This week focuses on: Psychosocial Conditions & Interventions, Groups and Group Dynamics, Allen’s Cognitive Level (ACL), and Activities of Daily Living
This week focuses on: Psychosocial Conditions & Interventions, Groups and Group Dynamics, Allen’s Cognitive Level (ACL), and Activities of Daily Living
Study Materials:To streamline studying, we have highlighted our most recommended material. If you are limited on time, please review this material first.
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Mental Health Clinical Simulation
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Scenario: An OTR® working in a skilled nursing facility receives an order from a physician to evaluate a middle-aged woman who presents with generalized muscle weakness due to several physical ailments. As the OTR® is reviewing the patient’s chart, she notices that the patient has also been diagnosed with several mental health diagnoses, including borderline personality disorder and an anxiety disorder. The doctor has stated in the patient’s chart that her prognosis is guarded and her potential for returning home is fair to poor.
Section A: The OTR® has already completed the physical portions of the evaluation, including range of motion, strength, and coordination tests. Given the woman’s diagnoses, what additional tests should the OTR® attempt? Select the best 3 choices.
Rationale:This patient presents with both physical and mental health issues that will both have an impact on her ability to return home. The doctor’s statement that “the woman’s potential for returning home is fair to poor”, may be based purely on her physical condition. As the OT has assessed the patient from a physical perspective, it is important to also assess her cognitive and functional abilities as her mental health status could affect her recovery and her ability to function independently regardless of her living situation. An evaluation of the patient’s cognitive skills, ADL and general functional performance are tools which can be used to evaluate her level of functioning in these areas.
A. Allen Cognitive Levels Screening Test – a test that evaluates the patient’s ability to make decisions, function independently, safely perform basic skills, and learn new skills.
C. Klein-Bell Activities of Daily Living Scale – measures ADL independence to determine current status, change in status, & sub activities to focus on in treatment.
D. Bay Area Functional Performance Evaluation (BaFPE) – developed to assess the general functional performance of patients treated in psychiatric occupational therapy. It consists of two subtests, the Task-Oriented Assessment (TAO) and the Social Interaction Scale. TAO subtest includes evaluating – memory of instructions, organization, attention span, thought disorder, ability to abstract, task completion, motivation and compliance, frustration tolerance, self-confidence, and general affective impression.
B. Mini-Mental State Exam – a widely used test of cognitive function among the elderly; it includes tests of orientation, attention, memory, language. In many settings, it is not an accepted assessment for standardized testing. E.and F. Competency Rating Scale – self-report instrument asks the patient to rate his/her degree of difficulty in a variety of tasks and functions. Occupational Self-Assessment – measures a patient’s perspective on their competence of occupational tasks, the value the patient places on performing each task, and how the environment impacts occupational competence. Both these tests are subjective. Using objective assessments is more reliable, especially when a patient may have a lack of insight or may be manipulative( symptom of personality disorder).
Rationale:This patient presents with both physical and mental health issues that will both have an impact on her ability to return home. The doctor’s statement that “the woman’s potential for returning home is fair to poor”, may be based purely on her physical condition. As the OT has assessed the patient from a physical perspective, it is important to also assess her cognitive and functional abilities as her mental health status could affect her recovery and her ability to function independently regardless of her living situation. An evaluation of the patient’s cognitive skills, ADL and general functional performance are tools which can be used to evaluate her level of functioning in these areas.
A. Allen Cognitive Levels Screening Test – a test that evaluates the patient’s ability to make decisions, function independently, safely perform basic skills, and learn new skills.
C. Klein-Bell Activities of Daily Living Scale – measures ADL independence to determine current status, change in status, & sub activities to focus on in treatment.
D. Bay Area Functional Performance Evaluation (BaFPE) – developed to assess the general functional performance of patients treated in psychiatric occupational therapy. It consists of two subtests, the Task-Oriented Assessment (TAO) and the Social Interaction Scale. TAO subtest includes evaluating – memory of instructions, organization, attention span, thought disorder, ability to abstract, task completion, motivation and compliance, frustration tolerance, self-confidence, and general affective impression.
B. Mini-Mental State Exam – a widely used test of cognitive function among the elderly; it includes tests of orientation, attention, memory, language. In many settings, it is not an accepted assessment for standardized testing. E.and F. Competency Rating Scale – self-report instrument asks the patient to rate his/her degree of difficulty in a variety of tasks and functions. Occupational Self-Assessment – measures a patient’s perspective on their competence of occupational tasks, the value the patient places on performing each task, and how the environment impacts occupational competence. Both these tests are subjective. Using objective assessments is more reliable, especially when a patient may have a lack of insight or may be manipulative( symptom of personality disorder).
Scenario: An OTR® working in a skilled nursing facility receives an order from a physician to evaluate a middle-aged woman who presents with generalized muscle weakness due to several physical ailments. As the OTR® is reviewing the patient’s chart, she notices that the patient has also been diagnosed with several mental health diagnoses, including borderline personality disorder and an anxiety disorder. The doctor has stated in the patient’s chart that her prognosis is guarded and her potential for returning home is fair to poor.
Section B: At a later stage, the OTR® is informed by the social worker that the plan is for the woman to become a permanent resident of the skilled nursing facility’s long term care unit. How should the OTR® proceed when developing the woman’s OT intervention treatment plan? Select the best 3 choices.
Rationale: Even though the woman will be staying at the facility long term, she should still be encouraged to be as independent as possible. Addressing overall strength and endurance, ADL skills, functional mobility and leisure skills will help to ensure that the woman is as active as she can be. Adaptations for cognitive skills will help the woman to complete self-care tasks and participate in activities within the facility. Addressing the woman’s new role as a resident of a nursing home and teaching her coping skills related to that new role can be incorporated into treatment but should not be addressed as a specific goal as this overlaps with goals addressed by the social worker. The OTR® should collaborate with the social worker when addressing this area.
Rationale: Even though the woman will be staying at the facility long term, she should still be encouraged to be as independent as possible. Addressing overall strength and endurance, ADL skills, functional mobility and leisure skills will help to ensure that the woman is as active as she can be. Adaptations for cognitive skills will help the woman to complete self-care tasks and participate in activities within the facility. Addressing the woman’s new role as a resident of a nursing home and teaching her coping skills related to that new role can be incorporated into treatment but should not be addressed as a specific goal as this overlaps with goals addressed by the social worker. The OTR® should collaborate with the social worker when addressing this area.
Scenario: An OTR® working in a skilled nursing facility receives an order from a physician to evaluate a middle-aged woman who presents with generalized muscle weakness due to several physical ailments. As the OTR® is reviewing the patient’s chart, she notices that the patient has also been diagnosed with several mental health diagnoses, including borderline personality disorder and an anxiety disorder. The doctor has stated in the patient’s chart that her prognosis is guarded and her potential for returning home is fair to poor.
Section C: An occupational therapy student is working with the OTR® to provide treatment to the woman. The student notices that the woman is constantly talking about how wonderful physical therapy is and the student asks the OTR® if there is anything she can do to make OT more pleasant for the woman. How should the OTR® respond, in this situation? Select the best 3 choices.
Rationale: People with borderline personality disorder often make statements or take actions that will result in friction between other people. In health care settings, they frequently “play people against each other”, resulting in conflict. Since the student has not had experience dealing with this type of behavior, the OTR® should discuss borderline personality with the student and give her some strategies to use to deal with the woman’s behavior. The strategies will be most effective if all staff members use them and interact with the woman in a consistent manner, so the OTR® should also collaborate with physical therapy to address the woman’s behavior. The behavior can be directly addressed with the woman, but this is not likely to result in a lasting solution as the woman will probably resume her behavior in some other way. The student should be allowed to provide treatment to the woman so that she can learn how to handle this type of behavior.
Rationale: People with borderline personality disorder often make statements or take actions that will result in friction between other people. In health care settings, they frequently “play people against each other”, resulting in conflict. Since the student has not had experience dealing with this type of behavior, the OTR® should discuss borderline personality with the student and give her some strategies to use to deal with the woman’s behavior. The strategies will be most effective if all staff members use them and interact with the woman in a consistent manner, so the OTR® should also collaborate with physical therapy to address the woman’s behavior. The behavior can be directly addressed with the woman, but this is not likely to result in a lasting solution as the woman will probably resume her behavior in some other way. The student should be allowed to provide treatment to the woman so that she can learn how to handle this type of behavior.
Scenario: An OTR® working in a skilled nursing facility receives an order from a physician to evaluate a middle-aged woman who presents with generalized muscle weakness due to several physical ailments. As the OTR® is reviewing the patient’s chart, she notices that the patient has also been diagnosed with several mental health diagnoses, including borderline personality disorder and an anxiety disorder. The doctor has stated in the patient’s chart that her prognosis is guarded and her potential for returning home is fair to poor.
Section D: During the woman’s care plan meeting, an argument between the nurse case manager and the dietician occurs regarding the woman’s meals. After the meeting, the occupational therapy student discusses the situation with the OTR® and states that she feels the argument occurred because the woman has been manipulating staff due to her borderline personality disorder. How should the OTR® respond to the student’s observation? Select the best 3 choices.
Rationale: Even if facility staff are familiar with borderline personality disorder, they sometimes become wrapped up in the dysfunctional social situation that the patient creates. Reminding staff members of the nature of borderline personality disorder and the potential for these situations to happen can help prevent their occurrence. The student was very observant in identifying the problem behind the conflict between the nurse case manager and the dietician and she should be praised for her observation. The OTR® should help the student learn how to deal with this type of conflict by working with her to meet with the staff members involved and discuss the problem, as well as to work out a plan with other staff members to manage the woman’s behavior. The OTR® should be present during any efforts of the student to address the situation. If the OTR® addresses the situation without the student present, the student will not learn how to address the problem with other staff and will not see the outcome of her efforts, so the student should be involved in the process.
Rationale: Even if facility staff are familiar with borderline personality disorder, they sometimes become wrapped up in the dysfunctional social situation that the patient creates. Reminding staff members of the nature of borderline personality disorder and the potential for these situations to happen can help prevent their occurrence. The student was very observant in identifying the problem behind the conflict between the nurse case manager and the dietician and she should be praised for her observation. The OTR® should help the student learn how to deal with this type of conflict by working with her to meet with the staff members involved and discuss the problem, as well as to work out a plan with other staff members to manage the woman’s behavior. The OTR® should be present during any efforts of the student to address the situation. If the OTR® addresses the situation without the student present, the student will not learn how to address the problem with other staff and will not see the outcome of her efforts, so the student should be involved in the process.
Scenario: An OTR® working in a community mental health setting receives an order to evaluate and treat a 44 year old woman for independent living skills. Through chart review, the OTR® learns that the woman has a dual diagnosis of schizoaffective disorder and cognitive deficits. The woman lives in a rented home with her four daughters who range in age from 17 to 10. She is not married and does not have a boyfriend at the time that the OTR® begins services.
Section A: Through interview with the woman and her case manager, the OTR® determines that the woman displays deficits in the areas of cooking and meal planning, money management, time management, and problem solving regarding parenting her daughters. Based on these deficits, what additional tests should the OTR® administer? Select the best 3 choices.
Rationale: The woman has a diagnosis of cognitive deficits, so evaluating her cognitive status using the Allen Cognitive Levels Screening Test is appropriate. The COPM will provide a comprehensive picture of the woman’s functional abilities. The KELS could also be used to pinpoint more specific skills. The Rabideau Kitchen Evaluation has a normative base of people who have suffered traumatic brain injury, so this test is not appropriate in this situation. The Klein-Bell ADL Scale only addresses basic self-care tasks, and chart review has revealed that the woman is independent with these activities. Since the woman has a dual diagnosis, she may not be the most reliable source for information, so informal interview alone is not sufficient.
Rationale: The woman has a diagnosis of cognitive deficits, so evaluating her cognitive status using the Allen Cognitive Levels Screening Test is appropriate. The COPM will provide a comprehensive picture of the woman’s functional abilities. The KELS could also be used to pinpoint more specific skills. The Rabideau Kitchen Evaluation has a normative base of people who have suffered traumatic brain injury, so this test is not appropriate in this situation. The Klein-Bell ADL Scale only addresses basic self-care tasks, and chart review has revealed that the woman is independent with these activities. Since the woman has a dual diagnosis, she may not be the most reliable source for information, so informal interview alone is not sufficient.
Scenario: An OTR® working in a community mental health setting receives an order to evaluate and treat a 44 year old woman for independent living skills. Through chart review, the OTR® learns that the woman has a dual diagnosis of schizoaffective disorder and cognitive deficits. The woman lives in a rented home with her four daughters who range in age from 17 to 10. She is not married and does not have a boyfriend at the time that the OTR® begins services.
Section B: The community mental health program has options for occupational therapy treatment that include in home or through an outpatient mental health facility. How should the OTR® provide services to the woman and why? Select the best 3 choices.
Rationale: Providing services to the woman in her home would be best for the woman, who will have an easier time learning new skills in a familiar environment, rather than attempting to generalize information learned in a clinic setting. Her daughters will also be able to observe how the woman does in therapy and will be able to learn how to help guide their mother through certain activities. One advantage of providing services at the outpatient facility, however, might be the ability to include the woman in community outings designed to focus on independent skills in the community. The selection of the place of service should be based on the woman’s treatment goals and anticipated outcome, not on personal preference or convenience. The OTR®’s safety should be considered when scheduling services, but this should not be the primary reason for the selection of the place of service.
Rationale: Providing services to the woman in her home would be best for the woman, who will have an easier time learning new skills in a familiar environment, rather than attempting to generalize information learned in a clinic setting. Her daughters will also be able to observe how the woman does in therapy and will be able to learn how to help guide their mother through certain activities. One advantage of providing services at the outpatient facility, however, might be the ability to include the woman in community outings designed to focus on independent skills in the community. The selection of the place of service should be based on the woman’s treatment goals and anticipated outcome, not on personal preference or convenience. The OTR®’s safety should be considered when scheduling services, but this should not be the primary reason for the selection of the place of service.
Scenario: An OTR® working in a community mental health setting receives an order to evaluate and treat a 44 year old woman for independent living skills. Through chart review, the OTR® learns that the woman has a dual diagnosis of schizoaffective disorder and cognitive deficits. The woman lives in a rented home with her four daughters who range in age from 17 to 10. She is not married and does not have a boyfriend at the time that the OTR® begins services.
Section C: During treatment, the woman demonstrates that she is unable to remember how to select healthy foods for meals. What should the OTR® do to facilitate the woman’s ability to complete this task? Select the best 3 choices.
Rationale: Since the woman has cognitive deficits, she will benefit from visual reminders of which healthy foods she needs to shop for. Organizing her refrigerator and pantry into food groups with the healthy foods in front will give the woman a visual reminder when her stock of these foods is getting low. Making a chart of healthy foods for the kitchen wall will help the woman to identify and select healthy foods when preparing meals for her family. Organizing the woman’s shopping list into food groups will also help the woman to select foods in each food group. The woman’s 17-year-old daughter is old enough to be aware of the food groups and to assist her mother in selecting healthy foods while grocery shopping. The woman will not learn how to select healthy foods if she is given preplanned shopping lists. A home health aide might assist the woman with learning this skill, but this service might not be available to the woman in her area and there is a chance that the aide would be selecting food items for the woman rather than assisting her in selecting items herself. The woman is not considered home bound and would not qualify for Meals on Wheels. She also would not be able to provide food for her children through this option.
Rationale: Since the woman has cognitive deficits, she will benefit from visual reminders of which healthy foods she needs to shop for. Organizing her refrigerator and pantry into food groups with the healthy foods in front will give the woman a visual reminder when her stock of these foods is getting low. Making a chart of healthy foods for the kitchen wall will help the woman to identify and select healthy foods when preparing meals for her family. Organizing the woman’s shopping list into food groups will also help the woman to select foods in each food group. The woman’s 17-year-old daughter is old enough to be aware of the food groups and to assist her mother in selecting healthy foods while grocery shopping. The woman will not learn how to select healthy foods if she is given preplanned shopping lists. A home health aide might assist the woman with learning this skill, but this service might not be available to the woman in her area and there is a chance that the aide would be selecting food items for the woman rather than assisting her in selecting items herself. The woman is not considered home bound and would not qualify for Meals on Wheels. She also would not be able to provide food for her children through this option.
Scenario: An OTR® working in a community mental health setting receives an order to evaluate and treat a 44 year old woman for independent living skills. Through chart review, the OTR® learns that the woman has a dual diagnosis of schizoaffective disorder and cognitive deficits. The woman lives in a rented home with her four daughters who range in age from 17 to 10. She is not married and does not have a boyfriend at the time that the OTR® begins services.
Section D: One day when the OTR® arrives at the woman’s house, the woman is crying and states she cannot participate in the session that day because she heard on the radio that the world is going to end. How should the OTR® respond to this situation? Select the best 3 choices.
Rationale: Regardless of the actual source or meaning of the information the woman received, the fact that she believes the world is going to end has caused her symptoms to flare and her mood to be volatile. The OTR® should not invalidate the woman’s statement or pressure her to participate in treatment, as the session will probably not be productive and the woman’s symptoms could escalate. The OTR® can offer to help the woman relax by using relaxation techniques. The OTR® should find out why the woman does not want to participate in therapy and should notify the woman’s case manager of her symptoms.
Rationale: Regardless of the actual source or meaning of the information the woman received, the fact that she believes the world is going to end has caused her symptoms to flare and her mood to be volatile. The OTR® should not invalidate the woman’s statement or pressure her to participate in treatment, as the session will probably not be productive and the woman’s symptoms could escalate. The OTR® can offer to help the woman relax by using relaxation techniques. The OTR® should find out why the woman does not want to participate in therapy and should notify the woman’s case manager of her symptoms.
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Module 6 OT Assessment
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Module 6 OT Assessment
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An OTR® is working with a 60-year-old patient who was recently diagnosed with stage 3 breast cancer and subsequently had to undergo a double mastectomy. The focus of the session is to help the patient accept and adapt to the physical changes to her body, while she performs her ADLs. As she is dressing, the patient looks at her image in the mirror and then turns away and states, “I am not ready to see my grandchildren this afternoon”. What is the BEST way to react in this situation?
C. Ask questions to gain insight into the patient’s perspective on her body image.
It is important to get a sense of how the patient is feeling about her body and how you as the therapist, can help her come to terms with what has happened to her body. Only by understanding what triggered her behavior, will you get a sense of what adaptations you may need to make for her.
C. Ask questions to gain insight into the patient’s perspective on her body image.
It is important to get a sense of how the patient is feeling about her body and how you as the therapist, can help her come to terms with what has happened to her body. Only by understanding what triggered her behavior, will you get a sense of what adaptations you may need to make for her.
An OT practitioner is working with a group of patients in an inpatient mental health setting. During a group session, one of the patient’s who has a history of poor anger management, becomes agitated which unsettles the other group members. The OT practitioner is concerned that this patient’s behavior will escalate to aggression. How should the OT practitioner INITIALLY react in this situation?
D. Remain calm and approach the patient in a non-threatening and respectful manner.
Protocols should be in place to handle aggressive behavior in a therapeutic setting. If a patient becomes aggressive during a group session, it is essential to prioritize the safety of all patients and themselves. Handling an aggressive patient during a group intervention can be challenging, but there are steps that an OT practitioner can take to ensure the safety of all individuals involved.
1. Remain calm: The OT practitioner should stay calm and composed in such a situation, as getting agitated or panicking can worsen the situation.
2. As this patient’s behavior may escalate, the OT practitioner should ensure that all other patients are safe and away from the aggressive patient. They may ask the other patients to move to a different area while they address the aggressive patient.
3. Redirect: The OT practitioner can try to redirect the patient’s attention to another task or topic in the group intervention. This can help to distract the patient and reduce their aggression.
4. Address the behavior: The OT practitioner should address the patient’s behavior in a non-confrontational manner. They should express their concern for the patient’s safety and the safety of others in the group. The OT practitioner can remind the patient of the rules and expectations for the group.
5. Remove the patient: If the patient’s aggression persists and poses a risk to the safety of others, the OT practitioner may need to remove the patient from the group.
6. Call for help if necessary.
A. Asking the patient to leave the group should be the last resort. Only if the patient’s aggression persists and poses a risk to the safety of others, the OT practitioner may need to remove the patient from the group.
B. Only by being non-threatening and respectful can the OT practitioner be successful in de-escalating the situation. The OT practitioner should avoid physical contact unless necessary for safety reasons.
C. After the incident, the OT practitioner should only then document the event and report it as per protocol.
D. Remain calm and approach the patient in a non-threatening and respectful manner.
Protocols should be in place to handle aggressive behavior in a therapeutic setting. If a patient becomes aggressive during a group session, it is essential to prioritize the safety of all patients and themselves. Handling an aggressive patient during a group intervention can be challenging, but there are steps that an OT practitioner can take to ensure the safety of all individuals involved.
1. Remain calm: The OT practitioner should stay calm and composed in such a situation, as getting agitated or panicking can worsen the situation.
2. As this patient’s behavior may escalate, the OT practitioner should ensure that all other patients are safe and away from the aggressive patient. They may ask the other patients to move to a different area while they address the aggressive patient.
3. Redirect: The OT practitioner can try to redirect the patient’s attention to another task or topic in the group intervention. This can help to distract the patient and reduce their aggression.
4. Address the behavior: The OT practitioner should address the patient’s behavior in a non-confrontational manner. They should express their concern for the patient’s safety and the safety of others in the group. The OT practitioner can remind the patient of the rules and expectations for the group.
5. Remove the patient: If the patient’s aggression persists and poses a risk to the safety of others, the OT practitioner may need to remove the patient from the group.
6. Call for help if necessary.
A. Asking the patient to leave the group should be the last resort. Only if the patient’s aggression persists and poses a risk to the safety of others, the OT practitioner may need to remove the patient from the group.
B. Only by being non-threatening and respectful can the OT practitioner be successful in de-escalating the situation. The OT practitioner should avoid physical contact unless necessary for safety reasons.
C. After the incident, the OT practitioner should only then document the event and report it as per protocol.
According to Mosey, what type of developmental group provides the BEST structure to help parents who have recently lost a child, to come together to express and share their thoughts and feelings about their experience?
C. Cooperative group.A Cooperative Group provides an environment for group members to openly share emotions, challenges and shared intentions. This type of group is about sharing and listening. The OT practitioner should not focus on completing a goal or changing behavior. The goal is simply to gain the satisfaction of a mutual experience.
Mosey’s 5 developmental groups:
1. Parallel
2. Project
3. Egocentric – Cooperative
4. Cooperative
5. Mature
A. The main goal of a Project Group is to enhance cooperation and help group members to feel comfortable around each other. The OT practitioner will encourage cooperation, healthy competition, and sharing.
B. Egocentric-Cooperative group- Group members collaborate to complete a specific task in a long-term setting. Each group member is expected to provide input on the task – this input should be specific to that member’s skillset.
D. A Parallel Group focuses on developing interaction between people while they work on individual tasks
PTOT. Module 6. Types of Groups- 5 Types of Developmental Groups. https://passtheot.com/5-types-groups/
C. Cooperative group.A Cooperative Group provides an environment for group members to openly share emotions, challenges and shared intentions. This type of group is about sharing and listening. The OT practitioner should not focus on completing a goal or changing behavior. The goal is simply to gain the satisfaction of a mutual experience.
Mosey’s 5 developmental groups:
1. Parallel
2. Project
3. Egocentric – Cooperative
4. Cooperative
5. Mature
A. The main goal of a Project Group is to enhance cooperation and help group members to feel comfortable around each other. The OT practitioner will encourage cooperation, healthy competition, and sharing.
B. Egocentric-Cooperative group- Group members collaborate to complete a specific task in a long-term setting. Each group member is expected to provide input on the task – this input should be specific to that member’s skillset.
D. A Parallel Group focuses on developing interaction between people while they work on individual tasks
PTOT. Module 6. Types of Groups- 5 Types of Developmental Groups. https://passtheot.com/5-types-groups/
Jane, a 35-year-old widow, who has been diagnosed with a dependent personality disorder, has recently joined a community skills group which is focused on assertiveness training. The group is on their first outing, shopping for ingredients at the local grocery store for an upcoming cooking activity. The group members have been given a budget and instructed to buy the ingredients for the activity. Which of the following tasks is the MOST appropriate to request Jane to perform at this stage of her assertiveness training.
A. Before buying a product, ask the sales-clerk more information about it.
Patients with dependent personality disorders have difficulty making decisions and depend on guidance and support from others that is out of proportion to the situation. Assertiveness training will help the patient gradually empower themselves to make their own decision, ask for help, and provide constructive criticism when appropriate. Obtaining information is a good starting point for assertiveness training.
B,C,D- All these answers require more assertiveness and confidence, and may result in a confrontation.
Early, M. B. (2009). Mental health concepts and techniques for the occupational therapy assistant. Baltimore, MD: Wolters Kluwer, p 174, 543.
A. Before buying a product, ask the sales-clerk more information about it.
Patients with dependent personality disorders have difficulty making decisions and depend on guidance and support from others that is out of proportion to the situation. Assertiveness training will help the patient gradually empower themselves to make their own decision, ask for help, and provide constructive criticism when appropriate. Obtaining information is a good starting point for assertiveness training.
B,C,D- All these answers require more assertiveness and confidence, and may result in a confrontation.
Early, M. B. (2009). Mental health concepts and techniques for the occupational therapy assistant. Baltimore, MD: Wolters Kluwer, p 174, 543.
A middle aged man who has been diagnosed with substance abuse becomes increasingly agitated and storms out of the room to get a cigarette while completing a fairly simple task. What is this most likely behavior indicative of?
B. Poor stress management. A patient diagnosed with substance abuse is likely to have difficulties with stress.
Treatment interventions include:
-Identify reasons for substance abuse
-Developing coping skills
-Developing skills for drug-free lifestyle
-Assisting with concrete services
B. Poor stress management. A patient diagnosed with substance abuse is likely to have difficulties with stress.
Treatment interventions include:
-Identify reasons for substance abuse
-Developing coping skills
-Developing skills for drug-free lifestyle
-Assisting with concrete services
What is the BEST response when a patient diagnosed with dementia, becomes upset and cries for his mother who passed away many years ago?
A. “You must miss your mother, tell me about her”. It is important to validate the person’s feelings and allow them to reminisce.
‐ Facilitate memory with familiar objects.
A. “You must miss your mother, tell me about her”. It is important to validate the person’s feelings and allow them to reminisce.
‐ Facilitate memory with familiar objects.
Which of the following environments is best for a patient diagnosed with schizophrenia?
B. Quiet and structured.
Patients with schizophrenia need a safe, quiet, and structured environment, especially if they are experiencing psychosis.
Treatment for a patient with schizophrenia:
Early steps of treatment – one on one to build relationship
Groups – builds social skills
Example of a time and cost-effective treatment: OT visiting rooms on an inpatient unit with grooming supplies – brief contact paves way for sustained one on one and group activities.
People who display positive symptoms benefit from activities that divert attention away from symptoms. Activities that bolster the sense of achievement and mastery are most successful in coping with hallucinations.
For people with negative symptoms, specific skill training and psychoeducation are very beneficial. They need highly structured activities.
Improving quality of life is the main objective.
Themes in quality of life:
– Managing time
– Connecting and belonging
– Making choices and maintaining control
B. Quiet and structured.
Patients with schizophrenia need a safe, quiet, and structured environment, especially if they are experiencing psychosis.
Treatment for a patient with schizophrenia:
Early steps of treatment – one on one to build relationship
Groups – builds social skills
Example of a time and cost-effective treatment: OT visiting rooms on an inpatient unit with grooming supplies – brief contact paves way for sustained one on one and group activities.
People who display positive symptoms benefit from activities that divert attention away from symptoms. Activities that bolster the sense of achievement and mastery are most successful in coping with hallucinations.
For people with negative symptoms, specific skill training and psychoeducation are very beneficial. They need highly structured activities.
Improving quality of life is the main objective.
Themes in quality of life:
– Managing time
– Connecting and belonging
– Making choices and maintaining control
Barry, a veteran, has been admitted to an inpatient mental health hospital for treatment of his depression and obsessive-compulsive disorder. He is participating in an activity group with other patients who have similar diagnoses. The clinician has noticed that Barry’s compulsions seem to become more pronounced when he feels pressured to complete tasks within a certain time limit. What is the MOST appropriate type of activity that can be used in this group setting, focussing specifically on Barry’s needs?
A. Repotting plants in the garden center.
Patients who exhibit symptoms of OCD have compulsions and recurrent obsessions severe enough to interfere with a person’s daily routine. This causes marked distress and makes socialization difficult. The compulsions are behaviors to relieve the anxiety. Repotting plants gives an opportunity to break from routine and rituals which leads to stress and anxiety.
B, C and D. Promote repetitive behavior and ritualism of perfections which may lead to a cycle of behaviors the patient will have difficulty breaking.
Bavaro, S.M. (1991). Occupational therapy and obsessive-compulsive disorder. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 45 5, 456-8 .
https://www.healthline.com/health/ocd/social-signs#3
A. Repotting plants in the garden center.
Patients who exhibit symptoms of OCD have compulsions and recurrent obsessions severe enough to interfere with a person’s daily routine. This causes marked distress and makes socialization difficult. The compulsions are behaviors to relieve the anxiety. Repotting plants gives an opportunity to break from routine and rituals which leads to stress and anxiety.
B, C and D. Promote repetitive behavior and ritualism of perfections which may lead to a cycle of behaviors the patient will have difficulty breaking.
Bavaro, S.M. (1991). Occupational therapy and obsessive-compulsive disorder. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 45 5, 456-8 .
https://www.healthline.com/health/ocd/social-signs#3
Which approach often includes a homework component and utilizes a teacher-student format as opposed to learning by doing approach?
A. Psychoeducational approach .
Psychoeducation refers to the education offered to individuals with a mental health condition and their families to help empower them and deal with their condition in an optimal way. Frequently psychoeducational training involves individuals with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context of the treatment of physical illnesses. Family members are also included. A goal is for the consumer to understand and be better able to deal with the presented illness. Also, the patient’s own capabilities, resources and coping skills are strengthened and used to contribute to their own health and wellbeing on a long-term basis.
A. Psychoeducational approach .
Psychoeducation refers to the education offered to individuals with a mental health condition and their families to help empower them and deal with their condition in an optimal way. Frequently psychoeducational training involves individuals with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context of the treatment of physical illnesses. Family members are also included. A goal is for the consumer to understand and be better able to deal with the presented illness. Also, the patient’s own capabilities, resources and coping skills are strengthened and used to contribute to their own health and wellbeing on a long-term basis.
A young adult with a moderate intellectual disability has been referred to an inpatient psychiatric unit for treatment of self-injurious behavior which began after learning that the group home in which he was living, was being closed. The young man has responded positively to treatment and upon discharge, will be living with his parents until a new group home is located. What advice should be given to the parents in terms of how they should manage their child while he is living in their home?
D. Balance the patient’s day with familiar valued tasks. By early adulthood, the majority of individuals who have an intellectual disability are able to complete familiar functional and leisure activities. It is important to maintain familiar routines to reduce the likelihood of reoccurrence of psychiatric response to change. Routines should be balanced and based on the individual’s skills and interests.
D. Balance the patient’s day with familiar valued tasks. By early adulthood, the majority of individuals who have an intellectual disability are able to complete familiar functional and leisure activities. It is important to maintain familiar routines to reduce the likelihood of reoccurrence of psychiatric response to change. Routines should be balanced and based on the individual’s skills and interests.
A patient who has been diagnosed with major depression has recently been admitted to an inpatient mental health facility. During this depressive episode, the patient reports that he is experiencing the following symptoms: difficulty concentrating, an inability to find pleasure in any type of activity, difficulty prioritizing and planning tasks, and feelings of incompetence. Which type of intervention is the MOST appropriate to incorporate into this patient’s intervention plan at this stage of his illness?
C. Identify purposeful short term goals. Occupational therapists need to focus on assisting the patient in finding gratifying activities that improve self-esteem and increase motivation. For this reason it is critical to involve the patient in setting realistic short-term goals. Re-engagement in valued activities that allow the patient to experience success and feelings of competence should be the first intervention strategy.
Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more-severe form of depression, also known as major depression or major depressive disorder.
The definition of a depressive episode is a period of depression that persists for at least two weeks. During a depressive episode, a person will typically experience low or depressed mood and/or loss of interest in most activities, as well as a number of other symptoms of depression, such as tiredness, changes in appetite, feelings of worthlessness and recurrent thoughts of death. The length of a depressive episode varies, but the average duration is thought to be six to eight months. The severity of a depressive episode varies; it may be classified as major or minor, depending on the number of symptoms and degree of impairment (social, domestic and work) experienced.
C. Identify purposeful short term goals. Occupational therapists need to focus on assisting the patient in finding gratifying activities that improve self-esteem and increase motivation. For this reason it is critical to involve the patient in setting realistic short-term goals. Re-engagement in valued activities that allow the patient to experience success and feelings of competence should be the first intervention strategy.
Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more-severe form of depression, also known as major depression or major depressive disorder.
The definition of a depressive episode is a period of depression that persists for at least two weeks. During a depressive episode, a person will typically experience low or depressed mood and/or loss of interest in most activities, as well as a number of other symptoms of depression, such as tiredness, changes in appetite, feelings of worthlessness and recurrent thoughts of death. The length of a depressive episode varies, but the average duration is thought to be six to eight months. The severity of a depressive episode varies; it may be classified as major or minor, depending on the number of symptoms and degree of impairment (social, domestic and work) experienced.
An OTR® is working with a group of 8 elderly patients in an adult day care program. The OTR® is planning on taking the group on a social outing, to a local restaurant. The group members have chosen to go to a very popular restaurant for lunch. As many of the members have difficulty hearing, how can the OTR® ensure that the members are able to actively socialize during the meal?
C. Ask the host to seat them at a round dining table versus a long dining table. A round table is the most effective way of structuring the environment so that the patients have the opportunity to hear and see each other during socialization.
A, B and D. Involve distractions, noises and glare that should be minimized to participate fully in social conversations.
C. Ask the host to seat them at a round dining table versus a long dining table. A round table is the most effective way of structuring the environment so that the patients have the opportunity to hear and see each other during socialization.
A, B and D. Involve distractions, noises and glare that should be minimized to participate fully in social conversations.
An OTR® and COTA® are collaboratively running a leisure group with senior adults who are aged 70 years and older. All group members are functioning at the same cognitive level and have equal communication abilities. The goal of the group is to enhance social interaction and promote relaxation. The clinicians decide to use a game as the group activity, with an emphasis on giving all members a fun experience with an equal opportunity of winning. Which type of game would be MOST APPROPRIATE to meet the goals of this specific group?
B. A game of Icebreaker Bingo.
An icebreaker Bingo game would be appropriate because it satisfies the goal of leisure and social interaction in which members must interact and match a description that satisfies a square on the Bingo card. All players have an equal chance of winning with this game.
A. This game would depend on the use of social media which all members may not have access to.
C and D. Requires skill and is very competitive.
https://www.activityvillage.co.uk/ice-breaker-bingo
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 532-533.
B. A game of Icebreaker Bingo.
An icebreaker Bingo game would be appropriate because it satisfies the goal of leisure and social interaction in which members must interact and match a description that satisfies a square on the Bingo card. All players have an equal chance of winning with this game.
A. This game would depend on the use of social media which all members may not have access to.
C and D. Requires skill and is very competitive.
https://www.activityvillage.co.uk/ice-breaker-bingo
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 532-533.
If a patient with acute mania gets frustrated and becomes verbally abusive toward you during treatment, what should your FIRST response be?
A. Remind the patient of the appropriate boundaries in the therapeutic relationship. When a patient is having a manic episode, an important role for the occupational therapist is monitoring behavioral changes, and providing a structured environment in which behavior can be managed. Mood lability is a common characteristic during this acute phase. The patient may be expansive and grandiose one minute, angry and hostile the next. The individual may be oblivious to the behavior and totally unaware there is a problem. The patient needs to have the behavior pointed out and limits need to be reinforced.
A. Remind the patient of the appropriate boundaries in the therapeutic relationship. When a patient is having a manic episode, an important role for the occupational therapist is monitoring behavioral changes, and providing a structured environment in which behavior can be managed. Mood lability is a common characteristic during this acute phase. The patient may be expansive and grandiose one minute, angry and hostile the next. The individual may be oblivious to the behavior and totally unaware there is a problem. The patient needs to have the behavior pointed out and limits need to be reinforced.
When working with a patient who has recently been prescribed anti-psychotic medication, what is the most important precaution this patient should adhere to as they begin a vocational retraining program with a landscaping company?
A. Photosensitivity. A patient on antipsychotic medication needs to be educated about the use of sunblock and protective clothing due to the increased risk of sunburn when taking the medication. This is critical for a patient working for a landscaping company where prolonged sun exposure is inherent in the job.
A. Photosensitivity. A patient on antipsychotic medication needs to be educated about the use of sunblock and protective clothing due to the increased risk of sunburn when taking the medication. This is critical for a patient working for a landscaping company where prolonged sun exposure is inherent in the job.
A patient who has been diagnosed with Alzheimer’s disease is starting to demonstrate neuropsychiatric symptoms such as aggression. The OT practitioner is educating the patient’s family on ways to handle the patient’s behavior when he becomes aggressive. What are the MOST appropriate strategies that can be used with a dementia patient who demonstrates aggression? Select the 3 best answers.
A. Determine if there are any triggers for this behavior and deal with them.
B. Educate the caregivers not to confront the patient.
E. Leave the patient alone if they are in a safe environment.
Neuropsychiatric symptoms (NPS) of dementia include aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, and disinhibition. NPS affect dementia patients nearly universally across dementia stages and etiologies. They are associated with poor patient and caregiver outcomes
Handling Aggression:
– Determine and modify underlying cause of aggression (e.g. psychosis, pain, particular caregiver interaction), evaluate triggers and patterns
– Warn caregiver not to confront or return physicality
– Discuss other self-protection strategies with caregiver (e.g. distract, backing away from patient, leaving patient alone if they are safe, and seeking help)
– Limit access to or remove dangerous items
– Create a calmer, more soothing environment
The Role of the Occupational Therapist in the Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209177/
A. Determine if there are any triggers for this behavior and deal with them.
B. Educate the caregivers not to confront the patient.
E. Leave the patient alone if they are in a safe environment.
Neuropsychiatric symptoms (NPS) of dementia include aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, and disinhibition. NPS affect dementia patients nearly universally across dementia stages and etiologies. They are associated with poor patient and caregiver outcomes
Handling Aggression:
– Determine and modify underlying cause of aggression (e.g. psychosis, pain, particular caregiver interaction), evaluate triggers and patterns
– Warn caregiver not to confront or return physicality
– Discuss other self-protection strategies with caregiver (e.g. distract, backing away from patient, leaving patient alone if they are safe, and seeking help)
– Limit access to or remove dangerous items
– Create a calmer, more soothing environment
The Role of the Occupational Therapist in the Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209177/
Which type of mental illness benefits the MOST from a structured and supportive social environment which focuses on increasing positive social and life skills?
A. Schizophrenia. Treatment for Schizophrenia- reality testing, stabilization of behavior, normalize environment, maintenance/development of skills, structure/organize. Peer support in many medical conditions has been shown to enhance functioning by fostering acceptance, coping and formulation of adapted goals that provide meaning and identity. In schizophrenia, peer support is an effective complement to medical care, aiming to enhance social support among a socially isolated population. It has the potential to enhance personal recovery in the sense of pursuing and attaining new goals and starting to live beyond the disorder.
https://academic.oup.com/schizophreniabulletin/article/41/6/1211/2526048
A. Schizophrenia. Treatment for Schizophrenia- reality testing, stabilization of behavior, normalize environment, maintenance/development of skills, structure/organize. Peer support in many medical conditions has been shown to enhance functioning by fostering acceptance, coping and formulation of adapted goals that provide meaning and identity. In schizophrenia, peer support is an effective complement to medical care, aiming to enhance social support among a socially isolated population. It has the potential to enhance personal recovery in the sense of pursuing and attaining new goals and starting to live beyond the disorder.
https://academic.oup.com/schizophreniabulletin/article/41/6/1211/2526048
What is the MOST effective way to prevent a patient with dementia from injuring themselves in the kitchen?
D. Install safety knobs on the stove.
To prevent access to potentially dangerous appliances, install safety knobs on the stove to prevent the person with dementia from turning the stove on or off.
B. There is always a risk of the patient wandering off if the caregiver is distracted and entering the kitchen unsupervised.
C. Remove artificial fruits or vegetables or food-shaped magnets. These objects might appear to be edible.
D. To prevent the patient from injuring themselves, it is imperative to disconnect the garbage disposal. The patient could remove the bowl from the garbage disposal.
D. Install safety knobs on the stove.
To prevent access to potentially dangerous appliances, install safety knobs on the stove to prevent the person with dementia from turning the stove on or off.
B. There is always a risk of the patient wandering off if the caregiver is distracted and entering the kitchen unsupervised.
C. Remove artificial fruits or vegetables or food-shaped magnets. These objects might appear to be edible.
D. To prevent the patient from injuring themselves, it is imperative to disconnect the garbage disposal. The patient could remove the bowl from the garbage disposal.
A 42-year-old man who has been diagnosed with GAD has been admitted to an inpatient mental health facility. The patient is an accountant by profession, and he has expressed his desire to return to work as soon as possible, but on modified duty. In order to facilitate the process of the patient achieving this goal, he is placed in an assertiveness training group as part of his initial therapy. By placing the patient in this type of group, what is the expected outcome for this patient?
C. Express clearly his expectations in a polite manner that is considerate of other people’s opinions.
Assertiveness is the ability to state one’s needs, thoughts, and feelings in an appropriate way while respecting the rights of others. In an assertiveness training group, the patient will learn to identify irrational beliefs and fears about social situations through practice via role-playing. This will help prepare the patient to request modified duty from his employer as well as teach him coping skills for his GAD.
A. Is an outcome associated with memory to improve work performance.
B and D. These are outcomes associated with social interaction skills training including appropriate communication and social conduct but do not have an assertiveness component to social interaction.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 543.
Reed, Kathlyn. (2001) Quick Reference to Occupational Therapy. Gaithersburg, MD: Aspen Publishers, p 763.
C. Express clearly his expectations in a polite manner that is considerate of other people’s opinions.
Assertiveness is the ability to state one’s needs, thoughts, and feelings in an appropriate way while respecting the rights of others. In an assertiveness training group, the patient will learn to identify irrational beliefs and fears about social situations through practice via role-playing. This will help prepare the patient to request modified duty from his employer as well as teach him coping skills for his GAD.
A. Is an outcome associated with memory to improve work performance.
B and D. These are outcomes associated with social interaction skills training including appropriate communication and social conduct but do not have an assertiveness component to social interaction.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 543.
Reed, Kathlyn. (2001) Quick Reference to Occupational Therapy. Gaithersburg, MD: Aspen Publishers, p 763.
After a PTSD relapse, a patient is admitted to an inpatient psychiatric unit. What would the BEST intervention be, at this stage of the patient’s OT treatment?
C. Daily meditation and yoga.
Relaxation is one of the primary interventions for people with PTSD.
Increasingly, researchers are investigating the use of complementary approaches for treating PTSD. Complementary therapies used to treat PTSD include acupuncture, mindfulness-based stress reduction, meditation, yoga, deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, and tai chi.
C. Daily meditation and yoga.
Relaxation is one of the primary interventions for people with PTSD.
Increasingly, researchers are investigating the use of complementary approaches for treating PTSD. Complementary therapies used to treat PTSD include acupuncture, mindfulness-based stress reduction, meditation, yoga, deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, and tai chi.
Michael, a 35-year-old male who has been diagnosed with Bipolar I Disorder, was recently admitted to a state psychiatric hospital as his family were concerned that he may self-harm. His primary goal is to resume living in the community with his wife. He also states that he wants to assist his wife with household chores, and he would like to return to, at least part-time, employment in his previous role as a gardener. As part of Michael’s intervention, he is placed in a work skills and home arts group. What approach should be used to ensure that Michael will have the best opportunity to maintain his roles and safely return to the community?
A. Use streamlined routines for housework and build confidence through assertiveness training.
Simple and structured routines will enable Michael to establish habits. Role playing situations will help Michael build assertiveness and build self-worth.
B. Looking into community resources would be more appropriate for those patients who are homeless.
C. Mental imagery for counteracting flashbacks would be an approach used for post-traumatic stress disorder.
D. Alertness, arousal, and time awareness is an appropriate approach for schizophrenia and psychotic symptoms.
A. Use streamlined routines for housework and build confidence through assertiveness training.
Simple and structured routines will enable Michael to establish habits. Role playing situations will help Michael build assertiveness and build self-worth.
B. Looking into community resources would be more appropriate for those patients who are homeless.
C. Mental imagery for counteracting flashbacks would be an approach used for post-traumatic stress disorder.
D. Alertness, arousal, and time awareness is an appropriate approach for schizophrenia and psychotic symptoms.
With which diagnosis does Obsessive-Compulsive Disorder (OCD) share the MOST similarities?
A. Generalized anxiety disorder (GAD).
The presentations of OCD and anxiety disorders, such as GAD, social anxiety disorder and specific phobias, can appear very similar. Historically, both Generalized Anxiety Disorder (GAD) and Obsessive-Compulsive Disorder (OCD) were considered anxiety disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM) once grouped GAD and OCD within the same section. However, the fifth edition of the DSM, published in May 2013, separated these diagnoses. While GAD remains in the anxiety disorders section, OCD is now called Obsessive-Compulsive and Related Conditions. Related conditions include hoarding disorder, trichotillomania (aka hair-pulling disorder), and body dysmorphic disorder.
OCD vs. Anxiety
– The primary behavioral difference between OCD and GAD involves the presence of compulsions. People with OCD engage in compulsive behaviors to cope with anxiety, while people with GAD do not.
– The thought patterns characteristic of GAD also distinguish it from OCD. The primary difference is whether these thoughts can be characterized as worry or obsessions.
D. Dissociative Disorders. These are disorders in which a person’s sense of self is disrupted, such as dissociative identity disorder and dissociative amnesia.
A. Generalized anxiety disorder (GAD).
The presentations of OCD and anxiety disorders, such as GAD, social anxiety disorder and specific phobias, can appear very similar. Historically, both Generalized Anxiety Disorder (GAD) and Obsessive-Compulsive Disorder (OCD) were considered anxiety disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM) once grouped GAD and OCD within the same section. However, the fifth edition of the DSM, published in May 2013, separated these diagnoses. While GAD remains in the anxiety disorders section, OCD is now called Obsessive-Compulsive and Related Conditions. Related conditions include hoarding disorder, trichotillomania (aka hair-pulling disorder), and body dysmorphic disorder.
OCD vs. Anxiety
– The primary behavioral difference between OCD and GAD involves the presence of compulsions. People with OCD engage in compulsive behaviors to cope with anxiety, while people with GAD do not.
– The thought patterns characteristic of GAD also distinguish it from OCD. The primary difference is whether these thoughts can be characterized as worry or obsessions.
D. Dissociative Disorders. These are disorders in which a person’s sense of self is disrupted, such as dissociative identity disorder and dissociative amnesia.
A patient who has a Borderline Personality Disorder has been hospitalized after exhibiting extreme mood swings, outbursts towards a roommate and self-harm behaviors. During her OT evaluation, the patient reports having trouble maintaining close ties with her family, being overwhelmed at work, and feeling a general lack of control in everyday situations. The results of a cognitive assessment indicate that she is functioning at Allen Cognitive Level V (Exploratory Actions). Which type of OT intervention would be MOST BENEFICIAL for this patient, at this stage?
C. Coping skills groups that address a variety of adaptive strategies.
Patients who are functioning at this cognitive level typically are able to use problem-solving and inductive reasoning. In this type of group, the patient can learn and try new, adaptive strategies to help modulate her emotions to optimal intensities.
A. This type of group would be appropriate for a patient functioning at an ACL3 when simple craft activities can be introduced.
B. At ACL 4, a main goal is to reinforce familiar routines and perform repetitive drilling. Basic self-care is typically not a problem for those who are functioning at ACL 5.
D. This is more appropriate for those with Dissociative Identity Disorder.
C. Coping skills groups that address a variety of adaptive strategies.
Patients who are functioning at this cognitive level typically are able to use problem-solving and inductive reasoning. In this type of group, the patient can learn and try new, adaptive strategies to help modulate her emotions to optimal intensities.
A. This type of group would be appropriate for a patient functioning at an ACL3 when simple craft activities can be introduced.
B. At ACL 4, a main goal is to reinforce familiar routines and perform repetitive drilling. Basic self-care is typically not a problem for those who are functioning at ACL 5.
D. This is more appropriate for those with Dissociative Identity Disorder.
A patient who has been diagnosed with paranoid schizophrenia was admitted to an inpatient mental health facility after physically threatening another resident, at the group home in which he resides. On admission, the patient was assessed by the OTR® and was found to be functioning at an ACL 3 (Manual Actions). As part of his OT intervention, the patient joined an assertiveness training group. During a recent group session which was co-led by the OTR® and COTA®, the patient began screaming uncontrollably while engaged in a role-play. The therapists reacted by immediately ending the role-play. What should the therapists do NEXT in response to the patient’s outburst?
D. Guide the patient on how the role-play can be performed in an acceptable manner, via demonstration and feedback.
As the patient is functioning at ACL 3 (Manual Actions), he requires structure and assistance with problem-solving. He would benefit from being shown how to respond in a role-play situation, in order to help him develop appropriate communication skills during assertiveness training.
D. Guide the patient on how the role-play can be performed in an acceptable manner, via demonstration and feedback.
As the patient is functioning at ACL 3 (Manual Actions), he requires structure and assistance with problem-solving. He would benefit from being shown how to respond in a role-play situation, in order to help him develop appropriate communication skills during assertiveness training.
An OTR® is working with a group of 6 adult patients who have intellectual disabilities. The focus of OT intervention is currently on improving these patients’ social skills. To achieve this intervention goal, the OTR® is organizing an outing to a local beach where the group members will be provided with a picnic lunch. On which type of developmental group is the OTR® basing their intervention?
C. Cooperative group.
The goal of this group is to provide an opportunity for the patients to practice social skills. A cooperative group is characterized by homogeneous membership and mutual need satisfaction to the extent that the task is often considered to be secondary to need fulfilment. Learning of this skill is acquired through interaction in an environment where there are compatible participants who are developmentally ready to engage in a cooperative group (Mosey, 1986).
A. An Egocentric-Cooperative Group- group members collaborate to complete a specific task in a long-term setting.
B. A Mature Group focuses on the accomplishment of a specific task in a limited amount of time. The completion of the task is more important than the group member’s individual needs.
D. Task-Oriented group is an activity group, and not a type of developmental group.
C. Cooperative group.
The goal of this group is to provide an opportunity for the patients to practice social skills. A cooperative group is characterized by homogeneous membership and mutual need satisfaction to the extent that the task is often considered to be secondary to need fulfilment. Learning of this skill is acquired through interaction in an environment where there are compatible participants who are developmentally ready to engage in a cooperative group (Mosey, 1986).
A. An Egocentric-Cooperative Group- group members collaborate to complete a specific task in a long-term setting.
B. A Mature Group focuses on the accomplishment of a specific task in a limited amount of time. The completion of the task is more important than the group member’s individual needs.
D. Task-Oriented group is an activity group, and not a type of developmental group.
An OT practitioner is planning a cooking activity group for teenagers who have social anxiety. The main goal of this group is to facilitate interaction between the group members. The group members will have to work together to complete recipes and will be encouraged to problem solve with other group members when planning and executing recipe steps. What type of activity group is being described?
D. Task-oriented group.
Task-Oriented group- The intent of this group is to provide a shared work experience where the members can be assisted in becoming aware of their needs, values, ideas, and feelings through the performance of a shared task. The members explore their thoughts and feelings while focusing on the problems which emerge in the process of choosing, planning, and implementing a group activity
A. Evaluation Group- This type of group exists only to allow the OT practitioner to observe the member’s behavior within a certain setting.
B. Topical Group- The group activity is a verbal discussion on an activity that members are engaged in or will become engaged in, in the future. The discussions aim to enable the group members to engage in their activities which occur outside of the group, more effectively.
D. Task-oriented group.
Task-Oriented group- The intent of this group is to provide a shared work experience where the members can be assisted in becoming aware of their needs, values, ideas, and feelings through the performance of a shared task. The members explore their thoughts and feelings while focusing on the problems which emerge in the process of choosing, planning, and implementing a group activity
A. Evaluation Group- This type of group exists only to allow the OT practitioner to observe the member’s behavior within a certain setting.
B. Topical Group- The group activity is a verbal discussion on an activity that members are engaged in or will become engaged in, in the future. The discussions aim to enable the group members to engage in their activities which occur outside of the group, more effectively.
An OT practitioner is working with a patient who sustained a TBI several years ago. The patient has a residual cognitive impairment and has recently been diagnosed with RA (Rheumatoid Arthritis). The OT practitioner has established that teaching this patient joint protection strategies is an important part of the OT practitioner’s role. What is the minimum ACL level this patient should be functioning at, for this treatment goal to be realistic?
B. Level 5.
ACL Level 5- Exploratory Actions. Global cognition is mildly impaired.
At ACL level 5.8 (Consulting with others)- Patient may benefit from discussion of complications such as fatigue, joint protections, functional positioning, etc. Patient may benefit from assistance in planning for the future.
PTOT Module 6: Topic: Allen’s Cognitive Level (ACL). https://passtheot.com/allen-cognitive-levels/.
B. Level 5.
ACL Level 5- Exploratory Actions. Global cognition is mildly impaired.
At ACL level 5.8 (Consulting with others)- Patient may benefit from discussion of complications such as fatigue, joint protections, functional positioning, etc. Patient may benefit from assistance in planning for the future.
PTOT Module 6: Topic: Allen’s Cognitive Level (ACL). https://passtheot.com/allen-cognitive-levels/.
Linda, an inpatient at a mental health facility who has been diagnosed with Major Depressive Disorder, is being seen by an OTR® for intervention. Which initial activity would address the goal of increasing Linda’s sense of mastery as well as develop leisure interests?
D. Painting a glass jar, using a template. This activity is basic, structured and short-term. A positive outcome is guaranteed which supports a sense of competence and self-worth especially for those patients who have a Depressive Mood Disorder.
A. The collage is a semi-structured activity that may overwhelm the patient unless it is structured with a few steps.
B. The ballroom dancing involves learning new steps and interacting with a partner which may be too overwhelming for Linda, as an initial activity.
C. Designing and decorating a cake will require more than 1 session and involves decision-making.
Early, M. B. (2009). Mental health concepts and techniques for the occupational therapy assistant. Philadelphia: Wolters Kluwer. (pp 289-311)
D. Painting a glass jar, using a template. This activity is basic, structured and short-term. A positive outcome is guaranteed which supports a sense of competence and self-worth especially for those patients who have a Depressive Mood Disorder.
A. The collage is a semi-structured activity that may overwhelm the patient unless it is structured with a few steps.
B. The ballroom dancing involves learning new steps and interacting with a partner which may be too overwhelming for Linda, as an initial activity.
C. Designing and decorating a cake will require more than 1 session and involves decision-making.
Early, M. B. (2009). Mental health concepts and techniques for the occupational therapy assistant. Philadelphia: Wolters Kluwer. (pp 289-311)
An OTR® is planning on working with a group of patients who have been diagnosed with either a major depressive disorder or Schizophrenia. Most of the group members have minimal social interaction, low energy, and present with stooped postures. What is MOST appropriate activity, the OTR® should select for the initial group session?
D. Plan a destination for a group walk, a few minutes away.
Since the patients spend their time at the facility, providing an opportunity to be outdoors stimulates a positive mood, increases sensorimotor opportunities which in turn increases their level of alertness and attention, as well as improves their posture. This is a simple activity that requires minimal to no cost. In addition, having the patients plan the outing, restores in them a sense of control.
A. This is a structured activity not appropriate for an initial session for those with low self-esteem.
B. This requires assertiveness which may be challenging for these members during an initial session.
C. This would be more appropriate for running an expressive task activity group, for patients with anxiety.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 559-561.
Cole, Marilyn B. (2012) Group Dynamics in Occupational Therapy (4th Ed). Slack Inc., pp 142-144.
D. Plan a destination for a group walk, a few minutes away.
Since the patients spend their time at the facility, providing an opportunity to be outdoors stimulates a positive mood, increases sensorimotor opportunities which in turn increases their level of alertness and attention, as well as improves their posture. This is a simple activity that requires minimal to no cost. In addition, having the patients plan the outing, restores in them a sense of control.
A. This is a structured activity not appropriate for an initial session for those with low self-esteem.
B. This requires assertiveness which may be challenging for these members during an initial session.
C. This would be more appropriate for running an expressive task activity group, for patients with anxiety.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 559-561.
Cole, Marilyn B. (2012) Group Dynamics in Occupational Therapy (4th Ed). Slack Inc., pp 142-144.
An OTR® is working with Sylvia, a 77-year-old retired elementary school teacher who has been diagnosed with Stage 4 Alzheimer’s disease. Sylvia is currently living with her daughter who has approached the OTR® during a home visit, to request advice on how she can help her mother with dressing in the mornings. Although Sylvia can dress herself, lately her choice of clothing is not appropriate for the weather and she wears her clothing “oddly”, often wearing her underwear over her clothing. Sylvia is also very hesitant to wear clean underwear as she insists on wearing the same pair of underwear daily, referring to them as her “favorite underwear”. The daughter has tried her best to help Sylvia, but Sylvia does not want to be told what to wear. What is the BEST advice the OTR® can give the daughter to help her with assisting her mother, with dressing?
B. Lay out Sylvia’s clothing in the order that each item should be put on.
Eating, dressing and grooming will become more challenging as dementia progresses. This loss of independence and privacy can be a very difficult transition for the person with dementia. Once your assistance is needed to complete daily tasks, think about the person’s abilities. Encourage the person to do as much as possible but be ready to help when needed. For example, when dressing, you can give direction indirectly by laying out clothing in the order in which item is put on. By doing this, the process of getting dressed is being organized for Sylvia. The appropriate clothing for the weather will be ready for her to put on, as well as the sequence of dressing will be simplified.
A. Simplify choices. Keep the closets free of excess clothing. A person may panic if clothing choices become overwhelming. If appropriate, give the person an opportunity to select favorite outfits or colors, but try offering just two choices.
C. Be flexible. If the individual wants to wear the same outfit repeatedly, buy duplicates or have similar options available. Even if the person’s outfit is mismatched, try to focus on the fact that she was able to get dressed.
D. It is important for the individual to maintain good personal hygiene, including wearing clean undergarments, as poor hygiene may lead to urinary tract or other infections that further complicate care.
https://www.alz.org/help-support/caregiving/daily-care/dressing-grooming
B. Lay out Sylvia’s clothing in the order that each item should be put on.
Eating, dressing and grooming will become more challenging as dementia progresses. This loss of independence and privacy can be a very difficult transition for the person with dementia. Once your assistance is needed to complete daily tasks, think about the person’s abilities. Encourage the person to do as much as possible but be ready to help when needed. For example, when dressing, you can give direction indirectly by laying out clothing in the order in which item is put on. By doing this, the process of getting dressed is being organized for Sylvia. The appropriate clothing for the weather will be ready for her to put on, as well as the sequence of dressing will be simplified.
A. Simplify choices. Keep the closets free of excess clothing. A person may panic if clothing choices become overwhelming. If appropriate, give the person an opportunity to select favorite outfits or colors, but try offering just two choices.
C. Be flexible. If the individual wants to wear the same outfit repeatedly, buy duplicates or have similar options available. Even if the person’s outfit is mismatched, try to focus on the fact that she was able to get dressed.
D. It is important for the individual to maintain good personal hygiene, including wearing clean undergarments, as poor hygiene may lead to urinary tract or other infections that further complicate care.
https://www.alz.org/help-support/caregiving/daily-care/dressing-grooming
A patient who was diagnosed with major depression 5 years ago, has recently been admitted to an inpatient mental health facility for treatment of a major depressive episode. As depression is linked to suicidal ideation, all professionals involved in this patient’s care have to be aware of any signs indicating that the patient may be planning to attempt suicide. At what stage of this patient’s depressive episode is the patient MOST LIKELY to plan and carry out harming themselves?
B. When the patient is coming out of the deepest part of their experience.
Depression typically involves a preoccupation with death, feelings of hopelessness and helplessness, and withdrawal. These are major contributors to suicide. When a patient is coming out of the deepest part of their experience, they get more energy and at this point they may mobilize their newly acquired energy to go through with their plans to harm themselves.
Depression is a mood disorder also called major depressive disorder or clinical depression.
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
– Depressed mood most of the day, nearly every day.
– Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
– Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
– A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
– Fatigue or loss of energy nearly every day.
– Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
– Diminished ability to think or concentrate, or indecisiveness, nearly every day.
– Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, added two specifiers to further classify diagnoses:
i. With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.
ii. With Anxious Distress – The presence of anxiety in patients. They experience both depression with anxious distress.
C. This is a symptom of many illnesses including depression. There is no link between loss of appetite and suicidal ideation.
D. Electroconvulsive Therapy (ECT) is a medical treatment that has been most commonly reserved for patients with severe major depression who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant. ECT has been used since the 1940s, and many years of research have led to major improvements and the recognition of its effectiveness as a mainstream rather than a “last resort” treatment.
https://emedicine.medscape.com/article/2013085-overview#a3
https://www.psychiatry.org/patients-families/depression/what-is-depression
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
B. When the patient is coming out of the deepest part of their experience.
Depression typically involves a preoccupation with death, feelings of hopelessness and helplessness, and withdrawal. These are major contributors to suicide. When a patient is coming out of the deepest part of their experience, they get more energy and at this point they may mobilize their newly acquired energy to go through with their plans to harm themselves.
Depression is a mood disorder also called major depressive disorder or clinical depression.
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
– Depressed mood most of the day, nearly every day.
– Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
– Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
– A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
– Fatigue or loss of energy nearly every day.
– Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
– Diminished ability to think or concentrate, or indecisiveness, nearly every day.
– Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, added two specifiers to further classify diagnoses:
i. With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.
ii. With Anxious Distress – The presence of anxiety in patients. They experience both depression with anxious distress.
C. This is a symptom of many illnesses including depression. There is no link between loss of appetite and suicidal ideation.
D. Electroconvulsive Therapy (ECT) is a medical treatment that has been most commonly reserved for patients with severe major depression who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant. ECT has been used since the 1940s, and many years of research have led to major improvements and the recognition of its effectiveness as a mainstream rather than a “last resort” treatment.
https://emedicine.medscape.com/article/2013085-overview#a3
https://www.psychiatry.org/patients-families/depression/what-is-depression
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
A patient demonstrates goal directed behavior by being able to perform simple activities which are purposeful. Using demonstration as the means of instruction, the patient is able to copy short tasks such as simple crafts with 2-3 steps. At what ACL is this patient functioning?
B. Level 4.
At ACL 4: The person relies heavily on visual cues. They therefore require visual demonstrations for tasks because they cannot follow verbal and written directions. Their actions are goal-directed. Activities are purposeful and they are able to perform short tasks such as simple crafts with 2-3 steps. A person at this level does not plan for details such as spacing. They find it easier to imitate a sample than to follow a diagram or picture. Cannot recognize errors and may not be able to correct them when they are pointed out. Does not understand that objects can be hidden from view.
B. Level 4.
At ACL 4: The person relies heavily on visual cues. They therefore require visual demonstrations for tasks because they cannot follow verbal and written directions. Their actions are goal-directed. Activities are purposeful and they are able to perform short tasks such as simple crafts with 2-3 steps. A person at this level does not plan for details such as spacing. They find it easier to imitate a sample than to follow a diagram or picture. Cannot recognize errors and may not be able to correct them when they are pointed out. Does not understand that objects can be hidden from view.
A patient who is suffering from generalized anxiety disorder (GAD) shows increased feelings of incompetence and is having trouble planning future events. What is the BEST intervention for this patient?
D. Prioritize short-term goals, especially goals with a high chance of success for the patient.
Developing achievable short-term goals is an effective strategy for an individual who has difficulty with planning. Feelings of competence are enhanced by successful progression toward achievable goals.
D. Prioritize short-term goals, especially goals with a high chance of success for the patient.
Developing achievable short-term goals is an effective strategy for an individual who has difficulty with planning. Feelings of competence are enhanced by successful progression toward achievable goals.
Your patient with dementia seems uninterested in participating in a therapeutic activity of cooking. What would help motivate this patient?
A. Put on her favorite music.
Putting on her favorite music might motivate her to participate in therapy.
Music-based interventions including music therapy, community singing groups and listening to music are widely accepted as being beneficial for the psychological well-being of people with dementia. Music memory is preserved in the brain, in patients with dementia up until the late stages and significantly impacts dementia patients. Memories of various events are closely associated with music. It has a motivating effect and can positively influence mood.
https://link.springer.com/article/10.1007/s12662-021-00765-z#citeas
A. Put on her favorite music.
Putting on her favorite music might motivate her to participate in therapy.
Music-based interventions including music therapy, community singing groups and listening to music are widely accepted as being beneficial for the psychological well-being of people with dementia. Music memory is preserved in the brain, in patients with dementia up until the late stages and significantly impacts dementia patients. Memories of various events are closely associated with music. It has a motivating effect and can positively influence mood.
https://link.springer.com/article/10.1007/s12662-021-00765-z#citeas
An auto mechanic recently lost his daughter to a chronic disease and he is now presenting with symptoms of depression. He has been missing work, picking his wife up late from work, and spends all his free time watching television. What is the BEST recommendation the OT practitioner can make to this patient?
A. Participate in a cognitive behavioral therapy group.
A cognitive behavioral therapy group will aim to teach him coping skills.
A. Participate in a cognitive behavioral therapy group.
A cognitive behavioral therapy group will aim to teach him coping skills.
An OT notices the following in a patient diagnosed with depression: feelings of incompetence, an inability to prioritize tasks or plan ahead, little or no interest in pleasurable activities, and a general lack of concentration. The BEST course of action would be to allow the patient to:
C. Identify purposeful short-term goals.
This is the correct response. Occupational therapists need to focus on assisting the patient in finding gratifying activities that improve self-esteem and increase motivation. For this reason, it is critical to involve the patient in setting realistic short-term goals. Re-engagement in valued activities that allow the patient to experience success and feelings of competence should be the first intervention strategy.
C. Identify purposeful short-term goals.
This is the correct response. Occupational therapists need to focus on assisting the patient in finding gratifying activities that improve self-esteem and increase motivation. For this reason, it is critical to involve the patient in setting realistic short-term goals. Re-engagement in valued activities that allow the patient to experience success and feelings of competence should be the first intervention strategy.
For the past 2 weeks, an army veteran who has been admitted to an inpatient mental health facility, has consistently been waking up at 8am and completing his morning ADLs by 9am. His medication has, however, recently been adjusted and the OT has noticed that there has been a decline in the patient’s ADL performance as he is now having difficulty waking-up in the mornings. Based on the patient’s reaction to the adjustment in his medication, what action should the OTR® take NEXT?
C. Discuss the effects of the medication change with the treatment team.
The team process is essential to successful treatment of the patient and is reflected in the OT process. Any change in patient performance should be discussed with the team so that an appropriate action can be taken.
C. Discuss the effects of the medication change with the treatment team.
The team process is essential to successful treatment of the patient and is reflected in the OT process. Any change in patient performance should be discussed with the team so that an appropriate action can be taken.
A patient who is experiencing an acute major depressive episode has recently been admitted to an inpatient mental health facility. The patient has been assessed and is due to begin sessions with the OT practitioner. What types of activities are the MOST appropriate for this patient during this phase of their illness?
B. Solitary, short term, simplified, structured activities.
Major depressive episodes are most often part of a recurring, chronic mental illness. Depressive episodes recur periodically in people diagnosed with major depression. A depressive episode lasts at least two weeks, and the symptoms of depression are persistent and occur nearly every day for the duration of the episode. They cannot be explained by another medical condition or by substance abuse. Hallmark features of depression are feelings of sadness and loss of interest. The loss of interest in daily activity results in social withdrawal, decreased ability to function in occupation and interpersonal areas and decreased involvement in previously pleasurable activities. When working with a patient who is acutely depressed, the OT practitioner aims to provide positive experiences and feelings of self-worth by involving the patient in meaningful and pleasurable activities.
Other features of depression include: Difficulty in thinking and concentration, poor memory, indecisiveness, lack of initiation and energy, and not being able to socialize. Therefore, short term, solitary, simple and structured activities are the most appropriate, at this stage of the illness.
B. Solitary, short term, simplified, structured activities.
Major depressive episodes are most often part of a recurring, chronic mental illness. Depressive episodes recur periodically in people diagnosed with major depression. A depressive episode lasts at least two weeks, and the symptoms of depression are persistent and occur nearly every day for the duration of the episode. They cannot be explained by another medical condition or by substance abuse. Hallmark features of depression are feelings of sadness and loss of interest. The loss of interest in daily activity results in social withdrawal, decreased ability to function in occupation and interpersonal areas and decreased involvement in previously pleasurable activities. When working with a patient who is acutely depressed, the OT practitioner aims to provide positive experiences and feelings of self-worth by involving the patient in meaningful and pleasurable activities.
Other features of depression include: Difficulty in thinking and concentration, poor memory, indecisiveness, lack of initiation and energy, and not being able to socialize. Therefore, short term, solitary, simple and structured activities are the most appropriate, at this stage of the illness.
A hypochondriasis patient who is partaking in a partial-hospitalization program has an impaired self-concept and cannot perform daily tasks because of a preoccupation with health-related issues. By using an informational approach, the OTR should:
B. Assist the patient with learning methods for incorporating valued activities into daily routines.
This approach encourages the patient to incorporate valued activities into their daily routines, therefore reducing opportunities for preoccupation with health-related issues.
B. Assist the patient with learning methods for incorporating valued activities into daily routines.
This approach encourages the patient to incorporate valued activities into their daily routines, therefore reducing opportunities for preoccupation with health-related issues.
An OT practitioner is working with a group of 10 patients who are all experiencing post Covid-19 PTSD. As this group is a ‘self-help” group, it is classified as being a mature group according to Mosey. What is the MOST effective leadership style to use with this type of group?
C. Participatory.
In this type of group the OT functions as a group member and the group should function independently.
Parallel Group- Directive leadership
Project Group- Modified directive
Egocentric– Cooperative Group- Facilitative leadership
Cooperative Group- Advisory leadership
Mature Group- Participatory leadership
Module 6. Group Dynamics- Facilitation and Leadership.
C. Participatory.
In this type of group the OT functions as a group member and the group should function independently.
Parallel Group- Directive leadership
Project Group- Modified directive
Egocentric– Cooperative Group- Facilitative leadership
Cooperative Group- Advisory leadership
Mature Group- Participatory leadership
Module 6. Group Dynamics- Facilitation and Leadership.
A patient, who suffers from early-stage Alzheimer’s (Stage III on the Reisberg Scale) is being discharged from a long-term care facility to be supervised by a caregiver at home. What is the BEST advice the OT can give the patient’s caregiver, to make this transition the most successful?
C. Simplify the home surroundings and reduce stimuli.
Stage 3 on the Reisberg Scale is regarded as a mild cognitive decline. At this stage, early-stage Alzheimer’s can be diagnosed in some, but not all, individuals.
Patients who are at Stage 3 exhibit performance deficits in function, especially organization and planning, and increased anxiety, especially when confronted with new information and unfamiliar situations. Reduction of stimuli and environmental modifications will increase the individual’s ability to function.
C. Simplify the home surroundings and reduce stimuli.
Stage 3 on the Reisberg Scale is regarded as a mild cognitive decline. At this stage, early-stage Alzheimer’s can be diagnosed in some, but not all, individuals.
Patients who are at Stage 3 exhibit performance deficits in function, especially organization and planning, and increased anxiety, especially when confronted with new information and unfamiliar situations. Reduction of stimuli and environmental modifications will increase the individual’s ability to function.
A COTA® and OTR® are collaboratively running a craft activity group for patients who have been diagnosed with dementia. The COTA® is tasked with demonstrating the steps to sand, paint, and glue tiles onto a wooden box which will be used as a plant holder. Cognitive performance levels have been assessed for each member of the group and the activity has been structured accordingly. Which observations BEST describes the actions and behaviors a patient would display at Allen Cognitive Level 3.6?
D. Copies demo one step at-a-time; may miss all or part of the visible surface.
Patients will note features of objects like shape and effects on objects especially when held and moved but without understanding cause and effect at Allen Cognitive Level 3.6. Patients require close supervision to provide supplies, organize, sequence, check results and remove hazards through steps of basic functional tasks. They benefit with 1-step cues for 1 action repeated.
Levels 3.6 – 3.8 Caregiver Guide for Activities
• Encourage engaging in meaningful activities to prevent sitting for extended periods of time.
• Provide daily social opportunities and facilitate engagement when needed.
• Use repetitive tasks (polishing, sanding, folding) or basic crafts/activities.
• Place objects directly in front of the person.
• Give limited choices and fully set up the activity.
• Demonstrate each step and provide cues to “keep going”.
• Allow extra time for all activities due to slow pace.
• Provide a place to sit and watch activities of others.
• Provide calming environment: consider lighting, sound, and amount of stimulation.
• Provide a calm yet sensory rich environment to prevent both over-stimulation and/or sensory deprivation.
A. This patient is functioning at Allen Cognitive Level 4.6.
B. This patient is functioning at Allen Cognitive Level 3.0.
C. This patient is functioning at Allen Cognitive Level 4.0
https://www.ot-innovations.com/wp-content/uploads/2012/11 /Caregiver Guide36_38.pdf
http://allencognitive.com/wp-content/uploads/Summary-of-Modes-of-Performance-101216-1.pdf
Cole, Marilyn B. (2012) Group Dynamics in Occupational Therapy (4th Ed). Slack Inc., pp 204-213.
D. Copies demo one step at-a-time; may miss all or part of the visible surface.
Patients will note features of objects like shape and effects on objects especially when held and moved but without understanding cause and effect at Allen Cognitive Level 3.6. Patients require close supervision to provide supplies, organize, sequence, check results and remove hazards through steps of basic functional tasks. They benefit with 1-step cues for 1 action repeated.
Levels 3.6 – 3.8 Caregiver Guide for Activities
• Encourage engaging in meaningful activities to prevent sitting for extended periods of time.
• Provide daily social opportunities and facilitate engagement when needed.
• Use repetitive tasks (polishing, sanding, folding) or basic crafts/activities.
• Place objects directly in front of the person.
• Give limited choices and fully set up the activity.
• Demonstrate each step and provide cues to “keep going”.
• Allow extra time for all activities due to slow pace.
• Provide a place to sit and watch activities of others.
• Provide calming environment: consider lighting, sound, and amount of stimulation.
• Provide a calm yet sensory rich environment to prevent both over-stimulation and/or sensory deprivation.
A. This patient is functioning at Allen Cognitive Level 4.6.
B. This patient is functioning at Allen Cognitive Level 3.0.
C. This patient is functioning at Allen Cognitive Level 4.0
https://www.ot-innovations.com/wp-content/uploads/2012/11 /Caregiver Guide36_38.pdf
http://allencognitive.com/wp-content/uploads/Summary-of-Modes-of-Performance-101216-1.pdf
Cole, Marilyn B. (2012) Group Dynamics in Occupational Therapy (4th Ed). Slack Inc., pp 204-213.
A 75-year-old resident at a skilled nursing facility is participating in OT. She has been losing weight at a rate of 2 pounds per week which the dietician is addressing. During the initial OT evaluation, it was determined that the resident has mild dementia and moderate hearing loss. One of the goals of her OT intervention is to improve the resident’s engagement in self-feeding. Given her deficits, what is the BEST method for the OTR® to use when providing instructions to this resident during treatment sessions?
B. Use a combination of hand gestures with verbal instructions.
When it comes to communicating with the patient, the main difficulty is her moderate hearing loss. The question is asking about providing instructions. The answer therefore needs to address her hearing loss first and then the mild dementia should be addressed.
A combination of the use of verbal communication, expressions and gestures will provide a clearer understanding of instructions received by the patient. It is important to keep communication simple for those with mild cognitive deficits.
C. This is strategy for those with visual deficits.
https://www.nidcd.nih.gov/health/hearing-loss-older-adults
https://www.aota.org/~/media/Corporate/Files/Publications/CE-Articles/CEA_August_2020.pdf
B. Use a combination of hand gestures with verbal instructions.
When it comes to communicating with the patient, the main difficulty is her moderate hearing loss. The question is asking about providing instructions. The answer therefore needs to address her hearing loss first and then the mild dementia should be addressed.
A combination of the use of verbal communication, expressions and gestures will provide a clearer understanding of instructions received by the patient. It is important to keep communication simple for those with mild cognitive deficits.
C. This is strategy for those with visual deficits.
https://www.nidcd.nih.gov/health/hearing-loss-older-adults
https://www.aota.org/~/media/Corporate/Files/Publications/CE-Articles/CEA_August_2020.pdf
An OT practitioner is consulting with the adult children of a patient who has been diagnosed with early stage Alzheimer’s Disease. At this stage of the patient’s disease, which activity is the patient MOST likely going to need assistance performing?
A. Paying the bills.Patients with early stage Alzheimer’s Disease will most likely have difficulty with instrumental activities of daily living (IADLs) that require problem solving and other executive functions. While the patient should still be able to remember how to complete basic ADL tasks such as bathing, and simple IADLs such as washing dishes and doing laundry, she may begin to have difficulty with more complicated IADL tasks, such as shopping, scheduling, and money management.
A. Paying the bills.Patients with early stage Alzheimer’s Disease will most likely have difficulty with instrumental activities of daily living (IADLs) that require problem solving and other executive functions. While the patient should still be able to remember how to complete basic ADL tasks such as bathing, and simple IADLs such as washing dishes and doing laundry, she may begin to have difficulty with more complicated IADL tasks, such as shopping, scheduling, and money management.
An OT is working with a patient who has ASD on BADLs. During a dressing task, the OT prompts the patient to apply deodorant before dressing. The patient, however, does not respond by following these instructions. What should the OT do NEXT?
D. Ask the patient if he needs some assistance and then place the deodorant in his hand.
This question is basically drawing on your knowledge of ASD having difficulty with task initiation and the OT’s role of using prompting as a strategy to help the patient. Autistic inertia may be related to other conditions that are part of ASD or often accompany it, such as anxiety and executive dysfunction. It applies both to getting started on a task or focus as well as stopping once engaged in something.
Prompting is a recognized strategy that is used to help with task initiation.
Prompts include:
• verbally telling the patient you what to do
• handing the patient something to get them started
• reminding the patient to look at a checklist which has the steps of a task written out
• having an alarm to get them started
D. Ask the patient if he needs some assistance and then place the deodorant in his hand.
This question is basically drawing on your knowledge of ASD having difficulty with task initiation and the OT’s role of using prompting as a strategy to help the patient. Autistic inertia may be related to other conditions that are part of ASD or often accompany it, such as anxiety and executive dysfunction. It applies both to getting started on a task or focus as well as stopping once engaged in something.
Prompting is a recognized strategy that is used to help with task initiation.
Prompts include:
• verbally telling the patient you what to do
• handing the patient something to get them started
• reminding the patient to look at a checklist which has the steps of a task written out
• having an alarm to get them started
A patient who has Major Depressive Disorder has been participating in OT services for the past 6 weeks at an outpatient mental health center. She has been attending weekly groups in assertiveness training, communication, and parenting. In recent sessions, the patient has demonstrated increased engagement in sharing stories involving confronting her teenage children. In order to effectively advocate for additional OT services for this patient, what information should be included in the patient’s notes to justify the need for additional OT intervention?
B. The patient’s progress towards achieving the goals of improving her mood and communication skills.
The progress report includes recommendations and rationales as well as the patient’s performance and progress towards achieving her goals.
A. The transition plan is written whenever a patient transfers from one setting to another.
C. Comments about anticipated function are subjective and not evidence-based.
D. Is part of the discharge report when additional services are not needed.
B. The patient’s progress towards achieving the goals of improving her mood and communication skills.
The progress report includes recommendations and rationales as well as the patient’s performance and progress towards achieving her goals.
A. The transition plan is written whenever a patient transfers from one setting to another.
C. Comments about anticipated function are subjective and not evidence-based.
D. Is part of the discharge report when additional services are not needed.
What is the name of the group in which the emphasis is on providing social opportunities for sharing life stories and feelings, expressing pride in past life experiences, and gaining support for past life difficulties, which enhances self-esteem and helps residents achieve acceptance of past and present life?
A. Reminiscence group.
Group reminiscence therapy is a brief and structured intervention in which participants share personal past events with peers. This approach has been shown to be promising for improving wellbeing and reducing depressive symptoms among institutionalized older adults.
A. Reminiscence group.
Group reminiscence therapy is a brief and structured intervention in which participants share personal past events with peers. This approach has been shown to be promising for improving wellbeing and reducing depressive symptoms among institutionalized older adults.
What is the best course of action to take if a patient with oppositional defiant disorder (ODD) suddenly screams at another patient for not following the directions that were provided at the beginning of a crafting group session?
B. Use techniques to de-escalate the situation.
How an OT practitioner can de-escalate a situation when a patient is angry or agitated:
When there are signs of anger or verbal aggression it is important to remember that:
• you need to stay calm
• anger may be a sign that the person is in distress, experiencing fear or frustrated
• it is not possible to reason or problem solve with someone who is enraged
• effective communication skills are the key to settling, resolving and de-escalating a situation.
Use the strategies below to de-escalate a situation:
• Listen to what the issue is and the person’s concerns.
• Offer reflective comments to show that you have heard what their concerns are.
• Wait until the person has released their frustration and explained how they are feeling.
• Look and maintain appropriate eye contact to connect with the person.
• Nod to confirm that you are listening and have understood.
• Express empathy to show you have understood.
https://www.health.nsw.gov.au/mentalhealth/psychosocial/strategies/Pages/managing-anger.aspx
B. Use techniques to de-escalate the situation.
How an OT practitioner can de-escalate a situation when a patient is angry or agitated:
When there are signs of anger or verbal aggression it is important to remember that:
• you need to stay calm
• anger may be a sign that the person is in distress, experiencing fear or frustrated
• it is not possible to reason or problem solve with someone who is enraged
• effective communication skills are the key to settling, resolving and de-escalating a situation.
Use the strategies below to de-escalate a situation:
• Listen to what the issue is and the person’s concerns.
• Offer reflective comments to show that you have heard what their concerns are.
• Wait until the person has released their frustration and explained how they are feeling.
• Look and maintain appropriate eye contact to connect with the person.
• Nod to confirm that you are listening and have understood.
• Express empathy to show you have understood.
https://www.health.nsw.gov.au/mentalhealth/psychosocial/strategies/Pages/managing-anger.aspx
Which type of developmental group would be the MOST appropriate to incorporate into an OT intervention plan for young children who have been diagnosed with selective mutism. The goal of the group is to promote some interaction and co-operation among the children while they decorate cookies. The group will be structured to only include children who are 3-4 years old, the activity will last for 30-minutes and the children will be required to share the icing and toppings?
C. Project group. Selective mutism is predominantly a childhood anxiety disorder that is diagnosed when a child consistently does not speak in some situations. A Project Group is brought together for a short time to complete a small project while group members cooperate with each other. The main goal of a Project Group is to enhance cooperation and to help group members feel comfortable around each other. The OT practitioner typically encourages cooperation, healthy competition, and sharing.
Mosey’s 5 Developmental Group Levels, and associated age level.
1. Parallel (18 months–2 years)
2. Project (2–4 years)
3. Egocentric cooperative (5–7 years)
4. Cooperative (9–12 years)
5. Mature (15–18 years)
C. Project group. Selective mutism is predominantly a childhood anxiety disorder that is diagnosed when a child consistently does not speak in some situations. A Project Group is brought together for a short time to complete a small project while group members cooperate with each other. The main goal of a Project Group is to enhance cooperation and to help group members feel comfortable around each other. The OT practitioner typically encourages cooperation, healthy competition, and sharing.
Mosey’s 5 Developmental Group Levels, and associated age level.
1. Parallel (18 months–2 years)
2. Project (2–4 years)
3. Egocentric cooperative (5–7 years)
4. Cooperative (9–12 years)
5. Mature (15–18 years)
When working with a group of 10-patients in a cooperative group, what is the MOST appropriate group activity to present to the group members?
C. Group collage. This type of group is about sharing and listening. The OTA should not focus on completing a goal or changing behavior. The goal is simply to gain the satisfaction of a mutual experience. Cooperative group- facilitating free expression; developing trust, love, belonging, and cohesion; identifying and meeting socio-emotional needs (working cooperatively).
A group collage is the only activity which provides an environment for group members to openly share emotions, challenges and shared intentions.
C. Group collage. This type of group is about sharing and listening. The OTA should not focus on completing a goal or changing behavior. The goal is simply to gain the satisfaction of a mutual experience. Cooperative group- facilitating free expression; developing trust, love, belonging, and cohesion; identifying and meeting socio-emotional needs (working cooperatively).
A group collage is the only activity which provides an environment for group members to openly share emotions, challenges and shared intentions.
A patient is attending an outpatient substance abuse program which is focused on having the members of the group interact with each other. During the session, the patient begins to show signs of stress and frustration, and he eventually stands up and leaves the room. What is the BEST way to handle this situation?
B. The OT can help the patient by teaching the group members coping skills, in future sessions.
A patient diagnosed with substance abuse typically has difficulties with stress.
Treatment interventions include:
-identify reasons for abuse
-developing coping skills
-developing skills for drug-free lifestyle
-assisting with concrete services
B. The OT can help the patient by teaching the group members coping skills, in future sessions.
A patient diagnosed with substance abuse typically has difficulties with stress.
Treatment interventions include:
-identify reasons for abuse
-developing coping skills
-developing skills for drug-free lifestyle
-assisting with concrete services
Which type of question is the BEST indicator to determine if a patient’s long-term memory is still intact?
D. What was the name of your first pet?
Episodic memory is the memory of autobiographical events (times, places, associated emotions, and other contextual who, what, when, where, why knowledge) that can be explicitly stated. It is the collection of past personal experiences that occurred at a particular time and place. For example, if you remember the party on your 6th birthday, this is an episodic memory. They allow you to figuratively travel back in time to remember the event that took place at that particular time and place.
D. What was the name of your first pet?
Episodic memory is the memory of autobiographical events (times, places, associated emotions, and other contextual who, what, when, where, why knowledge) that can be explicitly stated. It is the collection of past personal experiences that occurred at a particular time and place. For example, if you remember the party on your 6th birthday, this is an episodic memory. They allow you to figuratively travel back in time to remember the event that took place at that particular time and place.
While conducting an evaluation with a patient who resides in a SNF and presents with dementia, an OT asks the patient several questions about his routines and roles. After several questions, the OT detects that the patient is making up many of the answers and being untruthful. What should the OT do now?
C. Interview the patient’s caregiver.
When an OT suspects an individual is making up information, the OT should attempt to get information from a reliable informant instead of the individual.
C. Interview the patient’s caregiver.
When an OT suspects an individual is making up information, the OT should attempt to get information from a reliable informant instead of the individual.
A college professor who is employed by the university, is starting to have difficulty remembering where she left her car keys and she often forgets to attend appointments if they have not been written down. What is the MOST LIKELY cause for the change in this woman’s behavior?
A. Mild cognitive decline.
Mild cognitive impairment and mild dementia are common problems in the elderly. Both mild cognitive impairment and mild dementia are characterized by objective evidence of cognitive impairment. The main distinctions between mild cognitive impairment and mild dementia are that with dementia, more than one cognitive domain is involved and substantial interference with daily life is evident.
Mild Cognitive impairment (MCI) – objective evidence of cognitive impairment that represents a decline from the past, but they function independently or nearly so in their daily lives in a manner that is indistinguishable from the past.
Mild dementia- also defined by cognitive impairment and poor performance on objective cognitive assessments that represents a decline from the past, but importantly, dementia requires evidence of significant difficulties in daily life that interfere with independence. In mild dementia, patients retain independence in simpler activities, in contrast to more severe forms of dementia where basic activities of daily living are compromised.
Signs of MCI may include:
• Losing things often
• Forgetting to go to events or appointments
• Having more trouble coming up with words than other people of the same age
A. Mild cognitive decline.
Mild cognitive impairment and mild dementia are common problems in the elderly. Both mild cognitive impairment and mild dementia are characterized by objective evidence of cognitive impairment. The main distinctions between mild cognitive impairment and mild dementia are that with dementia, more than one cognitive domain is involved and substantial interference with daily life is evident.
Mild Cognitive impairment (MCI) – objective evidence of cognitive impairment that represents a decline from the past, but they function independently or nearly so in their daily lives in a manner that is indistinguishable from the past.
Mild dementia- also defined by cognitive impairment and poor performance on objective cognitive assessments that represents a decline from the past, but importantly, dementia requires evidence of significant difficulties in daily life that interfere with independence. In mild dementia, patients retain independence in simpler activities, in contrast to more severe forms of dementia where basic activities of daily living are compromised.
Signs of MCI may include:
• Losing things often
• Forgetting to go to events or appointments
• Having more trouble coming up with words than other people of the same age
An OT is treating a patient who is often forgetting things at the market due to his decreased memory and has poor sequencing abilities due to his cognitive impairment. Which interventions would be best to work on with this patient?
A. Establish a morning routine of a morning alarm, a checklist of what he needs to do next, and labels on his drawers so he can find things.
When working with a patient who has decreased memory and poor sequencing, the OT can work on establishing routines, grading, using visual cues and using AT devices such as alarms.
A. Establish a morning routine of a morning alarm, a checklist of what he needs to do next, and labels on his drawers so he can find things.
When working with a patient who has decreased memory and poor sequencing, the OT can work on establishing routines, grading, using visual cues and using AT devices such as alarms.
What aspect is the MOST important to evaluate and monitor when working with a patient with borderline personality disorder?
C. Relationships with others.
Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships with other people. People with borderline personality disorder may experience mood swings and may display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly. People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships.
C. Relationships with others.
Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships with other people. People with borderline personality disorder may experience mood swings and may display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly. People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships.
Which type of therapy model is designed to help a patient with depression or schizophrenia change their thinking to promote growth and change?
A. Cognitive behavioral therapy (CBT).
The goal of CBT is to change one’s thinking to influence one’s feelings (from negative to positive) and therefore one’s behavior. To improve one’s quality of life not by changing the circumstances in which the person lives, but by helping them take control of their own perception of those circumstances. CBT can help change a person’s thinking to ultimately change their behavior.
Some interventions include:
• Intervention goals designed to help the client monitor negative thoughts
• Assist the client in identifying current problems and potential solutions
• Help client identify distorted or unhelpful thinking patterns
• Facilitating the client’s role in the therapeutic process by frequently providing homework and structured assignments
• Behavioral techniques include: Scheduling activities (increasing mastery; grading tasks to ensure success)
A. Cognitive behavioral therapy (CBT).
The goal of CBT is to change one’s thinking to influence one’s feelings (from negative to positive) and therefore one’s behavior. To improve one’s quality of life not by changing the circumstances in which the person lives, but by helping them take control of their own perception of those circumstances. CBT can help change a person’s thinking to ultimately change their behavior.
Some interventions include:
• Intervention goals designed to help the client monitor negative thoughts
• Assist the client in identifying current problems and potential solutions
• Help client identify distorted or unhelpful thinking patterns
• Facilitating the client’s role in the therapeutic process by frequently providing homework and structured assignments
• Behavioral techniques include: Scheduling activities (increasing mastery; grading tasks to ensure success)
An OT is working with a patient with cognitive dysfunction in inpatient rehab. What psychological assessment will provide a quick screening test of cognitive functioning?
Mini-Mental State Examination
Mini-Mental State Examination (a.k.a. Folstein Mini-Mental)
• Focus: quick screening test of cognitive functioning
• Method: Structured tasks presented in an interview format
• Scoring: Maximum score of 30; score of 24 or below = cognitive impairments
• Population: individuals with cognitive or psychiatric dysfunction
Mini-Mental State Examination
Mini-Mental State Examination (a.k.a. Folstein Mini-Mental)
• Focus: quick screening test of cognitive functioning
• Method: Structured tasks presented in an interview format
• Scoring: Maximum score of 30; score of 24 or below = cognitive impairments
• Population: individuals with cognitive or psychiatric dysfunction
In an inpatient mental health facility, what is the role of the OT practitioner when leading a task-oriented group with patients who present with major depression?
D. Assist with activity selection, facilitate discussion, and assist members in exploring relationships between thoughts, feelings, and actions.
Task-oriented groups—assist members in becoming aware of their needs, values, ideas and feelings through performance of a shared task
• For clients whose primary dysfunction is in the cognition and socioemotional areas due to psychological or physical trauma
• Clients with fair verbal skills who can interact with others
Role of the therapist:
• Initially, very active—assists with activity selection, facilitates discussion, gives feedback and support, assists members in exploring relationships between thoughts, feelings, and actions
• As the group develops, the leader is less active
D. Assist with activity selection, facilitate discussion, and assist members in exploring relationships between thoughts, feelings, and actions.
Task-oriented groups—assist members in becoming aware of their needs, values, ideas and feelings through performance of a shared task
• For clients whose primary dysfunction is in the cognition and socioemotional areas due to psychological or physical trauma
• Clients with fair verbal skills who can interact with others
Role of the therapist:
• Initially, very active—assists with activity selection, facilitates discussion, gives feedback and support, assists members in exploring relationships between thoughts, feelings, and actions
• As the group develops, the leader is less active
An OT practitioner is working with a group of young women who have intellectual disabilities. These women live in group home and they have recently acquired small dogs for the home. The focus of the group is on activities that will educate these women on pet care. What type of activity group is being described in this scenario?
A. Topical group. Topical group which focuses on discussion of activities/issues members are engaged in outside of the group, to enable members to engage in these activities in a more effective, need-satisfying manner (e.g., a parenting skills group for parents of children with disabilities).
A thematic group is incorrect because it focuses on the development of a specific skill or attitude in order for the group members to be able to complete a specific activity.
A mature group is incorrect and focuses on the accomplishment of a specific task in a limited amount of time. The completion of the task is more important than the group member’s individual needs.
An egocentric cooperative group is incorrect and focuses on group members collaborating to complete a specific task in a long-term setting.
A. Topical group. Topical group which focuses on discussion of activities/issues members are engaged in outside of the group, to enable members to engage in these activities in a more effective, need-satisfying manner (e.g., a parenting skills group for parents of children with disabilities).
A thematic group is incorrect because it focuses on the development of a specific skill or attitude in order for the group members to be able to complete a specific activity.
A mature group is incorrect and focuses on the accomplishment of a specific task in a limited amount of time. The completion of the task is more important than the group member’s individual needs.
An egocentric cooperative group is incorrect and focuses on group members collaborating to complete a specific task in a long-term setting.
An OT observes a patient who is diagnosed with Alzheimer’s with bruises on his left cheek. What should the OT do NEXT?
B. Follow facility procedures for a patient safety investigation.
If a patient with Alzheimer’s has bruises, follow facility procedures for investigating patient safety. A patient with dementia may not provide accurate information, so we have to contact professionals who are trained in abuse investigation.
B. Follow facility procedures for a patient safety investigation.
If a patient with Alzheimer’s has bruises, follow facility procedures for investigating patient safety. A patient with dementia may not provide accurate information, so we have to contact professionals who are trained in abuse investigation.
A patient who was diagnosed with bulimia has recently been admitted to an inpatient rehabilitation unit for further testing. Which activity is most useful to assess this patient’s task and social skills?
C. Completing a group collage that reflects personal interests.
Completing a group collage and reflecting on personal interests is the best activity to use for assessing task and social skills. Discussion groups don’t require task skills. Cooking may be too threatening for the patient at this point based on her diagnosis, and completing ADLs does not assess social skills.
C. Completing a group collage that reflects personal interests.
Completing a group collage and reflecting on personal interests is the best activity to use for assessing task and social skills. Discussion groups don’t require task skills. Cooking may be too threatening for the patient at this point based on her diagnosis, and completing ADLs does not assess social skills.
In a cooperative group, what type of leadership style does the therapist adopt?
C. Advisory.
A cooperative group provides an environment for group members to openly share emotions, challenges and shared intentions. This type of group is about sharing and listening. The OT does not focus on completing a goal or changing behavior. The goal is simply to gain the satisfaction of a mutual experience. In this type of group the OT acts more like an advisor instead of a strong leader. The OT offers expertise as needed/requested but does not provide structure or goals. The OT functions as a resource to the members.
Parallel Group – Directive leadership
Project Group – Modified directive
Egocentric–Cooperative Group – Facilitative leadership
Cooperative Group – Advisory leadership
Mature Group – Participatory leadership
PTOT. Module 6. Group Dynamics- Group Facilitation & Leadership Style. https://passtheot.com/ot-leadership-style/
C. Advisory.
A cooperative group provides an environment for group members to openly share emotions, challenges and shared intentions. This type of group is about sharing and listening. The OT does not focus on completing a goal or changing behavior. The goal is simply to gain the satisfaction of a mutual experience. In this type of group the OT acts more like an advisor instead of a strong leader. The OT offers expertise as needed/requested but does not provide structure or goals. The OT functions as a resource to the members.
Parallel Group – Directive leadership
Project Group – Modified directive
Egocentric–Cooperative Group – Facilitative leadership
Cooperative Group – Advisory leadership
Mature Group – Participatory leadership
PTOT. Module 6. Group Dynamics- Group Facilitation & Leadership Style. https://passtheot.com/ot-leadership-style/
An OT forms a topical group for patients with diagnoses of substance abuse who are currently residing in an inpatient rehab facility. The focus of the group is on learning ways of relaxation without using substances such as drugs and alcohol. What would the BEST activity for the first session be?
D. Identify leisure pursuits.
A topical group takes the form of a verbal discussion where the group is focused on a specific activity which they engage in outside of the group. Identifying leisure activities that can be pursued in a substance-free environment is a relevant focus for patients in an inpatient unit who need to plan concretely for discharge. Topical groups are activity focused. Increasing self-esteem and coping skills and identifying assertive behaviors are very broad and not related to the specific activity.
D. Identify leisure pursuits.
A topical group takes the form of a verbal discussion where the group is focused on a specific activity which they engage in outside of the group. Identifying leisure activities that can be pursued in a substance-free environment is a relevant focus for patients in an inpatient unit who need to plan concretely for discharge. Topical groups are activity focused. Increasing self-esteem and coping skills and identifying assertive behaviors are very broad and not related to the specific activity.
A 23-year-old patient was recently admitted into a mental health group for PTSD. Upon observation, the patient listens to other group members speak about their diagnosis, but the patient does not communicate throughout the session and does not engage in the OT activity. How should the OT help this patient participate in the next session?
A. Let the patient know he is welcome to participate in the conversation when he is ready.
By inviting the patient to join in the discussion, it will allow him a choice to participate and allow him comfort in sharing his personal thoughts. The OT does not want to pressure the patient to participate before the patient is ready.
A. Let the patient know he is welcome to participate in the conversation when he is ready.
By inviting the patient to join in the discussion, it will allow him a choice to participate and allow him comfort in sharing his personal thoughts. The OT does not want to pressure the patient to participate before the patient is ready.
While participating in a group which is focused on improving social skills, a female patient who is recovering from a recent TBI, begins making sexually suggestive comments to other group members. Initially, the OT tries to redirect the patient to the group activity, but she continues to make these inappropriate comments. How should the OT respond NEXT to this behavior?
D. Explain that such statements are not tolerated in the group and she must either stop or leave .
Explaining that such statements are not tolerated in the group and that she must either stop or leave, gives the patient the opportunity to practice decision-making and options for developing appropriate social interaction skills.
D. Explain that such statements are not tolerated in the group and she must either stop or leave .
Explaining that such statements are not tolerated in the group and that she must either stop or leave, gives the patient the opportunity to practice decision-making and options for developing appropriate social interaction skills.
A 21-year-old patient who has been diagnosed with Bulimia nervosa has recently been admitted to an inpatient psychiatric unit for intervention. The patient works as a barista in the mornings and attends community college in the evenings. Her episodes of binge eating and then purging has become more frequent and this has resulted in her becoming severely dehydrated. What is the main goal for this patient during the initial stage of OT intervention?
A. Help the patient develop a healthy use of leisure time.
Often, patients with eating disorders are constantly thinking about food. It is important for the OT to explore the patient’s interests and passions without food being involved.
A. Help the patient develop a healthy use of leisure time.
Often, patients with eating disorders are constantly thinking about food. It is important for the OT to explore the patient’s interests and passions without food being involved.
Schizophrenia is associated with both positive and negative symptoms. Which of the following symptoms is not considered a negative symptom, associated with schizophrenia?
B. Hypermanic, outgoing and sociable. A negative symptom associated with schizophrenia is when a person begins to socially withdraw and become isolated.
The symptoms of schizophrenia are usually classified into: Positive and negative symptoms.
i. Positive symptoms – any change in behaviour or thoughts, such as hallucinations or delusions.
ii. Negative symptoms – where people appear to withdraw from the world around then, take no interest in everyday social interactions, and often appear emotionless and flat.
Negative symptoms- This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn’t make eye contact, doesn’t change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.
A. Avolition is the reduction, difficulty, or inability to initiate and persist in goal-directed behavior; it is often mistaken for apparent disinterest.
C. Alogia, or poverty of speech, is the lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts, and often manifested as short, empty replies to questions.
D. Affective flattening is the reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact (person seems to stare, doesn’t maintain eye contact in a normal process), and is not able to interpret body language nor use appropriate body language.
A short summary of a list of negative symptoms are:
• Lack of emotion – the inability to enjoy regular activities (visiting with friends, etc.) As much as before
• Low energy – the person tends to sit around and sleep much more than normal
• Lack of interest in life, low motivation
• Affective flattening – a blank, blunted facial expression or less lively facial movements, flat voice (lack of normal intonations and variance) or physical movements.
• Alogia (difficulty or inability to speak)
• Inappropriate social skills or lack of interest or ability to socialize with other people
• Inability to make friends or keep friends, or not caring to have friends
• Social isolation – person spends most of the day alone or only with close family
http://schizophrenia.com/diag.php
https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
B. Hypermanic, outgoing and sociable. A negative symptom associated with schizophrenia is when a person begins to socially withdraw and become isolated.
The symptoms of schizophrenia are usually classified into: Positive and negative symptoms.
i. Positive symptoms – any change in behaviour or thoughts, such as hallucinations or delusions.
ii. Negative symptoms – where people appear to withdraw from the world around then, take no interest in everyday social interactions, and often appear emotionless and flat.
Negative symptoms- This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn’t make eye contact, doesn’t change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.
A. Avolition is the reduction, difficulty, or inability to initiate and persist in goal-directed behavior; it is often mistaken for apparent disinterest.
C. Alogia, or poverty of speech, is the lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts, and often manifested as short, empty replies to questions.
D. Affective flattening is the reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact (person seems to stare, doesn’t maintain eye contact in a normal process), and is not able to interpret body language nor use appropriate body language.
A short summary of a list of negative symptoms are:
• Lack of emotion – the inability to enjoy regular activities (visiting with friends, etc.) As much as before
• Low energy – the person tends to sit around and sleep much more than normal
• Lack of interest in life, low motivation
• Affective flattening – a blank, blunted facial expression or less lively facial movements, flat voice (lack of normal intonations and variance) or physical movements.
• Alogia (difficulty or inability to speak)
• Inappropriate social skills or lack of interest or ability to socialize with other people
• Inability to make friends or keep friends, or not caring to have friends
• Social isolation – person spends most of the day alone or only with close family
http://schizophrenia.com/diag.php
https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
You are observing a patient in a dementia care unit, to identify at which ACL this patient is currently functioning. The patient demonstrates the following behavior: The patient’s attention span is short, and he is easily distracted by environmental stimuli. He is curious and touches and manipulates objects, but his actions are disorganized. He is able to participate in simple crafts and the emergence of cause and effect is evident. What ACL would you assign this patient?
B. Level 3.
A person at this level will also engage in simple repetitive crafts, but is likely to be surprised to see that something has been produced. They will have difficulty understanding cause and effect. They may become easily disoriented and may get lost.
B. Level 3.
A person at this level will also engage in simple repetitive crafts, but is likely to be surprised to see that something has been produced. They will have difficulty understanding cause and effect. They may become easily disoriented and may get lost.
What is the name of the group where patients are interested in the task or game and recognize that they need other people to do it, therefore the patients are willing to take turns, share materials, cooperate, ask for help, and give it?
Project group.
In addition, patients have the ability to share a short-term task with one or two other people. Not so much interested in the people as they are the task. Activities shared at this level only last for a short time and usually not more than a half hour. Patients may engage in a number of activities in succession. An adult is needed to provide individual attention and to intervene when the patient has difficulty sharing.
Project group.
In addition, patients have the ability to share a short-term task with one or two other people. Not so much interested in the people as they are the task. Activities shared at this level only last for a short time and usually not more than a half hour. Patients may engage in a number of activities in succession. An adult is needed to provide individual attention and to intervene when the patient has difficulty sharing.
In the middle of a craft activity, a patient starts experiencing a delusion that he is being secretly watched by the CIA. What is the best action for the OT to take?
Redirect thoughts to reality-based thinking and actions
Delusions are false beliefs: “I am a king of Spain”. Redirect thoughts to reality-based thinking and actions. Avoid discussions that validate and reinforce delusional material.
Redirect thoughts to reality-based thinking and actions
Delusions are false beliefs: “I am a king of Spain”. Redirect thoughts to reality-based thinking and actions. Avoid discussions that validate and reinforce delusional material.
An OT is training an elderly woman who is suffering from Alzheimer’s disease in transfer skills. During the training, the woman falls and seriously injures her hip. The OT informs the doctor. What other action should the OT take?
D. Report the incident according to facility guidelines.
All facilities have policies and procedures for reporting and documenting incidents. It is the responsibility of the OT to know and follow these procedures.
D. Report the incident according to facility guidelines.
All facilities have policies and procedures for reporting and documenting incidents. It is the responsibility of the OT to know and follow these procedures.
A former US Marine is suffering from PTSD after a recent tour in Iraq. His symptoms of fitful sleep, anxiety, and hypervigilance are all impairing function in ADL. The OT’s FIRST focus should be on activities that:
A. Facilitate expression of emotion and promote relaxation.
Depending on the severity of the disorder, function may be minimally or severely impaired. If the trauma occurred in a place that is difficult to avoid, it may become quite disabling. First, an effort should be made to promote relaxation so patients develop the ability to concentrate on functional tasks. Likewise, allowing the patient to express emotion is valuable in reducing anxiety. As anxiety is resolved, attention should shift to restoring participation in valued activities.
A. Facilitate expression of emotion and promote relaxation.
Depending on the severity of the disorder, function may be minimally or severely impaired. If the trauma occurred in a place that is difficult to avoid, it may become quite disabling. First, an effort should be made to promote relaxation so patients develop the ability to concentrate on functional tasks. Likewise, allowing the patient to express emotion is valuable in reducing anxiety. As anxiety is resolved, attention should shift to restoring participation in valued activities.
To determine the level at which a patient with schizophrenia is functioning, including their ability to problem-solve, what activity should the OT select to use as an assessment tool?