy (PSP) is an uncommon degenerative neurological disorder that causes progressive impairment of balance and walking; impaired eye movement, especially in the downward direction; abnormal muscle tone (rigidity); speech difficulties (dysarthria); and problems related to swallowing and eating (dysphagia). Affected individuals frequently experience personality changes and cognitive impairment. Symptoms typically begin after age 60 but can begin earlier. The exact cause of PSP is unknown.

Top-down approach: Although condition-specific treatments are essential to target adaptation to specific skills, a top-down approach with community interventions should be initiated concurrently to improve client-centered social integration. It is beneficial to identify a client’s real-world routines, patterns, and responsibilities to help build a meaningful treatment plan. Goals for vision-based treatments should be centered on function rather than remediation to accurately reflect the occupational therapy scope of practice and client-stated objectives.

https://www.aota.org/Publications-News/otp/Archive/2018/community-vision.aspx
https://www.aota.org/~/media/Corporate/Files/Secure/Practice/Manage/value/SNF-Evaluation-Checklist-Quality-Measures.pdf

Pass the OT Study Materials – Module 1: “Bottom-Up and Top-Down Approaches”
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Progressive-Supranuclear-Palsy-Fact-Sheet
https://rarediseases.org/rare-diseases/progressive-supranuclear-palsy/

C. Compensatory.  This frame of reference states that patients who will not regain functional skills can compensate by using adaptive equipment or techniques to complete tasks in a different way. By teaching the patient to look to the right to compensate for his right side neglect, the OTA is using the compensatory frame of reference.

D. Volition.The definition of volition is the cognitive process in which a person decides on a particular course of action. Within MOHO, volition refers to the motivation for occupation. The patient is motivated to participate in surfing, so the OTA has utilized the patient’s volition to increase his participation in a range of motion activity.

C. Patient appears to use appropriate judgement when role-playing various tasks that involve social skills.
The assessment section summarizes and interprets the observations of the patient’s performance, allowing the therapist to determine conclusions based on the patient’s performance. Any specific observations or evidence should be reported in the objective section of the note.

C. Sensory input. This is one of the 4 basic principles of the Rood frame of reference. Sensory input may be manipulated in treatment through facilitation techniques such as brushing and inhibition techniques such as neutral warmth.

D. Jonathan’s power wheelchair and his relationship with his mother.
Environmental factors, according to the PEOP Frame of Reference, are extrinsic factors and include:
•Built environment and technology- physical
•Natural Environment- geographic, air quality, climate, terrain
•Culture and values– customs, values, beliefs, and behaviors that affect interpretation and meaning of occupations/life
•Social Support- Social interactions and relationships, societal values, and attitudes
•Social and Economic Systems – access to health care, policies and procedures, and monetary resources

A. It depends on the licensure requirements of the state where the OTA lives.
This question is specifically asking about the OTA’s state license and not their NBCOT® license.
The number of continuing education units needed depends on the licensure requirements of the state where the COTA® lives. Each state sets its own license renewal requirements. While the state may receive input from the national certification board or the American Occupational Therapy Association, the state has the final say on license requirements.

https://www.aota.org/~/media/Corporate/Files/Advocacy/Licensure/StateRegs/ContComp/Continuing-Competence-Chart-Summary.pdf

A. 36.
The NBCOT® certification requires at least 36 Professional Development Units (PDUs) accrued during the 3-year renewal cycle for both Registered Occupational Therapists and Certified Occupational Therapy Assistants.

C. Prudence.
Prudence which is using clinical and ethical reasoning skills.
Prudence: Occupational therapy personnel use their clinical and ethical reasoning skills, sound judgment, and reflection to make decisions to direct them in their area(s) of practice.

http://www.shawnee.edu/academics/rehabilitation-sports/master-occupational-therapy/media/MOT-2017-handbook-ACOTE.pdf

D.”I wake up in the morning and rush to get my clothes on, wash my teeth, and make breakfast. Then I am exhausted”
The first section of the SOAP note format is the S which contains subjective information obtained from the patient. In order for this part to include subjective information, documenting what the patient said regarding complaints of fatigue, is necessary.
Based on the information which the patient gave you, it is clear that you need to educate the patient about COPD and the need for her to learn to use strategies to help her cope with her ADLs. Strategies include: energy conservation, pacing, and slowing down.

A. Rehabilitative frame of reference.
The Rehabilitative FOR is a comprehensive approach to treatment in which the ultimate outcome is for the person to become as independent as possible despite any residual dysfunction. The primary focus of this frame of reference is adaptation to facilitate independence. This FOR is used with patients whose underlying impairments are unlikely to be remediated or with patients who lack motivation to participate in remediation. The theoretical basis of this FOR is that the patient must focus on his/her remaining abilities, despite any disabilities, to attain his/her highest level of functioning in the desired occupational performance.This FOR includes concepts of adaptation, compensation, and environmental modifications. It uses the method of teaching compensatory or functional methods, and makes use of assistive equipment and environmental modifications to restore function.

https://ottheory.com/therapy-model/rehabilitative-frame-reference

B. Allow Rose to place her coffee pot on a separate, lower hot plate after the coffee is brewed.

Since Rose’s limitation involves the rotator cuff, she will have difficulty reaching up to the top of the coffee maker to lift her full coffee pot. Eliminating this step by lowering the hot plate where Rose keeps her pot is the most reasonable and cost effective accommodation listed.

A. Purchasing a new coffee maker is an unnecessary expense for the restaurant.
C. Providing a step stool is unreasonable because it causes a safety risk for both Rose and the other employees.
D. Asking another waitress to pour Rose’s coffee implies that Rose is not capable of performing her job duties and therefore not eligible for reasonable accommodations under the ADA. 

B. Administer a standardized test to determine the patient’s cognitive function. COTA® contributes to the evaluation by helping to gather data, administer parts of the evaluation, and reporting observations. However, they cannot assess, analyze, nor interpret results of assessments

D.  Help the patient identify leisure activities that can be incorporated into her daily routine.
The patient has Onychophagia, otherwise known as compulsive nail biting. This is often a sign of stress/anxiety. Taking healthy steps, such as getting active, to manage stress and anxiety is the best approach in this scenario. Leisure is “non obligatory activity that is intrinsically motivating and engaged in during discretion time, time that is not committed to obligatory occupations such as work, self-care, or sleep” (OTPF-3 Parham & Fazio, 1997, as cited in the Occupational Therapy Practice Framework, p. S21).
A, B, and C are strategies associated with the Cognitive Behavioral approach for anxiety management. https://www.unk.com/blog/3-instantly-calming-cbt-techniques-for-anxiety/ Occupational Therapy Practice Framework: Domain and Process (3rd Edition). Am J Occup Ther  2017;68(Supplement_1):S1-S48. doi: 10.5014/ajot.2014.682006.

C. Autonomy. The Code of Ethics Principle of Autonomy reads as follows: “Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent.” (Occupational Therapy Code of Ethics, 2015). Actions taken that respect a patient’s right to privacy and decision making while receiving occupational therapy services reflect this principle, including respecting a patient’s right to refuse a treatment session due to illness.

D. No. Although OT is recognized as a covered service under Medicaid, it not mandatory and depends on each state if it is included in their program.

Under Medicaid, federal law sets floor requirements that each state must meet, however states have considerable discretion to tailor their specific Medicaid programs to meet their population, service, and budgetary needs. Although occupational therapy is recognized as a covered service under Medicaid, it is an optional, rather than mandatory, benefit for states to include in their programs. Each state has the discretion to establish and ultimately design its own Medicaid programs within the broad federal guidelines. As long as states cover certain “mandatory benefits,” they can also choose whether to provide other “optional benefits,” like occupational therapy, physical therapy, and speech language pathology, or leave them out of their Medicaid program.

https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/Pay/medicaid.aspx

A. Day 1.
Planning for a successful discharge from therapy services begins at admission. In order to establish clear goals for your patient, you need to have a wholistic picture of your patient’s needs during their period of OT intervention, as well as their possible needs post-discharge. By starting to plan for your patient’s discharge right away, you will be ensuring that your patient will be able to transition smoothly to the next stage of their recovery.

B. The interrelationship of person and context and which tasks fall within the person’s performance range.
A person’s occupational performance is viewed in relation to the context in which activity occurs. Activity is selected and adapted based on physical, social, temporal and cultural contexts.In theory and in practice, context (as an area of concern to occupational therapists) has not received the same attention as performance components and performance areas. The Ecology of Human performance serves as a framework for considering the effect of context. Context is described as a lens from which persons view their world. The interrelationship of person and context determines which tasks fall within the person’s performance range. The Ecology of Human Performance framework provides guidelines for encompassing context in occupational therapy theory, practice, and research.

C. Neurodevelopmental Treatment (NDT).
Neurodevelopmental Treatment and Proprioceptive Neuromuscular Facilitation are frames of reference that were developed to address neurological conditions such as a traumatic brain injury (TBI).

A. Psychodynamic Theory is a frame of reference that primarily relates to people with mental health disorders
B. Sensory Integration is a frame of reference developed for use with children and adults who have neuro-psychological conditions that include sensory processing dysfunction.
D. Psychoeducation is a frame of reference commonly used in psychiatric settings and although TBI can result in psychiatric symptoms, it is not necessarily considered a psychiatric diagnosis.

B. Sensory integration.The Sensory Integration (SI) frame of reference focuses on how the interaction between the sensory systems including auditory, vestibular, proprioceptive, tactile, and visual systems, provides integrated information that contributes to a child’s learning and adaptive behaviors. Improved sensory processing provides a foundation for enhanced attention and academic ability.  Responding adaptively to the environment enhances the intake and combining of sensory information

D. Occupational Adaptation. Occupational Adaptation is a complex series of steps and factors that occur when the person is faced with an occupational challenge that takes place within one’s environment and within one’s role capacity. It involves 1) the person, 2) the occupational environment, 3) the interaction or process that takes places between the person and environment. This process depicts how a person can respond adaptively and masterfully when engaged in occupations.

D. Incorporate gentle range of motion exercises.
The biomechanical approach using range of motion will help loosen the patient’s joints. In the first session the OTA can use gentle range of motion exercises to mobilize the patient’s joints.

A. Person-Environment-Occupation-Performance (PEOP).
Person-Environment-Occupation-Performance model (PEOP). Occupational performance is emphasized in the PEOP model and involves three components: (1) characteristics of the person (including physiological, psychological, motor, sensory/perceptual, cognitive, or spiritual), (2) features of the environment (including cultural, social support, social determinants, and social capital, physical and natural environments, health education and public policy, assistive technology), and (3) characteristics of the activity, task, or role. When people perform occupations, they also interact with environment. Thus, there are reciprocal consequences; that is, a person’s goals and intentions influence his/her occupational performance, and the action changes his/her environment and his/her characteristics at the same time. The interaction between the person and environmental components positively or negatively influences occupational performance. When there is a person-environment fit in supporting the valued occupation, success in occupational performance eventually leads to participation and well-being. In addition, the PEOP model is a client-centered model; that is, client must actively set goals and participate in determining a plan that promotes occupational performance.
https://ottheory.com/therapy-model/person-environment-occupation-performance-model-peop

A. Working within a person’s home to modify it for their needs.
Ecology of Human Performance: A focus on the person choosing appropriate tasks within the environment. The environment can be temporal, physical, social, and cultural. How does the context affect the person’s occupational performance. Examples include:
Working within a person’s home to modify it for their needs; In acute care teaching person to select correct self-care tools; ability to choose to sit and knit then gather and prepare a station with necessary tools, lighting, etc.

D. Biomechanical.
The theoretical base of biomechanical frame of reference (FOR) is considered as a remedial approach focusing on impairments that limit occupational performance. This FOR assumes clients are able to acquire the voluntary motor skills necessary to perform the desired human occupation, meaning that the underlying impairment is amenable to remediation. It also assumes that engaging in occupation and therapeutic activities has the potential to remediate the underlying impairment, and results in improvement in occupational performance. The goals are to prevent deterioration and maintain existing movements for occupational performance, to restore movements for occupational performance, and to compensate/adapt for loss of movements in occupational performance. Individuals who have limitations in performing occupations due to limitations in movements, inadequate muscle strength, loss of endurance, or other biomedical conditions are suitable to use this FOR. The goals are to prevent limitation of range of motion, to move the target body part through full range of motion, either passively or actively appropriately, and to position the body to prevent contractures and edema. Assessment includes assessing the performance components on movements, strength and endurance. Some assessments associated with this FOR include standardized objective tests of occupational performance, pain scales, examination of skin/wounds, sensory testing, etc. Interventions associated with this FOR include ADL retraining, work hardening, static and dynamic orthoses, active, active assistive, passive range of motion exercises, nerve gliding, etc. The variety of interventions aims to amend underlying impairment and result in enhanced occupational performance in desired occupations.

https://ottheory.com/therapy-model/biomechanical-frame-reference

B. Biomechanical Frame of Reference. This frame of reference is used with patients who have deficits in range of motion, strength, and endurance. It is the oldest known frame of reference for physical disabilities.

A. Occupational Adaptation. This frame of reference addresses the ability of a person to adapt to the environment so he or she can participate in meaningful occupations. Part of the adaptation process include person, environment, and the interaction between the two. Providing recommendations to a patient regarding modifications to the patient’s home to allow for safe, independent function is an example of occupational adaptation.

B. Dress your left side first.
The stroke dressing technique – Always dress your weak side first and when undressing take the clothes off the weak side last. Using the compensatory approach, the patient should be taught to complete lower body using the stroke dressing technique (dress your weak side first and when undressing take the clothes off the weak side last). A right CVA would affect the patient’s left side so dressing the weaker left side first should be taught.

A. Help the patient acquire specific skills needed to function in her environment.
Stage 3. Considered mid-stage, loss of balance and slowness of movements are hallmarks. Falls are more common. The person is still fully independent, but symptoms significantly impair activities such as dressing and eating.

Lifestyle performance model: Intervention focuses on enhancing the environment and the patient’s needs
Psychoanalytic and Psychodynamic theory: Intervention should help improve a patient’s self-identity and improve interpersonal relationships
Biomechanical Frame of Reference: Intervention focuses on range of motion, strength, endurance, and restoring functional skills

D. Veracity.
Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession. Veracity is based on the virtues of truthfulness, candor, and honesty. The Principle of Veracity refers to comprehensive, accurate, and objective transmission of information and includes fostering understanding of such information (Beauchamp & Childress, 2013). Veracity is based on respect owed to others, including but not limited to recipients of service, colleagues, students, researchers, and research participants. In communicating with others, occupational therapy personnel implicitly promise to be truthful and not deceptive. When entering into a therapeutic or research relationship, the recipient of service or research participant has a right to accurate information.
http://ajot.aota.org/

C. Repetition of the task sub-steps with gradually fading cues. When using a functional skill training approach, the OTA should be focused on helping the patient master a task. Repeated practice with cueing is key.
A) Focused on caregiver training.
B) Using instructional cue cards is a compensatory approach.
D) Focuses on underlying performance components.

A. Measure the patient’s active ROM using a goniometer.
Occupational Therapy Assistants are able to deliver OT services under the supervision & in partnership with an OT. Specific Roles of a Certified Occupational Therapy Assistant includes performing designated assessments to contribute to the evaluation, if directed by the occupational therapist and deemed competent. The interpretation of assessment results and the overall evaluation is the responsibility of the occupational therapist.

B. The OT is responsible for determining the need for continuing, modifying, or discontinuing occupational therapy services.
C. The OT interprets the information provided by the OTA and integrates that information into the evaluation and decision-making process.
D. The OT is responsible for determining priorities of goals

D. Pt. has improved significantly in his ability to work at the computer by using periodic stretch breaks.
A – Assessment- A summary of the patient’s performance and conclusions based on the objective data are included here. An evaluation will include a statement on whether or not the patient requires occupational therapy services and what skills should be addressed. A progress report will include a statement on what level of progress the patient demonstrates.

SOAP:
S: Subjective- A quote from the patient
O: Objective- What happened during the session
A: Assessment- OT practitioner perspective on the session
P: Plan- What is your plan for the next session
“O”- Objective data related to the patient’s performance should be included. When documenting an evaluation, observations regarding performance and standardized test results are documented. When documenting progress, data related to treatment goals is included. Any quotes or information that the patient reports, is considered part of the “S” – subjective part of the documentation..

A. The ADA requires historic sites to provide accessible entrances but alternate entrances may be used if changing the front entrance of the site alters the historic significance of the site. Since installing a wheelchair ramp to the front entrance of the home would compromise the historic significance of the home, the historical society is allowed to make alternative arrangements under Title III of the ADA, such as installing the ramp on a side or back entrance instead of on the front.

A. Use your unaffected arm to dress the affected side first. To undress, take the garment off the unaffected side, then remove it from the affected side.
The general rule is to use your unaffected arm to dress the affected side first. To undress, take the garment off the unaffected side, then remove it from the affected side. http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/Dressing-Tips-for-Stroke-Survivors_UCM_310116_Article.jsp#.XDEEvFUzbIU’ defer onload=’

When dressing, use your strong arm to dress your weak side first. When undressing, pull your strong arm or leg out of your clothing first.

I.e: Always dress your weak side first and when undressing take the clothes off the weak side last.

D. Interactive reasoning.
Interactive reasoning is a strategy used by the OTA to understand the patient as a person. This type of reasoning takes place during face-to-face interactions between the clinician and patient.
Interactive reasoning is used for at least eight reasons or purposes, as follows:
1. To engage the person in the treatment session (Mattingly, 1989, identified six such strategies)
2. To know the person as a person (Cohn, 1989)
3. To understand a disability from the patient’s point of view (Mattingly, 1989)
4. To finely match the treatment goals and strategies to this patient with this disability and this experience. Therapists call this process individualizing treatment (Fleming, 1989),
5. To communicate a sense of acceptance, trust, or hope to the patient (Langthaler, 1990),
6. To use humor to relieve tension (Siegler, 1987),
7. To construct a shared language of actions and meanings (Crepeau, 1991),
8. To determine if the treatment session is going well (Fleming, 1990)

OT practitioners typically use three different types of reasoning when solving problems in day-to-day practice.
1. Procedural reasoning which guides the OT practitioner in thinking about the patient’s physical performance problems.
2. Interactive reasoning is used when the OT practitioner wants to understand the patient as a person.
3. Conditional reasoning is used to integrate the other two types of reasoning as well as to project an imagined future condition or situation for the person.
Experienced OT practitioners seem to shift smoothly from one mode of thinking to another in order to analyze, interpret, and resolve various types of clinical problems.

https://pubmed.ncbi.nlm.nih.gov/1793114/
https://ajot.aota.org/article.aspx?articleid=1877109

B. Follow the facility’s policy regarding contacting and reporting suspected abuse to child services. Federal law mandates that healthcare workers must report suspected abuse to the local child and family services agency. The facility where the OTA works should have a policy in place regarding reporting suspected abuse. The OTA should follow this policy to report the suspected abuse.

A. Review the patients’ medical charts and copy pertinent records. The COTA® is allowed to review medical records as a provider of health care services within the facility and she can copy pertinent information to expedite the evaluation process for the OTROTA involvement in the evaluation process is limited when using assessments such as the Sensory
Integration Praxis Test or the Assessment of Motor and Process Skills, which require training to administer that is available only to OTs.
.
The COTA® cannot complete evaluations, unless specifically delegated by the OTR®. If permitted by the relevant state practice act, the COTAOTA involvement in the evaluation process is limited when using assessments such as the Sensory
Integration Praxis Test or the Assessment of Motor and Process Skills, which require training to administer that is available only to OTs.
may administer some standardized assessments once service competency has been demonstrated. Service competency is defined as the ability of the OTA to obtain the same or equivalent results as the supervising OT in evaluation and treatment. The OTA’s involvement in the evaluation process is limited when using assessments such as the Sensory Integration Praxis Test or the Assessment of Motor and Process Skills, which require training to administer that is available only to OTs.

A. Prepare the clinic area for treatment sessions
C. Assess a meal time feeding group
E. Continue adaptive equipment training with patients

OTAs who work in inpatient settings work under direct or intermittent supervision from OTs. They are able to perform the following job duties from the answer choices according to occupational therapy practice guidelines and state licensure laws:

-Prepare the clinic area for treatment sessions. OTAs provide treatment to patients and can certainly prepare for those sessions.

-Assess a mealtime feeding group. This task falls under the category of ADL assessment. OTAs are allowed to complete ADL assessments according to the practice guidelines.

-Continue adaptive equipment training with patients. While the OTA would not be able to initiate adaptive equipment training, as this is a decision the OT has to make, the OTA can continue training with supervision from the OT.

Treatment cannot be initiated prior to the OT evaluation in any clinical setting. Establishing short-term treatment objectives and discharging patients from occupational therapy are both functions the OT must complete.

A. Educate the patient on car adaptations and safety so he can return to driving around his community
C. Map out directions for how the patient can get from his house to his senior softball game every Thursday
E. Provide the patient with a seat cushion he can use to sit more comfortably while driving

The Person Environment Occupational Performance (PEOP) emphasizes the essential interaction between the person, performance of a desired meaningful occupation, and the context in which the person engages in the occupation. This model helps describe the experiences of an individual and population and explains the impact of the key components of this model on health, wellness, and quality of life. Recommending and providing simple adaptations and written maps to places the 72-year-old man drives to frequently follow this frame of reference.

C. Exploring volition, habituation, and capacity for performance.

The Model of Human Occupation is dynamic and context is dependent. Personal occupational choices and engagement in occupation shape the individual.

The model centers around 3 elements are inherent to humans:

• (1) Volition includes thoughts and feelings that motivate people to act and is comprised of personal causation, values and interests
• (2) Habituation includes organized recurrent patterns of behavior and is comprised of habits and roles
• (3) Performance capacity includes the physical and mental skills needed for performance and subjective experience of engaging in occupation

If the COTA® is using MOHO during treatment, she should focus on these three elements.

C. The OTA should tell the YWCA that she is not a specialist in this subject area and should recommend an alternative treatment specialist.If the OTA only has basic understanding of an alternative treatment such as essential oils, she needs to disclose this information to the group. It is best to refer the YWCA to an alternative treatment specialist.

D. Occupational Adaptation. This frame of reference is a complex series of steps and factors that occur when the person is faced with an occupational challenge. Occupational adaptation takes place within one’s environment and within one’s role capacity. It involves 1) the person (the woman), 2) the occupational environment (the kitchen in the group home), 3) the interaction or process that takes places between the person and environment (making scones). This process depicts how a person can respond adaptively and masterfully when engaged in occupations.

A. Referring to an optometrist when the elderly patient begins to have trouble reading a newsletter about “home safety”.
C. Terminating therapy when the patient’s insurance coverage no longer covers it.
D. Incorporating therapeutic practices that are evidence based and are in lined with the patient’s goals.
The principle of Beneficence states that occupational therapy practitioners shall demonstrate a concern for the well being of service recipients and provide services that are in the patient’s best interests. This includes providing evidence-based treatment techniques, referring patients to other health care providers when health problems that might affect safety are observed, and terminating therapy when a patient’s insurance no longer covers services. Respecting a patient’s right to refuse treatment falls under the principle of Autonomy. Protecting the patient with dementia falls under the principle of Nonmaleficence. Refusing a gift from a patient falls under the principle of Justice.

D. Medicare A covers occupational therapy as a single service if continued service is medically necessary
E. Medicare A is covered for inpatient hospital stays if determined to be medically necessary by a patient’s physician
F. People age 65 and older are covered by Medicare A

D. “O”- objective
The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient’s chart.

SOAP
Subjective (What is SAID)
Write in this section anything that someone says to you or reports. This can be the patient, a relative, or a member of the MDT. This can be face to face or on the phone. The type of stuff that goes in this section includes:
• Consent to treatment
• Social history from patient or family member
• How the patient says they are feeling
• Client goals and wishes on discharge

Plan
Right, as a result of your analysis, what needs to be done? End with a statement justifying the continued need for OT input if required. In the plan I write any updated goals, modifications to therapy and subsequent treatment sessions. For example, an environmental assessment, to review the patient in two weeks, or a planned discharge date.

D. There is no longer a therapy cap.
Medicare Part B covers outpatient therapy, including physical therapy (PT), speech-language pathology (SLP), and occupational therapy (OT). Previously, there were limits, also known as the therapy cap, how much outpatient therapy Original Medicare covered annually. However, in 2019, the therapy cap was removed.
Original Medicare covers outpatient therapy at 80% of the Medicare-approved amount. If your total therapy costs reach a certain amount, Medicare requires your provider to confirm that your therapy is medically necessary. If Medicare denies coverage because it finds your care is not medically necessary, you can appeal.
Outpatient therapy includes therapy received:
• At therapists’ or doctors’ offices
• At Comprehensive Outpatient Rehabilitation Facilities (CORFs)
• At skilled nursing facilities (SNFs), when you are there as an outpatient or are otherwise ineligible for a Medicare-covered stay
• And, at home through therapists connected with home health agencies, when you are ineligible for Medicare’s home health benefit

https://www.medicareinteractive.org/get-answers/medicare-covered-services/rehabilitation-therapy-services/outpatient-therapy-costs

A. A water exercise program for people with multiple sclerosis.
Tertiary prevention focuses on people who have already been affected by a disease. The goal is to improve their quality of life by reducing disability, limiting or delaying complications, and restoring function. This is done by treating the disease and providing rehabilitation. The objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient.
3 levels of prevention:
1. Primary prevention—those preventive measures that prevent the onset of illness or injury before the disease process begins. An educational program for senior citizens on safety at home is an example of primary prevention.
2. Secondary prevention—those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury to prevent more severe problems developing. Treatment for oral motor skills for a 2-year-old through a birth-to-three program and adapting the home of a man recovering from a total hip replacement are examples of secondary prevention.
3. Tertiary prevention—those preventive measures aimed at rehabilitation following significant illness. At this level health services workers can work to retrain, re-educate and rehabilitate people who have already developed an impairment or disability.

https://courses.lumenlearning.com/diseaseprevention/chapter/three-levels-of-health-promotiondisease-prevention/

C. Medicare Part A – covers patients that are 65 years of age or older and have received social security benefits for 24 months. Part A will pay for occupational therapy services in the acute care setting if the patient needs therapy a minimum of 5 days per week.

Medicare Part B covers patients who require outpatient therapy in an outpatient or long term care setting. Medicaid provides health coverage for children, pregnant women, parents, seniors, and individuals with disabilities who meet certain income requirements. Blue Cross/Blue Shield PPO is private insurance with its own eligibility requirements. 

C. Neurodevelopmental Treatment (NDT).
Neurodevelopmental Treatment and Proprioceptive Neuromuscular Facilitation are frames of reference that were developed to address neurological conditions such as a traumatic brain injury (TBI).

A. Psychodynamic Theory is a frame of reference that primarily relates to people with mental health disorders
B. Sensory Integration is a frame of reference developed for use with children and adults who have neuro-psychological conditions that include sensory processing dysfunction.
D. Psychoeducation is a frame of reference commonly used in psychiatric settings and although TBI can result in psychiatric symptoms, it is not necessarily considered a psychiatric diagnosis.

D. Beneficence. The definition of Beneficence in the Occupational Therapy Code of Ethics states that occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. This includes termination of occupational therapy services when they are no longer beneficial. If the OTA continues to bill for services that are no longer necessary, she is putting the patient at risk for having services denied by her insurance company, causing a financial burden and affecting her well-being.

C. A walker for a person who cannot ambulate in the home independently.This is the only item that Medicare considers to be durable medical equipment (DME). DME requires that the item must be medically necessary and reasonable to treat an illness or when a patient has a decline in function
Medicare Part B covers medically necessary durable medical equipment (DME) if the patient’s doctor prescribes it for them to be used in their home.
DME that Medicare covers includes, but isn’t limited to:
– Blood sugar monitors
– Canes
– Commode chairs
– Continuous passive motion devices
– Continuous Positive Airway Pressure (CPAP) devices
– Crutches
– Hospital beds
– Oxygen equipment & accessories
– Patient lifts
– Pressure-reducing support surfaces
– Traction equipment
– Walkers
– Wheelchairs & scooters

A sock aid, grab bars, and a reacher are used for self-help and are not therefore covered by Medicare.

https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage

A. Ask the OTA if they have renewed their license. Determine if they are aware that it is their responsibility to renew their license, by the expiration date.

It is important talk to the OTA. Just because a new license is not present in the OTA’s personnel file does not mean that they didn’t renew it. The rehab director should find out if the OTA renewed their license and, if yes, should request a copy for the file. The rehab director should only contact the state licensing agency if the OTA has not renewed their license and is not legally permitted to practice.

D. Americans with Disabilities Act (ADA) provides the disabled, including those with mental impairment, access to employment and the community. Communities must provide transportation services for the disabled, including accommodation for wheelchairs. Public facilities (schools, museums, physician’s offices, post offices, and restaurants) must be accessible, with ramps and elevators as needed. HIPAA addresses the rights of the individual related to privacy of health information. OAA provides improved access to services for older adults and Native Americans, including community services (meals, transportation, home health care, adult day care, legal assistance, and home repair). OBRA provides guidelines for nursing facilities, such as long-term care facilities

A. Person-Environment-Occupation-Performance Model (PEOP). This frame of reference states that the interaction between a person’s abilities, environmental factors, and the demands of occupation influences performance outcomes.
– Emphasis on the interaction between person & environment, and how this affects occupation.
– Client-centred approach, collaborate with patient to establish therapeutic goals
Top-down rather than bottom-up model, so is holistic and person-centred.
– Comprehensive list of factors; useful guide for a novice OT who leans towards more prescriptive frameworks until they acquire tacit expertise.

A. Working with a patient in his home to modify it for his needs. The Ecology of Human Performance frame of reference states that a person’s occupational performance is viewed in relation to the context in which activity occurs. Holding a therapy session with a person in his home to help modify the environment is a good example of the application of this frame of reference.

B. Rehabilitative frame of reference.
Rehabilitative frame of reference: The focus is on what the patient can do, rather than on what they cannot do, and it utilizes adaptation, compensation, and modification in order to facilitate the patient’s ability to participate in the desired activities.  The rehabilitative approach looks at functional problems from a top-down approach and can be utilized regardless of the extent of the patient’s deficits because it does not require the restoration or development of missing skills, but instead focuses on maximizing independence where the patient is now in the recovery process. 

B. Cultural context.
This looks at the society the characters live in and at how their culture can affect their behavior and their opportunities. Customs, beliefs, activity patterns, behavioral standards, and expectations accepted by the society of which a person is a member. The cultural context influences the person’s identity and activity choices.

A. Virtual context refers to ‘interactions that occur in simulated, real time, or near real time situations absent of physical contact’ (American Occupational Therapy Association (AOTA), 2014: S9). Occupations that occur in a virtual context, however, still require physical interaction with devices.
C. Temporal context is the experience of time as shaped by engagement in occupations. It includes stage of life, time of day or year, duration or rhythm of activity, and history.
D. Personal context reflects an individual’s internal environment derived from his or her gender, values, beliefs, cultural background, or state of mind. Personal context refers to demographic features of the individual, such as age, gender, socioeconomic status, and educational level, that are not part of a health condition.

Occupational Therapy Practice Framework: Domain and Process (3rd Edition).

A. Yes, once the entry-level OTA shows service competency to a supervising OT.

Entry-level OTAs are allowed to supervise aides, technicians, and volunteers once they show service competency in this area to a supervising OT.

C. Routine.
A routine is a  customary or regular course of procedure , when ADLs, chores, or duties must be done regularly or at specified intervals. This patient follows a specific routine in the morning. 
The behavior is not a ritual because the patient does not do it for psychological reasons, but does it because it is a part of his regimen of physical self-care.

A. Yes, entry-level OTs and OTAs can supervise a level-I fieldwork student.
The AOTA Standards describe the goal of Level I Fieldwork “to introduce students to the fieldwork experience and develop a basic comfort level with an understanding of the needs of clients.” Level I Fieldwork is not intended to develop independent performance, but to “include experiences designed to enrich didactic coursework through directed observation and participation in selected aspects of the occupational therapy process. “Qualified personnel for supervision of Level I Fieldwork may include, but are not limited to, academic or fieldwork educators, occupational therapy practitioners initially certified nationally, psychologists, physician assistants, teachers, social workers, nurses, physical therapists, social workers, etc. The supervisors must be knowledgeable about occupational therapy and cognizant of the goals and objectives of the Level I Fieldwork experience. Entry Level OTA can supervise aides, techs, volunteers, level 1 FW students. OTAs must have 1 year of experience before supervising a level-II fieldwork student.
https://www.aota.org/Education-Careers/Fieldwork/LevelI.aspx
https://www.aota.org/Education-Careers/Fieldwork/Answers.aspx

C. Advise the patient to sign up for Medicare Part B.
Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. The OTA should therefore advise the patient to sign up for Medicare Part B. People who receive Social Security Disability Income (SSDI) are eligible for Medicare and can receive Medicare Part B benefits for a monthly premium payment. Medicare Part B covers mental health services.