This week focuses on: Spinal Cord Injury (SCI),Traumatic brain injury and Rancho Levels, Vision Interventions, Prosthetics/Amputations, Hip and Knee Replacements, Burns, Aging in Place & other diseases.
This week focuses on: Spinal Cord Injury (SCI),Traumatic brain injury and Rancho Levels, Vision Interventions, Prosthetics/Amputations, Hip and Knee Replacements, Burns, Aging in Place & other diseases.
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Scenario1: An OTR® who is working in an acute care hospital receives orders to evaluate and treat a patient who has been diagnosed with an acute right CVA. A brief chart review completed prior to the evaluation reveals that the patient is a 76-year-old female with a history of Type II diabetes. She is married and lives with her husband in a ground floor apartment. When the OTR® enters the patient’s hospital room, the patient makes eye contact and greets the OTR® by saying “hello”. The patient then attempts to sit up in bed, but she needs max assistance transitioning from supine to sitting as she has great difficulty maneuvering herself due to restricted movement of her left arm and leg. While conversing with the OTR®, the OTR® notices that the patient repeatedly turns her head toward her right side. The patient suddenly focuses her attention on a water jug which is directly in front of her, and while pointing at the jug, asks the OTR® to please pass her the hairbrush.
Section A: Based on the information in the scenario, how should the OTR® proceed with the evaluation? Select the best 3 choices.
Rationale: Since the woman is a new admission, she is in the early stage of recovery and the limitations caused by her CVA are new and her functional abilities are not yet clear. From her movement in bed, it can be observed that the woman has no, or severely limited, function in her left upper and lower extremities. Passive range of motion should be screened prior to taking any goniometer measurements. If passive range of motion is functional, goniometer measurements are not indicated. The woman would not be able to participate in a full manual muscle test, at this stage of her rehabilitation, as her inability to move the left side of her body in bed suggests that she has a hemiparesis/paralysis. Her muscle activity should however be palpated. It may be easier to feel muscle activity in the left upper extremity if palpation is done while the woman is moving her right upper extremity. This is based on the cross-activation theory- unilateral muscle contractions in the upper limb produce motor cortical activity in both the contralateral and ipsilateral motor cortices. The increase in excitability of the corticomotor pathway activating the resting limb has been termed “cross-activation”. Screening visual tracking and peripheral vision is important post CVA as visual impairment is common and may include impaired central vision, impaired peripheral vision (visual field loss), eye movement disorders, and visual perception disorders including visual inattention. Screening of tactile sensation should be completed to determine if a more in depth evaluation is necessary. Somatosensory loss after stroke is common – affecting sensations such as touch, vibration, temperature, proprioception and pain. Monitoring the loss and recovery of sensation is important. The woman would not be ready for an IADL evaluation, but an ADL evaluation should be completed.
Rationale: Since the woman is a new admission, she is in the early stage of recovery and the limitations caused by her CVA are new and her functional abilities are not yet clear. From her movement in bed, it can be observed that the woman has no, or severely limited, function in her left upper and lower extremities. Passive range of motion should be screened prior to taking any goniometer measurements. If passive range of motion is functional, goniometer measurements are not indicated. The woman would not be able to participate in a full manual muscle test, at this stage of her rehabilitation, as her inability to move the left side of her body in bed suggests that she has a hemiparesis/paralysis. Her muscle activity should however be palpated. It may be easier to feel muscle activity in the left upper extremity if palpation is done while the woman is moving her right upper extremity. This is based on the cross-activation theory- unilateral muscle contractions in the upper limb produce motor cortical activity in both the contralateral and ipsilateral motor cortices. The increase in excitability of the corticomotor pathway activating the resting limb has been termed “cross-activation”. Screening visual tracking and peripheral vision is important post CVA as visual impairment is common and may include impaired central vision, impaired peripheral vision (visual field loss), eye movement disorders, and visual perception disorders including visual inattention. Screening of tactile sensation should be completed to determine if a more in depth evaluation is necessary. Somatosensory loss after stroke is common – affecting sensations such as touch, vibration, temperature, proprioception and pain. Monitoring the loss and recovery of sensation is important. The woman would not be ready for an IADL evaluation, but an ADL evaluation should be completed.
Scenario2: An OTR® who is working in an acute care hospital receives orders to evaluate and treat a patient who has been diagnosed with an acute right CVA. A brief chart review completed prior to the evaluation reveals that the patient is a 76-year-old female with a history of Type II diabetes. She is married and lives with her husband in a ground floor apartment. When the OTR® enters the patient’s hospital room, the patient makes eye contact and greets the OTR® by saying “hello”. The patient then attempts to sit up in bed, but she needs max assistance transitioning from supine to sitting as she has great difficulty maneuvering herself due to restricted movement of her left arm and leg. While conversing with the OTR®, the OTR® notices that the patient repeatedly turns her head toward her right side. The patient suddenly focuses her attention on a water jug which is directly in front of her, and while pointing at the jug, asks the OTR® to please pass her the hairbrush.
Section B: The OTR® suspects that the patient may have a left hemianopsia. What standardized tests should the OTR® use to determine the extent of the patient’s visual perceptual limitations? Select the best 3 choices.
Rationale: The Trail Making Test, Bells Test, and Motor-Free Visual Perception Test all measure or have elements that measure hemianopsia. The Motor-Free Visual Perception Test will also measure other visual perceptual limitations, including deficits in form constancy, figure-ground discrimination, visual memory, and visual closure. The Developmental Test of Visual Perception – 3rd edition is normed on children up to the age of 10, so this test would not be appropriate. The Developmental Test of Visual Perception, Adolescent and Adult is the version of this test that would be appropriate. The Beery-Buktenica Developmental Test of Visual-Motor Integration is designed to measure visual perception, not hemianopsia. The Frostig Developmental Test of Visual Perception is normed on children aged 4 to 8 and would not be appropriate.
The diagnosis of hemianopsia- Normally, the left half of the brain processes visual information from both eyes about the right side of the world, and the right side of the brain processes visual information from both eyes about the left side of the world. In homonymous hemianopsia, an injury to the left hemisphere results in the loss of the right half of the visual field of each eye, and an injury to the right hemisphere produces loss of the left side of the visual field of each eye.
Symptoms of homonymous hemianopsia include:
• Missing parts of words or parts of an eye chart on the side of the hemianopsia when reading.
• Not noticing objects on a desk or table, or even food on a plate to the side of the hemianopsia.
• Frustration with reading because it is difficult for the eyes to pick up the beginning of the next line.
• Tendency to turn the head or body away from the side of the hemianopsia.
• Drifting in a direction away from the hemianopsia when walking.
• Visual hallucinations that appear in the form of lights, shapes, or geometric figures or as the image of a recognizable object.
Pointing to the jug while asking for a hairbrush may indicate that this patient has visual agnosia which is a difficulty in recognizing objects which are presented visually. Patients are unable to identify objects even though elementary sensory functions are protected. It is basically a processing problem- the brain is not able to interpret the information sent from the eyes.
Rationale: The Trail Making Test, Bells Test, and Motor-Free Visual Perception Test all measure or have elements that measure hemianopsia. The Motor-Free Visual Perception Test will also measure other visual perceptual limitations, including deficits in form constancy, figure-ground discrimination, visual memory, and visual closure. The Developmental Test of Visual Perception – 3rd edition is normed on children up to the age of 10, so this test would not be appropriate. The Developmental Test of Visual Perception, Adolescent and Adult is the version of this test that would be appropriate. The Beery-Buktenica Developmental Test of Visual-Motor Integration is designed to measure visual perception, not hemianopsia. The Frostig Developmental Test of Visual Perception is normed on children aged 4 to 8 and would not be appropriate.
The diagnosis of hemianopsia- Normally, the left half of the brain processes visual information from both eyes about the right side of the world, and the right side of the brain processes visual information from both eyes about the left side of the world. In homonymous hemianopsia, an injury to the left hemisphere results in the loss of the right half of the visual field of each eye, and an injury to the right hemisphere produces loss of the left side of the visual field of each eye.
Symptoms of homonymous hemianopsia include:
• Missing parts of words or parts of an eye chart on the side of the hemianopsia when reading.
• Not noticing objects on a desk or table, or even food on a plate to the side of the hemianopsia.
• Frustration with reading because it is difficult for the eyes to pick up the beginning of the next line.
• Tendency to turn the head or body away from the side of the hemianopsia.
• Drifting in a direction away from the hemianopsia when walking.
• Visual hallucinations that appear in the form of lights, shapes, or geometric figures or as the image of a recognizable object.
Pointing to the jug while asking for a hairbrush may indicate that this patient has visual agnosia which is a difficulty in recognizing objects which are presented visually. Patients are unable to identify objects even though elementary sensory functions are protected. It is basically a processing problem- the brain is not able to interpret the information sent from the eyes.
Scenario3: An OTR® who is working in an acute care hospital receives orders to evaluate and treat a patient who has been diagnosed with an acute right CVA. A brief chart review completed prior to the evaluation reveals that the patient is a 76-year-old female with a history of Type II diabetes. She is married and lives with her husband in a ground floor apartment. When the OTR® enters the patient’s hospital room, the patient makes eye contact and greets the OTR® by saying “hello”. The patient then attempts to sit up in bed, but she needs max assistance transitioning from supine to sitting as she has great difficulty maneuvering herself due to restricted movement of her left arm and leg. While conversing with the OTR®, the OTR® notices that the patient repeatedly turns her head toward her right side. The patient suddenly focuses her attention on a water jug which is directly in front of her, and while pointing at the jug, asks the OTR® to please pass her the hairbrush.
Section C: The initial evaluation has revealed trace muscle activity in the patient’s left upper extremity and a left hemianopsia. What initial treatment activities should the OTR® include in her treatment plan, based on the results of the evaluation? Select the best 3 choices.
Rationale: Since the woman has trace muscle activity in the left upper extremity, treatment with neuromuscular electrical stimulation should be effective. It is a common technique used for upper limb recovery in stroke patients. Treatment should begin with the proximal upper extremity, so the shoulder and biceps would be appropriate muscles to target for initial treatment. Techniques for completing ADL tasks with functional use of one hand is important at this stage as regaining function is the main goal of OT intervention. The woman should therefore be trained in hemi-dressing techniques and adaptations for meals should be provided. A divided plate will help keep the different foods separated and the lip will provide an easier scooping surface and prevent food from slipping off the plate. A dycem mat will stabilize the plate, and the lightly colored plate will support the patient in visually attending to the food. As the patient only has trace movement in her left upper extremity, active range of motion exercises will not be possible at this stage in her treatment. It is also too early to initiate tactile discrimination retraining. Similarly, it is too early for training in self range of motion exercises. This will be appropriate as treatment progresses.
Rationale: Since the woman has trace muscle activity in the left upper extremity, treatment with neuromuscular electrical stimulation should be effective. It is a common technique used for upper limb recovery in stroke patients. Treatment should begin with the proximal upper extremity, so the shoulder and biceps would be appropriate muscles to target for initial treatment. Techniques for completing ADL tasks with functional use of one hand is important at this stage as regaining function is the main goal of OT intervention. The woman should therefore be trained in hemi-dressing techniques and adaptations for meals should be provided. A divided plate will help keep the different foods separated and the lip will provide an easier scooping surface and prevent food from slipping off the plate. A dycem mat will stabilize the plate, and the lightly colored plate will support the patient in visually attending to the food. As the patient only has trace movement in her left upper extremity, active range of motion exercises will not be possible at this stage in her treatment. It is also too early to initiate tactile discrimination retraining. Similarly, it is too early for training in self range of motion exercises. This will be appropriate as treatment progresses.
Scenario4: An OTR® who is working in an acute care hospital receives orders to evaluate and treat a patient who has been diagnosed with an acute right CVA. A brief chart review completed prior to the evaluation reveals that the patient is a 76-year-old female with a history of Type II diabetes. She is married and lives with her husband in a ground floor apartment. When the OTR® enters the patient’s hospital room, the patient makes eye contact and greets the OTR® by saying “hello”. The patient then attempts to sit up in bed, but she needs max assistance transitioning from supine to sitting as she has great difficulty maneuvering herself due to restricted movement of her left arm and leg. While conversing with the OTR®, the OTR® notices that the patient repeatedly turns her head toward her right side. The patient suddenly focuses her attention on a water jug which is directly in front of her, and while pointing at the jug, asks the OTR® to please pass her the hairbrush.
Section D: After the woman has been in acute care for a week, her doctor orders inpatient rehabilitation. The woman’s husband asks the OTR® if his wife will be able to return home after rehabilitation. How should the OTR® respond? Select the best 3 choices.
Rationale: Rehabilitation following a cerebrovascular accident can take up to 6 months and recovery of function can continue for even longer. Since the woman has only been hospitalized for 1 week, it is too early to tell what her outcome will be. The woman and her husband should work with the therapists on the inpatient rehabilitation unit regarding the woman’s return to home. The woman may or may not have to go to a nursing home and the OTR® should not tell the husband that she will have to go to one. She should also not tell the husband that he will have to do everything for the woman, as the woman should be expected to do what she can for herself, regardless of where she lives. The husband can talk to the woman’s doctor about her potential to return home, but the doctor will be reluctant to give the man a firm prognosis so early in the recovery process.
Rationale: Rehabilitation following a cerebrovascular accident can take up to 6 months and recovery of function can continue for even longer. Since the woman has only been hospitalized for 1 week, it is too early to tell what her outcome will be. The woman and her husband should work with the therapists on the inpatient rehabilitation unit regarding the woman’s return to home. The woman may or may not have to go to a nursing home and the OTR® should not tell the husband that she will have to go to one. She should also not tell the husband that he will have to do everything for the woman, as the woman should be expected to do what she can for herself, regardless of where she lives. The husband can talk to the woman’s doctor about her potential to return home, but the doctor will be reluctant to give the man a firm prognosis so early in the recovery process.
Scenario5: An OTR® in a skilled nursing facility receives an order to evaluate and treat a man with a C7 spinal cord injury (SCI) resulting from a car accident. A review of the hospital records reveals that the man sustained his injuries when he was hit by a drunk driver. Prior to the accident, the patient lived independently on his own and ran his own business. During his time at the inpatient rehabilitation unit, he displayed progress but as he lives alone and he was not yet ready to return to his home, he was admitted to the skilled nursing home. His sister and her family live in the same town as the skilled nursing facility.
Section A: Based on the chart review and initial interview, what evaluation procedures should the OTR® complete? Select the best 3 choices.
Rationale: For continuity of care, a thorough review of the inpatient rehabilitation records should be completed. The OTR® may be able to use some of the discharge data from inpatient rehabilitation to begin treatment in the skilled nursing facility, including the man’s ADL status at discharge from inpatient rehabilitation. For this reason, a comprehensive ADL checklist should not be necessary. Since the man lived independently and ran his own business prior to his accident, the OTR® should gather information about the man’s functional status, including IADLs and self-perception regarding living independently again. The man does not need cognitive assessment as his injuries do not include traumatic brain injury and he was functioning at normal cognitive levels prior to his accident. For the same reason, there is also no need to evaluate visual perception.
Rationale: For continuity of care, a thorough review of the inpatient rehabilitation records should be completed. The OTR® may be able to use some of the discharge data from inpatient rehabilitation to begin treatment in the skilled nursing facility, including the man’s ADL status at discharge from inpatient rehabilitation. For this reason, a comprehensive ADL checklist should not be necessary. Since the man lived independently and ran his own business prior to his accident, the OTR® should gather information about the man’s functional status, including IADLs and self-perception regarding living independently again. The man does not need cognitive assessment as his injuries do not include traumatic brain injury and he was functioning at normal cognitive levels prior to his accident. For the same reason, there is also no need to evaluate visual perception.
Scenario: An OTR® in a skilled nursing facility receives an order to evaluate and treat a man with a C7 spinal cord injury (SCI) resulting from a car accident. A review of the hospital records reveals that the man sustained his injuries when he was hit by a drunk driver. Prior to the accident, the patient lived independently on his own and ran his own business. During his time at the inpatient rehabilitation unit, he displayed progress but as he lives alone and he was not yet ready to return to his home, he was admitted to the skilled nursing home. His sister and her family live in the same town as the skilled nursing facility.
Section B: A COTA® will be providing most of the treatment for this man. What direction should the OTR® give the COTA® prior to initiating treatment? Select the best 3 choices.
Rationale: The man lived alone prior to his accident, so the goal of therapy should be independent living unless or until it is determined that the man cannot live alone. The COTA® should focus on providing the man with adaptive equipment and techniques to allow him to be as independent as possible with ADL and IADL tasks. However, the man may not benefit from the facility’s cooking group as this group will be focused on elderly residents who have different functional problems than the man. The COTA® should also incorporate upper extremity strengthening and should provide the man with exercises that he can do on days when he does not receive therapy. The COTA® should not train the man’s girlfriend in how to assist him with ADLs unless the man and his girlfriend agree that she will act as his caregiver.
Rationale: The man lived alone prior to his accident, so the goal of therapy should be independent living unless or until it is determined that the man cannot live alone. The COTA® should focus on providing the man with adaptive equipment and techniques to allow him to be as independent as possible with ADL and IADL tasks. However, the man may not benefit from the facility’s cooking group as this group will be focused on elderly residents who have different functional problems than the man. The COTA® should also incorporate upper extremity strengthening and should provide the man with exercises that he can do on days when he does not receive therapy. The COTA® should not train the man’s girlfriend in how to assist him with ADLs unless the man and his girlfriend agree that she will act as his caregiver.
Scenario: An OTR® in a skilled nursing facility receives an order to evaluate and treat a man with a C7 spinal cord injury (SCI) resulting from a car accident. A review of the hospital records reveals that the man sustained his injuries when he was hit by a drunk driver. Prior to the accident, the patient lived independently on his own and ran his own business. During his time at the inpatient rehabilitation unit, he displayed progress but as he lives alone and he was not yet ready to return to his home, he was admitted to the skilled nursing home. His sister and her family live in the same town as the skilled nursing facility.
Section C: The man has progressed in rehabilitation and is preparing to return home. What steps should the OTR® take to ensure a smooth transition? Select the best 3 choices.
Rationale: The man’s goal is to return to home, so he should be encouraged to attempt to do so. A home evaluation will be necessary to identify any barriers to accessibility, since the man will now be using a wheelchair. A referral to the local independent living agency should be made to assist the man in making any needed changes to his home and obtaining any equipment he needs that the skilled nursing facility cannot provide. The OTR® should make sure that the man has all the equipment he needs for basic ADL tasks before he leaves the facility. A referral to a mobility specialist should have been completed well before the man’s discharge from the facility, so the OTR® should not have to do this at this point.
Rationale: The man’s goal is to return to home, so he should be encouraged to attempt to do so. A home evaluation will be necessary to identify any barriers to accessibility, since the man will now be using a wheelchair. A referral to the local independent living agency should be made to assist the man in making any needed changes to his home and obtaining any equipment he needs that the skilled nursing facility cannot provide. The OTR® should make sure that the man has all the equipment he needs for basic ADL tasks before he leaves the facility. A referral to a mobility specialist should have been completed well before the man’s discharge from the facility, so the OTR® should not have to do this at this point.
Scenario: An OTR® in a skilled nursing facility receives an order to evaluate and treat a man with a C7 spinal cord injury (SCI) resulting from a car accident. A review of the hospital records reveals that the man sustained his injuries when he was hit by a drunk driver. Prior to the accident, the patient lived independently on his own and ran his own business. During his time at the inpatient rehabilitation unit, he displayed progress but as he lives alone and he was not yet ready to return to his home, he was admitted to the skilled nursing home. His sister and her family live in the same town as the skilled nursing facility.
Section D: The man’s girlfriend asks the OTR® how the man will get around the community, as she does not want to commit to driving him all the time. How should the OTR® respond? Select the best 3 choices.
Rationale: It is important to respect the man’s wishes regarding communication with his girlfriend about discharge planning, since the man and his girlfriend are not married. The OTR® should provide the man with information about community mobility and driver rehabilitation so that he can arrange for services once he has returned home. The OTR® could ask the man if it is okay to share the information with his girlfriend but should not discuss it with her if he does not give permission.
Rationale: It is important to respect the man’s wishes regarding communication with his girlfriend about discharge planning, since the man and his girlfriend are not married. The OTR® should provide the man with information about community mobility and driver rehabilitation so that he can arrange for services once he has returned home. The OTR® could ask the man if it is okay to share the information with his girlfriend but should not discuss it with her if he does not give permission.
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You are planning an educational talk for older adults who reside at an assisted living facility. The focus of your talk is on how you can help them achieve their goal of aging in place. What is the MOST important information that should be included in your presentation?
B. Fall prevention.
Fall prevention is the MOST important factor to educate the residents on, as ensuring their safety should always be a priority.
Assisted living is a residential option for seniors who want or need help with some of their ADLs – for example, help with cooking meals, getting to the bathroom in the middle of the night, keeping house, and traveling to appointments. Assisted living facilities offer the safety and security of 24-hour support and access to care. Day or night, help is only a phone call away. If a person is having more and more difficulty with everyday activities such as showering, dressing, getting around the house, and running errands, an assisted living facility may be the answer. They can get daily support, while remaining as independent as possible.
C. There is no need to employ a caregiver as the residents all live in an assisted living facility.
D. Being in an assisted living facility, tells us that these individuals all want/need help with some of their ADLs. Moving to an apartment complex is therefore not feasible as the individuals would not be able to access the assistance they need. Apartment complexes that specialize in renting to senior citizens are usually smaller in size and adapted for mobility problems. People who rent senior apartments must be able to live independently. Retirement centers may also include a senior center that provides meals and activities, on-site medical facilities, and an on-site pharmacy.
B. Fall prevention.
Fall prevention is the MOST important factor to educate the residents on, as ensuring their safety should always be a priority.
Assisted living is a residential option for seniors who want or need help with some of their ADLs – for example, help with cooking meals, getting to the bathroom in the middle of the night, keeping house, and traveling to appointments. Assisted living facilities offer the safety and security of 24-hour support and access to care. Day or night, help is only a phone call away. If a person is having more and more difficulty with everyday activities such as showering, dressing, getting around the house, and running errands, an assisted living facility may be the answer. They can get daily support, while remaining as independent as possible.
C. There is no need to employ a caregiver as the residents all live in an assisted living facility.
D. Being in an assisted living facility, tells us that these individuals all want/need help with some of their ADLs. Moving to an apartment complex is therefore not feasible as the individuals would not be able to access the assistance they need. Apartment complexes that specialize in renting to senior citizens are usually smaller in size and adapted for mobility problems. People who rent senior apartments must be able to live independently. Retirement centers may also include a senior center that provides meals and activities, on-site medical facilities, and an on-site pharmacy.
An OT practitioner is working with a patient who has a visual impairment. The focus of the session is on helping this patient manage his medication independently. As the patient has difficulty reading standard labels on medicine bottles, the OT practitioner identifies that reprinting the labels in a larger print is necessary. Using a reading acuity test card, how can the OT practitioner determine the minimum size print that should be used for re-labelling this patient’s medication?
B. The last line of print that is easily read on the reading acuity test card indicates the minimum size of the print.
For visual impairments, objects should be enlarged to make them more visible. Instructions can be reprinted in larger print, medications and other items relabeled, and calendars enlarged. The last line of print that is easily read on the reading acuity test card indicates the minimum size that print should be enlarged for the patient. Contrast should also be increased because it does little good to enlarge print if the print is faint. Black on white or white on black print is usually more visible than any other color combination. Many items are now manufactured with larger print, including calculators, clocks, watches, telephones, check registers, glucose monitors, scales, playing cards, games, and puzzles.
B. The last line of print that is easily read on the reading acuity test card indicates the minimum size of the print.
For visual impairments, objects should be enlarged to make them more visible. Instructions can be reprinted in larger print, medications and other items relabeled, and calendars enlarged. The last line of print that is easily read on the reading acuity test card indicates the minimum size that print should be enlarged for the patient. Contrast should also be increased because it does little good to enlarge print if the print is faint. Black on white or white on black print is usually more visible than any other color combination. Many items are now manufactured with larger print, including calculators, clocks, watches, telephones, check registers, glucose monitors, scales, playing cards, games, and puzzles.
Adeline, a 50-year-old mother of 3 teenagers, is being seen in an oncology rehab unit, 2 weeks following a left mastectomy. Both the surgery and chemotherapy have resulted in Adeline experiencing difficulty performing her ADLs. She reports her overall exertion level with ADLs as “somewhat hard” (rate of perceived exertion level 13/20) and she cannot achieve end-range motion with her left shoulder. Adeline has reported that besides her goal of improving her performance in her ADLs, she wants to continue helping her children with making their breakfasts and packing their school lunches. What recommendations should the OTR® make, in order to help Adeline achieve her goals? Select the best 3 answers.
A. Maintain a journal for her to track how she is feeling before, during, and after activities.
C. Create a calendar of assigned duties for each of her children to do, if they are willing.
F. Work on seated-level IADLs that facilitates stretching the left upper extremity such as making her favorite pizza dough with a rolling pin.
By tracking activities affecting her endurance levels throughout the day, the patient can prioritize the type of activities she is able to do at the best times of the day, for that activity. Some of those activities can be assigned to her children, who are willing to help, maximizing her energy levels yet allowing the patient to fulfill her role as parent, by teaching them responsibilities. After a mastectomy, it is important to maintain and gain ROM with gentle stretches to prevent scar tissue formation.
B. The focus should be on remediation rather than compensation for increasing joint ROM.
E. The goal is not to increase strength but to increase ROM.
D. Hiring a housekeeper removes the patient from being involved in her preferred activities.
Cross, Darla (July 2019): Occupational Therapy Interventions in Cancer Care. OT Practice Magazine (Vol 24), p 11-14.
https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/exercises-after-breast-cancer-surgery.html
A. Maintain a journal for her to track how she is feeling before, during, and after activities.
C. Create a calendar of assigned duties for each of her children to do, if they are willing.
F. Work on seated-level IADLs that facilitates stretching the left upper extremity such as making her favorite pizza dough with a rolling pin.
By tracking activities affecting her endurance levels throughout the day, the patient can prioritize the type of activities she is able to do at the best times of the day, for that activity. Some of those activities can be assigned to her children, who are willing to help, maximizing her energy levels yet allowing the patient to fulfill her role as parent, by teaching them responsibilities. After a mastectomy, it is important to maintain and gain ROM with gentle stretches to prevent scar tissue formation.
B. The focus should be on remediation rather than compensation for increasing joint ROM.
E. The goal is not to increase strength but to increase ROM.
D. Hiring a housekeeper removes the patient from being involved in her preferred activities.
Cross, Darla (July 2019): Occupational Therapy Interventions in Cancer Care. OT Practice Magazine (Vol 24), p 11-14.
https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/exercises-after-breast-cancer-surgery.html
Tyra is a 32-year-old woman who recently sustained a complete C6 SCI. Tyra is the mother of 2 young children and she has expressed her desire to resume breastfeeding her 3-month old daughter despite her injury. However, Tyra’s milk production has been affected by her injury and her ability to handle her infant is impaired due to her poor hand function. With the help of medication and visualization, Tyra has started to produce some milk. How can the OTR® help Tyra handle her baby to promote successful breastfeeding?
C. Use nursing pillows and wedges to support the mother’s arms during breastfeeding.
A functional milk ejection reflex is required to provide adequate milk to a nursing infant. Infant suckling activates tactile receptors in the breast, and this signal is carried via afferent nerves in the T4-6 dorsal roots to the spinal cord and then to neurons in the hypothalamus, which releases oxytocin into the bloodstream. Oxytocin triggers milk ejection from the breast. Suckling-induced afferent stimuli are absent in women with SCI above T4. Fatigue is a concern for patients with spinal cord injuries. Supporting her arms is essential to reduce fatigue.
A. The patient has chosen to breastfeed instead of using a bottle.
B. The possible movements at C6 include forearm supination and elbow flexion – therefore, a sling is not necessary.
D. Holding the baby prone while the mother is in supine would cause fatigue in her shoulders. Therefore, it is not an optimal position for her to breast-feed.
Lee, A. H. X., Wen, B., Hocaloski, S., Sandholdt, N., Hultling, C., Elliott, S. L., & Krassioukov, A. V. (2019). Breastfeeding Before and After Spinal Cord Injury: A Case Report of a Mother With C6 Tetraplegia. Journal of Human Lactation. https://doi.org/10.1177/0890334419844234
C. Use nursing pillows and wedges to support the mother’s arms during breastfeeding.
A functional milk ejection reflex is required to provide adequate milk to a nursing infant. Infant suckling activates tactile receptors in the breast, and this signal is carried via afferent nerves in the T4-6 dorsal roots to the spinal cord and then to neurons in the hypothalamus, which releases oxytocin into the bloodstream. Oxytocin triggers milk ejection from the breast. Suckling-induced afferent stimuli are absent in women with SCI above T4. Fatigue is a concern for patients with spinal cord injuries. Supporting her arms is essential to reduce fatigue.
A. The patient has chosen to breastfeed instead of using a bottle.
B. The possible movements at C6 include forearm supination and elbow flexion – therefore, a sling is not necessary.
D. Holding the baby prone while the mother is in supine would cause fatigue in her shoulders. Therefore, it is not an optimal position for her to breast-feed.
Lee, A. H. X., Wen, B., Hocaloski, S., Sandholdt, N., Hultling, C., Elliott, S. L., & Krassioukov, A. V. (2019). Breastfeeding Before and After Spinal Cord Injury: A Case Report of a Mother With C6 Tetraplegia. Journal of Human Lactation. https://doi.org/10.1177/0890334419844234
A five-year-old girl is working on a worksheet that asks her to match objects that are the same. What skill does this activity address?
B. Visual discrimination. Visual discrimination is the ability to visually tell the similarities and differences between objects. This skill is required to match objects that are the same, so the girl is working on developing this skill as she completes the worksheet.
B. Visual discrimination. Visual discrimination is the ability to visually tell the similarities and differences between objects. This skill is required to match objects that are the same, so the girl is working on developing this skill as she completes the worksheet.
A patient who sustained a head injury as a result of a sports injury, is currently functioning at Level VI (Confused-Appropriate) on the Rancho Los Amigos Scale. The patient is due to be discharged and the plan is for him to go live with his 44-year-old sister. As she works from home, she has agreed to be available 24/7, to help with her brother’s care. Before the patient is discharged, what is the most important information the patient’s sister should be given to BEST equip her to take care of her brother?
C. Strategies to use to reduce or prevent caregiver burnout. Since the patient’s sister will be the primary caregiver and available 24 hours a day, the subject of burnout should be addressed early especially if the patient requires extensive assistance. The OT practitioner should consider the effects caregiving can have on a person. The patient will be dependent on his sister for all aspects of his life ie: safety, psycho-social support, and IADLs. Depressive mood, stress and anxiety, physical exhaustion and decreased social and leisure participation are some of the factors experienced by the caregiver. By teaching her strategies to cope, her new role as caregiver could be made easier.
C. Strategies to use to reduce or prevent caregiver burnout. Since the patient’s sister will be the primary caregiver and available 24 hours a day, the subject of burnout should be addressed early especially if the patient requires extensive assistance. The OT practitioner should consider the effects caregiving can have on a person. The patient will be dependent on his sister for all aspects of his life ie: safety, psycho-social support, and IADLs. Depressive mood, stress and anxiety, physical exhaustion and decreased social and leisure participation are some of the factors experienced by the caregiver. By teaching her strategies to cope, her new role as caregiver could be made easier.
A patient who has a T10 SCI has developed a Stage 3 decubitus ulcer on his sacrum and has therefore been admitted to an inpatient facility for wound care. The patient is independent in his self-care, only requiring stand-by assist for bathing. Pain and upper body weakness due to deconditioning have been identified as his barriers at this time. The discharge plan for this patient is for him to return home, and for continued wound care management to be implemented through home health care. The patient has stated that when he returns home, he would like to be able to continue using his riding lawn mower. Which aspect of him using his lawn mower could prevent him from achieving his goal?
B. If the method of transfer produces a shearing effect.
A shear force is described as a sliding or rubbing in the same direction as the movement. It is considered in therapy during movement as it can cause skin damage or breakdown. Therefore, the person should focus on upper body strengthening and weight shifting to offload the forces at the sacrum.
A. The biceps will need to be activated and the lumbar spine may not be fully supported. However, this does not place a negative impact on the patient’s ability to use his mower.
C. Compression forces occur during compression transfers when the patient pushes with both arms to lift his body. This method will avoid shearing, therefore, does not impact on his use of the mower.
D. Rotational forces are expected to occur in a squat-pivot method. However, the patient is unable to perform a squat-pivot method due to lower body paralysis.
Keogh, J., Sain, S.; and Roller, C. (2012). Kinesiology for Occupational Therapy Assistant: Essential Components of Function and Movement. Thorofare, NJ: SLACK Incorporated, pp 62.
B. If the method of transfer produces a shearing effect.
A shear force is described as a sliding or rubbing in the same direction as the movement. It is considered in therapy during movement as it can cause skin damage or breakdown. Therefore, the person should focus on upper body strengthening and weight shifting to offload the forces at the sacrum.
A. The biceps will need to be activated and the lumbar spine may not be fully supported. However, this does not place a negative impact on the patient’s ability to use his mower.
C. Compression forces occur during compression transfers when the patient pushes with both arms to lift his body. This method will avoid shearing, therefore, does not impact on his use of the mower.
D. Rotational forces are expected to occur in a squat-pivot method. However, the patient is unable to perform a squat-pivot method due to lower body paralysis.
Keogh, J., Sain, S.; and Roller, C. (2012). Kinesiology for Occupational Therapy Assistant: Essential Components of Function and Movement. Thorofare, NJ: SLACK Incorporated, pp 62.
What would be the BEST prosthesis for a patient who has had an above-elbow amputation? Prior to the amputation, the patient was a secretary at a law firm but will be switching jobs and will now be answering phones using a headset. The patient is independent in all one-handed skills and is mainly concerned about the appearance of their residual limb rather than the function of the prosthesis.
C. The best choice would be a cosmetic prosthesis. The patient is independent with using one hand and does not need an active/functional prosthesis. The patient will therefore simply need a cosmetic prosthesis.
C. The best choice would be a cosmetic prosthesis. The patient is independent with using one hand and does not need an active/functional prosthesis. The patient will therefore simply need a cosmetic prosthesis.
What is the most likely reason why a patient who recently had their second digit amputated, would complain of pain and tingling in that missing digit, when there are no signs of swelling or inflammation in the affected hand?
C. The most likely reason would be phantom pain. Phantom pain is pain that feels like it’s coming from a body part that’s no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain./em>
C. The most likely reason would be phantom pain. Phantom pain is pain that feels like it’s coming from a body part that’s no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain./em>
A patient who has developed a progressive eye disease is being seen by the OT at her home. The goal of the session is to start introducing home adaptations/modifications that will be graded as the patient’s condition progresses. What is NOT an example of an appropriate intervention for low vision?
D. Use natural sunlight consistently throughout the day.
Although natural sunlight is ideal for most everyday tasks, it can also present problems. Sunlight is not consistent throughout the day, and it can create glare spots and potentially dangerous shadowy areas in the home.
Low vision refers to vision loss that results in difficulty in everyday life activities even with regular glasses, contact lenses, medicine, or surgery (National Eye Institute, 2018).
To improve visibility.
– Use contrast to distinguish items, such as a dark bathmat with rubber backing on a light floor, a light cutting board on a dark countertop, colored tape on the edge of stair risers, and white sheets with a dark comforter and pillows.
– Light up the stairs, pathways, and walkways
– Use night lights, a flashlight, or hall or room lighting if you get up in the night.
– Avoid moving quickly from a dark room to a lighted area, and vice versa; allow your eyes time to adjust to changing light levels.
– Use an e-reader so you can adjust the font size, lighting level, and contrast.
– Use overhead lighting to help eliminate shadows and keep rooms evenly lit.
– Use shades on all light sources to reduce glare.
– Sit with your back towards a window or lamp. Use a gooseneck lamp for tabletop activities.
Papilledema refers to disc swelling that is usually bilateral and due to raised intracranial pressure. Acute papilledema does not cause loss of vision. Chronic papilledema can cause slow loss of vision because of optic atrophy. Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that predominantly affects obese women of childbearing age. The primary problem is chronically elevated intracranial pressure (ICP), and the most important neurologic manifestation is papilledema, which may lead to secondary progressive optic atrophy, visual loss, and possible blindness.
https://www.aota.org/about-occupational-therapy/patients-clients/adults/lowvision.aspx
D. Use natural sunlight consistently throughout the day.
Although natural sunlight is ideal for most everyday tasks, it can also present problems. Sunlight is not consistent throughout the day, and it can create glare spots and potentially dangerous shadowy areas in the home.
Low vision refers to vision loss that results in difficulty in everyday life activities even with regular glasses, contact lenses, medicine, or surgery (National Eye Institute, 2018).
To improve visibility.
– Use contrast to distinguish items, such as a dark bathmat with rubber backing on a light floor, a light cutting board on a dark countertop, colored tape on the edge of stair risers, and white sheets with a dark comforter and pillows.
– Light up the stairs, pathways, and walkways
– Use night lights, a flashlight, or hall or room lighting if you get up in the night.
– Avoid moving quickly from a dark room to a lighted area, and vice versa; allow your eyes time to adjust to changing light levels.
– Use an e-reader so you can adjust the font size, lighting level, and contrast.
– Use overhead lighting to help eliminate shadows and keep rooms evenly lit.
– Use shades on all light sources to reduce glare.
– Sit with your back towards a window or lamp. Use a gooseneck lamp for tabletop activities.
Papilledema refers to disc swelling that is usually bilateral and due to raised intracranial pressure. Acute papilledema does not cause loss of vision. Chronic papilledema can cause slow loss of vision because of optic atrophy. Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that predominantly affects obese women of childbearing age. The primary problem is chronically elevated intracranial pressure (ICP), and the most important neurologic manifestation is papilledema, which may lead to secondary progressive optic atrophy, visual loss, and possible blindness.
https://www.aota.org/about-occupational-therapy/patients-clients/adults/lowvision.aspx
What type of burn affect only the epidermis?
D. First-degree burn.
First degree, also referred to as a superficial burn. Findings: dry, no blisters, short-term moderate pain
Common causes: sunburn, brief flash burns, brief exposure to hot liquids or chemicals
Scar potential: no potential for hypertrophic scarring or contractures
D. First-degree burn.
First degree, also referred to as a superficial burn. Findings: dry, no blisters, short-term moderate pain
Common causes: sunburn, brief flash burns, brief exposure to hot liquids or chemicals
Scar potential: no potential for hypertrophic scarring or contractures
A patient was recently admitted to acute care after acquiring a full-thickness burn to both upper extremities. How long after having a skin graft, can this patient’s AROM be assessed?
B. 7-10 days post-op. The skin graft typically takes one week to heal, only then can the patient’s range of motion be assessed. For full-thickness skin grafts, the donor site wound heals by primary intention (sutured together). However, for split-thickness skin grafts, the wound heals by re-epithelialization. Epithelial cells migrate from the remnants of the underlying dermis across the wound bed. Initial healing of grafted area typically occurs 7 to10 days. Skin grafts contract during the healing phase, and immobility enhances loss of function.
The preferred position and length of immobilization will vary by physician and burn center protocol. Excision and grafting procedures usually require a period of postoperative immobilization to allow adherence and vascularization of the grafted skin. Although the time varies among burn centers, the average period of immobilization is 3 to 5 days for most split-thickness skin grafts (STSG), and 7 to 10 days for epithelial grafts. Exercises can be resumed as soon as graft adherence is confirmed. Gentle AROM is the treatment of choice to avoid shearing of the new grafts.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction)
B. 7-10 days post-op. The skin graft typically takes one week to heal, only then can the patient’s range of motion be assessed. For full-thickness skin grafts, the donor site wound heals by primary intention (sutured together). However, for split-thickness skin grafts, the wound heals by re-epithelialization. Epithelial cells migrate from the remnants of the underlying dermis across the wound bed. Initial healing of grafted area typically occurs 7 to10 days. Skin grafts contract during the healing phase, and immobility enhances loss of function.
The preferred position and length of immobilization will vary by physician and burn center protocol. Excision and grafting procedures usually require a period of postoperative immobilization to allow adherence and vascularization of the grafted skin. Although the time varies among burn centers, the average period of immobilization is 3 to 5 days for most split-thickness skin grafts (STSG), and 7 to 10 days for epithelial grafts. Exercises can be resumed as soon as graft adherence is confirmed. Gentle AROM is the treatment of choice to avoid shearing of the new grafts.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction)
A patient in the burn unit has been referred for OT intervention. The patient’s chart reveals that the degree of burns they sustained from their injury has resulted in nerve damage. What degree of burn affects nerve endings?
A. Third-degree burn.
Burns can be classified as first-degree, second-degree, third-degree, or fourth-degree depending on how deeply and severely they penetrate the skin’s surface. Burns classified according to the depth of tissue injury largely determines the healing potential and the need for surgical grafting.
1. Epidermal (superficial; was first degree) burns involve only the epidermal layer of skin.
2. Partial-thickness burns (was second degree) involve the epidermis and portions of the dermis. They are characterized as either superficial or deep.
3. Full-thickness burns (was third degree) extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissue. These burns affect all three skin layers: epidermis, dermis and fat. The burn also destroys hair follicles and sweat glands. Because third-degree burns damage nerve endings (sensory nerve), the patient probably won’t feel pain in the area of the burn itself, rather adjacent to it.
4. Deep burn injury (was fourth degree) extends into underlying soft tissue and can involve muscle and/or bone.
In more detail:
1. First-degree (superficial) burns. First-degree burns affect only the outer layer of skin, the epidermis. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and often consists of an increase or decrease in the skin color.
2. Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful.
3. Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred.
4. Fourth-degree burns. Fourth-degree burns go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.
A. Third-degree burn.
Burns can be classified as first-degree, second-degree, third-degree, or fourth-degree depending on how deeply and severely they penetrate the skin’s surface. Burns classified according to the depth of tissue injury largely determines the healing potential and the need for surgical grafting.
1. Epidermal (superficial; was first degree) burns involve only the epidermal layer of skin.
2. Partial-thickness burns (was second degree) involve the epidermis and portions of the dermis. They are characterized as either superficial or deep.
3. Full-thickness burns (was third degree) extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissue. These burns affect all three skin layers: epidermis, dermis and fat. The burn also destroys hair follicles and sweat glands. Because third-degree burns damage nerve endings (sensory nerve), the patient probably won’t feel pain in the area of the burn itself, rather adjacent to it.
4. Deep burn injury (was fourth degree) extends into underlying soft tissue and can involve muscle and/or bone.
In more detail:
1. First-degree (superficial) burns. First-degree burns affect only the outer layer of skin, the epidermis. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and often consists of an increase or decrease in the skin color.
2. Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful.
3. Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred.
4. Fourth-degree burns. Fourth-degree burns go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.
Chuck is a 24-year-old college student who was seriously injured while improperly handling fireworks. He was immediately transported to the local hospital where he received treatment for 3rd degree burns on his right dominant upper limb. Chuck is at risk for developing hypertrophic scarring and he desperately wants to prevent or minimize the appearance of any scarring as his role as a college campus tour guide involves interacting with the public. Which of the following strategies will aid in the prevention and/or improvement of hypertrophic scarring?
B. Insertion of silicone gel in pressure garments or splints.
Silicone gel is supplied in sheets and can be lined within the interior of the splint to assist in managing scars. It is believed to work by increasing hydration and local skin temperature of the affected area. It is important to monitor for skin maceration and dermatitis.
A. Covering the burn with gauze or a loose dressing is indicated in the treatment of a second degree burn. The loose dressing will not assist in preventing scarring.
C. The affected area should be positioned away from the position of comfort, opposite to the direction that a possible contracture could form.
D. Tissue rehabilitation following a burn injury is the priority of the surgeon, however, fractional ablative laser treatment is not the only option. There are conservative options that would be presented first as hypertrophic scarring is possible but varies with each person and would present itself within 3 – 6 months following injury of the burn site.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 27.
Son, D., & Harijan, A. (2014). Overview of surgical scar prevention and management. Journal of Korean medical science, 29(6), 751–757. doi:10.3346/jkms.2014.29.6.751
B. Insertion of silicone gel in pressure garments or splints.
Silicone gel is supplied in sheets and can be lined within the interior of the splint to assist in managing scars. It is believed to work by increasing hydration and local skin temperature of the affected area. It is important to monitor for skin maceration and dermatitis.
A. Covering the burn with gauze or a loose dressing is indicated in the treatment of a second degree burn. The loose dressing will not assist in preventing scarring.
C. The affected area should be positioned away from the position of comfort, opposite to the direction that a possible contracture could form.
D. Tissue rehabilitation following a burn injury is the priority of the surgeon, however, fractional ablative laser treatment is not the only option. There are conservative options that would be presented first as hypertrophic scarring is possible but varies with each person and would present itself within 3 – 6 months following injury of the burn site.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 27.
Son, D., & Harijan, A. (2014). Overview of surgical scar prevention and management. Journal of Korean medical science, 29(6), 751–757. doi:10.3346/jkms.2014.29.6.751
When assessing a patient who has 3rd degree burns, it is recommended to use a goniometer for assessing ROM so that you can accurately document baseline deficits and future changes in your recorded measurements. To be able to record the goniometer measurements accurately, what are the most important factors that should be taken into consideration when using a goniometer on an acutely burnt limb? Select the 3 best answers.
A. Pain, edema, bulky dressings may limit full ROM.
C. Pre-existing conditions that may alter expected AROM should always be considered.
F. Although AROM is preferred, PROM should be measured if a patient is unresponsive or unable to move their extremity sufficiently.
If pain, edema, or bulky dressings limit full ROM, such information should be documented. Pre-existing conditions that may alter expected AROM should be investigated during the patient and family interview. Although AROM is preferred, PROM should be measured if a patient is unresponsive or unable to move their extremity sufficiently. When using PROM, care must be taken not to apply excessive force, especially with older patients who my have degenerative joint disease or small children with hypermobile joints.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)
A. Pain, edema, bulky dressings may limit full ROM.
C. Pre-existing conditions that may alter expected AROM should always be considered.
F. Although AROM is preferred, PROM should be measured if a patient is unresponsive or unable to move their extremity sufficiently.
If pain, edema, or bulky dressings limit full ROM, such information should be documented. Pre-existing conditions that may alter expected AROM should be investigated during the patient and family interview. Although AROM is preferred, PROM should be measured if a patient is unresponsive or unable to move their extremity sufficiently. When using PROM, care must be taken not to apply excessive force, especially with older patients who my have degenerative joint disease or small children with hypermobile joints.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)
Joel, a 37-year-old male who is a construction worker, recently incurred deep partial-thickness burns to both his upper extremities while lighting a barbecue grill with lighter fluid. Joel has stated that he needs to return to work as soon as possible, as his family depends on his income. When formulating an OT intervention plan for Joel, what is the MOST efficient way to help him achieve his goal of returning to work?
B. Design treatment activities that simulate both functional activities and various work skills.
Partial thickness burns (Second Degree) extend through the epidermis and into the dermis. The depth into the dermis can vary (superficial or deep dermis). These burns are typically very painful, red, blistered, moist, soft and blanch when touched. Examples include burns from hot surfaces, hot liquids or flame.
Preparing a burn patient for return to work does not have to be a long-term process. Burn rehabilitation and work skills training have many similarities; therefore, it is possible to design treatment activities that simulate not only functional activities but also various work skills. Strength, activity tolerance, and flexibility, often identified as work tolerances, are obvious goals of burn rehabilitation. Physical demands of jobs, as described in the Dictionary of Occupational Titles, are also components of functional skills; lifting, stooping, pushing, pulling, handling, and manipulating are a few examples. A job analysis interview, performed as part of the activity needs analysis, will provide the type of information needed to integrate activities into the intervention plan, which should not only improve functional ability but also provide reconditioning for returning to work.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)
B. Design treatment activities that simulate both functional activities and various work skills.
Partial thickness burns (Second Degree) extend through the epidermis and into the dermis. The depth into the dermis can vary (superficial or deep dermis). These burns are typically very painful, red, blistered, moist, soft and blanch when touched. Examples include burns from hot surfaces, hot liquids or flame.
Preparing a burn patient for return to work does not have to be a long-term process. Burn rehabilitation and work skills training have many similarities; therefore, it is possible to design treatment activities that simulate not only functional activities but also various work skills. Strength, activity tolerance, and flexibility, often identified as work tolerances, are obvious goals of burn rehabilitation. Physical demands of jobs, as described in the Dictionary of Occupational Titles, are also components of functional skills; lifting, stooping, pushing, pulling, handling, and manipulating are a few examples. A job analysis interview, performed as part of the activity needs analysis, will provide the type of information needed to integrate activities into the intervention plan, which should not only improve functional ability but also provide reconditioning for returning to work.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)
When fitting a pressure garment glove on a patient’s right dominant hand, 6 weeks post burn injury, how can you ensure the best fit?
A. Make sure the compression garment exerts equal pressure, and if necessary, use a silicone gel pad under the garment to distribute the pressure more evenly
It is difficult to predict who will develop scarring. Research shows that less severe burns (also called superficial partial thickness burns) that heal in less than 10 days generally have no scarring. More severe burns such as deep partial thickness burns which take more than 21 days (3-weeks) to heal, usually develop scarring. Full thickness burns and other burns that require skin grafting are at high risk for scarring. To be effective, compression garments must exert equal pressure over the entire burned surface area. Because of body contours, bony prominences, and postural adjustments, flexible inserts or pressure-adapting conformers are often needed under the garments to distribute the pressure more evenly. As with the garments, the fit of a conformer should be monitored at regular intervals for effectiveness and signs of deterioration and be replaced as needed to maintain exact contouring. Silicone gel pads, Silastic elastomer, Otoform-K, Plastazote, and Velfoam are useful for hand scars. Topical silicone gel treatments seem to remain the first point of clinical recommendation in scar management. SGS has been used in scar therapy for over 30 years, during which its efficacy has been the subject of numerous clinical evaluations. The exact mechanism of action of silicone in the prevention and management of hypertrophic scars is unclear, although it is likely to influence the collagen remodeling phase of wound healing. It appears to soften, flatten and blanch the scar, making it comfortable and improving its appearance.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486716/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038404/
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1117). Kindle Edition.
A. Make sure the compression garment exerts equal pressure, and if necessary, use a silicone gel pad under the garment to distribute the pressure more evenly
It is difficult to predict who will develop scarring. Research shows that less severe burns (also called superficial partial thickness burns) that heal in less than 10 days generally have no scarring. More severe burns such as deep partial thickness burns which take more than 21 days (3-weeks) to heal, usually develop scarring. Full thickness burns and other burns that require skin grafting are at high risk for scarring. To be effective, compression garments must exert equal pressure over the entire burned surface area. Because of body contours, bony prominences, and postural adjustments, flexible inserts or pressure-adapting conformers are often needed under the garments to distribute the pressure more evenly. As with the garments, the fit of a conformer should be monitored at regular intervals for effectiveness and signs of deterioration and be replaced as needed to maintain exact contouring. Silicone gel pads, Silastic elastomer, Otoform-K, Plastazote, and Velfoam are useful for hand scars. Topical silicone gel treatments seem to remain the first point of clinical recommendation in scar management. SGS has been used in scar therapy for over 30 years, during which its efficacy has been the subject of numerous clinical evaluations. The exact mechanism of action of silicone in the prevention and management of hypertrophic scars is unclear, although it is likely to influence the collagen remodeling phase of wound healing. It appears to soften, flatten and blanch the scar, making it comfortable and improving its appearance.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486716/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038404/
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1117). Kindle Edition.
In burn management, massage is a recognized modality used to help soften and desensitize healed grafted areas and burn scars. What is the BEST massage technique for treating a burn scar that is hypersensitive?
B. Massage should be performed in a circular motion, using gentle pressure initially and increasing the pressure gradually as tolerated.
Massage is beneficial for desensitizing well-healed but hypersensitive grafted areas or burn scars and for softening tight scar bands during sustained stretching exercises. When massaging a scar band, the clinician should be sure that the scar is fully stretched and pre-moisturized to reduce shearing forces and prevent splitting of immature or unstable, problematic scar tissue. Massage should be performed in a circular motion, with more pressure applied gradually as tolerated over time.
Scar massage is widely advocated as an integral part of burn scar management; while the exact mechanisms of its effects are not known, it appears to help in several ways, for example:
i. Application of a moisturiser – burn scars are often lacking in moisture depending on the depth of the injury and the extent of the damage to the skin structures. They can become very dry and uncomfortable and this can lead to cracking and breakdown of the scar. By massaging with an unperfumed moisturiser or oil, the upper layer of the scar becomes softer and more pliable and therefore more comfortable; this also helps to reduce itching which can also be a common problem.
ii. When scars become thick and raised, they hold additional fluid which reduces their plasticity. Through deep firm massage of the scar using the thumb or fingertips, the effect of this excess fluid can be reduced. Massaging while performing stretches helps to increase ROM of a limb affected by a burn scar.
iv. Burn scars contain four times more collagen than other scars which is rapidly laid down in whorls and bundles. Deep massage of the scar in small circular movements is thought to help improve with alignment of the scar tissue as it is formed.
v. Sensory impairment and changes in cutaneous sensation is common in burn scars. Regular massage and touching of the scars helps with desensitisation of hypersensitive scars.
vi. Psychological factors of individuals having difficulty in coming to terms with having, what they feel is, an unsightly scar can also be reduced by touching the scar and learning to accept how it looks and feels.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038404/
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1117). Kindle Edition.
B. Massage should be performed in a circular motion, using gentle pressure initially and increasing the pressure gradually as tolerated.
Massage is beneficial for desensitizing well-healed but hypersensitive grafted areas or burn scars and for softening tight scar bands during sustained stretching exercises. When massaging a scar band, the clinician should be sure that the scar is fully stretched and pre-moisturized to reduce shearing forces and prevent splitting of immature or unstable, problematic scar tissue. Massage should be performed in a circular motion, with more pressure applied gradually as tolerated over time.
Scar massage is widely advocated as an integral part of burn scar management; while the exact mechanisms of its effects are not known, it appears to help in several ways, for example:
i. Application of a moisturiser – burn scars are often lacking in moisture depending on the depth of the injury and the extent of the damage to the skin structures. They can become very dry and uncomfortable and this can lead to cracking and breakdown of the scar. By massaging with an unperfumed moisturiser or oil, the upper layer of the scar becomes softer and more pliable and therefore more comfortable; this also helps to reduce itching which can also be a common problem.
ii. When scars become thick and raised, they hold additional fluid which reduces their plasticity. Through deep firm massage of the scar using the thumb or fingertips, the effect of this excess fluid can be reduced. Massaging while performing stretches helps to increase ROM of a limb affected by a burn scar.
iv. Burn scars contain four times more collagen than other scars which is rapidly laid down in whorls and bundles. Deep massage of the scar in small circular movements is thought to help improve with alignment of the scar tissue as it is formed.
v. Sensory impairment and changes in cutaneous sensation is common in burn scars. Regular massage and touching of the scars helps with desensitisation of hypersensitive scars.
vi. Psychological factors of individuals having difficulty in coming to terms with having, what they feel is, an unsightly scar can also be reduced by touching the scar and learning to accept how it looks and feels.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038404/
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1117). Kindle Edition.
What is the BEST intervention for edema control in a patient admitted to acute care, 72 hours after a burn?
A. Elevation of body part.
Elevation encourages drainage of fluid and allows it to be reabsorbed by the body. The swollen part should be positioned above the level of the heart so that gravity can assist with the drainage.
A. Elevation of body part.
Elevation encourages drainage of fluid and allows it to be reabsorbed by the body. The swollen part should be positioned above the level of the heart so that gravity can assist with the drainage.
Which splint would be appropriate for a patient who has second and third-degree burns on the dorsal surface of his right hand and forearm?
B. Intrinsic plus splint
Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70°–90° of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an antideformity splint or a safe position splint.
A. Cone splint is used to position the hand when severe flexion contracture is already present.
C. Dorsal flexor tendon repair splint is used to prevent stress to the flexor tendons following injury or repair.
D. A resting hand splint is for support or immobilization
B. Intrinsic plus splint
Burns to the dorsum of the hand require the metacarpophalangeal joints to be splinted in 70°–90° of flexion to prevent clawing of the fingers and shortening of the tendons and ligaments. This type of splint is also referred to as an antideformity splint or a safe position splint.
A. Cone splint is used to position the hand when severe flexion contracture is already present.
C. Dorsal flexor tendon repair splint is used to prevent stress to the flexor tendons following injury or repair.
D. A resting hand splint is for support or immobilization
A 52-year old man is voluntarily being seen for a driving assessment after recently being diagnosed with Parkinson’s disease. The patient presents with no motor control or perceptual difficulties and his ability to alternate his attention between tasks is within the normal functional limits for driving. In terms of his visual acuity, measurements are 20/60 without his corrective lenses, and 20/40 with his corrective lenses, which is the level at which an individual can pass a driver’s license test in the United States. How would you interpret the above visual acuity values of 20/40 and 20/60?
C. The patient is able to see at 20 feet what a person with normal vision could see at 40 feet, and without corrective lenses the patient is able to see at 20 feet what a person with normal vision could see at 60 feet.
20/20 vision is normal vision acuity (the clarity or sharpness of vision) measured at a distance of 20 feet. If you have 20/20 vision, you can see clearly at 20 feet what should normally be seen at a distance.
The 20/40 measurement measures what the patient who is being tested can see at 20 feet in comparison to what a person with normal vision (20/20 vision) sees at 20 feet. Therefore, 20/60 vision measures what the patient sees at 60 feet in comparison to what a person with normal vision can see at 60 feet.
D. This measures the refractive error of the eye and uses + and – symbols.
https://eyecaretyler.com/resources/how-the-eye-works/what-does-2020-mean/
C. The patient is able to see at 20 feet what a person with normal vision could see at 40 feet, and without corrective lenses the patient is able to see at 20 feet what a person with normal vision could see at 60 feet.
20/20 vision is normal vision acuity (the clarity or sharpness of vision) measured at a distance of 20 feet. If you have 20/20 vision, you can see clearly at 20 feet what should normally be seen at a distance.
The 20/40 measurement measures what the patient who is being tested can see at 20 feet in comparison to what a person with normal vision (20/20 vision) sees at 20 feet. Therefore, 20/60 vision measures what the patient sees at 60 feet in comparison to what a person with normal vision can see at 60 feet.
D. This measures the refractive error of the eye and uses + and – symbols.
https://eyecaretyler.com/resources/how-the-eye-works/what-does-2020-mean/
If a patient is able to follow a set schedule and perform a self-care routine independently, at what Rancho level are they functioning?
B. Level 7: Automatic and Appropriate.
In addition, this patient at level 7 can do routine self-care w/o help if physically able. Has problems planning, starting, and following through with Ax. Has trouble paying attention in distracting or stressful situations. Unaware of severity of injury, believes will go home and pick up where left off. Tx: Can complete Ax. for 30min with min. assist.
B. Level 7: Automatic and Appropriate.
In addition, this patient at level 7 can do routine self-care w/o help if physically able. Has problems planning, starting, and following through with Ax. Has trouble paying attention in distracting or stressful situations. Unaware of severity of injury, believes will go home and pick up where left off. Tx: Can complete Ax. for 30min with min. assist.
Celia, a patient who recently sustained 3rd degree burns to 70% of her body, has been admitted to the ICU and a referral for OT intervention has been received. What are the 3 MOST important treatment goals for Celia at this stage of her recovery? Select the 3 best answers.
D. Positioning for edema control.
E. Splinting to maintain the involved extremities in an antideformity position.
F. Active range of motion activities as tolerated.
Since Celia is in the intensive care unit she would be in the acute phase of rehabilitation. Treatment techniques that should be used during this phase include positioning for edema control, splinting to prevent contractures as well as passive and active range of motion activities as the patient will tolerate.
– Preventive Positioning: The purpose of preventive positioning is to reduce edema and maintain the involved extremities in an antideformity position. Elevation of the entire extremity above heart level can reduce the severity of distal edema formation, especially when paired with AROM exercises.
– The focus of movement in the acute phase is to preserve ROM and functional strength and decrease edema.
A, B and C. 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. Positioning for edema control.
E. Splinting to maintain the involved extremities in an antideformity position.
F. Active range of motion activities as tolerated.
Since Celia is in the intensive care unit she would be in the acute phase of rehabilitation. Treatment techniques that should be used during this phase include positioning for edema control, splinting to prevent contractures as well as passive and active range of motion activities as the patient will tolerate.
– Preventive Positioning: The purpose of preventive positioning is to reduce edema and maintain the involved extremities in an antideformity position. Elevation of the entire extremity above heart level can reduce the severity of distal edema formation, especially when paired with AROM exercises.
– The focus of movement in the acute phase is to preserve ROM and functional strength and decrease edema.
A, B and C. 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.
An OT is working with a patient in acute care who presents with a burn that has damaged the epidermis and deep layers of the dermis, including the hair follicles and blood vessels located in the dermis. The patient received this injury when taking a cake out from the oven. In the first treatment session, the patient asks the OT when the wound will heal. How should the OT best respond?
B. A deep partial-thickness burn typically resolves in 3-5 weeks.
When burns extend through the epidermis and into the dermis, they are considered to be partial-thickness burns. The dermis itself is divided into two regions, the uppermost being the papillary region. This area is composed mostly of connective tissue and serves only to strengthen the connection between the epidermis and the dermis. Partial-thickness burns that only extend down to this layer of the skin are considered superficial. The reticular region of the dermis contains not only connective tissue, but hair follicles, sebaceous and sweat glands, cutaneous sensory receptors, and blood vessels. Damage to this layer of the skin is classified as a deep partial-thickness burn.
i. First degree burn: A superficial burn that only affects the top layer of skin (epidermis). There is no blistering, it is painful, the skin is red, and it heals in 3-4 days
ii. Second degree burn:
There are two types of second-degree burns:
1. Superficial Partial Thickness
– extend through the first half of the dermis.
-pink, painful, moist skin under the blisters
-heal in 7-21 days
-no to minimal scarring or impairment
2. Deep Partial Thickness
– extend into the second half of the dermis.
-cause skin color to change, scarring
-heal in 3-5 weeks
-may acquire scar management
iii. Third degree burn: The burn extends all the way through all layers of skin. It appears white, brown, black or cherry red in appearance. It may or may not have blisters. It requires specialized treatment and possible surgery.
B. A deep partial-thickness burn typically resolves in 3-5 weeks.
When burns extend through the epidermis and into the dermis, they are considered to be partial-thickness burns. The dermis itself is divided into two regions, the uppermost being the papillary region. This area is composed mostly of connective tissue and serves only to strengthen the connection between the epidermis and the dermis. Partial-thickness burns that only extend down to this layer of the skin are considered superficial. The reticular region of the dermis contains not only connective tissue, but hair follicles, sebaceous and sweat glands, cutaneous sensory receptors, and blood vessels. Damage to this layer of the skin is classified as a deep partial-thickness burn.
i. First degree burn: A superficial burn that only affects the top layer of skin (epidermis). There is no blistering, it is painful, the skin is red, and it heals in 3-4 days
ii. Second degree burn:
There are two types of second-degree burns:
1. Superficial Partial Thickness
– extend through the first half of the dermis.
-pink, painful, moist skin under the blisters
-heal in 7-21 days
-no to minimal scarring or impairment
2. Deep Partial Thickness
– extend into the second half of the dermis.
-cause skin color to change, scarring
-heal in 3-5 weeks
-may acquire scar management
iii. Third degree burn: The burn extends all the way through all layers of skin. It appears white, brown, black or cherry red in appearance. It may or may not have blisters. It requires specialized treatment and possible surgery.
When working with a patient who is recovering from a 3rd degree burn injury, what phase of OT intervention aims to enhance performance skills, provide adaptive equipment, and teach alternative techniques in self-care as needed?
D. The phase would be the rehabilitative phase.
Post-operative Intervention:
– 72 hours: dressing changes, splint at all times
– 5-7 days: begin AROM, light ADL, sterile whirlpool, meaningful activities (MA)
– Over 7 days: PROM as tolerated, ADL, MA
– Use massage – when wounds are healed
– Order compression garments
D. The phase would be the rehabilitative phase.
Post-operative Intervention:
– 72 hours: dressing changes, splint at all times
– 5-7 days: begin AROM, light ADL, sterile whirlpool, meaningful activities (MA)
– Over 7 days: PROM as tolerated, ADL, MA
– Use massage – when wounds are healed
– Order compression garments
Visuospatial deficits are a common and early sign of dementia. As the OT practitioner working with a patient who presents with symptoms of dementia, which tool is the MOST effective for screening for visuospatial deficits?
C. Clock-Drawing Test.
Visuospatial ability is affected in multiple types of dementia, including in the very early stages of Alzheimer’s disease. The Clock Drawing Test (CDT) is a nonverbal screening tool in which the patient is asked to draw a clock. Placement of the numbers around the circle requires visual-spatial, numerical sequencing, and planning abilities.
A. The Assessment of Motor and Process Skills (AMPS) is an observational assessment that allows for the simultaneous evaluation of motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living (ADL).
B. The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) is too lengthy to use as a visual perception screening tool.
E. The Modified Ashworth Scale is the most universally accepted clinical tool used to measure the increase of muscle tone.
C. Clock-Drawing Test.
Visuospatial ability is affected in multiple types of dementia, including in the very early stages of Alzheimer’s disease. The Clock Drawing Test (CDT) is a nonverbal screening tool in which the patient is asked to draw a clock. Placement of the numbers around the circle requires visual-spatial, numerical sequencing, and planning abilities.
A. The Assessment of Motor and Process Skills (AMPS) is an observational assessment that allows for the simultaneous evaluation of motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living (ADL).
B. The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) is too lengthy to use as a visual perception screening tool.
E. The Modified Ashworth Scale is the most universally accepted clinical tool used to measure the increase of muscle tone.
An OT conducts a screening on a patient who recently sustained a traumatic brain injury. The patient is observed to be awake on and off during the day, turns towards the TV when it is on, and is able to squeeze the OT’s hand when instructed to. What Rancho Los Amigos level is this patient functioning at?
A. Level 3: Localized Response.
Cognitive Level III Localized Response:
A person at this level will: • be awake on and off during the day; • make more movements than before • react more specifically to what he sees, hears, or feels. For example, he may turn towards a sound, withdraw from pain, and attempt to watch a person move around the room; • react slowly and inconsistently • begin to recognize family and friends • follow some simple directions such as “Look at me” or “squeeze my hand” • begin to respond inconsistently to simple questions with “yes” and “no” head nods.
A. Level 3: Localized Response.
Cognitive Level III Localized Response:
A person at this level will: • be awake on and off during the day; • make more movements than before • react more specifically to what he sees, hears, or feels. For example, he may turn towards a sound, withdraw from pain, and attempt to watch a person move around the room; • react slowly and inconsistently • begin to recognize family and friends • follow some simple directions such as “Look at me” or “squeeze my hand” • begin to respond inconsistently to simple questions with “yes” and “no” head nods.
A 76-year-old patient has recently been admitted to a rehabilitation facility following a fall at a local grocery store. The patient was diagnosed with Diabetes Mellitus Type II, 15 years ago and her diabetes is being controlled by medication. The patient reports that although her “sugars are good”, she sometimes has “problems with her eyes”, and this is the reason for her fall. Observing the patient, she demonstrates some difficulty navigating around the facility and she describes seeing floaters, having blurry vison at times and poor night vision. Based on these symptoms, what secondary complication has this patient MOST likely developed from her Diabetes?
B. Retinopathy.
Diabetic retinopathy symptoms usually affect both eyes. The patient can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, the patient will notice symptoms such as:
• seeing an increasing number of floaters
• having blurry vision
• having vision that changes sometimes from blurry to clear
• seeing blank or dark areas in the field of vision
• having poor night vision
• noticing colors appear faded or washed out
• losing vision
A. Nephropathy (Kidney damage). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
C. Neuropathy (Nerve damage). Excess sugar can injure the walls of the capillaries that nourish the patient’s nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, the patient could lose all sense of feeling in the affected limbs.
D. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
https://www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy
B. Retinopathy.
Diabetic retinopathy symptoms usually affect both eyes. The patient can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, the patient will notice symptoms such as:
• seeing an increasing number of floaters
• having blurry vision
• having vision that changes sometimes from blurry to clear
• seeing blank or dark areas in the field of vision
• having poor night vision
• noticing colors appear faded or washed out
• losing vision
A. Nephropathy (Kidney damage). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
C. Neuropathy (Nerve damage). Excess sugar can injure the walls of the capillaries that nourish the patient’s nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, the patient could lose all sense of feeling in the affected limbs.
D. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
https://www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy
What activity would a patient who is functioning at Rancho Los Amigos 8 (Purposeful and Appropriate) be able to accomplish?
D. The patient will be able to come up with several solutions to a problem such as being out of milk when trying to cook macaroni and cheese.
Rancho Los Amigos 8 (Purposeful and Appropriate)
At this stage, the person has purpose in daily living.
• They can do more complex things such as meal planning and preparation, home tasks, and taking their medication.
• They can recall and integrate past and present.
• Carryover for new learning is evident.
• The person needs no supervision once activities are learned and can be independent at home and in the community.
• The person may continue to show some decreased abilities, reasoning, judgment, stress tolerance, and emotional and intellectual capacity compared to pre-injury, yet be functional in society.
D. The patient will be able to come up with several solutions to a problem such as being out of milk when trying to cook macaroni and cheese.
Rancho Los Amigos 8 (Purposeful and Appropriate)
At this stage, the person has purpose in daily living.
• They can do more complex things such as meal planning and preparation, home tasks, and taking their medication.
• They can recall and integrate past and present.
• Carryover for new learning is evident.
• The person needs no supervision once activities are learned and can be independent at home and in the community.
• The person may continue to show some decreased abilities, reasoning, judgment, stress tolerance, and emotional and intellectual capacity compared to pre-injury, yet be functional in society.
Joanne, a 78-year-old widow who lives alone in an apartment, is receiving OT services through a home health agency. Joanne is independent in her ADLs and uses a rolling walker to aid her mobility. She has chosen to age in place and at this stage, her main goal is to improve her medication management. Joanne reports that she generally remembers to take her medication as prescribed but now and then she takes her medication late and at times misses a dose. As Joanne has been prescribed one medication that is time-sensitive, she is experiencing significant anxiety related to her medication regimen. Which recommendations would be BEST for Joanne to follow in order to integrate good medication habits into her life routines? Choose the best 3 answer choices.
A. Use visual reminders such as a sticky note attached to the bathroom mirror.
B. Embed medication habits into daily routines such as mealtime, wake-up and sleep routines.
E. Help the patient identify cues that will trigger the medication habit.
After determining the patient’s typical routines, it is important to collaborate with the patient to determine the most realistic routine in which she can establish a habit with taking her medications. Then, identify the location where the medication bottles or pill box are placed. Lastly, identify cues that will trigger the medication habit. For example, if the patient places her medications by the microwave and coffee maker which are next to each other, she ensures she sees them daily, takes them while she makes coffee or makes microwaveable meals, and reduces the likelihood of missing her medications.
A. Placing notes as visual reminders that can be seen at specific times of the day.
– Place a brightly-colored sticky note on the bathroom mirror for morning medications.
– Place a note on the kitchen table or the refrigerator for mid-day medications.
– Fold an index card to create a standing sign and put on stand beside the bed for evening medications.
B. Medication habits that are embedded within daily routines help people structure their daily lives and promote adherence in order to maintain health (AOTA, 2008; Cooper, Letts, Rigby, Stewart, & Strong, 2005).
C. The patient wants to manage her medications herself.
D. The issue is remembering to take the medication and not needing color coding for distinguishing medications.
F. The patient may not take her walker everywhere with her.
American Journal of Occupational Therapy, January/February 2013, Vol. 67, 91-99.
A. Use visual reminders such as a sticky note attached to the bathroom mirror.
B. Embed medication habits into daily routines such as mealtime, wake-up and sleep routines.
E. Help the patient identify cues that will trigger the medication habit.
After determining the patient’s typical routines, it is important to collaborate with the patient to determine the most realistic routine in which she can establish a habit with taking her medications. Then, identify the location where the medication bottles or pill box are placed. Lastly, identify cues that will trigger the medication habit. For example, if the patient places her medications by the microwave and coffee maker which are next to each other, she ensures she sees them daily, takes them while she makes coffee or makes microwaveable meals, and reduces the likelihood of missing her medications.
A. Placing notes as visual reminders that can be seen at specific times of the day.
– Place a brightly-colored sticky note on the bathroom mirror for morning medications.
– Place a note on the kitchen table or the refrigerator for mid-day medications.
– Fold an index card to create a standing sign and put on stand beside the bed for evening medications.
B. Medication habits that are embedded within daily routines help people structure their daily lives and promote adherence in order to maintain health (AOTA, 2008; Cooper, Letts, Rigby, Stewart, & Strong, 2005).
C. The patient wants to manage her medications herself.
D. The issue is remembering to take the medication and not needing color coding for distinguishing medications.
F. The patient may not take her walker everywhere with her.
American Journal of Occupational Therapy, January/February 2013, Vol. 67, 91-99.
A patient who has been diagnosed with AMD (Age-related Macular Degeneration) is having difficulty applying her make-up in the mornings. She completes her morning ADL routine in her bathroom which is lit by a large central fluorescent light, and when applying her make-up, she uses a standard mirror which hangs on the wall. In terms of lighting, which adaptations are the MOST appropriate to recommend to this patient, to improve her efficiency when applying her make-up? Select the best 3 answers.
A. Use non-glare bulbs.
C. Avoid using fluorescent lighting.
D. Use lighting on a flexible arm.
A. Glare can be very difficult for people with low vision, so it is important to control glare as much as possible.
C. Exposure to harsh fluorescent lighting can cause eye strain and blurred vision as fluorescent lights are much brighter than other incandescent bulbs.
D. Lighting on a flexible arm can provide extra lighting for close work such as applying make-up, and it can be positioned to suit the task.
B. One important strategy to improve vision in low light situations is to use lightbulbs that are at least 60-100 watts
E. Having your back to a window and using direct lighting from behind are strategies to reduce glare
Macular degeneration is one of the most common causes of vision loss, especially in those over the age of 50. It is a progressive eye condition that causes damage to the macula. One of the symptoms of macular degeneration, including AMD, that some people might notice is difficulty seeing in low light situations, or when there’s a sudden change in lighting, like when you come inside from being out in the sun.
Other strategies to improve vision in low light situations:
– Add more light from desk or floor lamps or clip-on lamps (like on books or headboards)
– Put light behind and on the side of the stronger eye
– Increase contrast where needed
– Try different kinds of light (halogen, incandescent, flood)
https://visionaware.org/everyday-living/essential-skills/personal-self-care/makeup-application/applying-lipstick/
https://maculardegeneration.net/low-light-vision/
https://www.mdfoundation.com.au/content/lighting-for-low-vision#sthash.fFUPzlPq.dpuf
A. Use non-glare bulbs.
C. Avoid using fluorescent lighting.
D. Use lighting on a flexible arm.
A. Glare can be very difficult for people with low vision, so it is important to control glare as much as possible.
C. Exposure to harsh fluorescent lighting can cause eye strain and blurred vision as fluorescent lights are much brighter than other incandescent bulbs.
D. Lighting on a flexible arm can provide extra lighting for close work such as applying make-up, and it can be positioned to suit the task.
B. One important strategy to improve vision in low light situations is to use lightbulbs that are at least 60-100 watts
E. Having your back to a window and using direct lighting from behind are strategies to reduce glare
Macular degeneration is one of the most common causes of vision loss, especially in those over the age of 50. It is a progressive eye condition that causes damage to the macula. One of the symptoms of macular degeneration, including AMD, that some people might notice is difficulty seeing in low light situations, or when there’s a sudden change in lighting, like when you come inside from being out in the sun.
Other strategies to improve vision in low light situations:
– Add more light from desk or floor lamps or clip-on lamps (like on books or headboards)
– Put light behind and on the side of the stronger eye
– Increase contrast where needed
– Try different kinds of light (halogen, incandescent, flood)
https://visionaware.org/everyday-living/essential-skills/personal-self-care/makeup-application/applying-lipstick/
https://maculardegeneration.net/low-light-vision/
https://www.mdfoundation.com.au/content/lighting-for-low-vision#sthash.fFUPzlPq.dpuf
Adam, a 52-year-old male who is morbidly obese is having difficulty accessing his bathtub-shower combo as the glass shower door easily becomes dislodged when he is climbing into the shower. He manages to climb into and out of the bathtub with ease, holding onto a grab bar for support but due to his size, his body tends to dislodge the glass door from its frame. What is the BEST modification that can be made in this scenario, so that Adam can safely and independently enter his shower?
B. Remove the shower door and replace it with a shower curtain or a folding plastic door.
Removing the shower door is essential as it can result in the patient potentially injuring himself if it becomes completely dislodged and either falls on him or traps him between the grab bar and glass door. Purchasing a shower curtain or a folding plastic door is practical and affordable.
A. This is not a modification to the shower and the patient needs to remain mobile and independent.
C. This is a costly and unnecessary modification to undertake. At this stage, the patient is safely managing to step into and out of the shower. The only change that needs to be made at this point, is to remove the barrier (glass shower door).
D. This is not a modification, and the patient does need assistance getting into and out of the shower.
B. Remove the shower door and replace it with a shower curtain or a folding plastic door.
Removing the shower door is essential as it can result in the patient potentially injuring himself if it becomes completely dislodged and either falls on him or traps him between the grab bar and glass door. Purchasing a shower curtain or a folding plastic door is practical and affordable.
A. This is not a modification to the shower and the patient needs to remain mobile and independent.
C. This is a costly and unnecessary modification to undertake. At this stage, the patient is safely managing to step into and out of the shower. The only change that needs to be made at this point, is to remove the barrier (glass shower door).
D. This is not a modification, and the patient does need assistance getting into and out of the shower.
While fabricating a splint for a patient who has developed carpal tunnel syndrome after giving birth to her daughter 3 weeks ago, the patient starts to complain that her right leg is cramping and becoming sore, and her leg feels warm. Looking at her leg, it appears to be swollen in comparison to her other leg. What is this patient most likely experiencing and what action should the OT take FIRST?
A. The patient is experiencing a DVT and the activity should be stopped immediately.
Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in the patient’s body, usually in the patient’s legs.
Deep vein thrombosis signs and symptoms can include:
• Swelling in the affected leg. Rarely, there’s swelling in both legs.
• Pain in the patient’s leg. The pain often starts in the patient’s calf and can feel like cramping or soreness.
• Red or discolored skin on the leg.
• A feeling of warmth in the affected leg.
Deep vein thrombosis can occur without noticeable symptoms.
Risk factors include:
• Pregnancy. Pregnancy increases the pressure in the veins in the patient’s pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after the patient has delivered the baby.
• Prolonged bed rest, such as during a long hospital stay, or paralysis. When the patient’s legs remain still for long periods, their calf muscles don’t contract to help blood circulate, which can increase the risk of blood clots.
• Inheriting a blood-clotting disorder. Some people inherit a disorder that makes their blood clot more easily. This condition on its own might not cause blood clots unless combined with one or more other risk factors.
• Injury or surgery. Injury to the patient’s veins or surgery can increase the risk of blood clots.
A. The patient is experiencing a DVT and the activity should be stopped immediately.
Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in the patient’s body, usually in the patient’s legs.
Deep vein thrombosis signs and symptoms can include:
• Swelling in the affected leg. Rarely, there’s swelling in both legs.
• Pain in the patient’s leg. The pain often starts in the patient’s calf and can feel like cramping or soreness.
• Red or discolored skin on the leg.
• A feeling of warmth in the affected leg.
Deep vein thrombosis can occur without noticeable symptoms.
Risk factors include:
• Pregnancy. Pregnancy increases the pressure in the veins in the patient’s pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after the patient has delivered the baby.
• Prolonged bed rest, such as during a long hospital stay, or paralysis. When the patient’s legs remain still for long periods, their calf muscles don’t contract to help blood circulate, which can increase the risk of blood clots.
• Inheriting a blood-clotting disorder. Some people inherit a disorder that makes their blood clot more easily. This condition on its own might not cause blood clots unless combined with one or more other risk factors.
• Injury or surgery. Injury to the patient’s veins or surgery can increase the risk of blood clots.
An OTR® is working with a 72 year-old woman on a self-feeding task with the use of adaptive utensils. The patient has diabetes mellitus type II and hypertension. The OTR® notices that the patient’s skin is pale, she is breathing deeply and a fruity odor on her breath is evident. She suddenly appears very weak and starts to complain of excessive thirst. What should the OTR® do IMMEDIATELY in response to this observation?
D. Immediately report the symptoms to the patient’s charge nurse. This is considered a medical emergency requiring prompt action by a nurse or physician as this is a sign of diabetic ketoacidosis which can lead to a coma and possibly death if not treated. In this situation, the patient has to be left momentarily so that the OTR® can get help for the patient. This is the fastest way of getting this patient medical help, by having the nurse come to the patient with the necessary equipment and medication.
A. Offering the patient food with glucose can exacerbate the symptoms. Therefore this is not an option.
Early, Mary Beth. (2006). Infection Control and Safety Issues in the Clinic, Physical Dysfunction Practice Skills for the Occupational Therapy Assistant (3rd Edition, p 47). St. Louis, Missouri: Elsevier, Mosby Inc.
D. Immediately report the symptoms to the patient’s charge nurse. This is considered a medical emergency requiring prompt action by a nurse or physician as this is a sign of diabetic ketoacidosis which can lead to a coma and possibly death if not treated. In this situation, the patient has to be left momentarily so that the OTR® can get help for the patient. This is the fastest way of getting this patient medical help, by having the nurse come to the patient with the necessary equipment and medication.
A. Offering the patient food with glucose can exacerbate the symptoms. Therefore this is not an option.
Early, Mary Beth. (2006). Infection Control and Safety Issues in the Clinic, Physical Dysfunction Practice Skills for the Occupational Therapy Assistant (3rd Edition, p 47). St. Louis, Missouri: Elsevier, Mosby Inc.
An OT is working at an inpatient rehabilitation facility with a patient who sustained a complete C8-T1 SCI. Currently, the patient requires maximal assistance with dressing. What technique is the BEST to incorporate into therapy sessions to improve the patient’s independence in dressing?
C. Educate the patient on ways to don lower body dressing in bed, then transfer the patient to a supported chair/wheelchair to complete upper body dressing.
The patient should have adequate hand function to allow him to don and manipulate clothing, but does not have adequate postural control to stabilize his body against gravity while donning lower body clothing. Putting on lower body clothing in bed eliminates gravity as a factor during dressing.
C. Educate the patient on ways to don lower body dressing in bed, then transfer the patient to a supported chair/wheelchair to complete upper body dressing.
The patient should have adequate hand function to allow him to don and manipulate clothing, but does not have adequate postural control to stabilize his body against gravity while donning lower body clothing. Putting on lower body clothing in bed eliminates gravity as a factor during dressing.
2 days ago, a patient was admitted to the ICU after sustaining a SCI. Based on the initial assessment, it appears as if the patient has injured his spine at the level of C5. During a ward round, the patient’s wife asks the team about her husbands prognosis. What should the patient and his wife be told about his prognosis?
D. It is too soon post injury, to give a definitive prognosis.
Spinal shock is a term used to describe depressed spinal reflexes caudal to the injury site following SCI. This is an important concept to understand because the initial neurological examination may not be an accurate reflection of disrupted neuronal circuits, including those that control motor and sensory pathways. Normally, these reflex pathways receive continuous input from the brain. When this tonic input is disrupted, the normal reflex pattern is disrupted and can vary from areflexic through to hyperreflexic depending on the time since the original injury. Clinically, this translates into the potential for a misleading representation of deficits if spinal reflexes are absent following injury. It is therefore recommended that patients be examined not only on presentation to the treating physician but also at the 72-hour mark following injury.
https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/spinal-shock
D. It is too soon post injury, to give a definitive prognosis.
Spinal shock is a term used to describe depressed spinal reflexes caudal to the injury site following SCI. This is an important concept to understand because the initial neurological examination may not be an accurate reflection of disrupted neuronal circuits, including those that control motor and sensory pathways. Normally, these reflex pathways receive continuous input from the brain. When this tonic input is disrupted, the normal reflex pattern is disrupted and can vary from areflexic through to hyperreflexic depending on the time since the original injury. Clinically, this translates into the potential for a misleading representation of deficits if spinal reflexes are absent following injury. It is therefore recommended that patients be examined not only on presentation to the treating physician but also at the 72-hour mark following injury.
https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/spinal-shock
A patient with a high level SCI who resides in a nursing home has developed a reddened area on her sacral spine. The area is being monitored by nursing staff and they report that the area remains red for longer than one hour and it does not blanch when touched. What condition does the resident have?
A. A stage 1 pressure ulcer. Stage 1 ulcers are reddened areas that do not blanched when pressure is applied. Redness stays for longer than one hour when exposed. These ulcers are reversible.
A. A stage 1 pressure ulcer. Stage 1 ulcers are reddened areas that do not blanched when pressure is applied. Redness stays for longer than one hour when exposed. These ulcers are reversible.
A 22-year-old male patient who was recently involved in a motorcycle accident, enquires about his prognosis. He is told that he will most likely be able to walk again but that he may have a loss of function in his hips and legs, as well as little or no voluntary control of his bowel and bladder. At which spinal cord level did this patient MOST likely sustain his injury and which nerves have therefore been affected?
D. S1-S5 Sacral Nerves.
The spinal cord does not extend beyond the lumbar spine. L2 is the lowest vertebral segment that contains the actual spinal cord. After this level, nerve roots exit each of the remaining vertebral levels beyond the spinal cord. Damage to the spine at the sacrum levels affects the nerve roots as follows:
S1 – the hips and groin area
S2 – the back of the thighs
S3 – the medial buttock area
S4 & S5 – the perineal area
The pelvic organs are also controlled by the nerves in the sacral region. These organs include the bladder, bowel and genitals.
The sacral plexus is formed by the anterior rami of the sacral nerves S1, S2, S3 and S4. The sacral plexus is a network of nerve fibres which supplies the skin and muscles of the pelvis and lower limb. There are 5 major nerves within the sacral plexus. These major nerves can be remembered by the saying Some Irish Sailor Pesters Polly. The first letter of each of these words stands for Superior Gluteal nerve, Inferior Gluteal nerve, Sciatic nerve, Posterior cutaneous nerve, and Pudendal nerve. The superior gluteal nerve is a motor nerve that innervates the gluteus medius, gluteus minimus and tensor fascia lata. The inferior gluteal nerve is also a motor nerve, which innervates gluteus maximus. The sciatic nerve is the largest. It is both a motor and sensory nerve. The motor nerve component of the sciatic nerve innervates the muscles in the back of the leg and the sole of the foot. Sensory neurons of the sciatic nerve are found in the skin of parts of the leg and the foot. The posterior cutaneous nerve is a sensory nerve which innervates the skin of the back of the thigh and lower leg, as well as the perineum. The pudendal nerve has both sensory and motor functions. It innervates the genitals, anal and urethral sphincters.
https://study.com/academy/lesson/sacral-plexus-nerves-function-injury.html
D. S1-S5 Sacral Nerves.
The spinal cord does not extend beyond the lumbar spine. L2 is the lowest vertebral segment that contains the actual spinal cord. After this level, nerve roots exit each of the remaining vertebral levels beyond the spinal cord. Damage to the spine at the sacrum levels affects the nerve roots as follows:
S1 – the hips and groin area
S2 – the back of the thighs
S3 – the medial buttock area
S4 & S5 – the perineal area
The pelvic organs are also controlled by the nerves in the sacral region. These organs include the bladder, bowel and genitals.
The sacral plexus is formed by the anterior rami of the sacral nerves S1, S2, S3 and S4. The sacral plexus is a network of nerve fibres which supplies the skin and muscles of the pelvis and lower limb. There are 5 major nerves within the sacral plexus. These major nerves can be remembered by the saying Some Irish Sailor Pesters Polly. The first letter of each of these words stands for Superior Gluteal nerve, Inferior Gluteal nerve, Sciatic nerve, Posterior cutaneous nerve, and Pudendal nerve. The superior gluteal nerve is a motor nerve that innervates the gluteus medius, gluteus minimus and tensor fascia lata. The inferior gluteal nerve is also a motor nerve, which innervates gluteus maximus. The sciatic nerve is the largest. It is both a motor and sensory nerve. The motor nerve component of the sciatic nerve innervates the muscles in the back of the leg and the sole of the foot. Sensory neurons of the sciatic nerve are found in the skin of parts of the leg and the foot. The posterior cutaneous nerve is a sensory nerve which innervates the skin of the back of the thigh and lower leg, as well as the perineum. The pudendal nerve has both sensory and motor functions. It innervates the genitals, anal and urethral sphincters.
https://study.com/academy/lesson/sacral-plexus-nerves-function-injury.html
An elderly patient who has rheumatoid arthritis has chosen to age in place and has the resources to employ a fulltime caregiver to assist her when necessary with her ADLs. The patient has recently started to display symptoms of chronic fatigue and her doctor has been unable to find a medical cause to account for this new development in her status. However, it has been identified that the patient is experiencing difficulty falling asleep and her sleep is disrupted as she wakes up frequently throughout the night. What is the BEST OT intervention for this patient, at this stage?
B. Address any of the patient’s precipitating conditions such as pain, decreased range of motion, depression, anxiety that may be impacting on her sleep quality.
This patient has RA which usually presents with symptoms of joint pain, joint swelling and stiffness, and fatigue. RA and depression commonly occur together. Although this is known, people with rheumatoid arthritis often aren’t screened for depression, so it may not be diagnosed or treated. It’s unclear whether depression and anxiety in people with rheumatoid arthritis are a result of their physical symptoms, or if depression is yet another symptom caused by the chronic, systemic inflammation of rheumatoid arthritis. Addressing secondary conditions that may precipitate diminished sleep quality (e.g., pain, decreased range of motion, depression, anxiety) is an important role of the OT practitioner.
A. Part of establishing good sleep hygiene is establishing predictable routines, including regular times for waking and sleeping.
D. Sleep dysfunction is within the scope of OT.
Occupational therapists evaluate patient’s in areas that contribute to sleep dysfunction, including difficulties in sleep preparation and sleep participation; sleep latency (how long it takes to fall asleep, sleep duration (the number of hours of sleep, which varies by age), sleep maintenance (the ability to stay asleep), or daytime sleepiness; the impact of work, school, and life events, such as shift work or caregiving responsibilities; the influence of pain and fatigue; disturbances in balance, vision, strength, skin integrity, and sensory systems; psycho-emotional status, including depression, anxiety, and stress; the impact of caffeine, nicotine, drugs or alcohol, smoking, or medication (e.g., prescriptions or over-the-counter sleep aids); and the impact of the environment (e.g., those in acute care hospitals and long-term-care facilities report higher rates of sleep disturbance).
Occupational therapy interventions focus on promoting optimal sleep performance. These interventions include:
• Educating patients and caregivers on sleep misconceptions and expectations
• Addressing secondary conditions that may precipitate diminished sleep quality (e.g., pain, decreased range of motion, depression, anxiety)
• Encouraging health management behaviors such as smoking cessation, reduced caffeine intake, a balanced diet, and adequate exercise.
• Establishing predictable routines, including regular times for waking and sleeping
• Managing pain and fatigue
• Addressing performance deficits or barriers to activities of daily living, particularly for bed mobility and toileting
• Establishing individualized sleep hygiene routines (e.g., habits and patterns to facilitate restorative sleep)
• Teaching cognitive-behavioral and cognitive restructuring techniques, such as leaving the bedroom if awake and returning only when sleepy, or exploring self-talk statements regarding sleep patterns
• Increasing coping skills, stress management, and time management
• Addressing sensory disorders and teaching self-management or caregiver management
• Modifying the environment, including noise, light, temperature, bedding, and technology use while in bed
• Advocating on a state or national level for laws that protect workers from excessive work schedules that threaten their health or public safety
https://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/HW/Facts/Sleep-fact-sheet.pdf
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
B. Address any of the patient’s precipitating conditions such as pain, decreased range of motion, depression, anxiety that may be impacting on her sleep quality.
This patient has RA which usually presents with symptoms of joint pain, joint swelling and stiffness, and fatigue. RA and depression commonly occur together. Although this is known, people with rheumatoid arthritis often aren’t screened for depression, so it may not be diagnosed or treated. It’s unclear whether depression and anxiety in people with rheumatoid arthritis are a result of their physical symptoms, or if depression is yet another symptom caused by the chronic, systemic inflammation of rheumatoid arthritis. Addressing secondary conditions that may precipitate diminished sleep quality (e.g., pain, decreased range of motion, depression, anxiety) is an important role of the OT practitioner.
A. Part of establishing good sleep hygiene is establishing predictable routines, including regular times for waking and sleeping.
D. Sleep dysfunction is within the scope of OT.
Occupational therapists evaluate patient’s in areas that contribute to sleep dysfunction, including difficulties in sleep preparation and sleep participation; sleep latency (how long it takes to fall asleep, sleep duration (the number of hours of sleep, which varies by age), sleep maintenance (the ability to stay asleep), or daytime sleepiness; the impact of work, school, and life events, such as shift work or caregiving responsibilities; the influence of pain and fatigue; disturbances in balance, vision, strength, skin integrity, and sensory systems; psycho-emotional status, including depression, anxiety, and stress; the impact of caffeine, nicotine, drugs or alcohol, smoking, or medication (e.g., prescriptions or over-the-counter sleep aids); and the impact of the environment (e.g., those in acute care hospitals and long-term-care facilities report higher rates of sleep disturbance).
Occupational therapy interventions focus on promoting optimal sleep performance. These interventions include:
• Educating patients and caregivers on sleep misconceptions and expectations
• Addressing secondary conditions that may precipitate diminished sleep quality (e.g., pain, decreased range of motion, depression, anxiety)
• Encouraging health management behaviors such as smoking cessation, reduced caffeine intake, a balanced diet, and adequate exercise.
• Establishing predictable routines, including regular times for waking and sleeping
• Managing pain and fatigue
• Addressing performance deficits or barriers to activities of daily living, particularly for bed mobility and toileting
• Establishing individualized sleep hygiene routines (e.g., habits and patterns to facilitate restorative sleep)
• Teaching cognitive-behavioral and cognitive restructuring techniques, such as leaving the bedroom if awake and returning only when sleepy, or exploring self-talk statements regarding sleep patterns
• Increasing coping skills, stress management, and time management
• Addressing sensory disorders and teaching self-management or caregiver management
• Modifying the environment, including noise, light, temperature, bedding, and technology use while in bed
• Advocating on a state or national level for laws that protect workers from excessive work schedules that threaten their health or public safety
https://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/HW/Facts/Sleep-fact-sheet.pdf
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
Maryanne recently had to undergo a posterolateral total hip arthroplasty. She is planning on attending an event on Saturday evening with her sister, who will be picking her up in a standard motor vehicle. As this will be the first-time, post-surgery, for Maryanne to leave the rehab facility, the OTR® begins the process of training her in car transfers. After sliding the passenger seat back, Maryanne ambulates with her front-wheeled walker towards the car. What should the OTR® instruct Maryanne to do NEXT during this transfer?
B. Slowly turn the walker and back up to the front passenger seat.
After adjusting the passenger seat back and reclined, the patient should back up to the passenger seat, hold onto a stable part of the car, place the operated leg farther forward than the un-operated leg, and slowly scoot and sit on the passenger seat.
A, C and B – These steps are not appropriate as they do not adhere to post-surgical total hip precautions.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD: Walters Kluwer, p 630.
B. Slowly turn the walker and back up to the front passenger seat.
After adjusting the passenger seat back and reclined, the patient should back up to the passenger seat, hold onto a stable part of the car, place the operated leg farther forward than the un-operated leg, and slowly scoot and sit on the passenger seat.
A, C and B – These steps are not appropriate as they do not adhere to post-surgical total hip precautions.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD: Walters Kluwer, p 630.
A OTR® is training a caregiver on how to assist a 27-year-old patient who recently sustained a complete C6 spinal cord injury. The focus of the training is currently on bed to wheelchair transfers, using a sliding board. The OTR® is working with the caregiver and the patient at the patient’s home, where the patient has an adjustable bed with bed rails. What part of the transfer sequence will the patient MOST LIKELY have the ability to perform without assistance ?
D. The patient will be able to lock their elbows while rocking slightly forward and side to side as the caregiver places the board underneath their hips.
The patient has possible movements of scapular protraction, some horizontal adduction, forearm supination, and radial wrist extension. Gravity-assisted movements of the trunk while locking the arms by passively extending the elbows allows the patient to slide along the board, as long as the caregiver supports the hips and holds the board. When triceps function is impaired, a technique used by C6 SCI patients is to externally rotate the shoulders and lock their elbows in extension.
A. This requires the ability to sit upright unsupported while managing both lower extremities with the arms.
B. This requires the ability to use the triceps in order to perform depression transfers.
C. This requires the ability to use one’s fingers to manipulate power controls.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 544-547.
Pass the OT Module 4 Study Materials
D. The patient will be able to lock their elbows while rocking slightly forward and side to side as the caregiver places the board underneath their hips.
The patient has possible movements of scapular protraction, some horizontal adduction, forearm supination, and radial wrist extension. Gravity-assisted movements of the trunk while locking the arms by passively extending the elbows allows the patient to slide along the board, as long as the caregiver supports the hips and holds the board. When triceps function is impaired, a technique used by C6 SCI patients is to externally rotate the shoulders and lock their elbows in extension.
A. This requires the ability to sit upright unsupported while managing both lower extremities with the arms.
B. This requires the ability to use the triceps in order to perform depression transfers.
C. This requires the ability to use one’s fingers to manipulate power controls.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 544-547.
Pass the OT Module 4 Study Materials
Terence, a 22-year-old college student with a C7 quadriplegia, is being seen by an OTR® in an outpatient rehabilitation facility. He has fair to good muscle strength in his deltoids, shoulder rotators, and wrist extensors, and reasonable sitting balance. He is wheelchair-dependent for mobility. Terence states that when dressing, his toes tend to become caught in his pants, which affects his time management and he then has to rush to his appointments. What would the MOST EFFECTIVE method be, to teach Terence so that he is more efficient dressing his lower body?
B. Don socks before donning the pants.The socks would cover the toes and will slip more easily into the pant sleeves.
A. This would assist in donning the pants once it is thread. However, at the threading step of the process is where the patient is having the most trouble.
C. The patient would continue to make time to coordinate the use of the reacher to manage the pants over the toes, but overall, it would require an additional step to return to supine to roll side-to-side to complete dressing.
D. This method would require the patient to transfer back into bed to complete dressing adding more time and additional steps to the task.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, pp 269.
B. Don socks before donning the pants.The socks would cover the toes and will slip more easily into the pant sleeves.
A. This would assist in donning the pants once it is thread. However, at the threading step of the process is where the patient is having the most trouble.
C. The patient would continue to make time to coordinate the use of the reacher to manage the pants over the toes, but overall, it would require an additional step to return to supine to roll side-to-side to complete dressing.
D. This method would require the patient to transfer back into bed to complete dressing adding more time and additional steps to the task.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, pp 269.
A patient who had an anterolateral right total hip replacement, 10 days ago, is working with an OT practitioner with the goal of reinforcing post-op hip precautions. The patient is using a front-wheeled walker to assist him with his mobility. During a hot meal preparation, the patient requires moderate verbal cues to ensure that he adheres to his hip precautions by using proper body mechanics. Which task would MOST likely result in the patient not adhering to the prescribed precautions?
C. Transporting ingredients from the counter to the kitchen island by lunging and stepping forward onto his left leg.
In an anterolateral approach, the patient must prevent hip adduction, external rotation, and hyperextension of the operated leg.
1. No extension of the hip backward.
2. No external rotation of the hip.
3. No hip adduction.
When the patient is about to step forward and lunge onto his left leg, he is leaving his operated leg behind him, thereby, breaching his hip precautions for hyperextension. It would be best to keep the items close to his body and ambulate to the kitchen island using a walker tray.
A, B and D. These do not interfere with the hip precautions for the anterolateral approach.
Early, Mary Beth. (2013). Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, p 630.
C. Transporting ingredients from the counter to the kitchen island by lunging and stepping forward onto his left leg.
In an anterolateral approach, the patient must prevent hip adduction, external rotation, and hyperextension of the operated leg.
1. No extension of the hip backward.
2. No external rotation of the hip.
3. No hip adduction.
When the patient is about to step forward and lunge onto his left leg, he is leaving his operated leg behind him, thereby, breaching his hip precautions for hyperextension. It would be best to keep the items close to his body and ambulate to the kitchen island using a walker tray.
A, B and D. These do not interfere with the hip precautions for the anterolateral approach.
Early, Mary Beth. (2013). Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, p 630.
A 67-year-old man who has recently been diagnosed with glaucoma is receiving OT services. The patient lives independently and he has stated that he wants to continue living an independent life in his own home. In his spare time, he directs a choir at his local church, usually twice a week. His ability to read the music book while on the podium has, however, become very difficult for him due to the reflective glare from the glossy pages of the music book. Which adaptation would be MOST BENEFICIAL for helping him cope with his visual difficulties, while supporting his participation in his preferred leisure activity?
B. Direct a lamp from behind the patient’s shoulders while he is reading the music from matte sheet music paper. Glare is light directed to the eyes, either coming from the top or the sides. Flooding the light from the back of the person will reduce glare and make reading easier.
Glare is caused by the reflection of light off of surfaces. You can reduce glare by controlling the light source, adapting the surface reflecting it, or by filtering it before it reaches your eyes.
1. Adjust the Light Source
Direct light causes the most glare. Use a desk lamp for directed, diffused task lighting when needed instead of bright overhead light.
2. Adjust the Surface
Shininess is measured by reflection and glare. That means the duller the surface, the less glare there will be. Use work surfaces that have matte finishes.
3. Shield Your Eyes
If you cannot eliminate the glare, then stop it before it gets to your eyes. Polarized lenses on sunglasses eliminate a lot of glare. Prescription lenses can be polarized as well.
Adams, Chris. “How to Reduce and Eliminate Glare and Eyestrain.” ThoughtCo, Aug. 26, 2020, thoughtco.com/reduce-and-eliminate-glare-1206483.
Padilla, René L., Byers-Connon, Sue.Lohman, Helene. (Eds.) (2012) Occupational therapy with elders: Strategies for the COTA Maryland Heights, MO : Elsevier/Mosby, (p 207).
B. Direct a lamp from behind the patient’s shoulders while he is reading the music from matte sheet music paper. Glare is light directed to the eyes, either coming from the top or the sides. Flooding the light from the back of the person will reduce glare and make reading easier.
Glare is caused by the reflection of light off of surfaces. You can reduce glare by controlling the light source, adapting the surface reflecting it, or by filtering it before it reaches your eyes.
1. Adjust the Light Source
Direct light causes the most glare. Use a desk lamp for directed, diffused task lighting when needed instead of bright overhead light.
2. Adjust the Surface
Shininess is measured by reflection and glare. That means the duller the surface, the less glare there will be. Use work surfaces that have matte finishes.
3. Shield Your Eyes
If you cannot eliminate the glare, then stop it before it gets to your eyes. Polarized lenses on sunglasses eliminate a lot of glare. Prescription lenses can be polarized as well.
Adams, Chris. “How to Reduce and Eliminate Glare and Eyestrain.” ThoughtCo, Aug. 26, 2020, thoughtco.com/reduce-and-eliminate-glare-1206483.
Padilla, René L., Byers-Connon, Sue.Lohman, Helene. (Eds.) (2012) Occupational therapy with elders: Strategies for the COTA Maryland Heights, MO : Elsevier/Mosby, (p 207).
A patient with a C3 SCI is being evaluated for a wheelchair. The patient has stated that he wants to regain as much of his independence as possible. Which type of wheelchair is the MOST appropriate for this patient to enable him to achieve his goal?
B. Power wheelchair equipped with portable respirator with chin or breath controls.
A patient with spinal cord injury at C3 is totally dependent, respirator dependent, can instruct others in preferences for care, can chew and swallow, can propel power wheelchair equipped with portable respirator with chin or breath controls, can communicate with mouth stick, and has neck control.
B. Power wheelchair equipped with portable respirator with chin or breath controls.
A patient with spinal cord injury at C3 is totally dependent, respirator dependent, can instruct others in preferences for care, can chew and swallow, can propel power wheelchair equipped with portable respirator with chin or breath controls, can communicate with mouth stick, and has neck control.
An OTR® has received a referral to evaluate a patient with an acute SCI. While reviewing the patient’s medical chart, the OTR® reads that the patient has scored a grade C on the ASIA scale. What information does this ASIA grade indicate?
B. Incomplete SCI- Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3.
Grade C- The impairment is incomplete. Motor function is preserved below the neurologic level, but more than half of the key muscles below the neurologic level have a muscle grade less than 3 (i.e., they are not strong enough to move against gravity).
ASAI scale- A standard method of assessing the neurologic status of a person who has sustained a spinal cord injury.
A: Complete: No motor or sensory function is preserved in the sacral segments S4-S5.
B: Incomplete: Sensory, but not motor function, is preserved below the neurologic level and includes the sacral segments S4-S5.
C: Incomplete: Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3.
D: Incomplete: Motor function is preserved below the neurologic level, and at least half of the key muscles below the neurologic level have a muscle grade of 3 or more.
E: Normal: motor and sensory function are normal.
B. Incomplete SCI- Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3.
Grade C- The impairment is incomplete. Motor function is preserved below the neurologic level, but more than half of the key muscles below the neurologic level have a muscle grade less than 3 (i.e., they are not strong enough to move against gravity).
ASAI scale- A standard method of assessing the neurologic status of a person who has sustained a spinal cord injury.
A: Complete: No motor or sensory function is preserved in the sacral segments S4-S5.
B: Incomplete: Sensory, but not motor function, is preserved below the neurologic level and includes the sacral segments S4-S5.
C: Incomplete: Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3.
D: Incomplete: Motor function is preserved below the neurologic level, and at least half of the key muscles below the neurologic level have a muscle grade of 3 or more.
E: Normal: motor and sensory function are normal.
An OT practitioner is educating a patient who has recently undergone a total hip arthroplasty how to transfer to and from a chair while adhering to their post-op hip precautions. What is the BEST method to teach the patient to use when sitting down from a standing position?
B. Back up to the chair, extend the operated leg forward, reach back for the armrests and slowly lower to the sitting position.
A firmly based chair with armrests is recommended. To move from standing to sitting, the patient is instructed to back up to the chair, extend the operated leg forward, reach back for the armrests, and slowly lower to the sitting position. For the person with a posterolateral approach, care should be taken not to lean forward when sitting down. To stand, the patient extends the operated leg and pushes up from the armrests. Once standing, the patient can reach for an ambulatory aid, such as a walker if it is being used. Because of the hip flexion precaution for the posterolateral approach, the patient should sit on the front part of the chair and lean back. Firm cushions or blankets may be used to increase the height of chair seats and may be especially helpful if the patient is tall. Low chairs, soft chairs, reclining chairs, and rocking chairs should be avoided.
Please note: The goal is to teach the patient how to adhere to their post-op precautions. This includes using terminology that the patient can understand. The term extend the leg forward refers to the entire leg, including the knee joint. The word forward means in front of you and the word extend means straighten. It would be extremely confusing to use the technical terminology of flex your hip less than 90 degrees while keeping your knee extended.
General post-op rules for patients:
• Never cross your legs or ankle on sitting, standing, or lying down
• Avoid bending your leg greater than 90 degrees
• When sitting or standing from a chair, bed, or toilet you must extend your operated leg in front of you.
Pendleton, Heidi McHugh; Schultz-Krohn, Winifred. Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1084). Elsevier Health Sciences. Kindle Edition.
B. Back up to the chair, extend the operated leg forward, reach back for the armrests and slowly lower to the sitting position.
A firmly based chair with armrests is recommended. To move from standing to sitting, the patient is instructed to back up to the chair, extend the operated leg forward, reach back for the armrests, and slowly lower to the sitting position. For the person with a posterolateral approach, care should be taken not to lean forward when sitting down. To stand, the patient extends the operated leg and pushes up from the armrests. Once standing, the patient can reach for an ambulatory aid, such as a walker if it is being used. Because of the hip flexion precaution for the posterolateral approach, the patient should sit on the front part of the chair and lean back. Firm cushions or blankets may be used to increase the height of chair seats and may be especially helpful if the patient is tall. Low chairs, soft chairs, reclining chairs, and rocking chairs should be avoided.
Please note: The goal is to teach the patient how to adhere to their post-op precautions. This includes using terminology that the patient can understand. The term extend the leg forward refers to the entire leg, including the knee joint. The word forward means in front of you and the word extend means straighten. It would be extremely confusing to use the technical terminology of flex your hip less than 90 degrees while keeping your knee extended.
General post-op rules for patients:
• Never cross your legs or ankle on sitting, standing, or lying down
• Avoid bending your leg greater than 90 degrees
• When sitting or standing from a chair, bed, or toilet you must extend your operated leg in front of you.
Pendleton, Heidi McHugh; Schultz-Krohn, Winifred. Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1084). Elsevier Health Sciences. Kindle Edition.
Ken is a 56-year-old patient who 8 months ago, had to have a left above-knee-amputation due to peripheral vascular disease which developed as a secondary complication to advanced kidney failure. Fitting Ken for a prosthesis has not been possible at this time as he has had recurring infections of his stump which has necessitated frequent hospital admissions for intravenous antibiotic treatment. Ken is receiving dialysis 3 days per week, which has resulted in hemodialysis-related fatigue. Ken’s wife is acting as his caregiver and has been assisting him with minimal assistance for stand-pivot transfers. However, she is concerned about keeping Ken safe with transfers, especially on the days he has dialysis. What should the OTR® do NEXT in response to the wife’s concern?
C. Work on caregiver training with sliding board transfers to both sides, with emphasis on transferring to the patient’s stronger side.
It is best to learn to transfer in both directions as the patient must learn how to get on and off the transfer surface in both directions when using the slide board method. It is common for patients on dialysis to experience generalized fatigue. Emphasizing transferring to the stronger side is the NEXT step to compensate for fatigue. By having the wife and patient work together on a safe back-up plan to maximize independence in using the toilet and shower for ADL needs, the patient will be able to continue performing tasks even when he is most weak.
A. At this time, maximizing independence while maintaining the patient’s locus of control with the use of an alternate transfer method does not necessitate the need for additional assistance. It is also expected that he will be getting a prosthesis which may reduce the need for additional assistance.
B. This option would not be the next step.
D. This is contraindicated on days when the patient is expected to become fatigued with activity.
Early, Mary Beth. (2013). Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, p 313.
C. Work on caregiver training with sliding board transfers to both sides, with emphasis on transferring to the patient’s stronger side.
It is best to learn to transfer in both directions as the patient must learn how to get on and off the transfer surface in both directions when using the slide board method. It is common for patients on dialysis to experience generalized fatigue. Emphasizing transferring to the stronger side is the NEXT step to compensate for fatigue. By having the wife and patient work together on a safe back-up plan to maximize independence in using the toilet and shower for ADL needs, the patient will be able to continue performing tasks even when he is most weak.
A. At this time, maximizing independence while maintaining the patient’s locus of control with the use of an alternate transfer method does not necessitate the need for additional assistance. It is also expected that he will be getting a prosthesis which may reduce the need for additional assistance.
B. This option would not be the next step.
D. This is contraindicated on days when the patient is expected to become fatigued with activity.
Early, Mary Beth. (2013). Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, p 313.
Judyth is a 58-year-old woman who has been diagnosed with NPDR- non-proliferative diabetic retinopathy (early stage). At this stage, her only symptoms are occasional bouts of blurry vision. What home modifications should the OTR® recommend at this stage of Judyth’s OT intervention?
D. Help Judyth clear the clutter from her main hallway.
<NPDR (non-proliferative diabetic retinopathy). This is the early stage of diabetic eye disease.
Diabetic Retinopathy Symptoms. A patient can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, the patient will notice symptoms such as: seeing an increasing number of floaters, having blurry vision, having vision that changes sometimes from blurry to clear, seeing blank or dark areas in their visual field, having poor night vision, noticing colors appear faded or washed out, and losing vision. Diabetic retinopathy symptoms usually affect both eyes. Since Judyth is in the early stages of visual impairment, she still has some functional vision and may be able to get by for a while with some easy, low cost modifications. The OTR® could help by repositioning items, such as Judyth’s television set, to reduce glare and helping to clear clutter from high traffic areas, such as Judyth’s hallway. She could also increase contrast in areas that might pose a safety hazard, such as placing black tape on Judyth’s light colored entry steps to help Judyth see the edges of the steps. Judyth’s vision is not impaired to the point of needing low vision lighting or an audio clock, both of which would cost her some money. Judyth is not yet blind and has most likely not been educated in Braille, so Braille labels would not be helpful to her.
D. Help Judyth clear the clutter from her main hallway.
<NPDR (non-proliferative diabetic retinopathy). This is the early stage of diabetic eye disease.
Diabetic Retinopathy Symptoms. A patient can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, the patient will notice symptoms such as: seeing an increasing number of floaters, having blurry vision, having vision that changes sometimes from blurry to clear, seeing blank or dark areas in their visual field, having poor night vision, noticing colors appear faded or washed out, and losing vision. Diabetic retinopathy symptoms usually affect both eyes. Since Judyth is in the early stages of visual impairment, she still has some functional vision and may be able to get by for a while with some easy, low cost modifications. The OTR® could help by repositioning items, such as Judyth’s television set, to reduce glare and helping to clear clutter from high traffic areas, such as Judyth’s hallway. She could also increase contrast in areas that might pose a safety hazard, such as placing black tape on Judyth’s light colored entry steps to help Judyth see the edges of the steps. Judyth’s vision is not impaired to the point of needing low vision lighting or an audio clock, both of which would cost her some money. Judyth is not yet blind and has most likely not been educated in Braille, so Braille labels would not be helpful to her.
An OT practitioner is working with a patient who has moderate cognitive decline secondary to Alzheimer’s disease. The patient lives with his adult daughter and her family in a single story house. The patient is mostly independent in his ADLs but requires assistance for all IADLs. Over the past month, the patient has demonstrated a decrease in function and his daughter is concerned for her father’s safety in the home. She states that: “Dad seems to wander more and has been more and more confused when he wakes up.” What recommendation is the MOST appropriate at this stage, to promote patient safety in the home?
B. Disguise exits with drapes and conceal door knobs to discourage wandering outside the home.
By disguising exits and concealing door knobs, the patient’s daughter will be able to discourage her father from wandering without causing him harm or frustration.
A. This will result in the patient becoming frustrated and agitated and there is also the risk of the patient locking himself or others inside or out of the house.
C. Installing baby gates is not the MOST appropriate way to reduce wandering as they can be a safety hazard by causing the patient to trip and fall if he tries to climb over them.
D. This does not address safety in the home. It is unrealistic to assume the daughter will be available to consistently perform reality orientation techniques and it may actually contribute to caregiver burnout. In addition, reality orientation for individuals with moderate cognitive decline is not best practice.
B. Disguise exits with drapes and conceal door knobs to discourage wandering outside the home.
By disguising exits and concealing door knobs, the patient’s daughter will be able to discourage her father from wandering without causing him harm or frustration.
A. This will result in the patient becoming frustrated and agitated and there is also the risk of the patient locking himself or others inside or out of the house.
C. Installing baby gates is not the MOST appropriate way to reduce wandering as they can be a safety hazard by causing the patient to trip and fall if he tries to climb over them.
D. This does not address safety in the home. It is unrealistic to assume the daughter will be available to consistently perform reality orientation techniques and it may actually contribute to caregiver burnout. In addition, reality orientation for individuals with moderate cognitive decline is not best practice.
Following an above-knee amputation, what should be addressed FIRST when working with a 57-year-old diabetic patient who has impaired sensation in their residual lower limb?
A. Skin inspection. The first thing that should be addressed with a patient who recently had an amputation is a skin inspection. Being diabetic and having impaired sensation makes skin inspection even more crucial for this patient because skin breakdown could lead to another amputation. Skin inspection should be an immediate precaution that needs to be assessed before beginning intervention. If there is any skin breakdown, steps need to be taken to ensure that intervention strategies won’t further compromise skin integrity.
A. Skin inspection. The first thing that should be addressed with a patient who recently had an amputation is a skin inspection. Being diabetic and having impaired sensation makes skin inspection even more crucial for this patient because skin breakdown could lead to another amputation. Skin inspection should be an immediate precaution that needs to be assessed before beginning intervention. If there is any skin breakdown, steps need to be taken to ensure that intervention strategies won’t further compromise skin integrity.
An OTR® is working with a patient with a diagnosis of generalized weakness. The OTR® wants to use a top down approach to address the patient’s difficulty holding onto eating utensils during meals. Which intervention reflects a top down approach?
C. Providing lightweight, built-up handle utensils. A top down approach uses compensatory techniques to maximize existing skills and adapt activities to allow independence. Providing adaptive utensils so the woman has an easier time holding them reflects this type of approach.
C. Providing lightweight, built-up handle utensils. A top down approach uses compensatory techniques to maximize existing skills and adapt activities to allow independence. Providing adaptive utensils so the woman has an easier time holding them reflects this type of approach.
Gerald, a 67-year-old farmer, who has Stage 4 lung cancer and is undergoing chemotherapy, presents with chronic pain, fatigue and dyspnea. He has lost interest in most things and he is becoming less involved in everyday activities. His family is supportive and willing to assist him as much as they are able to. As part of a palliative care team, the OT’s goal is to maximize Gerald’s independence in his ADLs and simple IADLs, with an emphasis on maintaining his quality of life. What is the most relevant information the OT should provide the family during caregiver education to enhance Gerald’s quality of life, at this stage in his disease process? Choose the 3 best answers
A. Reduce isolation by maintaining the patient’s ability to engage in his social context.
D. Adjust daily routines according to the patient’s tolerance and allow for breaks.
F. The potential side effects of chemotherapy.
The focus is not on rehabilitation. Instead, it is on enabling and supporting a patient to do as much as he can, while he can. Maintain out-of-bed activity as much as the person can tolerate as it supports strength, balance, and mobility, key points in preventing falls. Education of the disease process and secondary effects of treatment is also important.
B. A person’s intrinsic motivation – interest, enjoyment, and values do not change – however, roles may be abandoned due to weakness, fatigue, concentration and focus. Roles and responsibilities may affect family dynamics as members may have to resume tasks that the patient has assumed in the past.
C. Although it is unlikely visual-perceptual changes may occur, sensory changes may occur as a side-effect of chemotherapy.
E. A significant and drastic modification of the environment is not necessary as simplification of work and load will be less disruptive to the household arrangement without causing major hardships.
Bognot, K. (2018). Reflections of a new grad’s first year of employment in the hospice setting. OT Practice, 23(17), 17–19.
Trump, S.; Zahuranski, M.; and Siebert, C. (2005): Occupational Therapy and Hospice. American Occupational Therapy Association, Inc. (Vol 59, No 6), p 672.
A. Reduce isolation by maintaining the patient’s ability to engage in his social context.
D. Adjust daily routines according to the patient’s tolerance and allow for breaks.
F. The potential side effects of chemotherapy.
The focus is not on rehabilitation. Instead, it is on enabling and supporting a patient to do as much as he can, while he can. Maintain out-of-bed activity as much as the person can tolerate as it supports strength, balance, and mobility, key points in preventing falls. Education of the disease process and secondary effects of treatment is also important.
B. A person’s intrinsic motivation – interest, enjoyment, and values do not change – however, roles may be abandoned due to weakness, fatigue, concentration and focus. Roles and responsibilities may affect family dynamics as members may have to resume tasks that the patient has assumed in the past.
C. Although it is unlikely visual-perceptual changes may occur, sensory changes may occur as a side-effect of chemotherapy.
E. A significant and drastic modification of the environment is not necessary as simplification of work and load will be less disruptive to the household arrangement without causing major hardships.
Bognot, K. (2018). Reflections of a new grad’s first year of employment in the hospice setting. OT Practice, 23(17), 17–19.
Trump, S.; Zahuranski, M.; and Siebert, C. (2005): Occupational Therapy and Hospice. American Occupational Therapy Association, Inc. (Vol 59, No 6), p 672.
Which Rancho Los Amigos Level would you assign to a patient who is able remember the main theme of stories but confuses the details and who can pay attention for about 30 minutes unless the environment or complexity of the task distract them?
A. Level VI.
Also, this patient will believe he will be fine once he leaves the hospital (Mod. Assistance) Tx: Repeat things, requires encouragement for initiation and continuation of activities.
A. Level VI.
Also, this patient will believe he will be fine once he leaves the hospital (Mod. Assistance) Tx: Repeat things, requires encouragement for initiation and continuation of activities.
Carol, a 58-year-old housewife who recently sustained a mild TBI, has been admitted to a rehabilitation facility. She is currently working with a OTR® and the focus of the session is on identifying the components of ADL tasks using card sorting exercises. Once Carol is able to achieve this, the OTR® asks her to separate clothing into 2 piles of light colors and dark colors, before washing the clothing. What approach is the OTR® using in this scenario?
D. A transfer-of-training approach using the skill of categorization.
Categorization is chunking information or placing it in groups. It is a part of thought functions that relies on the person’s past experiences by identifying something they have seen or encountered in the past. After working on a tabletop activity such as sorting pictures to identify parts of a task, the patient “transfers” this skill to real-life situations to improve or restore cognitive skills. A transfer-of-training approach promotes engagement in tasks that will enhance recovery from a brain injury.
A. This task is working on a specific cognitive deficit area, specifically thought functions, not visual perceptual problems.
B. Working on compensating for expressive aphasia is not a goal in this task.
C. Deficit of inattention is not observed in this task
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 451-455.
D. A transfer-of-training approach using the skill of categorization.
Categorization is chunking information or placing it in groups. It is a part of thought functions that relies on the person’s past experiences by identifying something they have seen or encountered in the past. After working on a tabletop activity such as sorting pictures to identify parts of a task, the patient “transfers” this skill to real-life situations to improve or restore cognitive skills. A transfer-of-training approach promotes engagement in tasks that will enhance recovery from a brain injury.
A. This task is working on a specific cognitive deficit area, specifically thought functions, not visual perceptual problems.
B. Working on compensating for expressive aphasia is not a goal in this task.
C. Deficit of inattention is not observed in this task
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 451-455.
4 months ago, a 35-year-old patient was involved in a MVA which resulted in his spinal cord being completely severed. The focus of his OT intervention has been on strengthening his wrist so that he can have the opportunity to actively participate in his dressing tasks, at home. The patient however has very weak wrist extensors and requires the assistance of a tenodesis splint. What level of spinal cord injury does this patient most likely have?
B. C6 SCI.
A patient with a C6 injury typically has head, neck, shoulder, arm and wrist movement. He can shrug his shoulders, bend is elbows, pronate/supinate his forearms, and extend his wrists. A Tenodesis Splint is an ideal splint for a C6 quadriplegic patient or anyone with wrist extension strength but no finger strength. As the patient is able to achieve wrist extension, he can utilize the tenodesis grasp pattern. The tenodesis grasp is the natural flexion of the fingers when the wrist is extended, and extension of the fingers with wrist flexion. This natural movement pattern allows the patient to grasp an object. Although this movement is present, it is often weak and may need to be supported with a tenodesis splint. This splint stabilizes the thumb and holds the fingers in slight flexion. When the wrist is extended, the static line attached to the wrist cuff pulls the finger MP joints into flexion, creating a fingertip pinch ability and gross grasp ability. Some tenodesis splints are simple and provide just enough support to enhance the natural movement of the hand while others may be more elaborate with moving parts to provide increased grip strength.
A. At this level, the patient would have no voluntary wrist and hand movement.
C. At this level the patient would have intact hand function. Only his lower limbs would be affected/paralysed.
D. From T1, hand function is fully intact.
B. C6 SCI.
A patient with a C6 injury typically has head, neck, shoulder, arm and wrist movement. He can shrug his shoulders, bend is elbows, pronate/supinate his forearms, and extend his wrists. A Tenodesis Splint is an ideal splint for a C6 quadriplegic patient or anyone with wrist extension strength but no finger strength. As the patient is able to achieve wrist extension, he can utilize the tenodesis grasp pattern. The tenodesis grasp is the natural flexion of the fingers when the wrist is extended, and extension of the fingers with wrist flexion. This natural movement pattern allows the patient to grasp an object. Although this movement is present, it is often weak and may need to be supported with a tenodesis splint. This splint stabilizes the thumb and holds the fingers in slight flexion. When the wrist is extended, the static line attached to the wrist cuff pulls the finger MP joints into flexion, creating a fingertip pinch ability and gross grasp ability. Some tenodesis splints are simple and provide just enough support to enhance the natural movement of the hand while others may be more elaborate with moving parts to provide increased grip strength.
A. At this level, the patient would have no voluntary wrist and hand movement.
C. At this level the patient would have intact hand function. Only his lower limbs would be affected/paralysed.
D. From T1, hand function is fully intact.
An OT is treating a patient with a C7 spinal cord injury after a recent motorcycle accident. The OT must help the patient get out of bed, but his blood pressure is too low and he becomes dizzy when he sits up. Which of the following interventions would be the LEAST effective method for elevating the patient’s blood pressure?
Massage the calf muscles. In order to elevate the patient’s blood pressure, the OT should use a more effective method such as placing an abdominal binder, wrapping the patient’s legs with ace bandages, or applying compression stockings. Massage alone will not be enough to raise the patient’s blood pressure.
Massage the calf muscles. In order to elevate the patient’s blood pressure, the OT should use a more effective method such as placing an abdominal binder, wrapping the patient’s legs with ace bandages, or applying compression stockings. Massage alone will not be enough to raise the patient’s blood pressure.
A patient with a TBI takes 23 minutes to brush his hair, despite being able to pick up his hair brush, comb his hair and apply hairspray independently. In which of the following areas does this behavior MOST likely indicate difficulty?
A. Task completion. A person who has had a traumatic brain injury may get “stuck” while performing an activity and may need assistance to end the task and transition to the next task. This behavior is characteristic of Rancho Los Amigos Level V.
A. Task completion. A person who has had a traumatic brain injury may get “stuck” while performing an activity and may need assistance to end the task and transition to the next task. This behavior is characteristic of Rancho Los Amigos Level V.
A patient who recently had to have a posterior total hip arthroplasty after fracturing her right hip, when she fell at her home, is being educated on post-operative precautions. What behavior would indicate that this patient is adhering to the prescribed hip precautions?
B. Stopping at 90 degrees of hip flexion to use a sock aid.
The patient is demonstrating compliance with hip precautions if they stop at 90 degrees of hip flexion to use a sock aid.
Precautions and Contraindications post total hip replacement:
Patients are at risk of hip dislocation after replacement as a result of the trauma to the hip stabilizers of the hip (capsule, ligaments and muscles) as well as due to the size difference of the prosthesis to the bones. Reduced size of the prosthetic femur head, when compared to the average human femur head, makes it easier to dislocate until the stabilizing tissues have healed and adapted to this smaller size.
Posterior approach:
No combination of the following hip movements on the operated side:
• Flexion > 90 degrees
• Internal rotation past neutral
• Adduction past midline
• Weight bearing restrictions as per surgeon (mostly partial to full weight-bearing for 6 weeks after surgery)
Posterior Approach THA Precautions: AVOID: hip flexion, adduction, internal rotation
Anterior Approach THA Precautions: AVOID: hip extension, external rotation
B. Stopping at 90 degrees of hip flexion to use a sock aid.
The patient is demonstrating compliance with hip precautions if they stop at 90 degrees of hip flexion to use a sock aid.
Precautions and Contraindications post total hip replacement:
Patients are at risk of hip dislocation after replacement as a result of the trauma to the hip stabilizers of the hip (capsule, ligaments and muscles) as well as due to the size difference of the prosthesis to the bones. Reduced size of the prosthetic femur head, when compared to the average human femur head, makes it easier to dislocate until the stabilizing tissues have healed and adapted to this smaller size.
Posterior approach:
No combination of the following hip movements on the operated side:
• Flexion > 90 degrees
• Internal rotation past neutral
• Adduction past midline
• Weight bearing restrictions as per surgeon (mostly partial to full weight-bearing for 6 weeks after surgery)
Posterior Approach THA Precautions: AVOID: hip flexion, adduction, internal rotation
Anterior Approach THA Precautions: AVOID: hip extension, external rotation
An OT enters a patient’s room in the inpatient recovery wing of the hospital. The patient underwent a total hip arthroplasty 2 hours prior and is now lying supine in her bed. While conducting an evaluation, the OT asks the patient if she would be willing to sit up. What is the best seated position for the evaluation?
When getting a patient out of bed for the first time, a patient will sit edge of bed (EOB) first. By sitting EOB, the OT can observe the patient’s unsupported sitting balance post-surgery. A hospital bed also offers optional handrails for support and height-adjustable features for safe transfers out-of-bed. Not all patients with a total hip replacement need a wheelchair and a wheelchair has too many supports (i.e. back and arm-rests) that skew a patient’s actual ability to sit upright. Leg extenders would not be useful in this situation because the patient is in the evaluation process. A sturdy chair would place the patient in an ideal, upright position; however, a sturdy standard chair lacks adjustable height which can be risky to a patient fresh out of a total hip arthroplasty operation.
When getting a patient out of bed for the first time, a patient will sit edge of bed (EOB) first. By sitting EOB, the OT can observe the patient’s unsupported sitting balance post-surgery. A hospital bed also offers optional handrails for support and height-adjustable features for safe transfers out-of-bed. Not all patients with a total hip replacement need a wheelchair and a wheelchair has too many supports (i.e. back and arm-rests) that skew a patient’s actual ability to sit upright. Leg extenders would not be useful in this situation because the patient is in the evaluation process. A sturdy chair would place the patient in an ideal, upright position; however, a sturdy standard chair lacks adjustable height which can be risky to a patient fresh out of a total hip arthroplasty operation.
An OT has determined that a patient is functioning at Level 8 on the Rancho Los Amigos scale. For today’s session, the patient is taken on an outing to a grocery store and handed a grocery list with 5 items written on it. The patient demonstrates that she is able to read the list, but she is unable to initiate looking for any of the items on the list. The OT simplifies the task by covering the list with a piece of paper, leaving only the top item visible. The patient is then able to successfully retrieve that item from the shelf. Based on this behavior, what should the OT document about this patient’s performance in the grocery store?
C. Deficits in executive functioning interfering with performance.
Impairment of executive functions is common after brain injury. Executive functioning is an umbrella term for many cognitive abilities including: Initiating tasks, planning and organization. Difficulties with initiating the task and carrying out the sequence of steps needed to complete the task are demonstrated by this patient in this scenario.
C. Deficits in executive functioning interfering with performance.
Impairment of executive functions is common after brain injury. Executive functioning is an umbrella term for many cognitive abilities including: Initiating tasks, planning and organization. Difficulties with initiating the task and carrying out the sequence of steps needed to complete the task are demonstrated by this patient in this scenario.
At which Rancho level would you place a recent TBI patient who blinks at light, turns towards sound, responds to family members, and whose eyes follow an object?
D. Rancho level 3
Rancho level 3: Localized response = total assistance – withdrawal from painful stimuli, turns towards sound, blinks at light, eyes follow object, response to family members – moving to music
D. Rancho level 3
Rancho level 3: Localized response = total assistance – withdrawal from painful stimuli, turns towards sound, blinks at light, eyes follow object, response to family members – moving to music
A patient with a spinal cord injury at C6 is being educated on how to use a button hook and zipper pull to perform upper body dressing tasks in bed. To provide the patient with some pressure relief while performing these dressing tasks, what is the BEST approach?
A. Forward weight shifting or sitting using loops attached to the side of the bed to pull himself up.
At C6, the patient will be able to flex their elbows. At this level, patients are unable to sit up in bed independently, They can, however, use bed rails or loops attached to the side of the bed to pull themselves up.
B. SCIs at levels C1-C4 are dependent for bed mobility.
C. The question is asking about bed mobility and pressure relief in bed. Therefore, moving the patient to a chair/wheelchair is not answering the question.
D. Only at SCI C7, is a patient able to perform a wheelchair pushup for pressure relief as they have elbow extension.
A. Forward weight shifting or sitting using loops attached to the side of the bed to pull himself up.
At C6, the patient will be able to flex their elbows. At this level, patients are unable to sit up in bed independently, They can, however, use bed rails or loops attached to the side of the bed to pull themselves up.
B. SCIs at levels C1-C4 are dependent for bed mobility.
C. The question is asking about bed mobility and pressure relief in bed. Therefore, moving the patient to a chair/wheelchair is not answering the question.
D. Only at SCI C7, is a patient able to perform a wheelchair pushup for pressure relief as they have elbow extension.
An OT who is working in outpatient rehab, is assisting a patient who has been diagnosed with fibromyalgia with transferring from their wheelchair to a chair. As the OT is in the process of helping the patient with the transfer, the patient begins to fall. What is the best course of action for the OT to take NEXT?
