Module Eight

B. Grounded Theory.
Grounded Theory Method involves the discovery of theory through the analysis of data. Grounded theory method is a research method which operates almost in a reverse fashion from traditional social science research. Rather than beginning with a hypothesis, the first step is data collection through a variety of methods. From the data collected, the key points are marked with a series of codes, which are extracted from the text. The codes are grouped into similar concepts in order to make the data more workable. From these concepts categories are formed, which are the basis for the creation of a theory, or a reverse engineered hypothesis. This contradicts the traditional model of research, where the researcher chooses a theoretical framework, and only then applies this model to the phenomenon to be studied.

A. The linear correlation (dependence) between two variables X and Y.
Correlation coefficient also known as r, R, or Pearson’s r.: measure of the strength and direction of the linear relationship between two variables that is defined as the (sample) covariance of the variables divided by the product of their (sample) standard deviations.

A. Randomized control trials.
Randomized control trials RCT is the highest level of evidence-based practice Randomized Controlled Trials (RCT): a specific type of scientific experiment, and the gold standard for a clinical trial. RCTs are often used to test the efficacy or effectiveness of various types of therapy interventions within a patient population.

C. Preparation for or concurrently with purposeful and occupation-based activities.
AOTA states that physical agent modalities (PAMs) may be used by occupational therapists and occupational therapy assistants in preparation for or concurrently with purposeful and occupation-based activities or interventions that ultimately enhance engagement in occupation. Preparatory methods support and promote the acquisition of the performance skills necessary to enable an individual to resume or assume habits, routines, and roles for engagement in occupation. The exclusive use of PAMs as a therapeutic intervention without application to occupational performance is not considered occupational therapy. PAMs are categorized as preparatory methods that also can be used concurrently with purposeful activity or during occupational engagement.
https://ajot.aota.org/article.aspx?articleid=1867124

A. True Experimental. The definition of true experimental research is a research design where subjects are randomly assigned to an experimental group or a control group.

B. Report on the patient’s progress at the meeting. The OTA can report on the patient’s status and progress during occupational therapy treatment. He will not be allowed to perform any functions that involve creating or revising treatment goals or revising the care plan. Only the OT can do this. The OTA can report on new treatment goals and the new plan of care if the OT has revised it ahead of time.

D. Motor Free Visual Perceptual Test (MVPT). The Motor Free Visual Perceptual Test  (MVPT) is designed to measure overall visual perceptual ability by employing a multiple-choice format of simple black-and-white drawings as stimulus items and answer choices. As its name suggests it does not place any demands upon a person’s motor-skills, which is best for a child who has DCD. The MVT assesses spatial relations, visual discrimination, visual memory, visual closure, and figure-ground

B. Encourage the moms to allow their infants to attempt to finger feed graham crackers or cookies made for infants.
With infants aged 7-13 months, it is important for the OT to promote self-feeding with solid foods rather than pureed foods, which happens at 4-6 months.

D. Food texture. When a child has an issue with tongue control, certain food textures can create a choking hazard because the child doesn’t have the ability to maneuver the food properly within his mouth. Pureed or soft foods that do not require fully developed tongue control should be provided until the child gains enough tongue control to maneuver more difficult textures in his mouth.

B. Peabody Developmental Motor Scales. The COTA® would be allowed to administer portions of tests that are standardized and have specific, objective instructions. The Peabody Developmental Motor Scales, Bruininks-Oseretsky Test of Motor Proficiency, Motor-Free Visual Perception Test, and Miller Assessment for Preschoolers meet this requirement.
A. The Sensory Profile is a questionnaire-style test that parents complete
C. The Transdisciplinary Play-Based Assessment is a non-standardized assessment that utilizes team observations

B. Sensory Profile Adolescent/Adult.
Ryan’s complaints match the symptoms of sensory sensitivity, so an assessment addressing sensory processing should be used. The assessment should be normed for an age range that includes 16-year-olds. This assessment helps measure sensory processing patterns and effects on functional performance. An individual answers questions regarding how he or she generally responds to sensations, as opposed to how he or she responds at any given time. Can be used with from 11 years old up.

A. Any activity that will place Bella’s neck in extreme flexion.
Atlantoaxial Instability, also referred to as AAI or atlantoaxial subluxation, is a condition where increased movement occurs between the first and second vertebrae. Extreme neck flexion can cause further dislocation of these vertebrae.
Atlantoaxial instability (AAI) is characterized by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bony or ligamentous abnormality.
Atlantoaxial instability (AAI) affects 10–20% of individuals with Down syndrome (DS). The condition is mostly asymptomatic and diagnosed on radiography by an enlarged anterior atlanto-odontoid distance. Symptomatic AAI, which affects 1–2% of individuals with DS, and manifests with spinal cord compression.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2532127/

D. The patient’s shoulder should be adducted, elbow at 90 degrees of flexion, and the forearm in neutral.

C. Sitting and shaving.
Stage 2 (1.4-2.0 MET) ADLs and mobility
Unlimited sitting
Sitting: Self-bathing, shaving, grooming, dressing
Ambulation at slow pace in room, as tolerated

A. Sitting and ironing – Stage 3 (2.0 – 3.0) activities.
B. Walking downstairs – Walking downstairs – 3 MET. Therefore, it is an activity relevant for Stage 3 (2.0 – 3.0) activities.
D. Standing and dressing – Stage 4 (3.0 – 3.5) activities.

A. Kleinert – active extension, rubber-band passive flexion.
Duran – passive extension, passive flexion.

B. Poor/P.
Full range of motion is present with gravity eliminated.Sliding her arm along a table, is a movement in which gravity is elimated. When the body is put in a position that requires the limb to move parallel to the floor (and therefore perpendicular to the force of gravity), this is considered a “gravity eliminated” position for that limb. The force of gravity is perpendicular to the floor and the movement of the limb is parallel to the floor.
Grade 2 = Poor = Full ROM gravity eliminated.

Muscle Grading
Grade 0: No contraction or muscle movement.
Grade 1: Trace of contraction, but no movement at the joint.
Grade 2: Movement at the joint with gravity eliminated.
Grade 3: Movement against gravity, but not against added resistance.
Grade 4: Movement against external resistance with less strength than usual.
Grade 5: Normal strength.

B. Support and immobilize the upper limb. Provide the patient with a splint with elbow in 90 degrees and wrist in neutral.
In order to manage pain, supporting/immobilizing the affected joint/nerve is indicated. In this scenario, splinting to avoid forearm rotation is necessary. The OT can give the patient an elbow splint at 90° with the forearm in neutral. The patient most likely has Pronator Teres Syndrome which is caused by the median nerve being compressed between the two heads of pronator teres at the level of the elbow. Aching discomfort in the forearm is the common presentation especially pain over the median nerve distribution distal to the elbow. Symptoms are the same as CTS, with the addition of aching pain in proximal volar forearm.

A.The first goal of intervention is to help the patient with pain management as pain impacts on function. Only when the patient regains her function, will she be ready for work hardening.
C. Immobilizing the wrist will not help to limit forearm pronation.
D.Exercising is contraindicated.

B. Place a fruit on the table. This is the only activity which can be completed in a gravity eliminated plane. According to the MMT results, Janet is not yet able to move her proximal joints against gravity.
MMT Grading System:
Grade 2- (Poor-) Partial ROM, gravity eliminated
Grade 2 (Poor) Full ROM, gravity eliminated
Grade 2+ (Poor+) Gravity eliminated/slight resistance or < 1/2 range against gravity A, C and D require shoulder movements against gravity which would mean she would need at least a grade 2+ to be able to lift a toothbrush to her mouth.

A. Cubital tunnel syndrome.
Cubital tunnel syndrome occurs when the ulnar nerve, which passes through the cubital tunnel on the inside of the elbow, becomes irritated due to injury or pressure. Ulnar nerve compression at the elbow results in numbness/tingling along ulnar aspect of forearm/ hand, pain at elbow, weak power grip; + Tinel’s sign at elbow (pain or sensation).

B. CTD refers to an array of conditions that are all precipitated by repetitive stressors on muscles, joints, tendons, and nerves. Overuse syndromes, repetitive strain injuries, regional musculoskeletal disorders, and repetitive trauma disorders are all synonyms for Cumulative Trauma Disorders. These disorders are most common in the hands, wrists and elbows.
C. de Quervain’s tenosynovitis is caused by an inflammation and swelling of the tendons of the abductor pollicis longus and extensor pollicis brevis at the level of the radial styloid process. This inflammation and swelling are usually the result of trauma to the tendon from repetitive twisting motions.
D. The most common type of distal radius fracture is a Colles fracture, which produces a very distinctive sign known as the “dinner fork deformity.

C. Fluidotherapy.
Fluidotherapy is a dry thermal physical agent that transfers its energy (i.e. heat) to soft tissues by forced convection. Dry Heat Therapy relieves localized pain, increases localized blood circulation, increases range of motion and stiffness associated with non-rheumatoid arthritis.
Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The pain is out of proportion to the severity of the initial injury. The occupational therapist’s goal is to improve hand function through various treatment modalities and to facilitate re-engagement in ‘safe’ occupations.
D. Neuromuscular Electrostimulation (NMES) applies electrical impulses to nerves to make the muscles contract. It is sometimes confused with Transcutaneous electrical nerve stimulation (TENS) which is a type of electrical stimulation used to help decrease acute and chronic pain.

https://www.ninds.nih.gov/Disorders/…/Complex-Regional-Pain-Syndrome-Fact-Sheet
https://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/symptoms-causes/syc-20371151
https://www.djoglobal.com/products/chattanooga/fluidotherapy-double-extremity-unit-0

B. Erb’s palsy.
The classical sign of erb’s palsy is called Waiter’s tip deformity. Paralysis of the arm caused by injury to the upper trunks of C5–C6 nerves. The classic sign of erb’s palsy is called Waiter’s tip deformity. This is due to loss of the lateral rotators of the shoulder, arm flexors, and hand extensor muscles. The position of the limb is characterized by : the arm hanging by the side and is rotated medially, the forearm extended and pronated and the wrist flexed. There is also a loss of sensation in the lateral aspect of the forearm. The arm cannot be raised from the side; all power of flexion of the elbow is lost, as is also supination of the forearm. Muscles most often paralyzed are supraspinatus and infraspinatus because the suprascapular nerve is fixed at the suprascapular notch (Erb’s point). In more severely affected patients deltoid, biceps, brachialis, and subscapular is affected (C5 and C6). Elbow flexion is weakened because of weakness in biceps & brachialis. If roots are damaged above their junction, paralysis of rhomboids and serratus anterior is added, producing weakness in retraction and protraction of scapula.

A. The most common type of fracture in the pediatric population is elbow fractures.No matter where the break occurs, most elbow fractures result in sudden, intense pain in the elbow and forearm. Other common symptoms include: swelling around the elbow, numbness in the hand and an inability to straighten the arm.
C. An extensor tendon injury is a cut or tear to one of the extensor tendons. Due to this injury, there is an inability to fully and forcefully extend the wrist and/or fingers.
D. This is a term used to describe muscles that are hypotonic – A decrease of the skeletal muscle tone marked by a diminished resistance to passive stretching.

D. Triceps, pectoralis minor, lower fibers of the trapezius, subclavius, and latissimus dorsi. The triceps assist with extension of the elbow while the rest of the muscles are responsible for shoulder depression, both motions which are relevant to using a transfer board.
C5 – Biceps
C6 – Tenodesis
C7 – Triceps

B. No flexion beyond 90 degrees and do not adduct legs.
-No flexion beyond 90 degrees
-Do not adduct/cross legs
-Do not internally rotate
-Do not pivot at hip
-Only sit on raised chair/toilet seat
-Transfer sit to stand: keep operated hip in slight abduction and extended in front

C. Grab bars in kitchen, stairway, bathroom, and walkways.
Grade II brain tumors are cancerous yet slow-growing. The patient has vertigo secondary to her cancer or as a side-effect from her medication, and therefore her safety needs to considered. Grab bars will allow the patient to hold onto something if the patient feels unbalanced.

A. Passive range of motion to the upper extremities. A score of 3 on the Glasgow Coma Scale is the lowest score on the scale, indicating that the patient is unresponsive. The COTA® would provide positioning and passive range of motion to maintain upper extremity mobility and prevent contracture until the patient’s level of arousal improves. The COTA® would also initiate sensory stimulation techniques to help to facilitate arousal. PNF diagonals, ADL retraining, and strengthening exercises all require some level of response, so these activities are not appropriate when the Glasgow score is 3.

B. Spinal shock, which will start with hyporeflexia.
After a SCI, a patient will experience spinal shock, which will start with hyporeflexia, flaccid bowel and bladder, low blood pressure, slow heart rate, and no perspiration below the level of injury. Muscles will then develop into spasticity.
Stages of spinal shock: Spinal shock follows a predictable, stereotypical patterns.
This progression includes the following 4 phases:
1. Initial hyporeflexia (0 to 1 days)
2. Initial return of some reflexes (1 to 3 days)
Polysynaptic reflexes (those that require a signal to travel from a sensory neuron to a motor neuron) tend to return first. The delayed plantar reflex, a variation of the normal plantar reflex common among SCI survivors, typically returns first. Next is the bulbocavernosus reflex, which causes the anal sphincter to tighten in response to squeezing the clitoris or head of the penis.
3. Early hyperreflexia (4 days to 4 weeks). Hyperreflexia, a pattern of unusually strong reflexes. This is the result of new nerve synapse growth, and is normally temporary
4. Late hyperreflexia (1 to 12 months). Hyperreflexia continues, and spasticity may develop. This process is due to changes in the neuronal cell bodies.

C. Rancho Los Amigos level 10.
Level X – Purposeful, Appropriate: Modified Independent
• Able to handle multiple tasks simultaneously in all environments but may require periodic breaks.
• Able to independently procure, create and maintain own assistive memory devices.
• Independently initiates and carries out steps to complete familiar and unfamiliar personal, household, community, work and leisure tasks but may require more than usual amount of time and/or compensatory strategies to complete them.
• Anticipates impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than usual amount of time and/or compensatory strategies.
• Able to independently think about consequences of decisions or actions but may require more than usual amount of time and/or compensatory strategies to select the appropriate decision or action.
• Accurately estimates abilities and independently adjusts to task demands.
• Able to recognize the needs and feelings of others and automatically respond in appropriate manner.
• Periodic periods of depression may occur.
• Irritability and low frustration tolerance when sick, fatigued and/or under emotional stress.
• Social interaction behavior is consistently appropriate.

Rancho levels of cognitive functioning:
1. No response = total assistance – not even response to pain
2. Generalized response = total assistance – general response to pain, gross body movements, vocalizations, response may be delayed
3. Localized response = total assistance – withdrawal from painful stimuli, turns towards sound, blinks at light, eyes follow objects, responds to family members – moving to music
4. Confused/agitated = maximal assistance – alert, tries to remove restraints, can sit, stand, walk; aggressive, mood swings, uncooperative, incoherent
5. Confused, inappropriate, non-agitated – maximal assistance – wanders around, non-oriented to person, time, place; brief periods of attention, poor memory/learning, can respond to simple commands, able to converse for brief periods – making a sandwich
6. Confused appropriate – moderate assistance – sometimes oriented to person, time, place; able to do tasks for 30 min in structured environment, slight remote memory, carryover of easy tasks, unaware of impairments, appropriate verbal responses – repetitive self-care
7. Automatic appropriate – minimal assistance for ADLs – oriented to person, time, place; 30+ min on task in familiar environment, carryover of new learning, awareness of the condition, can’t estimate consequences of their actions
8. Purposeful appropriate – standby assistance – has memory of past events, can do household and community work, leisure; depressed, irritable, argumentative, recognizes inappropriate social behavior
9. Purposeful appropriate: standby assistance on request – 2+ hours on task, can do work and leisure, aware of impairments, able to think about consequences, depression, irritable, self-monitors appropriately
10. Purposeful appropriate – modified independence – able to multitask, independently maintains memory, anticipates consequences, brief depression periods, socially appropriate, low frustration tolerance

A. Vertigo. This woman is demonstrating many classic signs of Vertigo. Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you’re spinning or that the inside of your head is spinning. It causes brief episodes of mild to intense dizziness and is usually triggered by specific changes in the position of your head.  BPPV is rarely serious except when it increases the chance of one falling.
Symptoms may include:
Dizziness
A sense that you or your surroundings are spinning or moving (vertigo)
A loss of balance or unsteadiness
Nausea and Vomiting
Abnormal eye movements
Headaches
Lack of coordination
Ataxia
Nystagmus
Difficulty seeing clearly when moving, for example, when reading a sign while walking or driving.

href=”https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055″>https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dizziness-and-vertigo

B. Hemineglect – This is a neurological condition and typically results in neglect of the left side.
C. Intoxication –  No obvious signs were mentioned in the scenario, to indicate intoxication. E.g. Slurred or incoherent speech, clumsiness, delayed reflexes, euphoria, redness in the face.
D. Impaired balance – By this stage, the woman has most likely made a full recovery from her hip replacement. If she had impaired balance, she would have a walking aid with her.
 

C. Body-powered prosthesis. Since the boy has recently lost his arm, he will need to learn which remaining muscles to activate to make a prosthesis work. A body-powered prosthesis with a hook would give this boy practice in activating the correct muscles to open and close the hook while giving him a functional prosthetic arm. Body-powered prosthesis are generally more robust and reliable, can be used in wet or dirty environments, and may require shorter training periods. Once the boy has learned how to activate his muscles, he may then be ready to try a myoelectric prosthesis.
https://www.nap.edu/read/24740/chapter/6#128

C. Edge of the bed (EOB).
When getting a patient out of bed for the first time, a patient will first sit on the edge of the bed (EOB).  
A. Leg extenders would not be useful in this situation because the patient is in the evaluation process.
B. Not all patients with a total hip replacement need a wheelchair.
D. Hip replacements following this surgical approach are generally more stable. Typically, no hip extension and external rotation is permitted.

B. Place items with strong smells (i.e. cinnamon, lavender, orange) under the patient’s nose for 2-3 seconds.
Patients who are responding at Level III on the Rancho Los Amigos scale react to immediate stimuli, but are not able to process and interpret stimuli. The patient is probably not able to respond appropriately to stimuli placed in the mouth, as this requires a higher level of response, but will be able to respond to a strong smell.

A. Provide the patient with elongated utensils and extended grooming tools. Heterotopic ossification involves the calcification of scar tissue, permanently limiting range of motion in the affected joints. Providing the patient with elongated utensils will help compensate for limited elbow flexion resulting from this condition. Elbow flexion is the main issue, NOT shoulder ROM. The patient needs elongated utensils to in order to bring eating utensils to his mouth.

B. Stabilizing the wrist to 15 degrees of extension while performing isolated movements to IP joint.
The antideformity position of the hand with a dorsal burn is an intrinsic plus position, consisting of wrist extension, MP joint flexion, PIP and DIP joint extension, and thumb palmar abduction. It is important to keep safety in mind first when working with a patient who has a full thickness burn. The therapeutic position for the wrist is slight extension with burns. It will be safest to start distal to proximal with a small joint and initially placing the patient’s wrist in slight extension will give the new graft some slack and then the OT can provide ROM one joint at a time.
https://www.slideshare.net/AbeyPRajan1/hand-rehabilitation-in-burns

B. Bed positioning and controlled sensory stimulation. At a Level II on the Rancho Los Amigos scale, a general response to sensory stimulation is all that the patient is capable of. The family should be taught to provide this stimulation, as well as bed positioning to prevent contractures and preserve skin integrity.

C. Assisted Living. An assisted living facility will help this patient with his IADL’s. A SNF is a facility that provides 24/7 staff for individuals who struggle with basic ADLs. Adult day care and home health do not usually offer 24/7 nursing support.

C. Scar and pain management techniques, including deep heat, tissue massage and tapping to the stump scar.
Education in skin inspection and skin care, scar management, and pain management techniques including treatment for phantom limb pain are all a part of the pre-prosthetic phase of treatment for patients with new amputations. Training in donning and using a prosthesis is part of the prosthetic phase of treatment.

C. Positioning for edema control. Since Celia is in the intensive care unit and the OTR® is initiating treatment, Celia would be in the acute phase of rehabilitation. Treatment techniques that should be used during this phase include positioning and compression wrapping for edema control, as well as passive and active range of motion activities as the patient will tolerate. It is too early in the course of treatment for scar massage, self-range of motion exercises, or activities focusing on specific fine motor skills.

D. Identify and analyze the tasks and occupations that the individual will be performing in the home. Before the OT can determine what aspects of the environment will be barriers to the man, she has to determine what the man will be doing in the home.

D. Anosognosia.
Anosognosia also called “lack of insight,” is a neurological condition where the patient is unaware of his or her neurological deficit or psychiatric condition. It can affect the patient’s conscious awareness of deficits involving judgment, emotions, memory, executive function, language skills, and motor ability.

A. Aphasia is an acquired communication disorder that impairs a person’s ability to process language. It affects the production or comprehension of speech and the ability to read or write.
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. Denial is a psychological defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality.

A. Primary prevention.
Primary prevention – prevention to reduce the occurrence of the disease from happening within a population that is currently well or at risk for a disorder. Primary prevention aims to prevent disease or injury before it ever occurs.

B. Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent re-injury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems.
C. Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy.

https://www.iwh.on.ca/what-researchers-mean-by/primary-secondary-and-tertiary-prevention

D. Coughing or choking.Dysphagia is a condition in which disruption of the swallowing process interferes with a patient’s ability to eat. It can result in aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. Since dysphagia is an impairment in the motor mechanisms that regulate swallowing, a patient with dysphagia may cough or choke when attempting to swallow food.
– Signs and symptoms of oral or pharyngeal dysphagia include the following:
Coughing or choking with swallowing
Difficulty initiating swallowing
Food sticking in the throat
Sialorrhea
Change in voice or speech (wet voice)
Nasal regurgitation
– Signs and symptoms of esophageal dysphagia include the following:
Sensation of food sticking in the chest or throat
Recurrent pneumonia
Symptoms of gastroesophageal reflux disease (GERD), including heartburn, belching, sour regurgitation

https://emedicine.medscape.com/article/2212409-overview

A. OTs assess how patients function in the community, including living alone and driving.
Of primary importance in this response is that the OT is able to emphasize to the patient that OTs are specialists in assessing the independent living skills necessary to live independently in the community, including driving.

B. Light touch keyboard. A light touch or soft touch keyboard will make it easy for the patient to press on the keys, to compensate for muscle weakness.
Muscular Dystrophy (MD) is characterized by progressive weakness and degeneration of the skeletal muscles that control movement. The main sign of muscular dystrophy is progressive muscle weakness. Specific signs and symptoms begin at different ages and in different muscle groups, depending on the type of muscular dystrophy. Some forms of MD are seen in infancy or childhood, while others may not appear until middle age or later. The types od MD differ in terms of the distribution and extent of muscle weakness (some forms of MD also affect cardiac muscle), age of onset, rate of progression, and pattern of inheritance.
The prognosis for people with MD varies according to the type and progression of the disorder. Some cases may be mild and progress very slowly over a normal lifespan, while others produce severe muscle weakness, functional disability, and loss of the ability to walk. Some children with MD die in infancy while others live into adulthood with only moderate disability.
https://www.ninds.nih.gov/disorders/All-Disorders/Muscular-Dystrophy-Information-Page

C. Text-to-speech software.
Dyslexia is a learning disorder that involves difficulty reading due to problems identifying speech sounds and learning how they relate to letters and words (decoding). Also called reading disability, dyslexia affects areas of the brain that process language.
People with dyslexia have normal intelligence and usually have normal vision. Most children with dyslexia can succeed in school with tutoring or a specialized education program. Assistive technology- Any device or software that makes it easier to complete everyday tasks. For example, an app that lets you dictate a message into your phone instead of having to type the words can be considered assistive technology.
Text-to-speech (TTS) is a type of assistive technology that reads digital text aloud. It’s sometimes called “read aloud” technology. With a click of a button or the touch of a finger, TTS can take words on a computer or other digital device and convert them into audio. All kinds of text files can be read aloud, including Word documents and online web pages. The voice in TTS is computer-generated, and reading speed can usually be sped up or slowed down. Many TTS tools highlight words as they are read aloud. This allows kids to see text and hear it at the same time. Some TTS tools also have a technology called optical character recognition (OCR). OCR allows TTS tools to read text aloud from images. For example, a child could take a photo of a street sign and have the words on the sign turned into audio.

A. Word prediction suggests correct spellings of words after only a few letters are typed. Word prediction sometimes uses “word banks” (commonly used words in a topic area) to help writers come up with words and complete their sentences. Keep in mind that unlike dictation, word prediction requires using a keyboard.
B. Graphic organizers are considered an AT math tools as it help break down and lay out the steps for solving math problems. For instance, a graphic organizer for a word problem may have spaces for writing and keeping track of important numbers. Graphic organizers can be digital or pen and paper.
D. Personal listening devices (PLD) can help students hear a teacher’s voice more clearly. With a PLD, the teacher wears a clip-on wireless microphone. The mic transmits her voice directly to a student’s personal speaker or earpiece. Some PLDs are called frequency modulation (FM) listening systems because they rely on the same FM frequencies radio stations use. Some newer PLDs use Wifi or Bluetooth to transmit a voice.
https://www.understood.org/en/school-learning/assistive-technology/
https://www.mayoclinic.org/diseases-conditions/dyslexia/symptoms-causes/

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. This feature is appropriate for Martha because it addresses both her inability to pressure relieve and her severely reduced ability to transfer and to sit up on her own.

A. Evaluate the patient’s augmentative device settings. If the patient has successfully used the device in the past, the problem is most likely with the device rather than the patient. The OT should examine the device’s on/off status and its settings.

D. Word prediction.
Word prediction programs offer word choices as a person types. A program will predict the word that a person is typing based on the first couple of letters, presenting several possible words in a list. To select a word from the list, the person clicks on it and the word is inserted in the text. This allows the person to type longer pieces of text with fewer keystrokes.

A. Lightweight.
A T1 paraplegic will have the full use of his arms, chest, and upper back. A manual wheelchair may be used for everyday living. The patient will be able to transfer independently and drive his car with hand controls.

C. An environmental control unit.
An environmental control unit considered to be high-tech and can be the most useful in this scenario. High-tech devices, which often have microprocessor components, and include computers with voice output, print enlargement systems for persons with low vision, and environmental control units. In choosing an environmental control device there are many considerations, but simplicity of operation is perhaps the most important. The examples cited above are all relatively easy to install and to use. Reliability and durability are also important considerations. Are the features of the device appropriate for the intended user?
An environmental control device can increase a person’s ability to operate almost any device that runs on electricity—radios, computers, phones, lights, and security systems—and can be used in a home setting, an assisted living facility, or a nursing home. Some environmental control devices require training in their use, especially those that are integrated into a computer system. The amount of training required to ensure that the user will operate it successfully is another important consideration.
https://medicine.jrank.org/pages/814/Home-Adaptation-Equipment.html

D. Look at the computer control settings.
Looking at the control settings on the computer will help to make the mouse less sensitive.
Guillain-Barré syndrome (GBS) is a disorder in which the body’s immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs.

B. Level 6.
At level 6 a person can function independently, including making decisions, solving problems and anticipating problems before they happen.

D. Provide the patient with 24-hour supervision.
The OT should remind the family about safety and 24-hour supervision for the patient. The patient will be impulsive and unpredictable in their actions and will need to be watched, especially when outside the house.

A. Orientation activity.
Stage 1 consists of an orientation to the purpose and goals of the group (max 5 minutes).

C. Egocentric-cooperative group
Egocentric-cooperative: require joint interaction on long-term tasks; however, completion of the task is not the focus. The members are beginning to express their needs and address those of others.

D. Make suggestions to allow patients to choose and carry out the task and group plan.
Egocentric-Cooperative Group: OT Role
o Democratic leader
o Makes suggestions to allow patients to choose and carry out the task and group plan
o Resource for facilitating task completion and a support that promotes an atmosphere of acceptance and safety

D. Thematic group
Thematic groups — designed for learning a specific skill; learning is facilitated by practice and experiencing needed behavior with reinforcement of appropriate behaviors given.

B. A superficial-partial thickness burn typically heals within 21 days.
Second-degree or partial-thickness burns result when damage to the skin extends beneath the epidermis into the dermis.
Both the epidermis and the dermis are damaged. Second degree burns are classified into two types: superficial partial thickness or deep partial thickness burns. Superficial partial thickness burns are characterized by local redness, blisters. The burn takes around 3 weeks (21 days) to heal. There is generally no scarring, but the pigmentation of the burned area may change. A deep partial thickness burn is characterized by pain and whiteness in the area of the burn. This type of burn leaves a scar.
http://www.hadassah-med.com/children-site/parents/diseases,-infections-and-immunization/musculoskeletal-and-skin-diseases/burns

C. Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade of less than 3.
C = Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade of less than 3
The extent of spinal cord injury (SCI) is defined by the American Spinal Injury Association (ASIA) Impairment Scale (modified from the Frankel classification), using the following categories:
• A = Complete: No sensory or motor function is preserved in sacral segments S4-S5
• B = Incomplete: Sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5
• C = Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade of less than 3
• D = Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade that is greater than or equal to 3
• E = Normal: Sensory and motor functions are normal
https://emedicine.medscape.com/article/2172437-overview

C. Level 4. According to the ACL screening criteria, patients who are able to complete 3 whipstitches but do not progress further are functioning at an Allen Cognitive Level of 4. Individuals at this level function best with goal-directed activities. They can initiate and complete tasks with set-up help, periodic verbal prompting and assistance to solve problems. 

A. The girl lies prone in a net swing and picks up a bean bag from the ground to toss at a target.
 A. This activity works on neck and trunk extension because the girl is in prone in a swing, while maintaining an extended posture against gravity. The action of tossing the beanbag will promote shoulder stability. Using the swing provides vestibular stimulation which has an effect on improving muscle tone.
B. Sitting on the ball and being tilted slightly to the side aims to work on equilibrium reactions and core stability. Although there is movement involved it is activity, it is one directional and slow which will not activate the vestibular system to the same extent that the net activity does.
C. Standing on one leg and throwing the beanbag at different targets aims to work on balance.
D. Straddling the bolster and picking up a bean bag with both hands which has been placed to the side of the girl, aims to work on bilateral integration and crossing of the midline.

A. The woman can walk short distances indoors but is unable to walk further distances.
Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass. In muscular dystrophy, abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle. There are many different kinds of muscular dystrophy. The most common variety of MD begins in childhood, mostly in boys. Other types don’t surface until adulthood. The main sign of muscular dystrophy is progressive muscle weakness. Specific signs and symptoms begin at different ages and in different muscle groups, depending on the type of muscular dystrophy. There’s no cure for but medications and therapy can help manage symptoms and slow the course of the disease. Sooner or later, a wheelchair will be needed. Wheelchair use is usually gradual. At first patients typically use wheelchairs for long distances, such as at the mall, and continue to walk at home. Since the woman has the ability to walk short distances, she does not need to use a wheelchair full time. A scooter would however give the woman independence with longer distance mobility while preserving her ability to walk short distances indoors.

A. Feeding techniques.
The infant was born at 35 weeks gestational age ( 40 weeks – 6 weeks). The corrected age of the infant would therefore be 35 weeks plus 2 weeks, which works out to be 37 weeks. Infants who are born prematurely may lack the muscle strength in the oral and facial muscles to form a strong sucking motion. Their rooting and suck-swallow reflexes may be slow to appear. The OT should use oral motor facilitation techniques to help the infant learn to suck so he can get proper nutrition and grow. The OT should also teach these facilitation techniques to the infant’s mother so she can carry them over to every feeding.

B. Thumb opponens splint. Also called a thumb spica splint, this splint provides support to the CMC and MCP joints of the thumb. It is used for injuries to the thumb, including the CMC joint and supporting structures of the wrist. Since Travis’ injury involved the trapezium, which articulates with the first metacarpal, and the scaphoid, which articulates with the trapezium, a thumb opponens splint would provide Travis with the appropriate support to the injured area.

B. A vocational workshop, also called a sheltered workshop. This type of program offers a closed, structured environment in which adults with significant mental and physical disabilities can learn vocational skills and participate in adapted and modified vocational tasks. The goal of sheltered workshop programming is to eventually transition people from the sheltered workshop environment to a supported employment position in the community. Sheltered workshops typically serve people who will need extra support to transition to community based supported employment. Vocational rehabilitation is designed to help people who previously worked and who have experienced a physical or mental condition to return to work. Work conditioning and work hardening are programs included under the term vocational rehabilitation. A halfway house is a transitional program for people who have been hospitalized for substance abuse or acute mental health conditions, or who have been incarcerated for a long period of time.

D. A visual, action-adventure computer game that follows a linear sequence.
An adventure computer game relates to his interest of using computers and follows a linear sequence that requires a long attention span and organizing steps.

A. The wood coaster activity does not demand extensive attention and organization skills.
B. This would be more related to life-tasks in occupational roles other than that of the role of a student.
C. Competitive games do demand extensive attention, organization, and patience which may easily cause frustration.

Early, M. B. (2009). Mental health concepts and techniques for the occupational therapy assistant. Philadelphia: Wolters Kluwer, p. 319.

B. Recommend the dining room menus have increased font.
C. Add small bump dots on the doors to indicate the room number.
F. Use contrasting color to indicate the bedside and bathroom call lights.
All these strategies can be reasonably implemented that will not cause a major financial and labor impact for the skilled facility. All the other answers require increased cost and time.

A, E and D. Introduces glare.
Cagne, K.; and Pierce, C. (2017): Geriatric Low Vision. OT Practice Magazine (Vol 22, Issue 21), Nov 27, 2017, p 9-13.

B. Constructional apraxia and left-sided neglect.
Damage to the right parietal lobe can result in neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosagnosia) and drawing ability.
Constructional apraxia is an inability to reproduce patterns or join component parts into a whole. This condition is assessed through observation of a patient completing activities such as drawing, copying, or building three-dimensional object. Contralateral neglect involves a deficit in attention paid to one side of the visual field, usually the side that is contralateral to the damage. It can result in the individual not attending to stimuli in that area to the extent that he does not seem to be aware of such stimuli.
Bill is demonstrating constructional apraxia and an inattention to his left side as he is missing the left side of the picture.

A. Ideomotor apraxia (IMA) is a disorder traditionally characterized by deficits in properly performing tool-use pantomimes (e.g., pretending to use a hammer) and communicative gestures (e.g., waving goodbye). These deficits are typically identified with movements made to verbal command or imitation.
C. Right-left discrimination and body scheme is affected by the left parietal lobe. Damage to the left parietal lobe can result in what is called “Gerstmann’s Syndrome.” It includes right-left confusion, difficulty with writing (agraphia) and difficulty with mathematics (acalculia). It can also produce disorders of language (aphasia) and the inability to perceive objects normally (agnosia).
D. Bill is demonstrating apraxia and neglect assuming his memory is intact. The ability to solve problems requires observation and attention to the process the person uses to complete tasks. Memory and problem-solving would be affected by the frontal lobe.

https://www.neuroskills.com/brain-injury/parietal-lobes/ 
Pass the OT material Module 5
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, pp 165-169.

B. A bottom-up approach.
A bottom-up evaluation begins with factors that may interfere with occupational engagement. The medical necessity in this scenario outweighs the time needed to learn about the patient’s goals through an interview.

A. An environment-first approach is appropriate when safety is a primary concern, such as assessment of the home for an elderly who wants to age-in-place.
C. A Life Span approach is more appropriate where the focus is based on improvement of developmental outcomes, such as early screening and diagnosis of Autism Spectrum Disorder.
D. Top-down approach begins with the patient’s goals.

Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, p 404.
Murray-Slutsky, C., Pagano, J., & Richman, J. (2018). Evaluating clients with autism spectrum disorders: A life span approach. OT Practice 23(2), 8–14.

A. Use a programmable talking medication pill bottle with auto alarm feature.
The talking device is attached to a prescription bottle with the prescription information recorded into the device by a pharmacist. This method compensates for vision and memory deficits.

B. The calendar may help with his visual deficits and is easy to find. However, it would be best to have pills in plain sight with an audible reminder.
C This does not support independence in medication management.
D. Although this is a convenient option for reducing the need for medication setup and dispensing, it still demands the need to remember to take the medications.

Byers-Connon, Sue; Padilla, René L., & Lohman, Helene. (Eds.) (2012) Occupational therapy with elders: Strategies for the COTA Maryland Heights, MO : Elsevier/Mosby, p 178.

D. Bleeding of the gums requiring need to substitute a hard-bristle brush for a soft one.
Blood thinners such as Warfarin reduce the possibility of clotting in the blood in order to prevent another deep vein thrombosis from occurring. The blood thinners are intended to break up the clotting factors that lead to blood clots. It also dilates the vessels causing increased bleeding. Therefore, the patient should avoid shaving with a razor, where footwear in the house, avoid heavy contact sports, and opt for a soft bristle toothbrush. Due to having had a DVT, it is also best to avoid modalities involving heat, E-stim, or massage as it will increase circulation leading to the possibility of a pulmonary embolism.

A. Stooping is a precaution for total hip arthroplasty and is contraindicated during activities. The patient would therefore not be permitted to stoop while reaching into the dryer.
B. This is associated with symptoms related to use of anti-hypertensive medications to lower blood pressure.
C. Once the MD has initiated blood thinners, it is okay to resume therapy

https://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics

D. A Tango dance class at a local community center.
People with Parkinson’s Disease benefit from rhythmic auditory stimulation that enhances functional movement patterns associated with abnormal gait patterns, rigidity, incoordination, postural control and hypertonicity due to decreased dopaminergic production. Any type of movement-based therapy associated with following a rhythm would be helpful for balance, coordination, and mobility.

A. This activity focuses on attention, problem-solving, social interaction and fine-motor skills.
B. Water aerobics would be somewhat challenging for Charles as he would have to move against resistance. This activity is mostly beneficial for strengthening and cardiopulmonary efficiency.
C. Hosting an event would not address his mobility needs.

Bukowska, A. A., Krężałek, P., Mirek, E., Bujas, P., & Marchewka, A. (2016). Neurologic music therapy training for mobility and stability rehabilitation with Parkinson’s disease—a pilot study. Frontiers in Human Neuroscience, 9, 710–722. https://doi.org/10.3389/fnhum.2015.00710

C. Weakness in flexion of the MP and CMC thumb joints to hold her paint brushes.
A high median nerve injury or palsy occurs at the level of the elbow and above causing weakness in forearm pronation, wrist and finger flexion, and lack of thumb opposition.

A. Pulling off the apron strings would require the use of the wrist extensors.
B. Thumb adduction is innervated by the ulnar nerve.
D. Loss or weakness of forearm pronation would most likely occur.

Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 312.