Module Five

C. 7
The levels for transfer assistance refer to the amount of assistance a patient needs to transfer safely. These levels are as follows:
7 – Complete Independence – no assistance is required. The patient may require modifications or adaptations, but is able to use them independently.
6- Modified Independent- no manual assistance required; use of assistive devices, safety risks need to be considered, tasks take a little longer than a reasonable amount of time.
5- Supervision/Stand-by assistance – a caregiver needs to be in the room to supervise for safety, including making sure wheelchair brakes are locked and that the patient is using proper body mechanics. Physical assistance may be required if the patient loses his/her balance, but otherwise the patient can complete the transfer without physical assistance.
Contact guard assistance – a caregiver must keep a hand on the patient’s gait belt while the patient transfers to ensure safety. The patient is able to complete the physical requirements of the transfer without assistance. This assist level is not assigned a number on traditional FIM scoring sheet.
4 – Minimal (contact) assistance – the patient is able to perform 75% or more of the transfer. The caregiver must provide physical assistance to initiate the transfer and/or to help the patient maintain balance.
3 – Moderate assistance – the patient is able to perform 50% – 75% of the transfer. The caregiver must provide physical assistance to initiate the transfer, help the patient pivot, and help the patient maintain balance while standing. The patient is usually able to bear weight on his/her arms with no assistance and on his/her feet with support from the caregiver.
2– Maximum assistance – the patient is able to perform 25% – 50% of the transfer. One or two caregivers must provide physical assistance to help the patient complete all steps of the transfer. The patient may be able to help by using his/her arms to support weight and may be able to partially bear weight with his/her legs.
1 – Total assistance – the patient is able to perform less than 25% of the transfer. One or two caregivers must provide total assistance to transfer the patient. A mechanical lift may be used for caregiver safety.

Another way to describe the 7 levels of assistance that can be provided are:
1. Dependent: The patient is unable to assist.
2. Maximum Assist: Maximal assist means that the caregiver performs about 75 percent of the work during
transfers and the patient performs 25 percent of the work.
3. Moderate Assist: Moderate assist is a level of assist where the patient performs about 50 percent of the work
necessary to move and the caregiver performs about 50 percent.
4. Minimal Assist: Minimal assist means that the patient performs 75 percent of the work to move and the
caregiver provides about 25 percent of the work.
5. Contact Guard Assist: With contact guard assist, the caregiver needs to have one or two hands on the patient’s
body without providing other assistance to perform the transfer. The contact is made to help steady the
patient’s body or help with balance.
6. Stand-by Assist: During stand-by assist, the caregiver does not touch the patient or provide any assistance, but
he or she may need to be close by for safety in case the patient loses their balance or needs help to maintain
safety during the transfer.
7. Independent: The patient can perform the functional task with no help and is safe.

https://www.verywellhealth.com/assistance-with-mobility-in-physical-therapy-2696073

C. 16 inches.
The depth of a wheelchair is measured by measuring the length of the patient’s femur from the posterior portion of the buttocks to the popliteal fossa and then subtracting 2 inches. This allows the posterior crease of the knee joint to clear the edge of the wheelchair seat. The depth of 16 inches is based on average measurement data for adults.

B. Mobile arm support (MAS). This type of support allows a patient to use shoulder motion to flex and extend the elbow while the forearm is supported. The motion that results helps the patient with hand to mouth activities such as self feeding, as well as table top activities. Mobile arm supports must be balanced correctly before they will work as intended.

B. 18.5 inches.
                                             seat width                           seat depth          seat height

Junior                                    16”                                         16”                         18.5”

A. Chest harness.
Anterior trunk supports -Typically has a soft component that crosses the trunk or chest and attaches to
the wheelchair in four places with straps. Also referred to as chest harnesses or H straps. They are used to promote trunk extension and/or limit forward trunk movement.
http://shriver.umassmed.edu/sites/shriver.umassmed.edu/files/

D. Conceptual apraxia.
Conceptual apraxia is characterized by a difficulty in selecting an adequate tool for a specific action. The patient typically demonstrates poor knowledge of tool function and tool-object association, suggesting impaired conceptual knowledge of tool use. They may use the wrong tool for the task or may associate the wrong tool with the object to be acted on

A. Visual Agnosia is diagnosed if the client is unable to name four out of five objects
B. Constructional apraxia is characterized by an inability or difficulty to build, assemble, or draw objects.
C. Ideomotor apraxia is an inability to carry out a motor act on verbal command or imitation

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

B. Astereognosis. – inability to identify objects through touch.

Agnosia– inability to understand/interpret significance of sensory input.
Visual agnosia– inability to recognize people and objects.
Apraxia– inability to carry out specific motor tasks in absence of sensory/motor impairment.

A. Using a dynamic sitting cushion.
A dynamic sitting cushion activates intrinsic trunk muscles to encourage active sitting and also supports the spine.

B. Rocker knife.
Rocker knife- Using cutlery is usually a two-handed task. The food is secured/stabilized by a fork in one hand, whilst the other hand uses a knife to cut the food. The rocker knife is a knife with a rounded blade attached to a large, easy-grip handle directly above the blade. Knives with the blade positioned at right-angles to the handle allow a stronger grip to be maintained during cutting as the wrist remains in a neutral position. Rocker blades cut food using a rocking motion, rather than the traditional sawing motion.

A. Swivel utensil- has a pivoting joint between the head and the handle of the utensil, helping to keep the head of the utensil horizontal as it is brought towards the mouth. The swivel mechanism of these utensils is engineered to stay level thus keeping the spoon bowl or fork tines level which reduces spills.
C. Weighted utensil- Heavier cutlery is particularly helpful to people who have a tremor as the extra weight can suppress unwanted movement. i.e. It helps to reduce/dampen a tremor which in turn enables the patient to have more control over the utensil. With more control, the utensil can reach the patient’s mouth more efficiently (smoother movement with less spillage)
D. Universal cuff- Designed to give people with limited grip, hand strength, or dexterity, controlled use of items such as eating utensil, toothbrush, writing tools, and other small items.

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

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

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

C. Cover the patient’s eyes and then ask him to identify objects by feel.
Stereognosis – recognition by touch of common objects by touch

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

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

A. Increase/facilitate muscle tone
The Rood approach- Rood developed a system of therapeutic exercises enhanced by cutaneous stimulation for patients with neuromuscular dysfunctions. In addition to proprioceptive maneuvers such as positioning, joint compression, joint distraction and the general use of reflexes, stretch, and resistance, the greatest emphasis is given on exteroceptive applications such as stroking, brushing, icing, warmth, pressure, and vibration in order to achieve optimal muscular action.

A. Parkinson’s disease.
Slow progressive, degenerative movement disorder

1. Diagnosis usually made after age 55
2. Not considered fatal, increases risk for pneumonia which is fatal
3. Dysfunction in both voluntary and involuntary movements
4. Difficulty initiating movements (akinesia), slowness in maintaining movement (bradykinesia)

A. Dysmetria.
Dysmetria: This refers to disturbance of the trajectory or placement of a body part during active movement, both in range and direction. It is sometimes described as an inability to judge distance or scale.

B. Dysdiadochokinesia: inability to defined as the inability to perform rapid alternating muscle movements. These can be quick, synchronous, and can include pronation/supination, fast finger tapping, opening and closing of the fists, and foot tapping.
C. Agnosia: inability to understand/interpret significance of sensory input.
D. Astereognosis: inability to identify objects through touch.

B. Have the salesman use a powered wheelchair to get from the parking lot to his meetings
Since the patient has a progressive disease, it would be advisable to suggest a power wheelchair because he was getting tired propelling his manual wheelchair.

A. Cylindrical foam attached to utensil.
Cutlery with built-up handles allows the patient to grasp the handle of the utensil without having to wrap their fingers tightly around the handle for a stable and secure hold. Handles that are enlarged and/or contoured make it easier to grip. Helpful for patients who have pain in their hands which makes forming a tight grip difficult.

B. Implement aspiration precautions.
Dysphagia post CVA is common and protecting the patients’ airways is the first priority, so it is important to implement aspiration precautions first.
Prevention of aspiration during eating includes:
• Making sure the patients are sitting upright in their chairs/wheelchairs
• Implementing postural changes that improve swallowing. For example, a chin tuck.
• Adjusting the rate of eating and size of bites; avoiding rushed or forced eating.
• Alternating solid and liquid boluses.
• Varying the placement of food in a patient’s mouth according to the type of deficit. For example, food may be placed on the right side of the mouth if left facial weakness is present.
• Determining the food viscosity beforehand that is best tolerated by each individual. Ideally a trained dysphagia clinician (such as a speech therapist) should be consulted.

C. A rested person will likely have less difficulty swallowing.
D. Thickened liquids are commonly used to promote safer bolus transit and better airway protection (Joyce et al., 2015). However, they may not be appropriate for all patients. Some patients may find thickened liquids unpalatable and thus drink insufficient fluids.
Preventing Aspiration in Older Adults with Dysphagia. https://hign.org/consultgeri/try-this-series/preventing-aspiration-older-adults-dysphagia

D. Best ways to operate a wheelchair without upper extremities becoming fatigued.
Patients who use a wheelchair can become very fatigued and tired with their upper extremities. It is important to address proper body mechanics in the first session and then answer A,B,C.

C. Report the findings to the patient’s physician.
If an OT practitioner notices a decline in a patient’s function, it is important to notify the patient’s physician. The physician will need to reassess the patient and check for hemorrhage etc.

D. Air.
The adjustable air cells make this cushion an excellent option for individuals who have had past issues with pressure related sores and ulcers
• Excellent weight distribution
• Lightweight
• Washable
ROHO cushions are widely used air filled cushions. Most ROHO cushions format their air cells in different contours and in a gradation of heights. These contours are designed to ensure that areas at higher risk of skin breakdown are given focused protection.

A. Honeycomb cushions are not recommended if positioning or weight distribution are a major concern.
B. Foam cushions offer limited pressure relief.
C. Contoured cushions are used for patients with a posterior pelvic tilt.

Module 5. Worksheet: Wheelchair Cushions. https://passtheot.com/wheelchair-cushions/

A. Body mechanics during lifting and carrying
C. Joint protection techniques.
E. Stress management techniques.

This presentation is on injury prevention techniques for all employees. The presentation should cover general topics that pertain to all the workers in attendance. These topics could include body mechanics to use while lifting and carrying, joint protection techniques, and stress management techniques. Muscle conditioning, adaptations to work stations, and compensation techniques are done on an individual basis with patients in worker rehabilitation programs and should not be addressed during an in-service presentation.

B. Therapeutic exercises to improve neck and shoulder range of motion
C. Visual motor tracking with an emphasis on reaction time
F. Strengthening exercises to improve Wade’s ankle/foot control and grip strength

The underlying skills for driving can be addressed in the clinical setting, before driver’s rehabilitation begins. Activities to address these skills include range of motion exercises to improve head, neck and shoulder mobility, strengthening to ensure hands and feet are in condition for operating vehicle controls, and visual motor tracking skills to insure adequate visual reaction time during driving. Other tasks like ADL skills, fine motor skills, or pre-vocational skills could be addressed in the clinic, but would not directly apply to driver’s rehabilitation.

D. Spinner knob. Adaptation for patients who only have use of one hand.
A steering spinner or steering knob is a small rotating handle which is fitted onto the steering wheel, to enhance one-handed control of the steering wheel. It gives the driver far greater control when manoeuvring the vehicle, however they also have the effect of making the steering super-sensitive at high speeds and it is essential that the driver is correctly trained in how to drive with a spinner. There are a variety of shapes and sizes available, and they are generally selected according to what hand function the driver has. They are made up of a base which is clamped to the steering wheel, and the spinner handle. These come with the option of having a quick release system where the handle can easily be removed from the base, thus only leaving the base on the steering wheel.

B. Utilize a mirror while dressing.
A mirror will provide the patient with visual cues to attend to her left side so she can dress independently.

D. Quick stretch, tapping, and brushing.
Rood developed a system of therapeutic exercises enhanced by cutaneous stimulation for patients with neuromuscular dysfunctions. In addition to proprioceptive manoeuvres such as positioning, joint compression, joint distraction and the general use of reflexes, stretch, and resistance, the greatest emphasis is given on exteroceptive applications such as stroking, brushing, icing, warmth, pressure, and vibration in order to achieve optimal muscular action. Basic principles of the Rood Approach include normalization of tone. This is achieved by using appropriate sensory stimuli for evocating the desired muscular response.

B. 36″.
The ADA Guide for Small Businesses stipulates that when sales or service counters are provided, the counters must be accessible, if doing so is readily achievable. This access is an important part of receiving the goods and services provided by a business. At counters having a cash register, a section of counter at least 36 inches long and not more than 36 inches above the floor will make the counter accessible. This provides a lowered surface where goods and services and money can be exchanged. An alternative solution is to provide an auxiliary counter nearby. Accessible counter is at least 36″ long and no more than 36″ above the floor. Provide a 30″ by 48″ space in front of the sales or service counter to accommodate a wheelchair or electric scooter.
Where food or drinks are served at counters and the counter height is more than 34 inches above the floor, providing a lowered section of the serving counter at least 60 inches long and no higher than 34 inches will make the counter accessible.
https://www.ada.gov/smbustxt.html.

B. Hand controls for acceleration and braking.
Since the patient has lower extremity paralysis, it is best to recommend hand controls for acceleration and braking.

B. Lightweight manual wheelchair.
A lightweight manual wheelchair is flexible, can easily fold, and can be used for all kind of sports.

C. Asomatognosia.
Asomatognosia is a disturbance of body schema. Resulting from a disturbance in the normal awareness of one’s own body, typically characterized by one or more of the following symptoms:
1. A tendency to ignore or neglect one side of the body
2. A failure to recognize or difficulty in identifying a specific part of the body (usually a limb or part of a limb)
3. Difficulty in differentiating the right from the left side of the body
4. Recognizing an impairment in a part of the body (anosognosia)

A. Gravitational insecurity – seen in children with sensory processing disorders who react with exaggerated emotional responses to movements, typically when off the floor.
B. Ideomotor apraxia is a neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement.
D. Astereognosis – a person cannot recognize objects by touch.

C. Use empathy by listening to the patient’s concerns and feelings.
The OTA’s immediate response is to listen empathetically to the patient; it creates an atmosphere that fosters trust and demonstrates compassion.

A. 36 inches.
ADA requires a maximum height of 36 inches, all accessible counters must have a clear floor space in front of the accessible surface that permits a patient using a wheelchair to pull alongside. This space is at least 30 inches by 48 inches and may be parallel or perpendicular to the counter.

C. Completing jobs to take care of the everyday needs of the clubhouse. In the clubhouse model, each patient takes on a work task to help keep the clubhouse maintained and running efficiently, just like a real cooperative work environment.

B. Multiple sclerosis

While many symptoms are associated with multiple sclerosis, three of the primary symptoms are disabling levels of fatigue, impaired sensation in the extremities that results in pins and needles sensations, and a sensitivity to heat that exacerbates fatigue and muscle weakness.

C. A plate guard.
A plate guard is a plastic strip that clips to the side of a regular plate, creating a wall that blocks food from sliding off the edge of the plate. When Doris uses her unaffected hand to scoop food, she can use the plate guard as an edge to push the food on to her utensil.

A. Dictation software.
Since the student’s muscle weakness is progressive, he will likely have more difficulty typing in the future. Adaptations to the keyboard will have to be revised as the student loses functional ability in his hands. Dictation software would allow the student to compose written work without requiring him to use his hands to type. The student will be able to use this adaptation even if he loses functional movement in his hands, so this would be the best adaptation.

C. The universal cuff should be placed on the volar surface of the hand and the spoon placed in the radial side of the pocket.

The universal cuff should be positioned to most closely simulate how a person with normal movement would hold a spoon to scoop food. Placing the cuff on the volar surface of the hand with the spoon in the radial side of the pocket most closely simulates grasping a spoon to scoop food.

B. Dyskinesia

Dyskinesia refers to a movement disorder characterized by involuntary muscle movements. These movements can include twitching, tremors, and athetoid movements. A person with dyskinesia may have some or all of these characteristics. Dyskinesia is often a symptom of a systemic neurological disorder, such as Parkinson’s Disease or Huntington’s Chorea.

B. “Change is difficult. How about we just focus on changing your throw rugs first?”

Many elderly people do not want to admit that they are having difficulty functioning at home and they are reluctant to change things. Ruth may be afraid that if she changes something, she is admitting that she needs help. Introducing change slowly may help Ruth to adjust to the changes she needs to make to insure her safety in her home. Reminding Ruth of the possibility of a fall will probably not be effective because She has likely heard this argument from her family. Allowing Ruth to make the decisions without guidance will not insure that Ruth is taking action to improve her safety. The OTA works on the rehabilitation unit, not in home health, and has already completed a home assessment. She would most likely not be allowed to provide Ruth with additional assistance in her home, as this is the role of home health.

A. A swivel spoon. Swivel spoons are designed so that the bowl of the spoon sits somewhat lower than the handle, decreasing the amount of wrist flexion and pronation that is required to scoop food with a regular spoon. A swivel spoon is mounted to the spoon handle with a swivel mount, allowing the bowl of the spoon to swing back and forth. The swinging motion compensates for any tremor that is present, making it easier for the person using the spoon to keep the food in the bowl while lifting it to the mouth. The functions of the swivel spoon should help compensate for Anton’s limitations and allow him to feed himself without assistance to scoop food.

C. Conceptual apraxia. When conceptual apraxia is present, the patient is typically unable to understand the concept of tools and/or how to use them correctly. The boy understands that the toothbrush is used to clean his teeth but as he does not remember how to use a toothbrush correctly, his symptoms are consistent with conceptual apraxia.

D. Broca’s Aphasia. The patient in this scenario is having difficulty expressing herself. Broca’s is also called Expressive or non-fluent aphasia. People with this pattern of aphasia may understand what other people say better than they can speak. People with this pattern of aphasia struggle to get words out, speak in very short sentences and omit words. A person might say, “Want food” or “Walk park today.” A listener can usually understand the meaning, but people with this aphasia pattern are often aware of their difficulty communicating and may get frustrated.

A. Comprehensive aphasia. People with this pattern of aphasia (also called fluent or Wernicke’s aphasia) may speak easily and fluently in long, complex sentences that don’t make sense or include unrecognizable, incorrect, or unnecessary words. They usually don’t understand spoken language well and often don’t realize that others can’t understand them.
Global aphasia. This aphasia pattern is characterized by poor comprehension and difficulty forming words and sentences. Global aphasia results from extensive damage to the brain’s language networks. People with global aphasia have severe disabilities with expression and comprehension.

https://www.mayoclinic.org/diseases-conditions/aphasia/symptoms-causes/syc-20369518

C. Teach the man one-handed shoe tying techniques. Best practice states that tasks should be adapted using the technique that most closely resembles normal performance of the activity first. Based on best practice, the patient should be taught one-handed shoelace tying methods first, since this is a compensatory strategy that does not require any special adaptive equipment. In addition, the man is motivated to learn how to tie his shoes, so this is the approach that should be tried first.

D. Reach too far and miss grasping an object. Dysmetria is a form of apraxia in which a patient has difficulty with timing, speed and distance during motor activity. This causes the patient to have trouble judging where his or her body is in relation to an object, resulting over-reaching or under-reaching for that object.

B. Trackball mouse. A trackball mouse positions the trackball on top of the mouse, allowing the user to move the computer cursor by moving the ball with the fingers, rather than sliding the mouse around on the desktop. This adaptation works well for people with limited upper extremity range of motion. Paula does still have upper extremity movement, so she would not need to use voice commands or a head pointer. Using a touch screen would probably be difficult for Paula as she would have to reach forward and up to touch the screen.

B. Use a walker with a basket while shopping. Rachelle can walk independently but may not have the stability or endurance to walk longer distances in the community. A walker would give her support, improving her stability and allowing her to safely walk the distances required to do her shopping. She could also use the walker when walking to other places in her community.

A. Her level of disability does not require the use of a wheelchair. She is not disabled enough to require a wheelchair.
C. Using the shopping cart could only be used in the store, and would not assist her to walk to and from the store.

C. Self range of motion exercises. Randy has mild muscle tone and no active movement in his right arm. If he lets his arm hang and does not stretch it out, the muscles may tighten more, and contractures may develop at the joints. He can be taught how to complete self range of motion exercises by locking his fingers together and using his unaffected arm to help his affected arm.

A. Massage, elevation and compression wraps. The OT practitioner should recommend edema control techniques to nursing staff to help reduce the edema in Sherry’s left arm as soon as possible. The nursing staff can also be trained in anti-edema massage techniques, as well as how to elevate Sherry’s arm and how to use compression wraps or garments effectively to reduce edema.

B. An electric razor. The man’s safety during grooming tasks is priority and he must have a way to shave without cutting himself. An electric razor will allow him to do this.

B. Actual work tasks at Matthew’s place of employment. Transitional employment involves on-site job training for a period of 3 to 6 months. The OT practitioner would help Matthew by training him to perform actual work tasks at his place of employment. Matthew’s job would be pre-arranged by the school and would last 3 to 6 months, after which time the OT would work with Matthew’s IEP team to determine what type of ongoing employment Matthew can complete.

B. Built-up handle utensils. Enlarging the gripping surface of a utensil will give Holly more contact area while grasping the handle, allowing her to distribute the strength needed to grasp the utensil between all of her fingers and making the utensil easier to hold. Plastic utensils are the same size as regular metal utensils and will not help Holly by providing more gripping surface. Holly does not need a universal cuff as she still has some strength in her hands and universal cuffs are appropriate for people who have no active grasp. Redware is designed for patients with Alzheimer’s disease.

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

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

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

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

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

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

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

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

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

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

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

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

C. Crossing out items only on the right side of the paper.
Hemispatial neglect, also known as unilateral spatial neglect, is a condition in which a patient fails to respond to stimuli on the side of space opposite to the side of the brain lesion. Hemispatial neglect is common following unilateral brain damage, particularly of the right hemisphere (Right CVA). Patients with neglect often fail to be aware of or acknowledge items on their contralesional side (the left side for patients with right brain damage) and attend instead to items towards the same side as their brain damage—their ipsilesional side. Their neglect may be so profound that they are unaware of large objects, or even people, in extra-personal space. Neglect may also extend or be confined to personal space, with patients failing to acknowledge their own contralesional body parts in daily life. In this scenario, the patient suffered a R-CVA which has resulted in a left hemispatial neglect. Therefore, they would only attend to the items they are aware of, which are on their right side.
Cancellation tasks are popular clinical and scientific tools for identifying spatial neglect, with neglect patients tending to miss targets on the contralesional side of the test. Typically, the individual is shown a piece of paper with a cluttered array of items, and asked to mark all of the target items, while ignoring other distractors. The prevalence of these tests stems from many factors including the ease of describing the task to participants in a clinical situation and speed of administration (a couple of minutes).

A. This would most likely be displayed when there is a deficit with attention. 
D. The patient has corrective lenses which were recently updated. Therefore, he would likely not have difficulty with acuity.

https://jnnp.bmj.com/content/75/1/13

B. Install grab bars near the toilet, tub and shower.
C. Remove throw rugs and clutter.
E. Recommend chairs that are stable and have arm rests.

Parkinson’s disease impacts both motor and nonmotor skills throughout the disease process. Symptoms like fatigue, gait difficulties, cognitive or vision changes can impact the person’s ability to stay safe at home independently. Gait difficulties due to mobility changes related to freezing of gait, shuffling steps, or posture changes can increase fall risk for people living with Parkinson’s. Most falls take place in the bathroom because of difficulty getting on and off the toilet and in and out of the tub; difficulty seeing due to poor lighting; slipping on wet surfaces; tripping on throw rugs; or getting dizzy while standing from the toilet to the sink.
Tips:
• Install grab bars near the toilet, tub and shower: no location should require use of towel racks, faucets or soap dishes as grab bars.
• Ensure the toilet has an elevated seat and arm rests or grab bar within easy reach.
• Add a sturdy bench with back support to the tub or shower for safety.
• Make seating available to perform tasks such as brushing teeth or shaving.
• Place light switches near the door to avoid walking into a dark area.
• Keep floors unwaxed and debris free.

General tips:
• Chairs should be stable, have arm rests and adequate seat height to make standing up easier.
• Decreasing clutter reduces tripping hazards
PD-related reductions in balance skills and protective reflexes increase fall risk. Avoid climbing, whether on ladders, step stools or chairs.

C. Energy conservation and gross motor movements to complete preferred basic activities of daily living.
Although some people can take months and even years to recover, most people with Guillain-Barré syndrome experience this general timeline:
– After the first signs and symptoms, the condition tends to progressively worsen for about two weeks
– Symptoms reach a plateau within four weeks
– Recovery begins, usually lasting six to 12 months, though for some people it could take as long as three years
This patient is therefore in the recovery phase. The patient’s primary focus is returning home to care for her children. Therefore, energy conservation and gross motor movements will allow the patient to maximize the energy available to perform preferred activities and gradually gain tolerance to utilize the upper and lower body for mobility needs.

A. Based on the patient’s functional status and progression towards recovery in this Recovery Phase of Rehabilitation (6 months forward), hand strengthening would not be the primary focus, although it may be a component of the intervention plan.
B. The primary focus at this time would be maximizing energy levels to tolerate functional tasks as the patient had just started ambulation.
D. The focus of treatment is based on remediation, not compensation as patients with GBS are expected to gain most of their prior level of function due to the non-progressive nature of the disease.

Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, p 560.

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

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

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

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

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

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

A. Use seated positions as much as possible during fine motor tasks and arrange materials and tools so that they are easily accessible. The goal in this scenario is energy conservation through environmental modification

These are often the earliest symptoms of relapsing-remitting MS:
• Trouble seeing
• Sensitivity to heat
• Numbness, especially in the feet
• Weakness
• Fatigue
• Difficulty thinking clearly
• Depression
• Needing to urinate urgently
• Trouble with balance
• Lack of coordination
Relapsing-remitting MS is marked by relapses that last at least 24 hours. During a relapse, symptoms get worse. A relapse will be followed by a remission. During a remission, symptoms partly or completely go away. Since the relapsing-remitting type of MS has variable symptoms with expected function to be higher than that of other types, a combination of environmental modification and compensation techniques would support the patient’s goals. Seated positions and taking advantage of gravity-assisted work, such as pouring a drink from the edge of a table, will require less demand on the patient’s energy levels and coordination.

B and C. Holding items away and carrying weighted items require more energy and would result in the patient becoming easily fatigued
D. Giving him assistance would be helpful but this would not help him maintain his independence, and learning a new way of playing the guitar would not be a preferred form of performance.

Ryan, S., and Sladyk, C. (2015). Ryan’s Occupational Therapy Assistant: Principles, Practice Issues, and Techniques. Thorofare, NJ: SLACK Incorporated, pp 304-3

C. Dusting the blinds and ceiling fans with an extended wand and folding towels.
These activities require the greatest amount of bilateral shoulder flexion and elbow extension.

A. Although lifting and carrying items involve bilateral movements with an element of full body bending, they do not require the maximum shoulder flexion and elbow extension.
B. Although these activities involve bilateral components, they do not require the greatest amount of shoulder flexion and elbow extension.
D. Although these activities are graded to include some bilateral components they require an extensive amount of motions including stooping, crouching, and bending which were not included as requirements for this session and may be too challenging for the patient at this time.

Reed, Kathlyn. (2001) Quick Reference to Occupational Therapy. Gaithersburg, MD: Aspen Publishers, pp 300-301.

A. Mental rehearsal of the sequence of movements prior to standing up.
C. Using proprioceptive cues, such as gently rocking backward and forward prior to standing up.
D. Using auditory cues, such as saying “go”.
Movement disorders are the hallmark of PD and can severely compromise an individual’s ability to perform well-learned motor skills such as walking, writing, turning around, and transferring in and out of bed.
Standing up from a sitting position, requires the individual to sequence 4 actions:
1. Shifting the body forward so that the buttocks are close to the edge of the chair
2. Placing the feet flat on the floor so that the heels are well back
3. Leaning the trunk forward
4. Standing up quickly while thinking of leaning “for-ward and up” in an arc of movement.
A common problem is that people with PD fail to lean far enough forward when standing up. As a result, the line of center of gravity falls too far posteriorly in relation to the feet, and the loading moments of force on the hips and knees are increased. This problem makes rising very difficult. A downward gaze and loss of momentum due to akinesia further increase the difficulty in performing this task. With hypokinesia, mental rehearsal of the sequence prior to its performance as well as the use of verbal cues, such as counting or saying the action out loud, may enable this task to be performed more easily. With akinesia, the use of proprioceptive cues, such as gently rocking backward and forward prior to the movement, or auditory cues, such as saying “go,” can be of use.

B. A chair with a high seat and armrests can be used to enable the person to stand up. By increasing the height of the seat and using armrests, the loading of force on the hips, knees, and ankles is reduced, making the task easier to perform.
E. This is a strategy for managing anxiety.
F. A common problem is that people with PD fail to lean far enough forward when standing up. As a result, the line of center of gravity falls too far posteriorly in relation to the feet, and the loading moments of force on the hips and knees are increased.This problem makes rising very difficult.

https://academic.oup.com/ptj/article/80/6/578/2842508

D. Spoon-thick liquids.
Spoon-thick or “pudding” consistency are terms used to describe a liquid that is as thick as a pudding.

A. Give Wanda extra repetitions of specific tasks to help reduce intention tremor.
C. Use rhythmic cues to help Wanda pace her movements.
D. Have Wanda visualize a fine motor task prior to completing it.
Movement in patients who have Parkinson’s Disease is often limited by tremor, especially intention tremor that occurs before the patient initiates a movement. Treatment techniques that can help reduce this tremor focus on making movements more automatic and timing movements to reduce uncertainty. Extra repetitions, rhythmic cues, and visualizing tasks meet this requirement. Timing tasks causes the patient stress and actually increases intention tremor. Treatment should also focus on practicing specific steps of a task to improve individual movements, rather than integrating the task right away. Exercises should be graded from active assist through the full range of motion to independent movement.

B. Mashed potatoes and mashed carrots
C. Ground turkey with gravy
D. Tomato juice

A mechanical soft diet requires that dry or tough foods be ground up or mashed. Meat is usually ground up and sometimes mixed with liquid or gravy. Vegetables are usually cooked and/or mashed. Meat that is cut into bite sized pieces is not soft enough for a mechanical soft diet and saltine crackers are too dry and hard. Pureed spaghetti would not be necessary. Nectar thick liquids include liquids that have a slight thickness to them, such as tomato juice.

A. Have George practice appropriate sitting posture in front of a mirror.
B. Use handling techniques to make sure George’s posture is correct before initiating activity,
E. Use dynamic weight-shifting during reaching tasks to practice trunk control during weight shifting.

Occupations while seated should always be completed with the body in correct alignment. Handling techniques and visual feedback, such as working while looking in a mirror, can help facilitate this correct alignment. Dynamic weight-shifting activities can emphasize how the body should feel while in and out of correct alignment, as well as strengthen the core muscles during postural movements. Avoiding positions or activities that strengthen postural control will slow or even hinder progress during treatment.

A. Vinyl-coated spoon.
A tonic bite reflex causes the patient to bite down in a strong, sustained manner in response to stimulation of the teeth and gums. Using a coated spoon minimizes the exposure of the teeth and gums to hard metal or plastic, reducing the stimulation received and reducing the reflexive reaction.

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

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

C. 24 feet. 1 foot is equal to 12 inches. ADA recommends a 1:12 slope, which means that for every 1 inch of vertical rise, 12 inches of ramp length is required. In this scenario the vertical rise is 2-foot which equals 24-inch. The minimum ramp length would therefore be 24 inches X 12 = 288 inches. To convert 288″ to foot measurements, divide 288 by 12 which equals 24 feet. Or simply put, the ratio is 1:12. The vertical rise is 2 feet which means that the calculation is simply 2:24. Make you are using the scale of measurement.

View this website for more information. View this website for more information. http://www.adawheelchairramps.com

B. A word prediction program to save keystrokes.
A word prediction program to save keystrokes will help a patient who becomes fatigued from typing. Word prediction programs reduce the number of keystrokes necessary to transcribe a word by using the first one to three letters that are typed to predict the target word. Based on what letters of the word have been typed, these programs first presents a list of choices or guesses as to the desired target word. The proposed word list is then dynamically changed as more letters are typed, thus increasing the accuracy of the predictions. Word prediction was originally developed for people with physical disabilities to decrease the number of keystrokes needed to input text. Today, word prediction is fairly common as an integrated feature of texting and email apps for smartphones and tablet computers (e.g., iPads).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

B. Light touch keyboard. A light touch or soft touch keyboard will make it easier for this patient to press on the keys.
Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass. In muscular dystrophy, abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle. There are many kinds of muscular dystrophy. Symptoms of the most common variety begin in childhood, mostly in boys. Other types don’t surface until adulthood. There’s no cure for muscular dystrophy. But medications and therapy can help manage symptoms and slow the course of the disease. The main sign of muscular dystrophy is progressive muscle weakness. Specific signs and symptoms begin at different ages and in different muscle groups, depending on the type of muscular dystrophy.

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

A. Basic ADL skills related to work – hygiene and grooming, how to dress for work, etc.
B. Time and schedule management.
F. Training in community mobility.

Pre-vocational training involves the development of skills necessary to obtain and hold a job in the community. Even though Jared will be working in a supported employment position, he will still be expected to demonstrate the skills needed to hold a job, including appropriate hygiene, grooming, and clothing. He will also need skills related to time and schedule management, such as how to fill out a time card and how to read a work schedule. He will also need training in how to get to work, such as riding the city bus. On-site training in tasks specific to the job Jared will be working will occur during supported employment, not during pre-vocational training. Handwriting skills would have been addressed with Jared when he was in elementary school. Driver training must be provided by specially licensed driver rehabilitation practitioners.

B. Use sectioned dishes.
For a patient with impaired cognitive abilities, the following strategies are recommended:
– use sectioned dishes to separate foods of different textures.
– use high contrast place settings, i.e. white plate on dark placemat.
– make sure food colors contrast with the plate.
-provide smaller size utensils to control the amount of food that enters the mouth.

D. Handling techniques to align the jaw is a strategy used to facilitate alignment and lower jaw mobility when a patient has a weak or misaligned bite.

In addition to the defining motor symptoms of Parkinson’s disease, multiple non-motor symptoms occur; among them, cognitive impairment is common and can potentially occur at any disease stage. Similar to slowness of movement (or bradykinesia), people with PD often report slower thinking and information processing (termed “bradyphrenia”). Attention and working memory, executive function, and visuospatial function are the most frequently affected cognitive domains in PD.

Module 5. Dysphagia Worksheet. https://passtheot.com/swallowing-dysphagia-and-feeding-problems/

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

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

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

B. 16 inches.

The depth of a wheelchair is measured by measuring the length of the patient’s femur from the posterior portion of the buttocks to the popliteal fossa and then subtracting 2 inches. This allows the posterior crease of the knee joint to clear the edge of the wheelchair seat. The depth of 16 inches is based on average measurement data for