Module Four

D. A transfer-of-training approach using the skill of categorization.
Categorization is chunking information or placing it in groups. It is a part of thought functions that relies on the person’s past experiences by identifying something they have seen or encountered in the past. After working on a tabletop activity such as sorting pictures to identify parts of a task, the patient “transfers” this skill to real-life situations to improve or restore cognitive skills. A transfer-of-training approach promotes engagement in tasks that will enhance recovery from a brain injury.

A. This task is working on a specific cognitive deficit area, specifically thought functions, not visual perceptual problems.
B. Working on compensating for expressive aphasia is not a goal in this task.
C. Deficit of inattention is not observed in this task

Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 451-455.

B. Maintaining function.
When a patient has a progressive disease, it means the patient will not improve in function. Therefore, it is important to maintain function as much as possible.

A. Increase background contrast.
D. Increase illumination using halogen lighting.
E. Reduce background patterns.

A. Changing the background color to contrast with an object can help the patient see objects more clearly. Application of this technique can be as simple as using a black cup for milk and a white cup for coffee. In cases in which the background color cannot be changed, such as on carpeted steps, color can be applied to provide a marker. For example, a line of bright fluorescent tape can be applied to the end of each step riser on the carpeted stairs to distinguish between them.
D. Increase Illumination Increasing the intensity and amount of available light enables objects and environmental features to be seen more readily and reduces the need for high contrast between objects. The challenge in providing light is to increase illumination without increasing glare. Halogen, fluorescent, and full-spectrum lights provide the best sources of bright illumination with minimum glare and are generally recommended over standard incandescent lighting for both room and task illumination. Lighting should be strategically placed to provide full, even illumination without areas of surface shadow.
E. Patterned backgrounds have the effect of camouflaging the objects lying on them. The detrimental effect of pattern on object identification can be minimized by using solid colors for background surfaces such as bedspreads, place mats, dishes, countertops, rugs, towels, and furniture coverings. Objects in the environment also create a background pattern. Cluttered environments with haphazardly placed objects create challenges, even for persons with good acuity

Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (p. 605).

A. No hip adduction.
B. No hip internal rotation.
E. Avoid hip flexion greater than 90 degrees.
There are two different types of total hip replacements (also referred to as total hip arthroplasty). The most common is the posterolateral approach. Precautions for this approach include the following: Avoid hip flexion greater than 90 degrees, no hip adduction, and no hip internal rotation. In simpler terms, no bending past 90 degrees, crossing legs, or pointing toes inward.

D. The use of a long bottle or straw. Patients who are at SCI C1-C4 would benefit from using a long bottle or straw in order to drink independently.

B. The last line of print that is easily read on the reading acuity test card indicates the minimum size of the print. 

For visual impairments, objects should be enlarged to make them more visible. Instructions can be reprinted in larger print, medications and other items relabeled, and calendars enlarged. The last line of print that is easily read on the reading acuity test card indicates the minimum size that  print should be enlarged for the patient. Contrast should also be increased because it does little good to enlarge print if  the print is faint. Black on white or white on black print is  usually more visible than any other color combination. Many items are now manufactured with larger print, including calculators, clocks, watches, telephones, check registers,  glucose monitors, scales, playing cards, games, and puzzles. 

A. Typing Stick. A C6 SCI will be able to use a tenodesis grasp to hold and use a typing stick.

A. Maintain a journal to track how she is feeling before, during, and after activities.
C. Create a calendar of assigned duties for each of her children to do, if they are willing.
F. Work on seated-level IADLs that facilitates stretching the left upper extremity such as making her favorite pizza dough with a rolling pin.
By tracking activities affecting her endurance levels throughout the day, the patient can prioritize the type of activities she is able to do at the best times of the day, for that activity. Some of those activities can be assigned to her children, who are willing to help, maximizing her energy levels yet allowing the patient to fulfill her role as parent, by teaching them responsibilities. After a mastectomy, it is important to maintain and gain ROM with gentle stretches to prevent scar tissue formation.

B. The focus should be on remediation rather than compensation for increasing joint ROM.
E. The goal is not to increase strength but to increase ROM.
D. Hiring a housekeeper removes the patient from being involved in her preferred activities.

Cross, Darla (July 2019): Occupational Therapy Interventions in Cancer Care. OT Practice Magazine (Vol 24), p 11-14.
https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/exercises-after-breast-cancer-surgery.html

C. Use nursing pillows and wedges to support the mother’s arms during breastfeeding.
A functional let-down reflex is required to provide adequate milk to a nursing infant. Infant suckling activates tactile receptors in the breast, and this signal is carried via afferent nerves in the T4-6 dorsal roots to the spinal cord and then to neurons in the hypothalamus, which releases oxytocin into the bloodstream. Oxytocin triggers milk ejection from the breast. Suckling-induced afferent stimuli are absent in women with SCI above T4. Fatigue is a concern for patients with spinal cord injuries. Supporting her arms is essential to reduce fatigue.

A. The patient has chosen to breastfeed instead of using a bottle.
B. The possible movements at C6 include forearm supination and elbow flexion – therefore, a sling is not necessary.
D. Holding the baby prone while the mother is in supine would cause fatigue in her shoulders. Therefore, it is not an optimal position for her to breast-feed.

Lee, A. H. X., Wen, B., Hocaloski, S., Sandholdt, N., Hultling, C., Elliott, S. L., & Krassioukov, A. V. (2019). Breastfeeding Before and After Spinal Cord Injury: A Case Report of a Mother With C6 Tetraplegia. Journal of Human Lactation. https://doi.org/10.1177/0890334419844234

C. Playing simple scales to integrate bilateral use. Bilateral activities that require one dominant extremity (the TD) and one functional assist (the non-dominant hand) are the best tasks for practice during the functional training phase.

A. Although this task requires bilateral use and is an important part of playing the violin, it allows a simple motion of the prosthetic rather than integrating its use during the actual musical performance.
B. Positioning is important, but it doesn’t include bilateral use.
D. Accessing and storing the violin and bow would be important during holding and carrying, in the controlling and use training steps of the phase.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 559.
http://www.acpoc.org/index.php/membership/newsletters-journals/icib–jacpoc-volumes-1961-1989/volume-12/number-3/musical-instruments-for-upper-limb-amputees-2

A. Use a guide or window to aid in maintaining place and to limit the amount of work presented at one time
C. Focus on auditory skills while building visual skills
D. Break prolonged near work into shorter tasks

These adaptations will compensate for decreased visual attention and scanning and allow Analisa to tolerate and complete her reading tasks as she continues to improve her visual skills.
B, E, and F. are adaptations that are counterintuitive. It would be most difficult to read smaller print material farther away. Increasing complexity gradually and having lighting flooding reading material above and behind the reader would be most ideal.
Anderson, S. L., and Lehman, S. S. (2014). Ophthalmological and Occupational Therapy Collaboration: Treating the Visual Consequences of Traumatic Brain Injury. OT Practice 19(20), 7–11

A. To watch for any flushing, chills, or abnormal perspiration exhibited by the patient.
C. To be aware of the patient’s loss of kinesthesia and proprioception. The patient’s lower limbs can therefore knock into or get caught in environmental barriers.
F. Maintain fluids to regulate body temperature and observe skin for overheating below the level of injury.

Watch for flushing, chills, abnormal perspiration; check limbs when navigating small spaces with wheelchair due to loss of sensation; and maintain body fluids to regulate body temperature.
Autonomic dysreflexia which is caused by obstruction of the catheter tubing, drain bladder, or constriction of the abdominal or groin area. It can be exhibited by signs of pounding headache, flushing and chills. Regular water intake will help maintain body temperature. Skin checks ensure the patient is not overheating in the summer heat and that the skin is clear of nicks, cuts, and bruises – this is important because of absence of sensation below the level of injury.

B, E and D. Power wheelchair use , fair muscle grading for the upper extremities, and resting hand splints are not relevant at T6 level of spinal cord injury.
Reed, Kathlyn. (2001) Quick Reference to Occupational Therapy. Gaithersburg, MD: Aspen Publishers, pp 548-549.

C. Visual Closure.
Visual Closure is the ability to visualize a complete whole when given incomplete information or a partial picture.

A. Visual discrimination is the ability to determine differences or similarities in objects based on size, color, shape, etc.
B. The ability to recall or remember the visual details of what you have seen is known as visual memory.
D. Visual acuity is a measure of the ability of the eye to distinguish shapes and the details of objects at a given distance. 20/20 vision is a term used to express normal visual acuity (the clarity or sharpness of vision) measured at a distance of 20 feet.

B. Use of the strategy of guiding the toothbrush followed by a one-step command such as “to mouth” with OT periodically stating, “Let’s focus.” This strategy minimizes cognitive demand and reduces stress experienced by the patient by breaking down the task into specific components followed by simple cues to reduce complexity.
A coup injury occurs on the brain directly under the point of impact. A contrecoup injury occurs on the opposite side of the brain from where the impact occurred. Coup and contrecoup injuries are a type of traumatic brain injury that results in the bruising of the brain.

A. Demands increased attention and processing to sequence the task as opposed to using simple 2-word auditory cues.
C. This would be a more appropriate intervention for a person with Parkinson’s who has difficulty initiating and continuing a movement pattern.
D. This would be a memory retraining approach, not an attention or focus approach.

A. Identify cues that will trigger a medication habit.
B. Identify the most realistic and simple routine in which the medication could be taken.
E. Practice the entire medication habit until it becomes automatic.

After determining the patient’s typical routines, it is important to collaborate with the patient to determine the most realistic routine in which she can establish a habit with taking her medications. Then, identify the location where the medication bottles or pill box are placed. Lastly, identify cues that will trigger the medication habit. For example, if the patient places her medications by the microwave and coffee maker which are next to each other, she ensures she sees them daily, takes them while she makes coffee or makes microwaveable meals, and reduces the likelihood of missing her medications.

C. Patient wants to manage her medications herself.
D. Although accessibility and readability are important, it would have been addressed at the pharmacy.
F. The patient may not take her walker everywhere with her.

American Journal of Occupational Therapy, January/February 2013, Vol. 67, 91-99.

C. Only give the patient one food type at a time.
By working with the patient on self-feeding and giving the patient one food type at a time, will help the patient with their goal. Feeding is not the same as eating or swallowing. If the OTA was working on the swallow reflex then putting the patient on a pureed diet would be the answer.

B. Adduction and flexion.
Anti-contracture positioning and splinting must start from day one and may continue for many months post-injury. It applies to all patients whether they have been skin grafted or not. Positioning is important to influence tissue length by limiting or inhibiting loss of ROM secondary to the development of scar tissue. Patients rest in a position of comfort; this is generally a position of flexion and also the position of contracture. Proper positioning is critical because the position of greatest comfort for the patient is usually the position of contracture. The typical position of comfort consists of adduction and flexion of the UEs, flexion of the hips and knees, and plantar flexion of the ankles. The toes are generally pulled dorsally. Acutely burned hands are held by edema in a dysfunctional position consisting of wrist flexion, MP extension, IP flexion, and thumb adduction.

Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti) Kindle Edition.

B. Claw hand deformity.
Acutely burned hands are held by edema in a dysfunctional position consisting of wrist flexion, MP extension, IP flexion, and thumb adduction. This position, often called the “claw hand” or “intrinsic minus” position, can lead to severe dysfunction if not prevented during the healing process and active scar formation. Claw hand deformity is characterized by:
• MCP hyperextension
• PIP & DIP flexion
Claw hand deformity can also be caused by:
• Congenital defect, a defect present at birth  
• Ulnar nerve palsy
• Paralysis of the ulna and median nerves 
• Leprosy, which still remains a common cause of the claw hand.

A. A baby born with polydactyly has more than five fingers on one hand. An extra finger is often a small piece of soft tissue that can be simply removed. Sometimes, the extra finger contains bones but not joints. Very rarely, the extra finger is a fully functioning digit. A baby may be born with several extra fingers.
C. In ape hand deformity (simian hand), the thenar muscles become paralyzed due to impingement of the median nerve and are subsequently flattened. This hand deformity is not by itself an individual diagnosis; it is seen only after the thenar muscles have atrophied.
D. Cleft hands are congenital disorders, and significant deformities are present at birth. Cleft hand is characterized by the absence of 1 or more central digits of the hand, also known as lobster-claw deformity.

D. Report the symptoms to the patient’s charge nurse. This patient is demonstrating a diabetic crisis which needs immediate medical management. Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can’t produce enough insulin. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours:
– Excessive thirst
– Frequent urination
– Nausea and vomiting
– Abdominal pain
– Weakness or fatigue
– Shortness of breath
– Fruity-scented breath
– Confusion
This is considered a medical emergency requiring prompt action by a nurse or physician as this is a sign of diabetic ketoacidosis which can lead to a coma and possibly death if not treated.

A. Offering the patient food with glucose can exacerbate the symptoms. Therefore this is not an option.

Early, Mary Beth. (2006). Infection Control and Safety Issues in the Clinic, Physical Dysfunction Practice Skills for the Occupational Therapy Assistant (3rd Edition, p 47). St. Louis, Missouri: Elsevier, Mosby Inc.

C. Strategies to use to reduce or prevent caregiver burnout. Since the patient’s sister will be the primary caregiver and available 24 hours a day, the subject of burnout should be addressed early especially if the patient requires extensive assistance. The OT practitioner should consider the effects caregiving can have on a person. The patient will be dependent on his sister for all aspects of his life ie: safety, psycho-social support, and IADLs. Depressive mood, stress and anxiety, physical exhaustion and decreased social and leisure participation are some of the factors experienced by the caregiver. By teaching her strategies to cope, her new role as caregiver could be made easier.

A. The graft and donor sites will be sensitive to hot and cold temperatures.
C. After skin grafts and donor sites heal it is very important to put on a non-perfumed (unscented) lotion or mineral oil many times a day.
D. Wear sunscreen with an SPF of 30 or higher and avoid prolonged sun exposure.

A. Because nerve endings were damaged, the new skin will be sensitive to hot and cold temperatures.
C. After skin grafts and donor sites heal it is very important to put on a non-perfumed (unscented) lotion or mineral oil many times a day. This will help control itching and keep the skin soft, moist, and able to stretch. It is important to prevent the skin from becoming dry and starting to peel.
D. Because of damaged or lost skin pigment, burn survivors are at a greater risk for sunburn. Precautions, including the use of sunblock and avoidance of prolonged sun exposure, should be taught before a patient is discharged.

B. Bathing- The patient may continue to bathe in their usual manner, however, soaking in a bathtub is not recommended. Testing the water temperature before getting into the tub or shower is essential as the patient’s new skin is sensitive to extremes of hot or cold and may be injured easily. Using a clean, soft towel and gently washing instead of vigorously rubbing will lessen any discomfort of bathing.
E. Nutrition is important during recovery from a burn injury. Choose foods rich in protein to complete healing and maintain good tissue structure. Protein may be obtained from beans, nuts, cheese, fish, eggs, meat, poultry, and milk. Vitamins and minerals are also essential for healing and maintaining normal body functions. They are provided by dairy products, whole grain cereals, enriched breads, fruits and vegetables.
F. Discoloration- The skin discoloration evident in the healed areas is a result of the normal healing process. It may appear light to deep pink, brown, or a grayish color; this is no cause for alarm. Discoloration varies with each individual, depending on the patient’s natural skin coloring. Natural color may return to superficial burns and some second-degree burns in several months. Other areas may take much longer, and some discoloration may be permanent in burns of greater depth.

https://uihc.org/health-topics/caring-your-burn-after-hospitalization.

B. Power wheelchair with chin or pneumatic (sip and puff) controls.
Patients with injuries at the C4 level will likely depend on others for help with almost all of their mobility and self-care needs. If injuries are at the C4 level, patients have active movement of the neck muscles, plus innervation to the diaphragm. This would allow them to use power wheelchairs operated by either chin or pneumatic (sip and puff) controls.

C. A spoon can be attached to a universal cuff which is strapped over the splint.

The goal is to support the patient to be independent when eating. By using the universal cuff 2 goals are achieved, namely independent eating and active movement to maintain ROM. If a UE is immobilized, creative ADL adaptations may be needed to allow patients continued involvement in their care and control over their environment. Though only temporary, simple techniques such as universal cuffs strapped over splints or extended handle utensils help preserve newly reacquired independence and foster confidence and feelings of self-actualization.

A common and distressing symptom of BPD is self-harm. People with BPD often act very impulsively and for a patient who feels overwhelmed it can seem like a logical and effective way to momentarily relieve the pain that they feel inside. A common belief regarding self-harm is that it is an attention seeking or manipulative behaviour, however this is not typically the case. Self-harm is seen as a coping mechanism, which provides temporary relief from intense feelings. Patients often feels guilty about their behaviour, embarrassed about their injuries, and goes to considerable lengths to conceal their behaviour, with most self-harm behaviours never presenting to hospital

https://www.academia.edu/8880473/Self_inflicted_burns_A_case_series
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti) Kindle Edition.

C, D, E. This activity targets visual spatial awareness, figure ground and visual integration.

C. Visual Spatial Awareness: The ability to understand where objects are in relation to each other
D. Figure ground:  The ability to see an object on top of a background color or scene
E. Visual motor integration: The ability to use both motor and visual skills in coordinating a task

A. Form constancy – the ability to notice that two objects are the same even if they are different in size, color, etc.
B. Visual closure – the ability to identify two objects that are the same even if part of one is missing
F. Visual memory – the ability to remember visual information

It is important to keep in mind that visual perception is not the same as visual acuity.

B. C6 SCI.
A patient with a C6 injury typically has head, neck, shoulder, arm and wrist movement. He can shrug his shoulders, bend is elbows, pronate/supinate his forearms, and extend his wrists. A Tenodesis Splint is an ideal splint for a C6 quadriplegic patient or anyone with wrist extension strength but no finger strength. As the patient is able to achieve wrist extension, he can utilize the tenodesis grasp pattern. The tenodesis grasp is the natural flexion of the fingers when the wrist is extended, and extension of the fingers with wrist flexion. This natural movement pattern allows the patient to grasp an object. Although this movement is present, it is often weak and may need to be supported with a tenodesis splint. This splint stabilizes the thumb and holds the fingers in slight flexion. When the wrist is extended, the static line attached to the wrist cuff pulls the finger MP joints into flexion, creating a fingertip pinch ability and gross grasp ability. Some tenodesis splints are simple and provide just enough support to enhance the natural movement of the hand while others may be more elaborate with moving parts to provide increased grip strength.

A. At this level, the patient would have no voluntary wrist and hand movement.
C. At this level the patient would have intact hand function. Only his lower limbs would be affected/paralysed.
D. From T1, hand function is fully intact.

B. Direct a lamp from behind the patient’s shoulders while he is reading the music from matte sheet music paper. Glare is light directed to the eyes, either coming from the top or the sides. Flooding the light from the back of the person will reduce glare and make reading easier.
Glare is caused by the reflection of light off of surfaces. You can reduce glare by controlling the light source, adapting the surface reflecting it, or by filtering it before it reaches your eyes.
1. Adjust the Light Source
Direct light causes the most glare. Use a desk lamp for directed, diffused task lighting when needed instead of bright overhead light.
2. Adjust the Surface
Shininess is measured by reflection and glare. That means the duller the surface, the less glare there will be. Use work surfaces that have matte finishes.
3. Shield Your Eyes
If you cannot eliminate the glare, then stop it before it gets to your eyes. Polarized lenses on sunglasses eliminate a lot of glare. Prescription lenses can be polarized as well.

Adams, Chris. “How to Reduce and Eliminate Glare and Eyestrain.” ThoughtCo, Aug. 26, 2020, thoughtco.com/reduce-and-eliminate-glare-1206483.
Padilla, René L., Byers-Connon, Sue.Lohman, Helene. (Eds.) (2012) Occupational therapy with elders: Strategies for the COTA Maryland Heights, MO : Elsevier/Mosby, (p 207).

A. Level 5.
RLA 7 corresponds to ACL 5. New learning is a hallmark feature in both scales and minimal supervision for ADLs and safety concerns are common in both.
RLA VII – Automatic, Appropriate. Patient requires minimal assistance for ADLs and requires minimal supervision for new learning and is able to carry over new learning. Unaware of the needs of others; unable to recognize inappropriate social interactions. Demonstrates impaired safety awareness and judgment.
ACL Level 5 – Exploratory Actions. Global cognition is mildly impaired. Patient requires standby assistance. New learning can occur- learns through trial and error and can learn independently through exploratory actions. Poor organization, planning and socialization. Safety needs to be monitored- behavior impulsive.

C. Prosthetist . A prosthetist, as defined by The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc.,[1] is a person who measures, designs, fabricates, fits, or services a prosthesis as prescribed by a licensed physician, and who assists in the formulation of the prosthesis prescription for the replacement of external parts of the human body lost due to amputation or congenital deformities or absences.

A. Place tactile labels on knobs of appliances.
This option has the most impact on safety as it will allow the patient to feel when appliances, especially the stove top, are on. The specialty cutting board is for one-handed adaptation for meal prep, not necessarily for low vision. Large crockpot with precut ingredients would eliminate the need for the patient to cut up ingredients, but the patient would still need to be able to identify when the crockpot is on or off. Arrangement of spices would be beneficial but does not have the most impact on safety.

C. A firm, elevated chair with armrests. This supports the optimal and safe position to maintain adherence to hip precautions with arm rests to allow safe transitions from sit-to-stand and stand-to-sit

After undergoing a total hip replacement surgery, there are certain precautions that need to be taken, especially if the surgery was performed via a posterior approach. The primary concern is the avoidance of a hip replacement dislocation. After a total hip replacement with a posterior incision, three movements should be avoided to prevent dislocation of the hip prosthesis.
1. Hip flexion past 90 degrees. Sitting in a low chair or flexing the knee and hip to don a sock may break this 90-degree rule and put the patient at risk for hip dislocation.
2. Crossing the operated leg over your non-operative leg (adduction). When lying down, the patient should not cross one leg over the other to maintain this hip precaution. When sleeping, many patients are required to use a special wedge called an abduction pillow to help keep their legs separated.
3. Internal rotation of the hip.

B. Retinopathy.
Diabetic retinopathy symptoms usually affect both eyes. The patient can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, the patient will notice symptoms such as:
• seeing an increasing number of floaters
• having blurry vision
• having vision that changes sometimes from blurry to clear
• seeing blank or dark areas in the field of vision
• having poor night vision
• noticing colors appear faded or washed out
• losing vision

A. Nephropathy (Kidney damage). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
C. Neuropathy (Nerve damage). Excess sugar can injure the walls of the capillaries that nourish the patient’s nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, the patient could lose all sense of feeling in the affected limbs.
D. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.

https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
https://www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy

D. Assisted living.
Many alternatives are available for older adults to age in place, with the idea being that aging in place relates to the preferred place of residence. The environment, when modified to address a good person-environment fit, can increase or maintain an older adult’s occupational participation. It may be in a single-family dwelling, an apartment, or an assisted living senior complex or with family. Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 120 or more. Typically, a few “levels of care” are offered, with residents paying more for higher levels of care. Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Exact arrangements vary from state to state.

C. Skilled nursing facilities, provide a wide range of health and personal care services. Their services focus on medical care more than most assisted living facilities. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available. Some people stay at a nursing home for a short time after being in the hospital. After they recover, they go home. However, most nursing home residents live there permanently because they have ongoing physical or mental conditions that require constant care and supervision.

https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes
Many more alternatives are available for older adults to age in place, with the idea being that aging in place relates to the preferred place of residence. The environment, when modified to address a good person-environment fit, can increase or maintain an older adult’s occupational participation. It may be in a single-family dwelling, an apartment, or an assisted living senior complex or with family.
Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1240).

A. Use non-glare bulbs.
C. Avoid using fluorescent lighting.
D. Use lighting on a flexible arm.

A. Glare can be very difficult for people with low vision, so it is important to control glare as much as possible.
C. Exposure to harsh fluorescent lighting can cause eye strain and blurred vision as fluorescent lights are much brighter than other incandescent bulbs.
D. Lighting on a flexible arm can provide extra lighting for close work such as applying make-up, and it can be positioned to suit the task.

B. One important strategy to improve vision in low light situations is to use lightbulbs that are at least 60-100 watts
E. Having your back to a window and using direct lighting from behind are strategies to reduce glare

Macular degeneration is one of the most common causes of vision loss, especially in those over the age of 50. It is a progressive eye condition that causes damage to the macula. One of the symptoms of macular degeneration, including AMD, that some people might notice is difficulty seeing in low light situations, or when there’s a sudden change in lighting, like when you come inside from being out in the sun.
Other strategies to improve vision in low light situations:
– Add more light from desk or floor lamps or clip-on lamps (like on books or headboards)
– Put light behind and on the side of the stronger eye
– Increase contrast where needed
– Try different kinds of light (halogen, incandescent, flood)

https://visionaware.org/everyday-living/essential-skills/personal-self-care/makeup-application/applying-lipstick/
https://maculardegeneration.net/low-light-vision/
https://www.mdfoundation.com.au/content/lighting-for-low-vision#sthash.fFUPzlPq.dpuf

D. Stop the activity, call for assistance, and provide him fruit juice.
The question is asking what the COTA®’s immediate response should be. The first step is to make sure that the patient is safe which involves stopping the activity and preventing a medical emergency by providing glucose orally while waiting for the medical staff to assess and treat the patient.
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. Patients with type 1 diabetes mellitus (DM) require lifelong insulin therapy. Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels. Hypoglycemia may result from a change in insulin dose, a small or missed meal, or strenuous exercise. Common symptoms of hypoglycemia are light-headedness, dizziness, confusion, shakiness, sweating, and headache. Patients should be made aware of these symptoms and educated to respond rapidly with sugar intake. They should be advised to carry candy or sugar cubes. Untreated, diabetic hypoglycemia can lead to seizures and loss of consciousness — a medical emergency.
Exercise is an important aspect of diabetes management. Patients should be encouraged to exercise regularly. Educating patients about the effects of exercise on the blood glucose level is important. If patients participate in rigorous exercise for more than 30 minutes, they may develop hypoglycemia unless they either decrease the preceding insulin injection by 10-20% or have an extra snack. Patients must also make sure to maintain their hydration status during exercise.
In this scenario, the patient is demonstrating signs and symptoms of hypoglycaemia. The therapist should immediately terminate the physical activity, allow the patient to rest, and call for assistance while she remains with the patient. The clinician can grab fruit juice or request the assistance of colleagues to do so, to help the patient increase his glucose levels.

A and B. These measures would not help with normalizing glucose levels.
C. An intervention of providing insulin intravenously is the role of the medical staff.

Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, p 47.
https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525
https://emedicine.medscape.com/article/117739-treatment

B. Remove the shower door and replace it with a shower curtain or a folding plastic door.
Removing the shower door is essential as it can result in the patient potentially injuring himself if it becomes completely dislodged and either falls on him or traps him between the grab bar and glass door. Purchasing a shower curtain or a folding plastic door is practical and affordable.

A. This is not a modification to the shower and the patient needs to remain mobile and independent.
C. This is a costly and unnecessary modification to undertake. At this stage, the patient is safely managing to step into and out of the shower. The only change that needs to be made at this point, is to remove the barrier (glass shower door).
D. This is not a modification, and the patient does need assistance getting into and out of the shower.

A. The patient is experiencing a DVT and the activity should be stopped immediately.
Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in the patient’s body, usually in the patient’s legs.
Deep vein thrombosis signs and symptoms can include:
• Swelling in the affected leg. Rarely, there’s swelling in both legs.
• Pain in the patient’s leg. The pain often starts in the patient’s calf and can feel like cramping or soreness.
• Red or discolored skin on the leg.
• A feeling of warmth in the affected leg.
Deep vein thrombosis can occur without noticeable symptoms.

Risk factors include:
• Pregnancy. Pregnancy increases the pressure in the veins in the patient’s pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after the patient has delivered the baby.
• Prolonged bed rest, such as during a long hospital stay, or paralysis. When the patient’s legs remain still for long periods, their calf muscles don’t contract to help blood circulate, which can increase the risk of blood clots.
• Inheriting a blood-clotting disorder. Some people inherit a disorder that makes their blood clot more easily. This condition on its own might not cause blood clots unless combined with one or more other risk factors.
• Injury or surgery. Injury to the patient’s veins or surgery can increase the risk of blood clots.

A. Avoid twisting.
B. Avoid bending.
C. Avoid lifting, pushing or pulling objects greater than 5 lbs.

In spondylolisthesis, the fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it. The severity of a spondylolisthesis is graded using five descriptive categories. Doctors commonly describe spondylolisthesis as either low grade or high grade, depending upon the amount of slippage. A high-grade slip occurs when more than 50 percent of the width of the fractured vertebra slips forward on the vertebra below it. Patients with high-grade slips are more likely to experience significant pain and nerve injury and to need surgery to relieve their symptoms. Spinal fusion is the surgical procedure most often used to treat patients with spondylolisthesis.
The goals of spinal fusion are to:
• Prevent further progression of the slip
• Stabilize the spine
• Alleviate significant back pain
The best sleeping position after surgery is either on your
back with your knees bent and a pillow under your knees or on your side with your knees bent and a pillow between your legs. If side sleeping provides the most benefit, then make sure your legs rest on top of each other with your knees bent or have your top leg slightly forward. Avoid resting your top knee on the bed and sleeping with your arms under your neck and head. A pillow placed behind the body and tucked under the back and hips can help you from rolling out of this position. Sleeping on
your stomach is not recommended.
Walking is the best activity you can do for the first 6 weeks after surgery. You should start out slowly and work up to walking 30 minutes at least twice a day.
After surgery, avoid sitting in soft chairs and on couches where your hips drop below your knees.

https://www.hopkinsmedicine.org/orthopaedic-surgery/_documents/patient-information/patient-forms-guides/JHULumbSpineSurgeryGuide.pdf

A. Refer the patient to an outpatient rehabilitation facility.
Patients are often referred to outpatient rehabilitation once they have met their inpatient rehabilitation goals. Patients with spinal cord injury continue to gain strength and increase independence during the first year of injury, so continuing intervention in another setting is most appropriate.

B, C and D. The outpatient rehabilitation therapist will address community integration needs of the patient, including referrals to vocational counseling and driver’s rehabilitation.

A. To increase surface area for maximal tissue lengthening and wound healing. As it is expected that the patient will most likely flex/clench her hand for comfort due to the pain caused by the burn, the likelihood of a contracture is high. Having her hand immobilized in an extended/open position should prevent the anticipated deformity from developing. When edema was present, the intrinsic plus splint prevented shortening of the collateral ligaments as swelling of the soft tissue increases the probability of a flexed pattern developing. When the edema subsides and wound healing begins, it is best to maintain normal muscle length with a slow stretch, using extension and abduction patterns.

Reed, Kathlyn. (2001) Quick Reference to Occupational Therapy. Gaithersburg, MD: Aspen Publishers, pp 670-671.
Procter, Fiona (2010): Rehabilitation of the Burn Patient. Indian Journal of Plastic Surgery (Vol 43 43(Suppl): S101–S113), p 3-4

A. As the wound matures, the scar will continue to develop and change.
Wound healing is a dynamic process. Wound healing is made up of 3 overlapping phases: inflammation, proliferation, and remodeling. The inflammation phase starts immediately after injury and serves as a means to prevent infection during healing and to deal with dead tissue. Proliferation closes the wound (epithelialization) and restores the vascular network and lasts days to weeks. Remodeling involves wound scar maturation and can take up to 1-2 years. Any disruption in these phases may result in abnormal or delayed wound healing.

B. Shearing is avoided with immobilization in the initial stages of healing following surgery.
C. While healing strengthens one of the skin’s overall functions, protection from the elements, this is not the best response to educating the patient  about the reason for conditioning and massage.
D. This is not the primary reason for massage and conditioning.

Ozgok Kangal MK, Regan JP. Wound Healing. [Updated 2018 Dec 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK535406/
Rowan, M. P., Cancio, L. C., Elster, E. A., Burmeister, D. M., Rose, L. F., Natesan, S., . Chung, K. K. (2015). Burn wound healing and treatment:
Review and advancements. Critical Care, 19(1), pp 2-3.
http://dx.doi.org/10.1186/s13054-015-0961-2
Reed, Kathlyn. (2001) Quick Reference to Occupational Therapy. Gaithersburg, MD: Aspen Publishers, pp 670-672.

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

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

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

D. Family values and functional capacity of the caregiver and whether independence will be encouraged.
The cultural values, physical and mental capacity will influence role expectations and whether independence will be encouraged. During caregiver training, the patient should be empowered to direct care effectively to support engagement and maintain self-efficacy.

A and B. These would not be primary concerns to be discussed until a home evaluation has been conducted.
C. This is not a priority at this stage.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 243.

C. Work together to select and transplant plants from pots into a vertical garden.
Working with others in a leisure activity related to the patient’s interests promotes well-being that is client-centered and facilitates out-of-bed participation. During gardening tasks, the patient is working on the transitional movements and mobility needs associated with progressing towards independence with lower body dressing including underlying fine motor and gross motor skills to manage clothing and use adaptive equipment. The clinician can also observe for carryover of integration of total hip precautions when sitting-to-standing and standing-to-sitting,  as well as transporting items using a walker tray.

A. Does not support the skills required to work towards the goal of self-care with total hip precautions in mind.
B and D. Works only on fine motor tasks.

Early, Mary Beth. (2013). Promoting Engagement in Leisure and Social Participation. Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, p 356.
Cole, Marilyn B. (2012) A Model of Human Occupation and Other Occupation-Based Models. Group Dynamics in Occupational Therapy (4th Ed). Slack Inc., p 283.

C. An object-matching activity in which familiar objects are placed in plain sight on multiple shelves. In normal saccades, the person would demonstrate the ability to gaze rapidly from one fixation point to another even when the targets are changing position on a vertical or horizontal axis without undershooting or overshooting targets and without difficulty finding the target. The goal for Mary is to improve saccades by looking between two visual fixation points with a wide visual field to generalize to community mobility. She may compensate by moving her head and trunk.

A, B and D. These focus on a narrow visual field.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141156/

B. Slowly turn the walker and back up to the front passenger seat.
After adjusting the passenger seat back and reclined, the patient should back up to the passenger seat, hold onto a stable part of the car, place the operated leg farther forward than the un-operated leg, and slowly scoot and sit on the passenger seat.

A, C and B – These steps are not appropriate as they do not adhere to post-surgical total hip precautions.

Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD: Walters Kluwer, p 630.

C. His current feelings about sex, sexual preferences, and the role he plays.
The patient’s hip replacement may have affected his ability to participate in sex by changing his role with his girlfriend due to the pain and difficulty he is experiencing during intercourse. The OTA should be aware of how the man normally participates in sex and how he feels about any changes in sex roles that have occurred as a result of the hip replacement before discussing the man’s concerns regarding sex.

B. Level 6.
Level VI – Confused, Appropriate: Moderate Assistance.
At this level, patients typically demonstrate the following:
• Goal directed behavior
• Unaware of impairments, disabilities, and safety risks
• Consistently follows simple directions
• Able to retain learning for familiar tasks they performed pre-injury (e.g. brushing teeth) however unable to retain learning for new tasks
• Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection
• Remote memory has more depth and detail than recent memory
• Vague recognition of some staff

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

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

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

D. Training in desensitizing techniques incorporating massage and wrapping of the residual limb.
Addressing the patient’s pain FIRST, should always be a priority.

A. This is necessary for sensory retraining, however, gradual use of textures would be beneficial.
B. Ace-wrapping should be performed diagonally, distal-to-proximal in a figure-of-eight pattern. Circular pattern can cause restriction to circulation. Tapping and gentle massage would be one of many preferred protocols for pain management.
C. Training in compensatory techniques and use of adaptive equipment for self-care should be the next step in the intervention plan, once the patient’s pain has been controlled. As the patient verbalized a preference for continuing to perform ADLs without the use of prosthetics, following the ethical principle of Autonomy, the patient’s wishes will be respected and the focus will be on client-centered adaptive and compensatory techniques that include the residual limb. Training will include use of the residual limb as a stabilizer for bimanual activities, training in adaptive equipment, and one-handed techniques.

Reed, Kathlyn. (2001) Quick Reference to Occupational Therapy. Gaithersburg, MD: Aspen Publishers, pp 364-365, 467.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 543-544.

B. Back up to the chair, extend the operated leg forward, reach back for the armrests and slowly lower to the sitting position.
A firmly based chair with armrests is recommended. To move from standing to sitting, the patient is instructed to back up to the chair, extend the operated leg forward, reach back for the armrests, and slowly lower to the sitting position. For the person with a posterolateral approach, care should be taken not to lean forward when sitting down. To stand, the patient extends the operated leg and pushes up from the armrests. Once standing, the patient can reach for an ambulatory aid, such as a walker if it is being used. Because of the hip flexion precaution for the posterolateral approach, the patient should sit on the front part of the chair and lean back. Firm cushions or blankets may be used to increase the height of chair seats and may be especially helpful if the patient is tall. Low chairs, soft chairs, reclining chairs, and rocking chairs should be avoided.

General post-op rules for patients:
• Never cross your legs or ankle on sitting, standing, or lying down
• Avoid bending your leg greater than 90 degrees
• When sitting or standing from a chair, bed, or toilet you must extend your operated leg in front of you.

Pendleton, Heidi McHugh; Schultz-Krohn, Winifred. Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 1084). Elsevier Health Sciences. Kindle Edition.

C. Work on caregiver training with sliding board transfers with emphasis on transferring to both sides of the patient’s body.
It is best to learn to transfer in both directions as the patient must learn how to get on and off the transfer surface in both directions when using the slide board method. It is common for patients on dialysis to experience generalized fatigue. By having the wife and patient work together on a safe back-up plan to maximize independence in using the toilet and shower for ADL needs, the patient will be able to continue performing tasks even when he is most weak.

A. At this time, maximizing independence while maintaining the patient’s locus of control with the use of an alternate transfer method does not necessitate the need for additional assistance. It is also expected that he will be getting a prosthesis which may reduce the need for additional assistance.
B. It is best to learn both directions of transfer.
D. This is contraindicated on days when the patient is expected to become fatigued with activity.

Early, Mary Beth. (2013). Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, p 313.

A. Adjusting the seams of his work shirts to loosen his clothing and adding dressing loops. Patients at this level (T1) are independent in upper body dressing with adaptive equipment and require moderate to maximal assistance with shoes and socks unless adapted. Fine motor functions are enhanced with orthoses. Simply making clothing loose will make dressing easier overall.

C. Changing the shoes to elastic shoelaces is a less challenging fix than adjusting his shirts.
B and D. These are unnecessary as the patient has sufficient hand function to manage fasteners.

Ryan, S., and Sladyk, C. (2015). Ryan’s Occupational Therapy Assistant: Principles, Practice Issues, and Techniques. Thorofare, NJ: SLACK Incorporated, pp 275.

A. Replace the existing round handles with a lever-type handle.
Lever handles will be easier to manage in comparison to handles that require turning. Round handles require more muscle strength and increased hand function to operate.

D. Energy Conservation.
Chemotherapy can result in muscle weakness, muscle cramps, and muscle fatigue. Energy conservation is achieved by the simplification of work. By changing the way certain activities are done, muscle fatigue; joint stress and pain can be minimized. Applying energy conservation techniques to daily living activities, for example, can increase his endurance, maintain his muscle strength and muscle power; therefore preventing unnecessary strain on the patient’s muscles, respiration and heart.

A. Shift upper body using arms to scoot along the sliding board towards the commode.
A transfer board bridges two surfaces, such as a wheelchair and a commode. The board allows the patient to scoot on their buttocks between 2 surfaces without needing the assistance of their lower limbs. This type of transfer can therefore be done independently. Method: If transferring from a wheelchair, place the wheelchair as close as you can next to the other surface e.g. bed. commode, toilet. Be sure to lock the wheels of the wheelchair. Slide one end of the board beneath your buttocks. The other end is placed flat on the surface you are moving onto. Use your upper body to scoot yourself along the board toward the second surface. Once you are settled fully on the second surface, the slide board can be removed. Keep the board within easy reach.

http://www.saintlukeskc.org/health-library/transfers-after-leg-amputation

6
Rancho Level VI
-Sometimes oriented to person, place and time
-Long-term memory more complete than short-term memory
-Able to pay attention to familiar activities for up to 30 minutes with some cuing
-Able to follow simple directions
-Beginning to respond appropriately to family and friends
-Able to complete familiar activities with supervision
-Requires maximum assistance for new activities
-Moderate assistance to problem-solve during tasks
-Vaguely recognizes staff members
-Unaware of impairments, safety risk

B. Place items with strong smells (i.e. cinnamon, lavender, orange) under the patients nose for 2-3 second.
RLA level II – Generalized Response. At this level, the patient begins to respond to sensory stimuli, including visual, auditory, tactile or movement. This RLA level corresponds to ACL level 1- Automatic Actions. ACL Level 1 describes the patient’s arousal to external cues. This cognitive level is largely instinctual behavior, and patients require total assistance with activities. A patient who is below cognitive level 1 would be in a coma. Patients react to immediate stimuli, but are not able to process and interpret stimuli. The patient is probably not able to respond appropriately to stimuli placed in the mouth, as this requires a higher level of response, but will be able to respond to a strong smell.

B. Try giving the patient instructions in writing.
C. Pair gestures and visual cues with auditory instructions.
E. Request training in use of the communication device provided by speech therapy.

Auditory agnosia is the inability to recognize and process sound in spite of intact hearing mechanisms. Presenting the woman with written instructions might help compensate for this deficit. If the woman cannot follow written instructions, pairing gestures and visual cues with the auditory instructions may also be effective. If speech therapy has introduced a communication device to compensate for the auditory agnosia, the CNAs responsible for the woman’s care should be trained in the use of the device. The other answers provide options that compensate for hearing impairment or cognitive limitations, not auditory agnosia.

B. Identify and retrieve loose change from a number of objects located in his coat pocket. When a burn has healed, massage is combined with stimulation activities such as immersion in textures or brushing and stereognosis activities to improve tactile sensation. If treatment is effective, the man’s tactile sensation will improve and his stereognosis will become functional once again.

A. Set-up help and use of universal cuff for grooming tasks.
D. Minimal to moderate assistance with upper body bathing with use of a sponge mitt.
E. Total assist with home management.
People with C5 spinal cord injuries have partial use of the upper arms, but no functional use of the hands and no muscular control in the upper torso. A person with this level injury should be able to complete grooming tasks with set-up help and the use of a universal cuff. He or she should be able to complete upper body dressing with minimal assistance using adaptive techniques and adaptations for fasteners, and should require minimal to moderate assistance with upper body bathing, using a sponge mitt to wash reachable areas. This person would be dependent with bed mobility, standing, and home management.

C. The patient has Type II diabetes.
AODM indicates that the patient has Type II diabetes. AODM stands for-Adult Onset Diabetes Mellitus

C. To ask open-ended questions in order to further explore his concerns

The best course of action would be to ask open-ended questions in order to further explore his concerns,especially if the patient is concerned with body image and sexual expression. Don’t provide reassurance because it doesn’t deal with concerns. Losing a limb is not just about the patient adjusting to functioning without that limb. There is also a significant psychological component that impacts on the person’s life. Most people, under normal circumstances have difficulty getting used to a change in their body image. Understandably, accepting the loss of a limb is a major adjustment for anyone. Prior to an amputation, the physical image a person has, is one of being “whole”, and after the amputation their physical image becomes one of being “part whole.” Fear of rejection often makes it difficult for the amputee to pursue a relationship and to be intimate. The presence of a disease or disability has been shown to have a large impact not only on the patient’s but also on their partner’s sexual activities. It is therefore important that professionals address sexuality during the rehabilitation process with the patients and their partners.

B. Visual field cut.
Visual field loss, also known as “visual field cut,” can be partial or complete. For example, it can range from a nearly complete loss of peripheral vision to a small area of partial loss. People with visual field loss may have trouble seeing objects out of the corners of their eyes, lose their place while reading, startle when people or objects move toward them, or bump into people and objects. Loss of peripheral vision is referred to as a visual field cut, meaning that you can’t see one side of vision from one of your eyes or you can’t see one side of vision from both of your eyes. A visual field cut is formally called hemianopsia or hemianopia. When both eyes have a symmetrical problem with peripheral vision, it is called homonymous hemianopsia.

C. Increase lighting.
Lighting takes on added importance for everyone as they grow older. Even normal healthy eyes generally require twice as much illumination at age 50 as they did at age 25. For people with limited vision, lighting becomes an even more critical factor. It is important to control the intensity of light and the glare, as well as to provide contrast. There are two types of lighting: General, overhead lighting, as in the type of lighting that lights up the whole room and task lighting, or lighting used for a specific activity, such as reading. While the pathologies and treatment of low vision disorders are medical issues, having access to an environment which provides optimal lighting, is a design issue. For a person with low vision, the right lighting can help enhance their visual acuity which will help them perform their ADLs as independently as is possible. The following are some recommendations to enhance what the person is able to see, by improving lighting: Ensure adequate lighting in every room, distributing it as evenly as possible. Devote special attention to task lighting, by using swing-arm lamps. Advise your patient that light should always be aimed at what task they are doing and not at their eyes. Replace burned out light bulbs regularly. Place mirrors so that lighting doesn’t reflect off them and create a glare. A chair by the window makes a good space for dressing. Be sure to make the most of natural light by using sheer or light curtains or adjustable blinds. Many modern buildings are designed with large areas of glass for daylight and views and with extensive artificial lighting. Glare from both sources of light is a major cause of distraction, discomfort and impediment to vision for many who live in these buildings.

• Increase lighting (up to four times brighter for tasks).
• Increase organization (de-clutter and sort like items together in trays).
• Increase contrast (use dark against white, use bright colors to identify settings and objects).
• Make it bigger (place large labels on items and use magnifiers).
• Get closer (decrease distance between person and TV or book).
• Decrease glare (from sun, light bulbs and shiny surfaces).

http://www.lowvisioninfo.org/rghtlite.htm. http://www.afb.org/info/low-vision/living-with-low-vision/creating-a-comfortable-environment-for-people-with-low-vision/235

D. Level 3.
Rancho level 3: Localized response = total assistance – withdrawal from painful stimuli, turns towards sound, blinks at light, eyes follow object, responds to family members – moving to music

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

B. The use of equipment and modified techniques to perform transfers and BADLs.
Provocative positions: hip flexion, adduction, internal rotation. Restrictions associated with posterior lateral hip replacements involve no bending past a 90° angle, no internal rotation of the operated leg, and no crossing one’s legs. The restrictions result in a patient having to modify the way in which they perform ADLs. Improving functional independence is a key component to the practice of occupational therapy. In order to achieve this in patients having a THR, an occupational therapist must educate the patient on the use of equipment, which includes a: raised toilet seat, reacher, sock aide and shoe horn.
The fact that the hospital stay for the patient is typically short, means that individuals are returning home sooner and as a result, need to feel prepared to perform their ADLs earlier. Therefore, educating patients on ways to perform ADLs with precautions is imperative. Gait training is usually addressed by physical therapy.
https://www.omicsonline.org/open-access/preoperative-occupational-therapy-for-patients-having-total-hip-replacements-2161-0711-1000563-94563.html 

B. SCI C1-C3.
C1-C2 Neck FL, EXT
C3 Lateral neck FL
Dependent in self-care, can instruct others, can chew and swallow.

B. Glaucoma
Causes increased pressure in the eye, which damages the optic nerve and results in decreased peripheral vision or tunnel vision

D. Difficulty with termination of activity.
Taking an excessive amount of time with an activity reflects that this patient has difficulty with terminating the activity.

D. The OTA should recommend assisted living.
Assisted living is a residential option for seniors who want or need help with IADLs, such as cooking meals, housekeeping, and traveling to appointments.

D. The OTA should tell the man that if sensation or motor function does not return within 24 – 48 hours, it is less likely to return.
Prognosis for recovery depends on whether the lesion is complete or incomplete. The faster sensation, motor function, or both return, the better the prognosis for recovery.

B. The symptoms would include lightheadedness, pallor, and visual changes.
Orthostatic hypotension- decrease in BP (result of lack of muscle tone in abdomen and BLE). Symptoms include lightheadedness, pallor, and visual changes. Check BP, if patient is in a wheelchair, elevate legs to bring BP within normal limits; if symptoms persist, then recline w/c back to lower head

B. Power w/c equipped with chin or head controls. A spinal cord injury at level C3 compromises innervation to the diaphragm, making it difficult or impossible for a person to breathe without mechanical intervention. Since Martin sustained a C3 injury, he most likely uses a ventilator to breathe and would not have enough breath control or power to use a sip n puff switch. He would have enough neck movement to use a chin or head control switch. These switches are easier to use and less expensive than eye gaze control systems, which would be more technology than what Martin requires to propel his wheelchair. He would not be able to use a manual wheelchair due to the level of his injury.

A. The best recommendation would be removing rugs.
Removing rugs in a patient’s home is the best way to prevent future falls.

C. Screen reading program.
The screen reading program will be the best adaptation for a child with a progressive condition resulting in loss of vision.
A screen reader is a software application that enables people with severe visual impairments to use a computer. Screen readers work closely with the computer’s Operating System (OS) to provide information about icons, menus, dialogue boxes, files and folders. A screen reader uses a Text-To-Speech (TTS) engine to translate on-screen information into speech, which can be heard through earphones or speakers. A TTS may be a software application that comes bundled with the screen reader, or it may be a hardware device that plugs into the computer. Since the majority of users don’t use a mouse, all screen readers use a wide variety of keyboard commands to carry out different tasks. Tasks include reading part or whole of a document, navigating web pages, opening and closing files, editing and listening to music. A visually impaired computer user will use a combination of screen reader commands and operating system commands to accomplish the many tasks a computer is capable of performing.

A. A screen magnifier can be purchased to fit the over the student’s current monitor. These screens can magnify up to 1.5X the original source. This is suitable for students who only need minimal text enlargement.
B. Speech recognition software is a computer program designed to type words as you dictate them into a microphone.
D. If the student has some usable sight, the student might find screen magnification software, which enlarges the information displayed on a computer screen, helpful. Screen enlargement software allows for the magnification of the computer screen so the screen can be easily read and allows the student to see whatever is on the monitor

A. Provide PROM and sensory input.
A person at this level will: begin to respond to sounds, sights, touch, or movement; respond slowly, inconsistently, or after a delay; respond in the same way to what he hears, sees or feels. Responses may include chewing, sweating, breathing faster, moaning, moving, and/or increasing blood pressure.

A. The best method would be maintenance of joint ROM.
Heterotopic ossification refers to the growth of bone in abnormal anatomic locations and is best prevented with a joint ROM and medication routine.

B. It would be best to ease the patient to the floor, then get assistance.
Easing the patient to the floor protects both the patient and the therapist from injury.

A, B: Trying to move the patient too quickly or reversing the transfer can result in injuries to both the patient and OT.
D: Help may not arrive in time to assist, resulting in the OTA dropping or injuring the patient.

D. Custom-fitted tenodesis splint. A patient with a C6 spinal cord injury will have decreased strength through scapular protraction and limited horizontal adduction, and a mobile arm support would be beneficial to better support the weight of the arm and improve position of the arm for activities. At C6 spinal cord injury level, the patient should be able to use active tenodesis motion with the need for a splint.

C. Pronation.
Functionally, a C5 CSI has shoulder control and the ability to actively flex their elbows and supinate their forearms. Their inability to actively pronate, makes them prone to contractures in their supinators. Range of motion and stretching exercises are therefore essential in the acute stage, to prevent elbow flexion and supination contractures.