This week focuses on: Musculoskeletal Conditions & Interventions, Physical Agent Modalities (PAM’s), COPD, CHF/Met Levels, and FIM levels.
This week focuses on: Musculoskeletal Conditions & Interventions, Physical Agent Modalities (PAM’s), COPD, CHF/Met Levels, and FIM levels.
Please take this assesment quiz, so that you know which study material you should focus on the most. You should study the areas you scored the poorest first and proceed to your best areas last. For paid members this test is a 100 questions or more.
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Module 3 OTA Quiz
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Module 3 OTA Quiz
We highly recommend that you take a screen shot of your score and results If you are a student enrolled though our program by your school or if you want to make sure that your quiz scores are saved.
The use of your hand to manipulate objects is described by which of the following terms?
D. Prehension.
Prehension (gripping) is an advanced skill in humans, resulting largely from the ability of the thumb to oppose the fingers. Two types of grip are described, ‘precision’ involving the thumb and fingers and ‘power’, involving the whole hand. Thumb opposition in conjunction with movement at other digits is used to execute functional prehension.
D. Prehension.
Prehension (gripping) is an advanced skill in humans, resulting largely from the ability of the thumb to oppose the fingers. Two types of grip are described, ‘precision’ involving the thumb and fingers and ‘power’, involving the whole hand. Thumb opposition in conjunction with movement at other digits is used to execute functional prehension.
What is the most appropriate muscle grade when a patient can raise and lower his arms to the ceiling without resistance?
C. Grade 3 (fair). Raising and lowering his arms to the ceiling without resistance is a movement against gravity, without any resistance. The motion of moving up towards the ceiling indicates that this is a full ROM of the upper extremity. When a patient can perform full range of motion without any resistance it is a grade 3.
The most commonly accepted method of evaluating muscle strength is the Oxford Scale (AKA Medical Research Council Manual Muscle Testing scale). This method involves testing key muscles from the upper and lower extremities and grading the patient’s strength on a 0 to 5 scale accordingly:
Flicker of movement
Through full range actively with gravity counterbalanced
Through full range actively against gravity
Through full range actively against some resistance
Through full range actively against strong resistance
C. Grade 3 (fair). Raising and lowering his arms to the ceiling without resistance is a movement against gravity, without any resistance. The motion of moving up towards the ceiling indicates that this is a full ROM of the upper extremity. When a patient can perform full range of motion without any resistance it is a grade 3.
The most commonly accepted method of evaluating muscle strength is the Oxford Scale (AKA Medical Research Council Manual Muscle Testing scale). This method involves testing key muscles from the upper and lower extremities and grading the patient’s strength on a 0 to 5 scale accordingly:
Flicker of movement
Through full range actively with gravity counterbalanced
Through full range actively against gravity
Through full range actively against some resistance
Through full range actively against strong resistance
An COTA® is fabricating bilateral volar resting hand splints for an 8-year-old child who has quadriplegic CP. The aim of these splints is to prevent or reduce joint deformity from developing, from the moderate spasticity in the child’s hands. The components of the resting hand splints include a forearm trough, a C-bar, a thumb trough, and a pan for the fingers. What should the FIRST STEP be, during splint fabrication and strap application?
B. Determining the best splinting position by handling the child’s extremity and feeling the amount of passive resistance.
This would occur “When handling the joints and feeling the resistance from the child’s muscles, the therapist can determine the most therapeutic position and the location of force application during splint fabrication and strap application”(Coppard, 412) He should take note of the joint angles involved and where pressure is being applied to obtain that position.
A. This would occur during splint fabrication and formation.
C. This would be the final step.
D. This would occur while the therapist is handling the child ( and not at the beginning), as the child is expected to demonstrate dysarthria associated with quadriplegic CP.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 406-412.
https://www.cerebralpalsyguidance.com/cerebral-palsy/types/spastic-quadriplegia/
B. Determining the best splinting position by handling the child’s extremity and feeling the amount of passive resistance.
This would occur “When handling the joints and feeling the resistance from the child’s muscles, the therapist can determine the most therapeutic position and the location of force application during splint fabrication and strap application”(Coppard, 412) He should take note of the joint angles involved and where pressure is being applied to obtain that position.
A. This would occur during splint fabrication and formation.
C. This would be the final step.
D. This would occur while the therapist is handling the child ( and not at the beginning), as the child is expected to demonstrate dysarthria associated with quadriplegic CP.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 406-412.
https://www.cerebralpalsyguidance.com/cerebral-palsy/types/spastic-quadriplegia/
A 60-year-old inpatient who is recovering from a recent myocardial infarction, has been referred for OT intervention. The patient lives alone in a 2-story apartment and works full-time as a baker at the local pastry-shop. The patient’s main goal is to return to work as soon as possible. At this stage of her recovery, the patient is only permitted to perform activities which expend 2.0 to 3.5. METs. Educating the patient on which types of activities are appropriate, is part of the patient’s intervention plan. Which of the following activities would be CONTRAINDICATED at this time?
A. Lifting up and carrying a large bag of flour, up 4 steps to enter the bakery from the loading dock. Carrying heavy loads while ascending an incline requires MET levels greater than 5.0.
B. C and D . Light housekeeping tasks without use of heavy equipment or heavy pushing and pulling, seated BADLs , and standing while writing are well within MET Levels 1.0 to 3.5.
Pass the OT Study Materials – Module 3: https://passtheot.com/met-levels-cardiac-rehabilitation/
A. Lifting up and carrying a large bag of flour, up 4 steps to enter the bakery from the loading dock. Carrying heavy loads while ascending an incline requires MET levels greater than 5.0.
B. C and D . Light housekeeping tasks without use of heavy equipment or heavy pushing and pulling, seated BADLs , and standing while writing are well within MET Levels 1.0 to 3.5.
Pass the OT Study Materials – Module 3: https://passtheot.com/met-levels-cardiac-rehabilitation/
Dan, a 36-year-old male, is accompanied by his wife to an outpatient hand therapy clinic. Dan who works as a truck driver, recently sustained an injury to his right dominant hand when he fell off a ladder at home. Before fabricating a splint for Dan, the COTA® becomes aware that there is a lot of tension between Dan and his wife. Dan verbalizes that he is extremely concerned about lost time from work as he is the only breadwinner. His wife, however, is reluctant to engage in any part of the conservation and Dan excuses her behavior by saying “she’s very upset with me!” Taking the couple’s emotional state into consideration, what approach should the COTA® use to initiate the discussion about the need for a splint for Dan’s recovery?
D. Clarify concerns and allow them to vent before determining their understanding about the diagnosis and splint order.
It is important to allow the patient and his wife the opportunity to express their emotions and concerns. This helps in establishing rapport in order to develop client-centered goals. The OT practitioner can positively influence the patient’s compliance and motivation and determine the readiness of his family members to help ensuring carryover and support of the patient’s self-maintenance of the splint, precautions, and home exercise program.
A. This would not be therapeutic and client-centered as the concerns must be addressed first.
B. The emotional state of the patient and his wife need to be addressed first.
C. Although environmental modification for therapeutic rapport may be an effective protocol for addressing anxiety, allowing the patient and his wife to speak first would be priority.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 113.
D. Clarify concerns and allow them to vent before determining their understanding about the diagnosis and splint order.
It is important to allow the patient and his wife the opportunity to express their emotions and concerns. This helps in establishing rapport in order to develop client-centered goals. The OT practitioner can positively influence the patient’s compliance and motivation and determine the readiness of his family members to help ensuring carryover and support of the patient’s self-maintenance of the splint, precautions, and home exercise program.
A. This would not be therapeutic and client-centered as the concerns must be addressed first.
B. The emotional state of the patient and his wife need to be addressed first.
C. Although environmental modification for therapeutic rapport may be an effective protocol for addressing anxiety, allowing the patient and his wife to speak first would be priority.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 113.
A 64-year-old patient who fractured his left femur when he fell onto a barricade, is currently 4 weeks post-op, and is attending outpatient rehab services. The patient has recently consulted with his orthopedic surgeon for a routine follow-up. At his next OT session, the patient presents the clinician with new orders from the surgeon, stating that the patient can progress from non-weight-bearing (NWB) to toe-touch weight bearing (TTWB) of the affected extremity. With this new change in his weight-bearing status, how would you BEST adapt a dish washing task, to incorporate the patient’s new weight-bearing precautions?
A. Wash dishes in a seated position.
Washing dishes requires the patient to use both their hands for the task and they can therefore not hold onto a walking aid to help them adhere to their weight bearing precautions, when they need to move along the work surface. Therefore, while the patient is only permitted to partially weight-bear, it is advisable that they complete kitchen tasks from a seated position to reduce the likelihood of them unintentionally taking full weight through their operated limb. This includes tasks such as making a hot drink, cooking and washing up. This is because the patient may be tempted to hold onto the work surface and step sideways without their walking aid, which means they will not be partially weight-bearing on their operated limb.
B. Washing dishes typically requires bilateral upper extremity use.
C and D. Weight-bearing 50% -100% of the body onto the operated leg is contraindicated as partial weight bearing is defined as bearing 30% to 50% of your body weight. Toe touch weight bearing is poorly defined in the research literature, however, in clinical practice, it is commonly described as having the ability to touch the foot or toes to the floor without supporting weight from the affected limb.
A. Wash dishes in a seated position.
Washing dishes requires the patient to use both their hands for the task and they can therefore not hold onto a walking aid to help them adhere to their weight bearing precautions, when they need to move along the work surface. Therefore, while the patient is only permitted to partially weight-bear, it is advisable that they complete kitchen tasks from a seated position to reduce the likelihood of them unintentionally taking full weight through their operated limb. This includes tasks such as making a hot drink, cooking and washing up. This is because the patient may be tempted to hold onto the work surface and step sideways without their walking aid, which means they will not be partially weight-bearing on their operated limb.
B. Washing dishes typically requires bilateral upper extremity use.
C and D. Weight-bearing 50% -100% of the body onto the operated leg is contraindicated as partial weight bearing is defined as bearing 30% to 50% of your body weight. Toe touch weight bearing is poorly defined in the research literature, however, in clinical practice, it is commonly described as having the ability to touch the foot or toes to the floor without supporting weight from the affected limb.
A patient who recently sustained a distal radius fracture has been fitted with a splint, as prescribed by the physician. Which type of movement of the non-immobilized joints of the affected upper limb is MOST likely to assist with edema reduction in the acute phase of healing?
B. Active range of motion (AROM).
AROM of all available joints while in the cast, orthosis, or external fixator is vital to edema control and to maintaining tissue length. AROM acts as a pump mobilizing edema through the lymphatic system.
Edema is a natural by-product of trauma, and the development of some edema following injury and surgery is normal and expected. However, moderate to severe swelling that persists is the silent enemy, as it will infiltrate every tissue and alter the normal gliding of joints and tendons. Over time, there can be increased collagen formation and progression from moveable edema to more fibrous protein-rich edema that ultimately turns to scar tissue.
Cooper’s Fundamentals of Hand Therapy Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity By: Christine M. Wietlisbach.
B. Active range of motion (AROM).
AROM of all available joints while in the cast, orthosis, or external fixator is vital to edema control and to maintaining tissue length. AROM acts as a pump mobilizing edema through the lymphatic system.
Edema is a natural by-product of trauma, and the development of some edema following injury and surgery is normal and expected. However, moderate to severe swelling that persists is the silent enemy, as it will infiltrate every tissue and alter the normal gliding of joints and tendons. Over time, there can be increased collagen formation and progression from moveable edema to more fibrous protein-rich edema that ultimately turns to scar tissue.
Cooper’s Fundamentals of Hand Therapy Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity By: Christine M. Wietlisbach.
When selecting an activity for a patient who is recovering from a recent MI, the impact an activity has on the patient’s cardiovascular system needs to be taken into consideration. Which activities would have the MOST impact on the patient’s cardiovascular system? Select the best 3 answers.
A. Activities requiring the use of one’s upper extremities.
B. Hot showers.
D. Activities performed in standing.
6 variables have been identified as increasing oxygen demand: increased rate, increased resistance, increased use of large muscles, increased involvement of the trunk musculature, raising one’s arms, and isometric work (straining). Upper extremity activity has also been shown to require greater cardiovascular output than lower extremity activity, and standing activity requires more energy than seated activity. Extremes of temperature, high humidity, and pollution make the heart work harder. By applying this information, an OT practitioner can suggest modifications in activity that will decrease the amount of energy needed for the task.
A. Activities requiring the use of one’s upper extremities.
B. Hot showers.
D. Activities performed in standing.
6 variables have been identified as increasing oxygen demand: increased rate, increased resistance, increased use of large muscles, increased involvement of the trunk musculature, raising one’s arms, and isometric work (straining). Upper extremity activity has also been shown to require greater cardiovascular output than lower extremity activity, and standing activity requires more energy than seated activity. Extremes of temperature, high humidity, and pollution make the heart work harder. By applying this information, an OT practitioner can suggest modifications in activity that will decrease the amount of energy needed for the task.
An OTA begins treatment with a new patient who suffered a right CVA, 3 days ago. The OT’s evaluation reports a left hemiparesis with no active movement but full passive movement. Passive range of motion, edema control, positioning, and a resting hand splint are included in the treatment plan. What should the OTA’s PRIMARY objective be, as they provide these treatment techniques?
C. Preventing the development of contractures in the affected extremity. The neurological damage caused by CVA places the patient with hemiparesis at a high risk of contracture development, especially if no active movement is observed. The OTA’s primary objective as she begins treatment should be to provide techniques that will reduce the risk of contracture development. The other techniques listed will also be included over the course of treatment, but contracture prevention is necessary before the OTA can shift the focus of treatment to any of the other objectives.
C. Preventing the development of contractures in the affected extremity. The neurological damage caused by CVA places the patient with hemiparesis at a high risk of contracture development, especially if no active movement is observed. The OTA’s primary objective as she begins treatment should be to provide techniques that will reduce the risk of contracture development. The other techniques listed will also be included over the course of treatment, but contracture prevention is necessary before the OTA can shift the focus of treatment to any of the other objectives.
Erika is being evaluated for functional use of her right dominant hand, 4 weeks after being diagnosed with a mallet finger affecting her right index finger. The COTA® observes that Erika has difficulty using chopsticks which are her preferred eating utensils. Erika is planning on helping her sister with cooking and serving at her housewarming party, in 1 week. As her appearance is very important to her, she is reluctant to use any type of splint or assistive device, especially if they are conspicuous. The COTA® fabricates a customized splint to meet Erika’s needs and makes a recommendation that should place less demand on her joints when she uses a pinch grasp to manipulate chopsticks . Which type of splint and what recommendation will Erika MOST LIKELY agree to comply with?
C. Translucent ring splint turned upside down along DIP, and child-size bamboo chopsticks.
A mallet finger is the term used to describe the deformity produced by disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint. Mallet finger is also been referred to as drop, hammer, or baseball finger. The ring splint in this position can provide anterior stability at the DIP joint of a mallet finger. It is inconspicuous, requires little material, and allows for mobility of the PIP and MCP joint to manage utensils. Chopsticks are class-3 lever hand tools. With short lightweight chopsticks, the patient will have more control and requires less force produced to pick up items on the end.
A. Although a plastic tong is less cumbersome for serving food and use applies forces across the hand, a mobilization splint with finger loops attached to the 4th and 5th digit would be more appropriate for an ulnar nerve injury.
B. A hand-based splint is unnecessary and is more conspicuous. A spring-loaded pair of chopsticks would also be obvious.
D. Although silver rings would be appealing, longer heavier chopsticks require more precision and use of intrinsic forces.
.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 474-475.
Keogh, J., Sain, S.; and Roller, C. (2012). Kinesiology for the Occupational Therapy Assistant: Essential Components of Function and Movement. Thorofare, NJ: SLACK Incorporated, pp 68-73.
C. Translucent ring splint turned upside down along DIP, and child-size bamboo chopsticks.
A mallet finger is the term used to describe the deformity produced by disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint. Mallet finger is also been referred to as drop, hammer, or baseball finger. The ring splint in this position can provide anterior stability at the DIP joint of a mallet finger. It is inconspicuous, requires little material, and allows for mobility of the PIP and MCP joint to manage utensils. Chopsticks are class-3 lever hand tools. With short lightweight chopsticks, the patient will have more control and requires less force produced to pick up items on the end.
A. Although a plastic tong is less cumbersome for serving food and use applies forces across the hand, a mobilization splint with finger loops attached to the 4th and 5th digit would be more appropriate for an ulnar nerve injury.
B. A hand-based splint is unnecessary and is more conspicuous. A spring-loaded pair of chopsticks would also be obvious.
D. Although silver rings would be appealing, longer heavier chopsticks require more precision and use of intrinsic forces.
.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 474-475.
Keogh, J., Sain, S.; and Roller, C. (2012). Kinesiology for the Occupational Therapy Assistant: Essential Components of Function and Movement. Thorofare, NJ: SLACK Incorporated, pp 68-73.
A patient who is experiencing an acute exacerbation of their RA is attending OT for pain management. As the patient is unable to tolerate oral corticosteroids, a specific PAM has been selected with the goal of decreasing inflammation and swelling by delivering this medication through the skin using continuous and direct electrical current. Which PAM is able to achieve the goal of transcutaneous delivery of corticosteroids to the affected joints?
A. Iontophoresis.
Iontophoresis is the application of ionized topical medication through the skin to tissues of the body by the continuous and direct electrical current. It is used to administer specific medication into the patient’s body, to treat a variety of different conditions. The specific medication that is used in iontophoresis depends upon the goals of treatment. Some medications are used to decrease inflammation, while others are used to decrease calcium deposits in muscle and tendon tissue. Iontophoresis is used for delivery of substances that need local penetration in order to avoid systemic effects, and in cases where oral absorption is variable or contraindicated.
B. TENS- Stimulates nerve fibers and provides symptomatic relief of pain.
C. Fluidotherapy- Superficial heating modality that transfers heat by convection. Dried corn husks or other cellulose material are suspended by warmed circulating air.
D. Neuromuscular Electrical Stimulation (NMES)- Therapeutic muscle stimulation: repetitive simulation to paralyzed muscle to minimize atrophy and maintain range of motion. Activate muscle by stimulating an intact or partially intact peripheral nerve./em>
A. Iontophoresis.
Iontophoresis is the application of ionized topical medication through the skin to tissues of the body by the continuous and direct electrical current. It is used to administer specific medication into the patient’s body, to treat a variety of different conditions. The specific medication that is used in iontophoresis depends upon the goals of treatment. Some medications are used to decrease inflammation, while others are used to decrease calcium deposits in muscle and tendon tissue. Iontophoresis is used for delivery of substances that need local penetration in order to avoid systemic effects, and in cases where oral absorption is variable or contraindicated.
B. TENS- Stimulates nerve fibers and provides symptomatic relief of pain.
C. Fluidotherapy- Superficial heating modality that transfers heat by convection. Dried corn husks or other cellulose material are suspended by warmed circulating air.
D. Neuromuscular Electrical Stimulation (NMES)- Therapeutic muscle stimulation: repetitive simulation to paralyzed muscle to minimize atrophy and maintain range of motion. Activate muscle by stimulating an intact or partially intact peripheral nerve./em>
Christina, a 72-year-old former school teacher has been diagnosed with a proximal humerus fracture which is being treated conservatively in a skilled nursing facility. Christina’s arm is currently being immobilized with a sling. The MD has referred her for OT intervention with orders to include weaning from using the sling, light weight-bearing of the affected extremity, and active-assisted ROM progressed to AROM as tolerated. Which of the following activities would be the MOST APPROPRIATE to include during self-care, to increase Christina’s functional use of her affected arm while adhering to the MD’s guidelines?
D. Ambulating to the closet with a front-wheeled walker and retrieving clothes one at-a-time with either hand.
To maintain functional use, it is important for the patient to perform routine self-care tasks and include the affected arm towards the goal of regaining full or functional range of motion. Because light weight-bearing is acceptable, the patient can use a front-wheeled walker and lay the affected arm on the hand grip for stability during ambulation. Using either hand depends on whether the patient is able to use “AROM as tolerated.”
A, B, C. are unsafe and are not appropriate methods of light functional use of the affected extremity at this time.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 56-57.
D. Ambulating to the closet with a front-wheeled walker and retrieving clothes one at-a-time with either hand.
To maintain functional use, it is important for the patient to perform routine self-care tasks and include the affected arm towards the goal of regaining full or functional range of motion. Because light weight-bearing is acceptable, the patient can use a front-wheeled walker and lay the affected arm on the hand grip for stability during ambulation. Using either hand depends on whether the patient is able to use “AROM as tolerated.”
A, B, C. are unsafe and are not appropriate methods of light functional use of the affected extremity at this time.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 56-57.
Which branch of the radial nerve if entrapped, results in sensory manifestations and no motor deficits?
B. Superficial branch.
Wartenberg’s Syndrome is described as the entrapment of the superficial branch of the radial nerve with only sensory manifestations and no motor deficits. In this condition, the patient reports pain over the distal radial forearm associated with paresthesia over the dorsal radial hand. This should not be confused with Wartenberg’s Sign which refers to the slightly greater abduction of the fifth digit, due to paralysis of the abducting palmar interosseous muscle and unopposed action of the radial innervated extensor muscles.
A. The posterior interosseous nerve (deep branch) is entirely motor. Patients with posterior interosseous nerve syndrome do not present with a sensory deficit.
C. The anterior interosseous nerve (volar interosseous nerve) is a branch of the median nerve that supplies the deep muscles on the anterior of the forearm, except the ulnar (medial) half of the flexor digitorum profundus.
D. The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes.
B. Superficial branch.
Wartenberg’s Syndrome is described as the entrapment of the superficial branch of the radial nerve with only sensory manifestations and no motor deficits. In this condition, the patient reports pain over the distal radial forearm associated with paresthesia over the dorsal radial hand. This should not be confused with Wartenberg’s Sign which refers to the slightly greater abduction of the fifth digit, due to paralysis of the abducting palmar interosseous muscle and unopposed action of the radial innervated extensor muscles.
A. The posterior interosseous nerve (deep branch) is entirely motor. Patients with posterior interosseous nerve syndrome do not present with a sensory deficit.
C. The anterior interosseous nerve (volar interosseous nerve) is a branch of the median nerve that supplies the deep muscles on the anterior of the forearm, except the ulnar (medial) half of the flexor digitorum profundus.
D. The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes.
An 80-year-old inpatient who has recently been hospitalized for an exacerbation of his COPD is due to be discharged. The patient will be returning to his home which he has shared with his elderly wife for the past 28 years. Despite being weak from his recent hospitalization, the patient remains independent in all his BADLs. He, however, has a history of falling and a quad cane has been issued to give him more stability when walking. Which additional safety precaution should be put into place to ensure this patient’s safety when ambulating?
D. Have the patient put on non-skid footwear before ambulating.
Non-skid footwear including non-skid socks or shoes with traction will reduce risk of falling. The focus of treatment is to promote independence with functional performance of BADLs.
A. This may increase risk for falls.
B and C. These would promote more need for assistance and dependence and downgrades the patient from his current functional level for mobility.
Byers-Connon, S., Lohman, H., Padilla, R. L. (2004). Occupational Therapy with Elders:
D. Have the patient put on non-skid footwear before ambulating.
Non-skid footwear including non-skid socks or shoes with traction will reduce risk of falling. The focus of treatment is to promote independence with functional performance of BADLs.
A. This may increase risk for falls.
B and C. These would promote more need for assistance and dependence and downgrades the patient from his current functional level for mobility.
Byers-Connon, S., Lohman, H., Padilla, R. L. (2004). Occupational Therapy with Elders:
An 85-year-old man who has been diagnosed with Type 2 Diabetes Mellitus and osteoarthritis is experiencing chronic pain in both his wrists and CMC joints. Symptomatically, his right dominant hand has been more affected by the arthritis and this has resulted in the patient having difficulty maintaining his grasp on objects and tools which in turn has compromised his level of hygiene and ability to participate in his woodworking hobbies. It has been determined that the patient would benefit from wearing a resting hand splint with D-ring straps at night to support his wrist and CMC joint, for pain management. What is the purpose of the D-ring straps in this scenario?
C. To improve ease of application and provide mechanical leverage.
Given pain symptoms, the patient can more easily tighten the straps by holding onto the end piece between 2 fingers (other than the thumb and index finger) and rotating the forearm to tighten the D-ring strap.
A. Cognitive function was not mentioned.
B. There are other options of straps that could decrease the weight of the splint.
D. Although edema was not a concern, it may not be expected in this case. Any strap is moveable and can accommodate fluctuating edema.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 381.
C. To improve ease of application and provide mechanical leverage.
Given pain symptoms, the patient can more easily tighten the straps by holding onto the end piece between 2 fingers (other than the thumb and index finger) and rotating the forearm to tighten the D-ring strap.
A. Cognitive function was not mentioned.
B. There are other options of straps that could decrease the weight of the splint.
D. Although edema was not a concern, it may not be expected in this case. Any strap is moveable and can accommodate fluctuating edema.
Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, p 381.
A patient who has been diagnosed with radial tunnel syndrome is being treated conservatively. The OT practitioner is fabricating a splint for this patient to manage their condition. What type of splint is the MOST appropriate for this patient, at this stage of their intervention?
B. Long arm splint.
Radial tunnel syndrome (RTS): Compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. With RTS, placing the elbow in extension, forearm in pronation and wrist in flexion along with resisting long finger extension will often provoke symptoms of dull pain or aching and burning in the lateral forearm. Fabricating a long arm orthosis with the wrist in extension, elbow in flexion, and forearm in pronation to neutral rotation is the classic recommended position .
A. Dorsal blocking splint is used to prevent stress to the flexor tendons following injury or repair.
C. Wrist volar splint with wrist in neutral is typically used to treat Carpal tunnel syndrome.
D. Opponens splint typically used for fractures, injuries, and repetitive motion syndromes of the thumb.
B. Long arm splint.
Radial tunnel syndrome (RTS): Compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. With RTS, placing the elbow in extension, forearm in pronation and wrist in flexion along with resisting long finger extension will often provoke symptoms of dull pain or aching and burning in the lateral forearm. Fabricating a long arm orthosis with the wrist in extension, elbow in flexion, and forearm in pronation to neutral rotation is the classic recommended position .
A. Dorsal blocking splint is used to prevent stress to the flexor tendons following injury or repair.
C. Wrist volar splint with wrist in neutral is typically used to treat Carpal tunnel syndrome.
D. Opponens splint typically used for fractures, injuries, and repetitive motion syndromes of the thumb.
A female patient underwent surgery on her right dominant hand to repair a tendon. Two days post surgery she arrives at the outpatient hand clinic for occupational therapy intervention, as directed by her surgeon. She tells the OTA that she has had paraffin treatments in the past which she thoroughly enjoyed. She asks the OTA to apply paraffin wax to her right hand as she feels it will help with her discomfort. How should the OTA respond to this patient’s request?
D. The OTA should explain to the patient that paraffin treatments are contraindicated at this stage of her recovery as her surgical scar has not yet healed.
Paraffin should not be used until the scab from an open wound or surgical scar has fallen off. Paraffin can easily seep into open wounds therefore, it is contraindicated when an open wound or surgical site is present.
D. The OTA should explain to the patient that paraffin treatments are contraindicated at this stage of her recovery as her surgical scar has not yet healed.
Paraffin should not be used until the scab from an open wound or surgical scar has fallen off. Paraffin can easily seep into open wounds therefore, it is contraindicated when an open wound or surgical site is present.
A 55-year old housewife and mother of 4 adolescent children has COPD. She reports fatigue and a Borg rating of 3/10 for moderate breathlessness which interferes with her ability to complete her morning routines. Her goal is to improve her endurance so that she can make breakfast for her children before they leave for school. Which techniques would be beneficial to teach the patient to use for supporting this goal? Select the best 3 choices
A. Pursed lip breathing technique.
B. Positioning techniques.
D. Diaphragmatic breathing.
Pursed lip breathing decreases hyperinflation of the lungs which enables the patient to breathe in more oxygen and reduces dyspnea on exertion.
Positioning techniques such as leaning slightly forwards, elevating the head of the bed, and sleeping propped up on pillows reduces dyspnea with rest.
Diaphragmatic breathing. Often, people with COPD use accessory muscles in their neck, shoulders and back to breathe more than they use their diaphragm. Belly breathing or diaphragmatic breathing helps people with COPD retrain the diaphragm to work better, so they can breathe more efficiently.
C. Myofascial release is a manual therapy technique to improve muscle mobility and reduce pain.
E. Is a method of measuring a person’s perception of pain.
F. Accessory muscle use is indicated when a person has trouble moving air out of their lungs normally; this is a compensatory method for poor respiratory function.
Causey, R. (2013). Breathing Easier: Pulmonary Rehabilitation in Skilled Nursing Facilities. OT Practice 18(21), 13–17. http://dx.doi.org/10.7138/otp.2013.1821f2
A. Pursed lip breathing technique.
B. Positioning techniques.
D. Diaphragmatic breathing.
Pursed lip breathing decreases hyperinflation of the lungs which enables the patient to breathe in more oxygen and reduces dyspnea on exertion.
Positioning techniques such as leaning slightly forwards, elevating the head of the bed, and sleeping propped up on pillows reduces dyspnea with rest.
Diaphragmatic breathing. Often, people with COPD use accessory muscles in their neck, shoulders and back to breathe more than they use their diaphragm. Belly breathing or diaphragmatic breathing helps people with COPD retrain the diaphragm to work better, so they can breathe more efficiently.
C. Myofascial release is a manual therapy technique to improve muscle mobility and reduce pain.
E. Is a method of measuring a person’s perception of pain.
F. Accessory muscle use is indicated when a person has trouble moving air out of their lungs normally; this is a compensatory method for poor respiratory function.
Causey, R. (2013). Breathing Easier: Pulmonary Rehabilitation in Skilled Nursing Facilities. OT Practice 18(21), 13–17. http://dx.doi.org/10.7138/otp.2013.1821f2
A patient who presents with chronic lower back pain is being educated on proper body mechanics. The patient works as a library technician and his job requires him to lift, carry and place books on shelves throughout the day. Which techniques should the COTA® teach the patient in order to help him cope with the demands of his job? Select the best 3 choices
A. Bend the knees and keep the back straight, when unpacking new books from a box.
D. Maintain spinal alignment when holding the books.
E. Carry the books at chest level with elbows fully flexed.
All three techniques support proper body mechanics. These techniques support the following principles: maintaining the load close to the body, maintaining upright posture, and reducing joint stress by promoting equal distribution along the joints and muscles of the body.
Planning for Lifting and Carrying:
1. Test the weight of the object to be lifted. An easy way to determine if you can lift it without assistance is to try pushing the object with your foot. However, even lightweight objects that are large in size, or cumbersome, may best be handled with assistance.
2. Plan the best way to hold the object to keep it close to your body before lifting.
3. Position your body close to, and directly facing, the object. Place your feet flat on the floor, shoulder width apart, to provide a stable base for your body. To turn directions, use your feet to pivot. Do not twist!
4. Depending on the shape of the object, try to hold it at the sides and bottom, and keep it close to your body. If possible, keep your elbows bent while carrying an object.
5. Use the muscles in your legs as the power for lifting, not the back! Bend the knees, keep the back straight, and lift smoothly. Repeat the same movements for setting the object down.
https://www.spineuniverse.com/wellness/ergonomics/body-mechanics-your-spine-tips-1-3
Early, Mary Beth. (2006). Habits of Health and Wellness, Physical Dysfunction Practice Skills for the Occupational Therapy Assistant (3rd Edition, p 192). St. Louis, Missouri: Elsevier, Mosby Inc.
A. Bend the knees and keep the back straight, when unpacking new books from a box.
D. Maintain spinal alignment when holding the books.
E. Carry the books at chest level with elbows fully flexed.
All three techniques support proper body mechanics. These techniques support the following principles: maintaining the load close to the body, maintaining upright posture, and reducing joint stress by promoting equal distribution along the joints and muscles of the body.
Planning for Lifting and Carrying:
1. Test the weight of the object to be lifted. An easy way to determine if you can lift it without assistance is to try pushing the object with your foot. However, even lightweight objects that are large in size, or cumbersome, may best be handled with assistance.
2. Plan the best way to hold the object to keep it close to your body before lifting.
3. Position your body close to, and directly facing, the object. Place your feet flat on the floor, shoulder width apart, to provide a stable base for your body. To turn directions, use your feet to pivot. Do not twist!
4. Depending on the shape of the object, try to hold it at the sides and bottom, and keep it close to your body. If possible, keep your elbows bent while carrying an object.
5. Use the muscles in your legs as the power for lifting, not the back! Bend the knees, keep the back straight, and lift smoothly. Repeat the same movements for setting the object down.
https://www.spineuniverse.com/wellness/ergonomics/body-mechanics-your-spine-tips-1-3
Early, Mary Beth. (2006). Habits of Health and Wellness, Physical Dysfunction Practice Skills for the Occupational Therapy Assistant (3rd Edition, p 192). St. Louis, Missouri: Elsevier, Mosby Inc.
Jerry, a 68-year-old asthmatic with recently diagnosed CHF, has been admitted to an inpatient cardiac unit. He has been referred to OT for intervention and he is currently working on his ADLs with the COTA®. Jerry has been living independently on his own in a ground-floor apartment and he has expressed his desire to return to his home, to resume his previous roles including running his home web-designing business. What information should the COTA® gather before beginning the INITIAL ADL session? Select the best 3 answers.
A. Living situation including available support from others.
C. Typical grooming and dressing habits and routines.
D. Home environment setup including DME.
Discharge planning should be initiated as soon as the patient’s OT intervention begins. Treatment methods are based on the goals which are guided by client factors including the client’s interests and routines. Preparation for discharge includes discussing the patient’s goals towards discharge, mobility and assistive devices, and consideration of caregiver and community support systems. The clinician will keep these factors in mind during treatment implementation.
B, E and F. These serve as a basis for selecting evaluation procedures and provides a guide for approaching the patient’s evaluation.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 57-68.
A. Living situation including available support from others.
C. Typical grooming and dressing habits and routines.
D. Home environment setup including DME.
Discharge planning should be initiated as soon as the patient’s OT intervention begins. Treatment methods are based on the goals which are guided by client factors including the client’s interests and routines. Preparation for discharge includes discussing the patient’s goals towards discharge, mobility and assistive devices, and consideration of caregiver and community support systems. The clinician will keep these factors in mind during treatment implementation.
B, E and F. These serve as a basis for selecting evaluation procedures and provides a guide for approaching the patient’s evaluation.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo. : Elsevier/Mosby, pp 57-68.
A home health COTA® is working with a 52-year-old patient who has been diagnosed with COPD. The patient currently lives alone in a single-storey house, he has all his meals delivered by a meal delivery service, and when he needs to go out, he uses his Uber app to request a ride. The patient is independent in all his other ADLs but reports that doing his laundry is becoming more challenging as he is becoming short of breath after just a few minutes. The COTA® confirms with the patient that he has been using the pursed lip breathing technique and continues to measures his rate of perceived exertion, as previously taught. What other strategy can the COTA® teach this patient to help him cope better with doing his laundry?
A. Coordinate exhalation while lifting a filled, small laundry basket
Patients with COPD typically use accessory muscles while breathing with little use of their diaphragm. This results in shallow breathing leading to fatigue in the muscles of the shoulder. Unloading the shoulder girdle by supporting the upper extremities, breathing on exertion, and preventing bending at the hip will allow the patient the continued use of diaphragmatic breathing.
Causey, Renee (2013): Breathing Easier – Pulmonary Rehabilitation in Skilled Nursing Facilities. OT Practice Magazine (Vol 18), p 15.
Radomski, M. & Trombly Latham, C. (2008). Occupational Therapy for Physical Dysfunction (6th ed). Baltimore, MD: Lippincott, Williams & Wilkins, p 1309.
Arm activities are especially demanding for patients with COPD. Some pulmonary rehabilitation programs instruct patients to inhale while raising their arms, whereas others recommend the opposite. A study conducted in 2013, aimed to determine the effect of coordinating breathing with arm movements on the endurance of a lifting task. The results of the study indicated that exhalation during the lift, improved task performance. https://www.ncbi.nlm.nih.gov/pubmed/23370697
A. Coordinate exhalation while lifting a filled, small laundry basket
Patients with COPD typically use accessory muscles while breathing with little use of their diaphragm. This results in shallow breathing leading to fatigue in the muscles of the shoulder. Unloading the shoulder girdle by supporting the upper extremities, breathing on exertion, and preventing bending at the hip will allow the patient the continued use of diaphragmatic breathing.
Causey, Renee (2013): Breathing Easier – Pulmonary Rehabilitation in Skilled Nursing Facilities. OT Practice Magazine (Vol 18), p 15.
Radomski, M. & Trombly Latham, C. (2008). Occupational Therapy for Physical Dysfunction (6th ed). Baltimore, MD: Lippincott, Williams & Wilkins, p 1309.
Arm activities are especially demanding for patients with COPD. Some pulmonary rehabilitation programs instruct patients to inhale while raising their arms, whereas others recommend the opposite. A study conducted in 2013, aimed to determine the effect of coordinating breathing with arm movements on the endurance of a lifting task. The results of the study indicated that exhalation during the lift, improved task performance. https://www.ncbi.nlm.nih.gov/pubmed/23370697
A patient who recently had a heart attack works as a janitor. His job duties include washing windows, mopping floors, and vacuuming. What MET level does the patient need to reach before he may return to work?
C. 3.0-4.0 METs.
MET 3.8
Occupation custodial work: moderate effort (e.g., electric buffer, feathering arena floors, mopping, taking out trash, vacuuming)
2011 Compendium of Physical Activities
https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/MSS/A/MSS_43_8_2011_06_13_AINSWORTH_202093_SDC1.pdf
C. 3.0-4.0 METs.
MET 3.8
Occupation custodial work: moderate effort (e.g., electric buffer, feathering arena floors, mopping, taking out trash, vacuuming)
2011 Compendium of Physical Activities
https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/MSS/A/MSS_43_8_2011_06_13_AINSWORTH_202093_SDC1.pdf
David, a 52-year-old male who has a history of COPD has been referred for OT intervention. David lives alone in a double story house and he usually enjoys going for leisurely walks around his neighborhood. Recently however, David has been experiencing more frequent episodes of dyspnea which is impacting on his physical activity, including walking up his stairs at home and performing his BADLs. David has had to resort to sponge bathing at the bathroom sink and he tries to avoid using his stairs as much as possible. The COTA® decides to instruct David on using a pursed lip breathing technique for dyspnea relief, but he has difficulty performing this breathing pattern. What modality would be the MOST helpful for David to use to help him improve his technique so that he can increase his tolerance for performing physical activities?
A. Auditory biofeedback to the sequence and speed of simulated breath sounds.
Biofeedback facilitates learning. Biofeedback allows the patient to self-monitor and control physiological responses. Auditory biofeedback gives the patient the opportunity to readily observe and monitor how they are performing and make adjustments necessary in order to promote a target response, such as maintaining a slower, deeper breathing pattern. This can be done with a recorded breathing pattern that can be played back.
B. The patient will have difficulty inhaling while counting aloud. It would be more appropriate to count in silence and/or exhale 4 breaths because exhalation for pursed lip breathing relies on moving air out of the lungs on exhale.
C. It is more appropriate to assume a stabilized forward lean position. However, it does not focus on the breathing pattern.
D. A spirometer measures lung volume capacity and also assesses for presence of airway obstruction. However, it is not an appropriate device to sensitize proper breathing pattern in pursed-lip breathing. Blowing on a tissue would be a better visual biofeedback.
Elizabeth Pyatak, Maggie King, Cheryl L. P. Vigen, Elia Salazar, Jesus Diaz, Stacey L. Schepens Niemiec, Jeanine Blanchard, Katie Jordan, Josh Banerjee, Jagruti Shukla; Addressing Diabetes in Primary Care: Hybrid Effectiveness–Implementation Study of Lifestyle Redesign® Occupational Therapy. Am J Occup Ther 2019;73(5):7305185020p1-7305185020p12. doi: 10.5014/ajot.2019.037317.
A. Auditory biofeedback to the sequence and speed of simulated breath sounds.
Biofeedback facilitates learning. Biofeedback allows the patient to self-monitor and control physiological responses. Auditory biofeedback gives the patient the opportunity to readily observe and monitor how they are performing and make adjustments necessary in order to promote a target response, such as maintaining a slower, deeper breathing pattern. This can be done with a recorded breathing pattern that can be played back.
B. The patient will have difficulty inhaling while counting aloud. It would be more appropriate to count in silence and/or exhale 4 breaths because exhalation for pursed lip breathing relies on moving air out of the lungs on exhale.
C. It is more appropriate to assume a stabilized forward lean position. However, it does not focus on the breathing pattern.
D. A spirometer measures lung volume capacity and also assesses for presence of airway obstruction. However, it is not an appropriate device to sensitize proper breathing pattern in pursed-lip breathing. Blowing on a tissue would be a better visual biofeedback.
Elizabeth Pyatak, Maggie King, Cheryl L. P. Vigen, Elia Salazar, Jesus Diaz, Stacey L. Schepens Niemiec, Jeanine Blanchard, Katie Jordan, Josh Banerjee, Jagruti Shukla; Addressing Diabetes in Primary Care: Hybrid Effectiveness–Implementation Study of Lifestyle Redesign® Occupational Therapy. Am J Occup Ther 2019;73(5):7305185020p1-7305185020p12. doi: 10.5014/ajot.2019.037317.
A 32-year-old ballet instructor who recently sustained a left proximal humeral fracture which required surgical intervention, has been referred to OT. The surgeon’s orders for treating the patient’s left upper limb include no weight bearing on that arm, maintaining full AROM of the wrist and fingers and extension/flexion of the elbow as tolerated, with supervision from the therapist. The COTA® is currently working with the patient on dressing and is instructing her on how to correctly don her elastic waist pants. The COTA® has already established that the patient has good trunk control and normal upper extremity strength of her unaffected arm. After carefully assisting the patient with doffing her sling, what sequence of dressing would be the MOST effective for the patient to follow, to help her learn to dress independently while adhering to the doctor’s instructions?
B. With right hand, open waist cuff, thread over feet in figure-4, pull to thighs, stand and manage pants over hips while left hand stabilizes waist band.
Proximal humeral fracture most likely occurred at the surgical neck of the upper arm limiting shoulder movements during the initial healing phase. The patient has good trunk control and is able to use her left hand with supervised movement of her left elbow as long as the patient supports her forearm against her body. This would allow her to stabilize the pants with her left hand while she pushes to stand with her right hand and complete dressing. Given her profession, it is likely her balance is within functional range.
A. Bending over would increase the chance of weight-bearing with her LUE which is contraindicated at this time.
C. Managing the reacher with her operated upper extremity would increase the chance of shoulder movement which is contraindicated at this stage of rehabilitation for a proximal humeral fracture.
D. The patient has optimal trunk control with no indication of balance deficits and is able to perform lower body dressing in a seated, unsupported position.
https://passtheot.com/hand-upper-extremity-worksheet/
http://bostonshoulderinstitute.com/wp-content/uploads/2017/03/Post-Fracture-Proximal-Humerus-Rehab-Guidelines.pdf
B. With right hand, open waist cuff, thread over feet in figure-4, pull to thighs, stand and manage pants over hips while left hand stabilizes waist band.
Proximal humeral fracture most likely occurred at the surgical neck of the upper arm limiting shoulder movements during the initial healing phase. The patient has good trunk control and is able to use her left hand with supervised movement of her left elbow as long as the patient supports her forearm against her body. This would allow her to stabilize the pants with her left hand while she pushes to stand with her right hand and complete dressing. Given her profession, it is likely her balance is within functional range.
A. Bending over would increase the chance of weight-bearing with her LUE which is contraindicated at this time.
C. Managing the reacher with her operated upper extremity would increase the chance of shoulder movement which is contraindicated at this stage of rehabilitation for a proximal humeral fracture.
D. The patient has optimal trunk control with no indication of balance deficits and is able to perform lower body dressing in a seated, unsupported position.
https://passtheot.com/hand-upper-extremity-worksheet/
http://bostonshoulderinstitute.com/wp-content/uploads/2017/03/Post-Fracture-Proximal-Humerus-Rehab-Guidelines.pdf
A patient who has been diagnosed with RA has recently joined an arts and crafts group and she has expressed that in order to fully participate in the activities, she needs to be able to use scissors. Which type of scissors is the BEST to recommend in this scenario?
A. Spring-operated scissors.
Cutting paper and fabric can put a surprising amount of stress on your joints, particularly those in your thumbs. Scissors which have soft-grip handles and spring-action blades that open after each cut, reduces the effort it takes to cut something and easing the strain on your hands.
B. Electric scissors require pushing buttons and maintaining a static grasp to operate them.
D. Embroidery scissors are small, sharp, pointed scissors
A. Spring-operated scissors.
Cutting paper and fabric can put a surprising amount of stress on your joints, particularly those in your thumbs. Scissors which have soft-grip handles and spring-action blades that open after each cut, reduces the effort it takes to cut something and easing the strain on your hands.
B. Electric scissors require pushing buttons and maintaining a static grasp to operate them.
D. Embroidery scissors are small, sharp, pointed scissors
You are running a topical group to educate patients on “What to Look for in RA-Friendly Devices”. What are the 3 most important properties to consider when purchasing any product for the kitchen? Select 3 best choices.
B. Put safety first.
C. Consider the benefits of texture.
D. Avoid anything heavy.
What to Look for in RA-Friendly Devices- there are plenty of considerations to keep in mind when looking for products that can help ease RA-related joint strain in your day-to-day life. According to the Arthritis Foundation, here is what you should consider when shopping for products to help you manage your RA:
• Put safety first — consider only those products that you can use as intended comfortably.
• Avoid anything heavy — like cast iron pots or ceramic bowls — which may be difficult to use.
• Think about texture — for example, glassware that has a bumpy exterior may be easier to grasp and hold on to than a smooth surface.
• Consider ease of use — products, for example, that have flip tops, zippers, or large, easy-to-open lids.
• Look for products that don’t require much upkeep or maintenance.
https://www.everydayhealth.com/hs/rheumatoid-arthritis-treatment-management/ra-gadgets/
B. Put safety first.
C. Consider the benefits of texture.
D. Avoid anything heavy.
What to Look for in RA-Friendly Devices- there are plenty of considerations to keep in mind when looking for products that can help ease RA-related joint strain in your day-to-day life. According to the Arthritis Foundation, here is what you should consider when shopping for products to help you manage your RA:
• Put safety first — consider only those products that you can use as intended comfortably.
• Avoid anything heavy — like cast iron pots or ceramic bowls — which may be difficult to use.
• Think about texture — for example, glassware that has a bumpy exterior may be easier to grasp and hold on to than a smooth surface.
• Consider ease of use — products, for example, that have flip tops, zippers, or large, easy-to-open lids.
• Look for products that don’t require much upkeep or maintenance.
https://www.everydayhealth.com/hs/rheumatoid-arthritis-treatment-management/ra-gadgets/
Jennifer, a 65-year-old patient who is in the 2nd Phase of her cardiac rehabilitation, is working on performing household tasks. The focus is on endurance training and the selected task is unloading the dishwasher. During the task, the COTA® observes Jennifer leaning more heavily on her rolling walker as time passes and she starts taking progressively smaller steps to ambulate around the kitchen. What action should the COTA® take NEXT?
C. Modify the task by allowing the patient to stand only when necessary to place items beyond her reach.
The goal is for the patient to improve endurance by working on completion of a meaningful task. The patient is demonstrating signs of fatigue with slow movements and need for upper extremity support. Therefore, the patient would benefit from activity modification to make the task less challenging, downgraded to a level that is more tolerable.
A. Termination of the activity would be necessary if the patient demonstrates more severe symptoms such as dyspnoea on exertion or chest pain.
B. The goal is for completion of the task during ambulation with pacing and rest. Wheelchair level is not preferred, and strengthening is not the goal.
D. Using the stationary bike is not the patient’s preferred functional task.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, p 10.
C. Modify the task by allowing the patient to stand only when necessary to place items beyond her reach.
The goal is for the patient to improve endurance by working on completion of a meaningful task. The patient is demonstrating signs of fatigue with slow movements and need for upper extremity support. Therefore, the patient would benefit from activity modification to make the task less challenging, downgraded to a level that is more tolerable.
A. Termination of the activity would be necessary if the patient demonstrates more severe symptoms such as dyspnoea on exertion or chest pain.
B. The goal is for completion of the task during ambulation with pacing and rest. Wheelchair level is not preferred, and strengthening is not the goal.
D. Using the stationary bike is not the patient’s preferred functional task.
Early, Mary Beth. (2013) Physical dysfunction practice skills for the occupational therapy assistant (3rd Edition). St. Louis, Mo.: Elsevier/Mosby, p 10.
A COTA® is fabricating a long arm splint for a 45-year-old patient who, 5 days ago sustained an injury to his right forearm (proximal to his elbow) when he was hit with a baseball bat during a fight. The blow to his forearm resulted in compression of the median nerve. The patient does not present with any sensory impairments which suggests that only the motor branch of the median nerve has been affected. He does however feel pain on the proximal volar surface of his forearm. The following morning during a follow-up appointment with the COTA® , the patient complains of paresthesia and on examination, the ventromedial compartment of his forearm is swollen, red and tender, and capillary refill is poor. What should the COTA® do NEXT to alleviate the problem?
D. Loosen the ace bandage under the splint, check the patient’s blood pressure and consult with the OTR® about contacting the orthopedic surgeon.
The patient may be displaying signs and symptoms of acute compartment syndrome of the forearm. This results from internal pressure within the tissues when there is limited space, compromising circulation and function of the contents of that space. The pressure has elevated for some time to reduce capillary perfusion. This is a medical emergency and diagnostic procedures may be required to assess the tissues in the painful area. The COTA® should inform the OTR® as they cannot take any action without first consulting with the OTR®.
A. This will add pressure to an already-compromised area.
B. This would be a more appropriate intervention to neuropathic pain, such as CRPS.
C. This modality is contraindicated for this condition
Chandraprakasam, T., & Kumar, R. A. (2011). Acute compartment syndrome of forearm and hand. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 44(2), 212–218. doi:10.4103/0970-0358.85342
https://www.ncbi.nlm.nih.gov/pubmed/14503155
https://www.choosept.com/symptomsconditionsdetail.aspx?cid=a373249d-d523-4eb7-90b0-b252f164f405
D. Loosen the ace bandage under the splint, check the patient’s blood pressure and consult with the OTR® about contacting the orthopedic surgeon.
The patient may be displaying signs and symptoms of acute compartment syndrome of the forearm. This results from internal pressure within the tissues when there is limited space, compromising circulation and function of the contents of that space. The pressure has elevated for some time to reduce capillary perfusion. This is a medical emergency and diagnostic procedures may be required to assess the tissues in the painful area. The COTA® should inform the OTR® as they cannot take any action without first consulting with the OTR®.
A. This will add pressure to an already-compromised area.
B. This would be a more appropriate intervention to neuropathic pain, such as CRPS.
C. This modality is contraindicated for this condition
Chandraprakasam, T., & Kumar, R. A. (2011). Acute compartment syndrome of forearm and hand. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 44(2), 212–218. doi:10.4103/0970-0358.85342
https://www.ncbi.nlm.nih.gov/pubmed/14503155
https://www.choosept.com/symptomsconditionsdetail.aspx?cid=a373249d-d523-4eb7-90b0-b252f164f405
Barbara is a 68-year old retired professional baker who, 5 years ago, was diagnosed with RA. Recently, Barbara has also been diagnosed with severe anxiety associated with her having to deal with her progressive RA symptoms. Barbara is currently participating in a community mobility group, which is focusing on public transportation. Lately, she has been missing her bus because she has been distracted by her thoughts which have been centred around thinking about her symptoms. During the group session, Barbara begins to display signs of anxiety. What should the COTA®’s NEXT course of action be at this point?
B. Acknowledge her concerns and redirect the patient onto a neutral topic.
It is important for a patient with anxiety to express her concerns, confront her fears, and release stress. The clinician’s role in maintaining a therapeutic relationship is by allowing patients to come to terms with their conditions, manage their symptoms, and carry on with their meaningful tasks by gradually turning their attention to a more constructive topic.
A. The problem with missing the bus is not because of a time management problem. It is related to anxiety.
C. The focus of action should be on gradual redirection, not encouraging discussion regarding physical symptoms.
D. It is important to report the patient’s behavior to the OTR®. as she may be experiencing an exacerbation of her symptoms, but the question is asking what NEXT, in the group situation.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 290-291.
B. Acknowledge her concerns and redirect the patient onto a neutral topic.
It is important for a patient with anxiety to express her concerns, confront her fears, and release stress. The clinician’s role in maintaining a therapeutic relationship is by allowing patients to come to terms with their conditions, manage their symptoms, and carry on with their meaningful tasks by gradually turning their attention to a more constructive topic.
A. The problem with missing the bus is not because of a time management problem. It is related to anxiety.
C. The focus of action should be on gradual redirection, not encouraging discussion regarding physical symptoms.
D. It is important to report the patient’s behavior to the OTR®. as she may be experiencing an exacerbation of her symptoms, but the question is asking what NEXT, in the group situation.
Early, Mary Beth. (2009) Mental Health Concepts & Techniques for the Occupational Therapy Assistant (4th Edition). Baltimore, MD.: Walters Kluwer, pp 290-291.
A 5-year-old girl is being treated in the hand therapy clinic following a distal ulnar fracture of her left arm. She is being fitted for a dorsal long forearm splint with Velcro straps. Her parents are concerned that she may try to remove the splint as she is a very curious child and tends to take everything apart, including her Velcro shoes. How should the COTA® adapt the splint to prevent the child from removing it from her forearm?
B. Replace the Velcro straps with shoelaces and shoelace locks, and apply stickers of her favorite animal or cartoon characters. This would prevent her from removing the splint. The cartoon design is fun and appealing and she is more likely to keep the splint on, to show the design to her peers and loved ones.
https://www.mitchmedical.us/extremity-splinting/splinting-the-pediatric-patient.html
B. Replace the Velcro straps with shoelaces and shoelace locks, and apply stickers of her favorite animal or cartoon characters. This would prevent her from removing the splint. The cartoon design is fun and appealing and she is more likely to keep the splint on, to show the design to her peers and loved ones.
https://www.mitchmedical.us/extremity-splinting/splinting-the-pediatric-patient.html
An OTA is working with a 73-year-old male patient who has COPD, on energy conservation. Which strategy would be the most effective in helping him conserve the most amount of energy while he completes a dish-washing task at the sink?
C. Suggest he sit on a tall kitchen stool at the sink while washing the dishes. Sitting down to complete a task is an energy conservation technique. By sitting down at the sink, the man can conserve his energy and still wash his dishes himself. The other answers suggest that the man find an alternative to washing his own dishes.
C. Suggest he sit on a tall kitchen stool at the sink while washing the dishes. Sitting down to complete a task is an energy conservation technique. By sitting down at the sink, the man can conserve his energy and still wash his dishes himself. The other answers suggest that the man find an alternative to washing his own dishes.
A patient has pain and decreased AROM of bilateral upper extremities and knees secondary to fibromyalgia. The symptoms interfere with the patient’s ability to independently wash her hands, brush her teeth and hair, and put makeup on in the morning. Which approach should the OTA use FIRST to improve the patient’s ability to groom while standing at the sink?
D. Teach the patient a variety of joint protection strategies for grooming.
It is important to deal with the patient’s pain first. Teaching the patient joint protection techniques and strategies will help eliminate the pain.
D. Teach the patient a variety of joint protection strategies for grooming.
It is important to deal with the patient’s pain first. Teaching the patient joint protection techniques and strategies will help eliminate the pain.
A patient with COPD complains of shortness of breath while walking up stairs, performing her grooming routine, and cooking in her kitchen. Which subjective statement would the OTA most likely write down in her SOAP note that would be correlated to educating a patient about her disease?
D. “I wake up in the morning and rush to get my clothes on, brush my teeth, and make breakfast. Then I am exhausted.”
Waking up in the morning and attempting to do all those activities will cause the patient to become short of breath and tired. It is important to educate the patient about energy conservation, pacing, and slowing down.
D. “I wake up in the morning and rush to get my clothes on, brush my teeth, and make breakfast. Then I am exhausted.”
Waking up in the morning and attempting to do all those activities will cause the patient to become short of breath and tired. It is important to educate the patient about energy conservation, pacing, and slowing down.
A 12-year-old boy sustained an injury to his right distal radial epiphysis from falling off a tree. The boy’s doctor has ordered physical agent modalities as a part of his occupational therapy treatment. Which modality is contraindicated for this type of injury?
A. Ultrasound. The bones of children and adults share many of the same risks for injury. But because they are still growing, a child’s bones are also subject to a unique injury called a growth plate fracture. Growth plates are areas of cartilage located near the ends of bones. Because they are the last portion of a child’s bones to harden (ossify), growth plates are particularly vulnerable to fracture. An epiphyseal injury therefore affects the growth plate of the bone. Since the patient is 12 years old, his growth plates are active and any treatments that could affect that growth should be avoided. Ultrasound which is a deep heat modality has been shown to interfere with active growth plates and the use of ultrasound over growth plates is therefore contraindicated.
A. Ultrasound. The bones of children and adults share many of the same risks for injury. But because they are still growing, a child’s bones are also subject to a unique injury called a growth plate fracture. Growth plates are areas of cartilage located near the ends of bones. Because they are the last portion of a child’s bones to harden (ossify), growth plates are particularly vulnerable to fracture. An epiphyseal injury therefore affects the growth plate of the bone. Since the patient is 12 years old, his growth plates are active and any treatments that could affect that growth should be avoided. Ultrasound which is a deep heat modality has been shown to interfere with active growth plates and the use of ultrasound over growth plates is therefore contraindicated.
An OTA is treating a teenage girl with a brachial plexus injury. The girl asks the OTA if there is anything she can do to use her affected arm. What could the OTA recommend to facilitate functional movement in the girl’s affected arm?
D. A flail arm splint. This type of splint is designed to support the entire arm and facilitate some functional movement that is initiated at the shoulder.
Flail arm splint provides the needed stability at both the shoulder and elbow for functional positioning of the hand.
For patients who have sustained a flail upper limb as a result of a brachial plexus lesion, functional splintage in the form of the flail arm splint is recommended. The full flail arm splint is basically a skeleton of an upper limb prosthesis. It fits around the patient’s arm and enables them to lock the elbow in one of five positions. By protracting their unaffected shoulder , they can operate various terminal devices, thereby increasing his functional capabilities.
https://journals.sagepub.com/doi/abs/10.1177/030802268604901008?journalCode=bjod
D. A flail arm splint. This type of splint is designed to support the entire arm and facilitate some functional movement that is initiated at the shoulder.
Flail arm splint provides the needed stability at both the shoulder and elbow for functional positioning of the hand.
For patients who have sustained a flail upper limb as a result of a brachial plexus lesion, functional splintage in the form of the flail arm splint is recommended. The full flail arm splint is basically a skeleton of an upper limb prosthesis. It fits around the patient’s arm and enables them to lock the elbow in one of five positions. By protracting their unaffected shoulder , they can operate various terminal devices, thereby increasing his functional capabilities.
https://journals.sagepub.com/doi/abs/10.1177/030802268604901008?journalCode=bjod
On which side of the hand is a wrist cock-up splint meant to be placed?
D. Volar or dorsal.
Volar means the palm of your hand. Dorsal means the back of your hand. A wrist cock-up splint can be fabricated with either a volar or dorsal design. Volar wrist cock-up splints are more commonly used. Dorsal wrist cock-up splints are used when a patient’s condition prevents the use of a volar wrist cock-up splint.
D. Volar or dorsal.
Volar means the palm of your hand. Dorsal means the back of your hand. A wrist cock-up splint can be fabricated with either a volar or dorsal design. Volar wrist cock-up splints are more commonly used. Dorsal wrist cock-up splints are used when a patient’s condition prevents the use of a volar wrist cock-up splint.
A 75-year-old male is a father of two children and has 3 grandchildren. He has been living alone for several years in a one-story home. He has smoked a pack of cigarettes every day since his wife died 5 years ago. He was recently diagnosed with Chronic Bronchitis and complains of an ongoing cough, shortness of breath, and tightness around his chest. The OTA needs to assess the patient’s current ADL ability. What is the best way for the OTA to assess this patient?
The OTA should assess the patient using the Borg Rating of Perceived Exertion during ADL tasks. The OTA needs to know the patient’s current level of ADL ability, including how much energy the patient feels he is exerting during tasks. The Borg Rating would give the OTA this information. The OTA should also monitor oxygen levels during any activity, but this will tell the OTA when the patient needs to rest, not what his current ADL ability is. Nursing staff may not allow the patient to perform ADL tasks by himself and his family might not know about his current ADL status.
The OTA should assess the patient using the Borg Rating of Perceived Exertion during ADL tasks. The OTA needs to know the patient’s current level of ADL ability, including how much energy the patient feels he is exerting during tasks. The Borg Rating would give the OTA this information. The OTA should also monitor oxygen levels during any activity, but this will tell the OTA when the patient needs to rest, not what his current ADL ability is. Nursing staff may not allow the patient to perform ADL tasks by himself and his family might not know about his current ADL status.
What is the most common use of a humeral fracture brace?
C. To support the humerus after a nondisplaced fracture. A humeral fracture brace supports all or a portion of the upper arm following a fracture of the humerus. Most commonly, a humeral fracture brace is used to support the humerus as a part of conservative management of a nondisplaced fracture.
C. To support the humerus after a nondisplaced fracture. A humeral fracture brace supports all or a portion of the upper arm following a fracture of the humerus. Most commonly, a humeral fracture brace is used to support the humerus as a part of conservative management of a nondisplaced fracture.
Amelia is a 3-year-old girl referred for special education services at her local elementary school by the county birth to three program. Her symptoms include brittle bones, deformities of the arms and legs, developmental growth problems, and eye abnormalities. Her mother reports that Amelia’s doctor stated Amelia is also at risk for developing hearing impairments. What disorder does Amelia have?
D. Osteogenesis Imperfecta. This congenital disorder is characterized by brittle bones that are prone to fracture. Children with this disorder are born with a deficiency in type 1 collagen that causes defective connective tissue or the inability of the body to make connective tissue.
D. Osteogenesis Imperfecta. This congenital disorder is characterized by brittle bones that are prone to fracture. Children with this disorder are born with a deficiency in type 1 collagen that causes defective connective tissue or the inability of the body to make connective tissue.
Which is the BEST OT treatment intervention for a patient who fractured his humerus while playing football and is now wearing a cast?
B. Compensatory technique to resume ADLs.
Rehabilitation for a patient with a fractured humerus typically involves a team approach, including physiotherapy and OT.
The main and unique treatment goal of OT in this situation, is to help the patient regain independence in his ADLs. In order to achieve this, teaching the patient new ways to perform these tasks (compensatory techniques) is usually required. For the patient to be able to perform his ADLs with ease, controlling his pain may be necessary. It is also important to maintain the patient’s muscle strength and range of motion, of the structures around his immobilized humerus as immobilization can result in tissue shortening. If a physiotherapist is not involved in the patient’s care, then the OTA would have to address this, as well
B. Compensatory technique to resume ADLs.
Rehabilitation for a patient with a fractured humerus typically involves a team approach, including physiotherapy and OT.
The main and unique treatment goal of OT in this situation, is to help the patient regain independence in his ADLs. In order to achieve this, teaching the patient new ways to perform these tasks (compensatory techniques) is usually required. For the patient to be able to perform his ADLs with ease, controlling his pain may be necessary. It is also important to maintain the patient’s muscle strength and range of motion, of the structures around his immobilized humerus as immobilization can result in tissue shortening. If a physiotherapist is not involved in the patient’s care, then the OTA would have to address this, as well
Which nerve provides motor innervation to the flexor muscles of the forearm and hand as well as to the muscles responsible for flexion, abduction, opposition, and extension of the thumb. It also provides sensory innervation to the volar aspect of the thumb, index, middle, and half of the ring finger, the palm, as well as the medial aspect of the forearm?
D. Median nerve
The median nerve originates from the lateral and medial cords of the brachial plexus, and has contributions from ventral roots of C5, C6 and C7 (lateral cord) and C8 and T1 (medial cord).
The median nerve is the only nerve that passes through the carpal tunnel. The median nerve predominantly provides motor innervation to the flexor muscles of the forearm and hand as well as those muscles responsible for flexion, abduction, opposition, and extension of the thumb. The median nerve also provides sensory innervation to the dorsal aspect (nail bed) of the distal first two digits of the hand, the volar aspect of the thumb, index, middle, and half of the ring finger, the palm, as well as the medial aspect of the forearm.Carpal tunnel syndrome is the condition that results from the median nerve being compressed in the carpal tunnel.
https://www.ncbi.nlm.nih.gov/books/NBK448084/
D. Median nerve
The median nerve originates from the lateral and medial cords of the brachial plexus, and has contributions from ventral roots of C5, C6 and C7 (lateral cord) and C8 and T1 (medial cord).
The median nerve is the only nerve that passes through the carpal tunnel. The median nerve predominantly provides motor innervation to the flexor muscles of the forearm and hand as well as those muscles responsible for flexion, abduction, opposition, and extension of the thumb. The median nerve also provides sensory innervation to the dorsal aspect (nail bed) of the distal first two digits of the hand, the volar aspect of the thumb, index, middle, and half of the ring finger, the palm, as well as the medial aspect of the forearm.Carpal tunnel syndrome is the condition that results from the median nerve being compressed in the carpal tunnel.
https://www.ncbi.nlm.nih.gov/books/NBK448084/
If a patient has a MMT score of grade 3+ for shoulder flexion, what activity should the patient be able to complete?
B. Lift a towel and place it on a towel rack.
A grade of Fair plus (3+) means the patient can move through full ROM against gravity and can tolerate slight resistance. The patient should be able to lift the towel as it provides slight resistance to movement. The other activities provide more resistance than what the patient will be able to tolerate at this grade.
B. Lift a towel and place it on a towel rack.
A grade of Fair plus (3+) means the patient can move through full ROM against gravity and can tolerate slight resistance. The patient should be able to lift the towel as it provides slight resistance to movement. The other activities provide more resistance than what the patient will be able to tolerate at this grade.
Upon completing 75% of a task, a patient is given which FIM score?
B. 4 – Minimal Contact Assistance. At this level, the patient can perform 75% or more of the task, but may need incidental assistance such as help adjusting clothing, applying toothpaste, etc.
B. 4 – Minimal Contact Assistance. At this level, the patient can perform 75% or more of the task, but may need incidental assistance such as help adjusting clothing, applying toothpaste, etc.
When a muscle moves a constant load through a range of motion, which of the following forces of action is being displayed?
C. Isotonic contraction.
Isotonic- intention to move.
Isometric- intention to hold.
Isotonic contractions generate force by changing the length of the muscle and can be concentric contractions or eccentric contractions.
A concentric contraction causes muscles to shorten, thereby generating force.
Eccentric contractions cause muscles to elongate in response to a greater opposing force.
Isometric contractions generate force without changing the length of the muscle.
C. Isotonic contraction.
Isotonic- intention to move.
Isometric- intention to hold.
Isotonic contractions generate force by changing the length of the muscle and can be concentric contractions or eccentric contractions.
A concentric contraction causes muscles to shorten, thereby generating force.
Eccentric contractions cause muscles to elongate in response to a greater opposing force.
Isometric contractions generate force without changing the length of the muscle.
What treatment technique uses graded sensory stimuli to retrain sensory pathways or stimulate unused pathways?
D. Sensory re-education.
Sensory re-education helps patients to interpret sensory impulses through graded sensory stimuli.
D. Sensory re-education.
Sensory re-education helps patients to interpret sensory impulses through graded sensory stimuli.
A patient has edema in her right upper extremity due to an obstruction in her lymphatic system. What is this condition called?
A. Lymphedema.
Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the thoracic duct and then the bloodstream. Though incurable and progressive, a number of treatments can ameliorate symptoms. Tissues with lymphedema are at risk of infection.
A. Lymphedema.
Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the thoracic duct and then the bloodstream. Though incurable and progressive, a number of treatments can ameliorate symptoms. Tissues with lymphedema are at risk of infection.
For a patient with rheumatoid arthritis who is experiencing an active flare up of the disease (joints are acutely inflamed), what type of movements are contraindicated?
A. PROM and resistive exercises.
Acutely, inflamed joints should be rested to prevent exacerbation of symptoms. Avoid stretching in acute cases. For non-inflamed joints, active or active-assisted stretching of all major joints is essential to prevent contracture formation and maintain the current range of motion to perform activities of daily living. When the patient experiences an exacerbation and the joints are acutely inflamed then only isometric exercises should be done. Avoid excessive stress over the tendons with stretches and avoid resistive movements.
https://www.hopkinsarthritis.org/
https://www.physio-pedia.com/Rheumatoid_Arthritis
A. PROM and resistive exercises.
Acutely, inflamed joints should be rested to prevent exacerbation of symptoms. Avoid stretching in acute cases. For non-inflamed joints, active or active-assisted stretching of all major joints is essential to prevent contracture formation and maintain the current range of motion to perform activities of daily living. When the patient experiences an exacerbation and the joints are acutely inflamed then only isometric exercises should be done. Avoid excessive stress over the tendons with stretches and avoid resistive movements.
https://www.hopkinsarthritis.org/
https://www.physio-pedia.com/Rheumatoid_Arthritis
A 62-year-old male office manager sustained an aneurysm and is now functioning at a level 3 on the Functional Independence Measure (FIM) for bathing and grooming. What does this score indicate?
C. Moderate assistance needed. A level 3 on the Functional Independence Measure (FIM) for bathing and grooming indicates that this patient requires moderate assistance and completes 50%-74% of the task.
C. Moderate assistance needed. A level 3 on the Functional Independence Measure (FIM) for bathing and grooming indicates that this patient requires moderate assistance and completes 50%-74% of the task.
A 24-year-old patient with RA is seen in the outpatient department for treatment, including a resting hand splint. Before working with this patient, what precaution should the OTA adhere to?
B. The patient should not perform resistive exercises to increase strength.
RA: Maintaining AROM is a PRIMARY recommendation in order to prevent deformity. PROM and resistive exercise is contraindicated.
B. The patient should not perform resistive exercises to increase strength.
RA: Maintaining AROM is a PRIMARY recommendation in order to prevent deformity. PROM and resistive exercise is contraindicated.
When treating a patient who has sustained an extensive hand injury, what phase of recovery includes enhancing the patient’s performance skills, providing adaptive equipment, and teaching them alternative techniques in self-care?
D. The phase would be the rehabilitative phase.
The ultimate goal of occupation-based hand therapy is to ensure that the rehabilitation process promotes healing while also enabling clients to perform meaningful activities both in the clinic and in their daily lives. This approach fosters positive outcomes for clients, including enhancing their satisfaction with the therapy experience and results, maintaining their ability to engage in desired roles within their family and the community, and most importantly, experiencing quality of life as they define it.
D. The phase would be the rehabilitative phase.
The ultimate goal of occupation-based hand therapy is to ensure that the rehabilitation process promotes healing while also enabling clients to perform meaningful activities both in the clinic and in their daily lives. This approach fosters positive outcomes for clients, including enhancing their satisfaction with the therapy experience and results, maintaining their ability to engage in desired roles within their family and the community, and most importantly, experiencing quality of life as they define it.
Name the type of grasp one adopts when holding a round object such as a small ball?
C. A spherical grasp.
This grasp is used when the fingers need to be shaped around the object in order to grasp it. In a spherical grasp, all of the fingers and the thumb are adduced around the object, and the fingers are spread apart. The palm of the hand is often not involved. Two ulnar digits are supported in greater extension to allow a more open hand posture.
C. A spherical grasp.
This grasp is used when the fingers need to be shaped around the object in order to grasp it. In a spherical grasp, all of the fingers and the thumb are adduced around the object, and the fingers are spread apart. The palm of the hand is often not involved. Two ulnar digits are supported in greater extension to allow a more open hand posture.
What is the name of the deformity when the PIP joint is hyperextended and the DIP joint is flexed?
C. Swan neck deformity
Hyperextension of the PIP and flexion of the DIP due to rupture of terminal ending lateral slips of extensor digitorum communis tendon OR rupture of flexor digitorum superficialis OR flexor tendon injury
C. Swan neck deformity
Hyperextension of the PIP and flexion of the DIP due to rupture of terminal ending lateral slips of extensor digitorum communis tendon OR rupture of flexor digitorum superficialis OR flexor tendon injury
When treating a patient who recently suffered a CVA, which physical agent modality (PAM) would cause the patient’s muscles to contract, thus strengthening the muscles which have become flaccid due to the CVA?
C. NMES.
NMES is a safe, low-frequency current that excites the nerves that innervate desired muscles, causing contractions, blocks pain pathways & reduces swelling and edema. NMES strengthens muscles in a different way than active muscle movements. Often NMES is positioned based on the angle of pull, from the origin to the insertion along the bulk of the muscle fibres.
A. TENS is typically applied over a surrounding area of pain (i.e., more client-specific).
C. NMES.
NMES is a safe, low-frequency current that excites the nerves that innervate desired muscles, causing contractions, blocks pain pathways & reduces swelling and edema. NMES strengthens muscles in a different way than active muscle movements. Often NMES is positioned based on the angle of pull, from the origin to the insertion along the bulk of the muscle fibres.
A. TENS is typically applied over a surrounding area of pain (i.e., more client-specific).
What is the term for a reciprocal motion of the wrist and fingers that occurs during active or passive wrist flexion and extension?
C. Tenodesis (grasp).
Tenodesis grasp and release is an orthopedic observation of a passive hand grasp and release mechanism, affected by wrist extension or flexion, respectively.
C. Tenodesis (grasp).
Tenodesis grasp and release is an orthopedic observation of a passive hand grasp and release mechanism, affected by wrist extension or flexion, respectively.
An OTA is working with a patient at home. The patient returned home from the hospital one week ago after sustaining a L. CVA which resulted in R. sided hemiparesis. The OTA is utilizing NDT techniques in order to facilitate the patient’s ability to pick up a water glass. Which grasp will the patient most likely use for this activity?
C. Cylindrical grasp
A cylindrical grasp is used to hold objects such as a glass, hammer, or a railing.
C. Cylindrical grasp
A cylindrical grasp is used to hold objects such as a glass, hammer, or a railing.
What exercise is best to recommend to a patient who needs to maintain strength when active motion is not possible or is contraindicated?
D. Isometric exercises.
Isometric exercises are contractions of a particular muscle or group of muscles. During isometric exercises, the muscle doesn’t noticeably change length and the affected joint doesn’t move.
D. Isometric exercises.
Isometric exercises are contractions of a particular muscle or group of muscles. During isometric exercises, the muscle doesn’t noticeably change length and the affected joint doesn’t move.
A patient is being seen in a hand therapy clinic for a median nerve injury at the elbow and proximal forearm. The patient displays decreased thumb abduction and hyperextension of the first, second and third MCP joints. What diagnosis does this patient most likely have?
D. Ape hand deformity is the result of a median nerve injury at the elbow and/or proximal forearm. The injury results in the inability to abduct the thumb and limitations to flexion of the MCP joints, resulting in an “ape hand” appearance.
Boutonniere (Buttonhole) Deformity: clinical presentation of flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint.
Swan Neck Deformity: clinical presentation of PIP hyperextension, with DIP flexion of the finger.
Wrist drop: as a result of damage to the radial nerve, active wrist and finger extension is inhibited.
D. Ape hand deformity is the result of a median nerve injury at the elbow and/or proximal forearm. The injury results in the inability to abduct the thumb and limitations to flexion of the MCP joints, resulting in an “ape hand” appearance.
Boutonniere (Buttonhole) Deformity: clinical presentation of flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint.
Swan Neck Deformity: clinical presentation of PIP hyperextension, with DIP flexion of the finger.
Wrist drop: as a result of damage to the radial nerve, active wrist and finger extension is inhibited.
When would an OT practitioner test for the Froment’s sign?
C. Test for ulnar nerve dysfunction (palsy).
Froment’s sign presents after damage to the ulnar nerve, which innervates the adductor pollicis and interossei muscles, which provide adduction of the thumb and extension of the interphalangeal joint. The flexor pollicis longus (innervated by the median nerve), will substitute for the adductor pollicis (innervated by the ulnar nerve) and cause the thumb to go into hyperflexion.
Froment’s Sign: The patient is asked to make a strong pinch between the thumb and index finger and grip a flat object such as a piece of paper between the thumb and index finger. The examiner then attempts to pull the object out of the subject’s hands. There is weakness of the adductor pollicus innervated by the ulnar nerve which would keep the IP joint relatively straight; instead, the FPL muscle which is innervated by the median nerve is substituted for the AP and will cause the IP joint to go into a hyperflexed position.
C. Test for ulnar nerve dysfunction (palsy).
Froment’s sign presents after damage to the ulnar nerve, which innervates the adductor pollicis and interossei muscles, which provide adduction of the thumb and extension of the interphalangeal joint. The flexor pollicis longus (innervated by the median nerve), will substitute for the adductor pollicis (innervated by the ulnar nerve) and cause the thumb to go into hyperflexion.
Froment’s Sign: The patient is asked to make a strong pinch between the thumb and index finger and grip a flat object such as a piece of paper between the thumb and index finger. The examiner then attempts to pull the object out of the subject’s hands. There is weakness of the adductor pollicus innervated by the ulnar nerve which would keep the IP joint relatively straight; instead, the FPL muscle which is innervated by the median nerve is substituted for the AP and will cause the IP joint to go into a hyperflexed position.
An OTA is working with a patient with a humerus fracture. When can the patient start performing isometric exercises?
B. 6-8 weeks post surgery.
Humerus fracture: Non-displaced or displaced, fall on outstretched hand
Fx of Greater tuberosity: rotator cuff injury
Fx of Shaft: radial injury, wrist drop
B. 6-8 weeks post surgery.
Humerus fracture: Non-displaced or displaced, fall on outstretched hand
Fx of Greater tuberosity: rotator cuff injury
Fx of Shaft: radial injury, wrist drop
A patient presents with the following symptoms: depression; fatigue; pain and stiffness of the wrist; the wrist is warm to the touch and there is decreased range of movement in that joint. As part of your treatment, you decide to make a splint for this patient, what splint do you choose?
D. Resting hand splint. This patient is demonstrating signs and symptoms of RA. RA is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. Signs and symptoms of rheumatoid arthritis may include:
– Tender, warm, swollen joints
– Joint stiffness that is usually worse in the mornings and after inactivity
– Fatigue, fever and loss of appetite
– Rheumatoid arthritis and depression commonly occur together. Although this is known, people with rheumatoid arthritis often aren’t screened for depression, so it may not be diagnosed or treated.
Intervention for RA:
Decrease pain and swelling, maintain ROM/strength/endurance.
Use resting hand splint night/day for jt. protection, assistive devices as needed, PAM’s (inflamed joints may exacerbate with heat, ice may be better).
Gentle AROM/PROM
Positioning, functional activities as tolerated, isometric exercises
D. Resting hand splint. This patient is demonstrating signs and symptoms of RA. RA is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. Signs and symptoms of rheumatoid arthritis may include:
– Tender, warm, swollen joints
– Joint stiffness that is usually worse in the mornings and after inactivity
– Fatigue, fever and loss of appetite
– Rheumatoid arthritis and depression commonly occur together. Although this is known, people with rheumatoid arthritis often aren’t screened for depression, so it may not be diagnosed or treated.
Intervention for RA:
Decrease pain and swelling, maintain ROM/strength/endurance.
Use resting hand splint night/day for jt. protection, assistive devices as needed, PAM’s (inflamed joints may exacerbate with heat, ice may be better).
Gentle AROM/PROM
Positioning, functional activities as tolerated, isometric exercises
Which splint helps to immobilize the thumb and provide support?
Thumb spica splint
A thumb spica splint is used to immobilize the thumb and provide support. Example: De Quervain’s
Thumb spica splint
A thumb spica splint is used to immobilize the thumb and provide support. Example: De Quervain’s
What is the purpose of a compression garment?
D. Prevent re-accumulation of fluids post retrograde massage.
Compression Garments:
· Prevent re-accumulation of fluids post retrograde massage
· Types: Isotoner gloves, Tubigrip (elastic stockinette), Ace wraps, Coban (wrapped distal to proximal) for edema in digits while exercising/ADL, but avoid too much tension.
D. Prevent re-accumulation of fluids post retrograde massage.
Compression Garments:
· Prevent re-accumulation of fluids post retrograde massage
· Types: Isotoner gloves, Tubigrip (elastic stockinette), Ace wraps, Coban (wrapped distal to proximal) for edema in digits while exercising/ADL, but avoid too much tension.
A patient is referred to OT for fabrication of a splint, following a surgical repair to their flexor tendons. What type of splint is typically used for a flexor tendon injury?
C. Dorsal blocking splint.
A dorsal blocking splint is used for flexor tendon injury repair to keep the hand and wrist flexed because if the patient extends their wrist and fingers, it could tear the repair by overstretching it. It is used to limit the amount of active and passive finger extension and thereby prevent possible tendon rupture following surgical repair. The exact wrist and finger joint placement may differ among the various post-op protocols.
C. Dorsal blocking splint.
A dorsal blocking splint is used for flexor tendon injury repair to keep the hand and wrist flexed because if the patient extends their wrist and fingers, it could tear the repair by overstretching it. It is used to limit the amount of active and passive finger extension and thereby prevent possible tendon rupture following surgical repair. The exact wrist and finger joint placement may differ among the various post-op protocols.
What is the medical term for the feeling of shortness of breath. This it is a symptom and not a disease in itself. It can be present in the absence of disease, or as a result of various disease processes?
B. Dyspnea.
Dyspnea = SOB. Despite its prevalence, the descriptions of dyspnea vary from patient to patient and no single definition encompasses all its qualitative aspects. Typically, it is defined as a feeling of shortness of breath or an inability to take a deep breath. The American Thoracic Society defines it as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Many overlapping mechanisms account for descriptive terms used in the medical literature, such as “air hunger,” “chest tightness,” and many others.
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/
B. Dyspnea.
Dyspnea = SOB. Despite its prevalence, the descriptions of dyspnea vary from patient to patient and no single definition encompasses all its qualitative aspects. Typically, it is defined as a feeling of shortness of breath or an inability to take a deep breath. The American Thoracic Society defines it as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Many overlapping mechanisms account for descriptive terms used in the medical literature, such as “air hunger,” “chest tightness,” and many others.
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/
A 30-year-old female who lives at the coast has chronic lower back pain. She asks her OTA for suggestions of how she can alleviate her pain. What is the OTA’s best response, in terms of recommending an appropriate physical activity for the patient?
C. Yoga in a warm to hot room. Gentle movement and stretching is best and a warm room as a modality will help loosen the muscles. Yoga has many forms. Of course poses that would be harmful to the back would not be recommended. Sitting in a chair will not help the patient’s pain.
C. Yoga in a warm to hot room. Gentle movement and stretching is best and a warm room as a modality will help loosen the muscles. Yoga has many forms. Of course poses that would be harmful to the back would not be recommended. Sitting in a chair will not help the patient’s pain.
An OTA is working with a carpenter who needs to hold several tools while he builds homes. He reports that he must repeatedly pound 3 inch framing nails, with a hammer throughout the day. What grasp pattern does the OTA observe when she watches the carpenter pound a nail?
C. Power grasp.
A variation of cylindrical grasp, used when extra force is required. The thumb helps to stabilize the shaft of the tool rather than opposing the fingers. The greater the effort to control an object with a power grasp, the greater the potential for injury.
C. Power grasp.
A variation of cylindrical grasp, used when extra force is required. The thumb helps to stabilize the shaft of the tool rather than opposing the fingers. The greater the effort to control an object with a power grasp, the greater the potential for injury.
What would be the most appropriate splint for the patient in this photo?
B. MCP blocking splint, also called a lumbrical blocking splint. The photo reveals what is referred to as a claw hand deformity (intrinsic hand deformity). This deformity results from compression or injury to the ulnar nerve, which innervates the intrinsic muscles of the hand. The ring and little fingers are extended at the MCP joints and flexed at the PIP joints, resembling a claw. PROM, joint mobilization to reduce contracture, splinting, therapeutic activity, adaptations for grip, are examples of appropriate intervention.
B. MCP blocking splint, also called a lumbrical blocking splint. The photo reveals what is referred to as a claw hand deformity (intrinsic hand deformity). This deformity results from compression or injury to the ulnar nerve, which innervates the intrinsic muscles of the hand. The ring and little fingers are extended at the MCP joints and flexed at the PIP joints, resembling a claw. PROM, joint mobilization to reduce contracture, splinting, therapeutic activity, adaptations for grip, are examples of appropriate intervention.
A patient who presents with arthritic deformities in her hands is unable to grasp a fork due to these deformities. How can this patient’s fork and other eating utensils be adapted to enable her to grasp and use them more effectively?
A. Built up handle or foam tubing. Providing a built up handle on the fork will give the patient more grasping surface, compensating for the deformities in her fingers. Built up handled utensils reduce stress on the finger joints. The soft, built-up foam handles spreads the fingers so that they don’t have to close completely around the utensil. Holding the utensil in this position reduces the stress on the joints, allowing the patient to grasp it more easily.
A. Built up handle or foam tubing. Providing a built up handle on the fork will give the patient more grasping surface, compensating for the deformities in her fingers. Built up handled utensils reduce stress on the finger joints. The soft, built-up foam handles spreads the fingers so that they don’t have to close completely around the utensil. Holding the utensil in this position reduces the stress on the joints, allowing the patient to grasp it more easily.
Which splint allows a C6 SCI patient to have a functional grasp, using active movement of their wrist?
D. Tenodesis splint.
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.
https://www.st-lukes.org/uploadedFiles/Patients/Patient_Care/
D. Tenodesis splint.
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.
https://www.st-lukes.org/uploadedFiles/Patients/Patient_Care/
A patient who is recuperating from a recent cardiac event, is in Stage 1 of their recovery and is able to safely perform ADLs which expend 1.0 to 1.4 METs. From the list below, which ADL activity is this patient permitted to perform?
A.Sitting: self-feeding.
Sitting: self-feeding, wash hands/face, bed mobility.
A.Sitting: self-feeding.
Sitting: self-feeding, wash hands/face, bed mobility.
At stage 1 (1.0 to 1.4 MET), what kind of exercises can a patient do?
A. Active exercises to all extremities in supine position.
Exercises permitted at Stage I (1.0-1.4 MET) :
Bed mobility, transfers, reading, table games, can exercise all extremities in supine and only neck and lower extremities in sitting. Sitting- Self-feeding, washing hands, table games, light handwork.
https://passtheot.com/met-levels-cardiac-rehabilitation/
A. Active exercises to all extremities in supine position.
Exercises permitted at Stage I (1.0-1.4 MET) :
Bed mobility, transfers, reading, table games, can exercise all extremities in supine and only neck and lower extremities in sitting. Sitting- Self-feeding, washing hands, table games, light handwork.
https://passtheot.com/met-levels-cardiac-rehabilitation/
You have been referred to work with a patient who is in Phase 1 of his cardiac rehabilitation. What recreational activity would he be able to perform, taking the appropriate MET level into consideration?
B. Reading. RECREATION: reading, radio, table games (noncompetitive), light handiwork.
B. Reading. RECREATION: reading, radio, table games (noncompetitive), light handiwork.
An OTA has received approval to increase a cardiac patient’s activity level from stage 1 to stage 2. How should the OTA set up the patient’s morning hygiene routine to comply with stage 2 activity restrictions?
D. Sitting in a chair near the bed with water and supplies on the bedside table. Stage 2 activity restrictions allow patients to sit up as tolerated. Slow walking is allowed for brief periods but standing is not allowed until stage 3. Based on this, the patient would be allowed to transfer to a chair near the bed and complete his hygiene routine with all supplies set up for him on the bedside table.
D. Sitting in a chair near the bed with water and supplies on the bedside table. Stage 2 activity restrictions allow patients to sit up as tolerated. Slow walking is allowed for brief periods but standing is not allowed until stage 3. Based on this, the patient would be allowed to transfer to a chair near the bed and complete his hygiene routine with all supplies set up for him on the bedside table.
For a patient who is in Stage 2 of their cardiac rehabilitation, what activity is contraindicated?
A. No isometrics.
MET levels are used to ensure that the activities do not exceed the patient’s activity tolerance. At stage 2, a MET level of 1.4 to 2.0 MET is permitted.
Exercise:
Sitting: active exercise to all extremities, progressively increasing the number of repetitions
NO ISOMETRICS
A. No isometrics.
MET levels are used to ensure that the activities do not exceed the patient’s activity tolerance. At stage 2, a MET level of 1.4 to 2.0 MET is permitted.
Exercise:
Sitting: active exercise to all extremities, progressively increasing the number of repetitions
NO ISOMETRICS
A patient who is recovering from a recent MI is permitted to walk at a very slow pace, about 1 mph, as tolerated. How many METs is this patient allowed to expend based on this activity?
A. 1.5 – 2.0 METS. MET levels are used to ensure that the activities do not exceed the patient’s activity tolerance. At this MET level, slow walking is allowed. The patient may also exercise all extremities but no isometric or strengthening exercises are allowed.
Stage 2: 1.5 – 2.0 METs.
– The patient may exercise all extremities but NO ISOMETRICS or strengthening exercises are allowed.
– AROM to all extremities, progressively increasing number of repetitions.
– Walking at slow pace in room, as tolerated.
A. 1.5 – 2.0 METS. MET levels are used to ensure that the activities do not exceed the patient’s activity tolerance. At this MET level, slow walking is allowed. The patient may also exercise all extremities but no isometric or strengthening exercises are allowed.
Stage 2: 1.5 – 2.0 METs.
– The patient may exercise all extremities but NO ISOMETRICS or strengthening exercises are allowed.
– AROM to all extremities, progressively increasing number of repetitions.
– Walking at slow pace in room, as tolerated.
A patient is 5 days post coronary artery bypass graft (CABG) and has been approved by his doctor to perform activities at a met level of 2 – 3. What activity can be introduced, at the beginning of this patient’s OT intervention?
C. Performing light housework in sitting. (2.0 – 3.0 met level, Stage 3). The only task that this patient is permitted to perform falls between 2.0 to 3.0 Met levels. The only task that falls within this range is performing light housework in sitting which expends 2.0 – 3.0 METs and corresponds to Stage 3 – Cardiac Rehabilitation.
At this at this stage, the patient is only able to perform his ADLs while seated. He can only stand up briefly, for short periods.
A. Grooming in sitting (1.4 – 2.0 met level, Stage 2). This is not challenging enough, as the most Mets the patient would expend, would be 2.0 and the target is 2.0-3.0
B. Showering in standing (3.0 – 3.5 met level, Stage 4)
D. Grooming while standing at the sink (3.0 – 3.5 met level, Stage 4)
STAGES OF CARDIAC REHAB & CORRESPONDING MET LEVELS
| Stage | MET Level Range | ADL Restrictions | Recreational Restrictions | Exercise Restrictions |
| I | 1.0 – 1.4 | Sitting up is allowed for short periods. Self-feeding, washing hands and face, bed mobility, transfers. | Sitting: Reading, radio, non-competitive table games, light handwork. | Can exercise all extremities in supine (10-15x, at a time). Can only sit to exercise neck and lower extremities. |
| II | 1.4 – 2.0 | Sitting up is allowed as tolerated – no limitations to sitting. Sitting: Self-bathing, shaving, dressing, grooming. |
Sitting: Crafts, painting, knitting, sewing, mosaics, embroidery. | May exercise all extremities but NO ISOMETRICS or strengthening exercises are allowed. AROM to all extremities, progressively increasing number of repetitions.
Walking at slow pace in room, as tolerated |
| III | 2.0 – 3.0 | Sitting: Showering in warm water.
Sitting: Ironing, housekeeping tasks with brief standing periods to transfer light items. |
Sitting: card playing, crafts, piano, machine sewing, typing. | Sitting: wheelchair mobility limited distances Standing: AROM exercises to all extremities, progressively increasing number of reps. May include: balance exercises, light mat work with no resistance Walking on a zero gradient and comfortable pace is allowed. |
| IV | 3.0 – 3.5 | Standing: showering in warm water, self, dressing, shaving, grooming,
Light housekeeping tasks while standing, using energy conservation – light vacuuming, dusting, sweeping, washing light clothing. |
Bowling, slow canoeing, golf putting, light gardening -planting, driving. | Standing: all previous exercise, progressively increasing number of reps and speed. May include balance and mat exercises with light resistance.
Walking: unlimited, zero gradient, progressing speed/duration for up to 15-20 min or target HR reached. May begin walking on a treadmill at 1 to 1.5 mph, at a 1-2% grade. |
| V | 3.5 – 4.0 | Standing: washing dishes, washing clothes, ironing, hanging light clothes, making beds. | Slow swimming, light carpentry, golfing, light home repairs. | Sitting: More resistance may be added to exercises completed while sitting, up to 10 lbs.
Standing: continue with previous exercises, progressively increasing number of reps and speed. Walking: Unlimited, increasing speed up to 2.5mph, on level surfaces. Stairs: Increase tolerance. Cycling: up to 8 mph with no resistance. |
| VI | 4.0 and above | Standing: showering in hot water, hanging/wringing clothes, mopping, stripping and making beds, raking. | Swimming-no advanced strokes, slow dancing, slow ice or roller skating, volleyball, badminton, table tennis, light calisthenics. | Sitting: Exercising upper and lower extremities, up to 10-15 lbs.
Walking: increase speed to 3.5 mph. Cycling up to 10 mph, no resistance. |
C. Performing light housework in sitting. (2.0 – 3.0 met level, Stage 3). The only task that this patient is permitted to perform falls between 2.0 to 3.0 Met levels. The only task that falls within this range is performing light housework in sitting which expends 2.0 – 3.0 METs and corresponds to Stage 3 – Cardiac Rehabilitation.
At this at this stage, the patient is only able to perform his ADLs while seated. He can only stand up briefly, for short periods.
A. Grooming in sitting (1.4 – 2.0 met level, Stage 2). This is not challenging enough, as the most Mets the patient would expend, would be 2.0 and the target is 2.0-3.0
B. Showering in standing (3.0 – 3.5 met level, Stage 4)
D. Grooming while standing at the sink (3.0 – 3.5 met level, Stage 4)
STAGES OF CARDIAC REHAB & CORRESPONDING MET LEVELS
| Stage | MET Level Range | ADL Restrictions | Recreational Restrictions | Exercise Restrictions |
| I | 1.0 – 1.4 | Sitting up is allowed for short periods. Self-feeding, washing hands and face, bed mobility, transfers. | Sitting: Reading, radio, non-competitive table games, light handwork. | Can exercise all extremities in supine (10-15x, at a time). Can only sit to exercise neck and lower extremities. |
| II | 1.4 – 2.0 | Sitting up is allowed as tolerated – no limitations to sitting. Sitting: Self-bathing, shaving, dressing, grooming. |
Sitting: Crafts, painting, knitting, sewing, mosaics, embroidery. | May exercise all extremities but NO ISOMETRICS or strengthening exercises are allowed. AROM to all extremities, progressively increasing number of repetitions.
Walking at slow pace in room, as tolerated |
| III | 2.0 – 3.0 | Sitting: Showering in warm water.
Sitting: Ironing, housekeeping tasks with brief standing periods to transfer light items. |
Sitting: card playing, crafts, piano, machine sewing, typing. | Sitting: wheelchair mobility limited distances Standing: AROM exercises to all extremities, progressively increasing number of reps. May include: balance exercises, light mat work with no resistance Walking on a zero gradient and comfortable pace is allowed. |
| IV | 3.0 – 3.5 | Standing: showering in warm water, self, dressing, shaving, grooming,
Light housekeeping tasks while standing, using energy conservation – light vacuuming, dusting, sweeping, washing light clothing. |
Bowling, slow canoeing, golf putting, light gardening -planting, driving. | Standing: all previous exercise, progressively increasing number of reps and speed. May include balance and mat exercises with light resistance.
Walking: unlimited, zero gradient, progressing speed/duration for up to 15-20 min or target HR reached. May begin walking on a treadmill at 1 to 1.5 mph, at a 1-2% grade. |
| V | 3.5 – 4.0 | Standing: washing dishes, washing clothes, ironing, hanging light clothes, making beds. | Slow swimming, light carpentry, golfing, light home repairs. | Sitting: More resistance may be added to exercises completed while sitting, up to 10 lbs.
Standing: continue with previous exercises, progressively increasing number of reps and speed. Walking: Unlimited, increasing speed up to 2.5mph, on level surfaces. Stairs: Increase tolerance. Cycling: up to 8 mph with no resistance. |
| VI | 4.0 and above | Standing: showering in hot water, hanging/wringing clothes, mopping, stripping and making beds, raking. | Swimming-no advanced strokes, slow dancing, slow ice or roller skating, volleyball, badminton, table tennis, light calisthenics. | Sitting: Exercising upper and lower extremities, up to 10-15 lbs.
Walking: increase speed to 3.5 mph. Cycling up to 10 mph, no resistance. |
What type of activity would a patient with an ulnar nerve injury have the MOST difficulty with?
B. Gripping a pillow.
Symptoms associated with ulnar nerve injury include:
• loss of sensation, especially in the ring and little fingers
• loss of coordination in the fingers
• pain
• tingling or burning in the hand
• hand weakness
• weakness that worsens with physical activity
• loss of grip strength
The ulnar side of the hand plays an important role in hand strength
B. Gripping a pillow.
Symptoms associated with ulnar nerve injury include:
• loss of sensation, especially in the ring and little fingers
• loss of coordination in the fingers
• pain
• tingling or burning in the hand
• hand weakness
• weakness that worsens with physical activity
• loss of grip strength
The ulnar side of the hand plays an important role in hand strength
A patient is completing an energy conservation program. What is the BEST expected outcome?
A. Getting dressed without becoming fatigued.
Getting dressed without becoming fatigued (prevention of fatigue is the primary purpose of energy conservation)
Lifting heavy cookware without pain (proper body mechanics)
Doing handicraft without damaging his or her joints
Dusting and vacuuming more quickly (techniques result in slower not faster)
A. Getting dressed without becoming fatigued.
Getting dressed without becoming fatigued (prevention of fatigue is the primary purpose of energy conservation)
Lifting heavy cookware without pain (proper body mechanics)
Doing handicraft without damaging his or her joints
Dusting and vacuuming more quickly (techniques result in slower not faster)
A mother of twins has been diagnosed with De Quervain’s tenosynovitis as a result of the manner in which she has repeatedly been lifting them. What is one method the woman’s doctor might have used to confirm this diagnosis?
A. Positive Finkelstein. To conduct this test, the patient bends the thumb across the palm of the hand and then encloses it in her fist. She then deviates her wrist toward the ulna. If the patient feels pain at or near the base of the thumb, the test is positive and indicates De Quervain’s tenosynovitis.
A. Positive Finkelstein. To conduct this test, the patient bends the thumb across the palm of the hand and then encloses it in her fist. She then deviates her wrist toward the ulna. If the patient feels pain at or near the base of the thumb, the test is positive and indicates De Quervain’s tenosynovitis.
The orthotic splint in this photo would be beneficial for a patient with which type of diagnosis?
C. C6 SCI.
A tenodesis splint is typically used by C6 tetraplegics to grasp objects, as they have active wrist extension.
The orthosis in this photo is a wrist extension tenodesis key grip orthosis. It has been developed to provide a lateral key-pinch grip for tetraplegics who have functional wrist extension. This new design is less obtrusive than previous tenodesis splints and may be donned and doffed by the user independently of their caregiver.
The action of extending the wrist causes tension on the cable which pulls the thumb into palmar adduction so that a grip forms against the lateral side of the proximal or middle phalanx of the index finger.
C. C6 SCI.
A tenodesis splint is typically used by C6 tetraplegics to grasp objects, as they have active wrist extension.
The orthosis in this photo is a wrist extension tenodesis key grip orthosis. It has been developed to provide a lateral key-pinch grip for tetraplegics who have functional wrist extension. This new design is less obtrusive than previous tenodesis splints and may be donned and doffed by the user independently of their caregiver.
The action of extending the wrist causes tension on the cable which pulls the thumb into palmar adduction so that a grip forms against the lateral side of the proximal or middle phalanx of the index finger.
A patient who is recovering from an injury to her right shoulder is working with an OTA on improving the active range of internal rotation of that shoulder. Which activity should the OTA select to achieve this patient’s goals?
A. Looping her belt through the front of her pants.
Ask the patient to loop her belt through the front of her pants. Internal rotation (also known as medial rotation) is an anatomical term referring to rotation towards the center of the body.
A. Looping her belt through the front of her pants.
Ask the patient to loop her belt through the front of her pants. Internal rotation (also known as medial rotation) is an anatomical term referring to rotation towards the center of the body.
What injury would use a dorsal blocking splint?
C. Flexor tendon injury.
A dorsal blocking splint is used for flexor tendon injury repair to keep the hand and wrist flexed because if the client extends it, it could tear the repair by overstretching it.
C. Flexor tendon injury.
A dorsal blocking splint is used for flexor tendon injury repair to keep the hand and wrist flexed because if the client extends it, it could tear the repair by overstretching it.
What is the Kleinert protocol for a flexor tendon injury repair?
D. Active extension of digit with passive flexion using rubber band traction.
Kleinert protocol: Active extension of digit with passive flexion using rubber band traction.
D. Active extension of digit with passive flexion using rubber band traction.
Kleinert protocol: Active extension of digit with passive flexion using rubber band traction.
What is the Duran protocol for a flexor tendon injury repair?
B. Passive flexion and extension of the digits.
Duran protocol: Passive flexion and extension of digit
B. Passive flexion and extension of the digits.
Duran protocol: Passive flexion and extension of digit
An OTA is working with a patient on in-hand manipulation. Which activity would be the MOST advanced when grading the activities?
D. Picking up three dice and putting them on a game board one at a time.
A patient will need the most dexterity to manipulate each dice separately to put them on the board.
Grabbing a Coke, shaking a pair of dice in one hand, and grabbing a pair of dice out of a bag requires more palmar grasp support while picking up three dice and placing them on a game board one at a time requires simultaneous palmar grasp support and fine motor finger manipulation.
D. Picking up three dice and putting them on a game board one at a time.
A patient will need the most dexterity to manipulate each dice separately to put them on the board.
Grabbing a Coke, shaking a pair of dice in one hand, and grabbing a pair of dice out of a bag requires more palmar grasp support while picking up three dice and placing them on a game board one at a time requires simultaneous palmar grasp support and fine motor finger manipulation.
Which grasp pattern requires thumb opposition?
Conoid grasp. Grasp patterns that require thumb opposition are patterns where the thumb stabilizes one side of a round or cylindrical objects while the fingers stabilize the other side. The conoid, cylindrical, and tripod grasp patterns meet this requirement. The thumb does not oppose when forming the hook grasp and lateral pinch. When forming a power grasp, the thumb shifts from opposing the fingers to stabilizing the shaft of the object being grasped, so it is not in true opposition.
Conoid grasp. Grasp patterns that require thumb opposition are patterns where the thumb stabilizes one side of a round or cylindrical objects while the fingers stabilize the other side. The conoid, cylindrical, and tripod grasp patterns meet this requirement. The thumb does not oppose when forming the hook grasp and lateral pinch. When forming a power grasp, the thumb shifts from opposing the fingers to stabilizing the shaft of the object being grasped, so it is not in true opposition.
The short thumb opponens splint is an effective intervention for several hand conditions. Which joint/joints of the thumb can be immobilized using this type of orthosis?
D. CMC, MCP, and IP.
The short thumb opponens orthosis is an important intervention for several hand conditions, such as:
• Ulnar and radial collateral ligament (UCL and RCL) injuries
• Osteoarthritis (OA) and Rheumatoid arthritis (RA)
• Generalized thumb pain
• Median nerve palsy
• Thumb fractures
The thumb includes three joints: the carpometacarpal CMC) joint, the Metacarpal- phalangeal (MCP) joint, and the interphalangeal (IP) joint. Whether your patient has a thumb fracture or osteoarthritis of the CMC joint, make sure that your orthosis provides the immobilization required for the specific diagnosis involved and only immobilizes the necessary joints. It all depends on the specific diagnosis and your treatment goals.
A short thumb opponens orthosis may immobilize:
1. Only the CMC joint
2. The CMC and MCP joints
3. All three joints (CMC, MCP, and IP)
D. CMC, MCP, and IP.
The short thumb opponens orthosis is an important intervention for several hand conditions, such as:
• Ulnar and radial collateral ligament (UCL and RCL) injuries
• Osteoarthritis (OA) and Rheumatoid arthritis (RA)
• Generalized thumb pain
• Median nerve palsy
• Thumb fractures
The thumb includes three joints: the carpometacarpal CMC) joint, the Metacarpal- phalangeal (MCP) joint, and the interphalangeal (IP) joint. Whether your patient has a thumb fracture or osteoarthritis of the CMC joint, make sure that your orthosis provides the immobilization required for the specific diagnosis involved and only immobilizes the necessary joints. It all depends on the specific diagnosis and your treatment goals.
A short thumb opponens orthosis may immobilize:
1. Only the CMC joint
2. The CMC and MCP joints
3. All three joints (CMC, MCP, and IP)
What is the best splint to use on a patient who did not have an operation and has radial tunnel syndrome?