a. Procedural: ID OT problems, goal setting and tx planning; documented the most for reimbursement.

b. Interactive: involves therapeutic relationship b/t the therapist the individual and caregivers.

c. Narrative: IDs the activities/roles before and during and what activities the person can do now and in the future.

d. Pragmatic: the tx enviro, value, knowledge, abilities and experiences (mental activities shape the situation; setting LTC or acute?)

e. Conditional: ongoing revision of tx; an integration of interactive, procedural and pragmatic.

1. Directive: 100% responsibility andstructured and needed for low cognitive functioning; goal is task accomplishment.

2. Facilitative: shares responsibility for group process w/ members; goal is for members to acquire skill through practice.

3. Advisory: functions as a source to members; goal is for members to self-direct the process.

4. Co-leadership: shares group membership b/t 2 or more therapists.

Name the leadership role of the following groups:

Parallel, Project, Ego-centric Cooperative, Cooperative and Mature.

Parallel: Directive.

Project: Directive.

Ego-centric cooperative: Facilitative.

Cooperative: Advisor.

Mature: Advisor/acts as a peer.

Sensory Processing: the way the brain detects, recieves and integrates the incoming sensory information.

*Registration:dectection of sensation.

*Modulation: adjusting/organizing (over/undersensitive?)

*Discrimination: interpretation (what are they seeking?)

 = Sensory Integration (tactile, proprioception & vestibular)

Describe the 4 stages of the swallow:

Pooling occurs in the ________, a pocket made by the ___________ which closes off the trachea and allows food to travel down esophagus.

1. Oral prep: difficulty taking in food and mixing it with saliva (bolus formation).

2. Oral: difficulty transporting bolus to back of mouth.

3. Pharyngeal: difficulty swallowing food at throat area.

4. Esophageal: difficulty swallowing food at esophagus.

Vallecula, Epiglottus

Palmar-Supinate Grasp (1-1 1/2yrs)

Digital-Pronate Grasp (2-3yrs)

Static Tripod Posture (3 1/2-4yrs)

Dynamic Tripod Posture (4 1/2-6yrs)

Name the correct developmental stages for:

Ulnar Palmar

Radial Palmar

Radial Distal Palmar

3 Jaw Chuck

Inferior Pinsor

Scissors

Fine Pinsor

Ulnar Palmar: 5mos

Radial Palmar: 6mos

Radial Distal Palmar: 8mos

3 Jaw Chuck: 10mos

Inferior Pinsor (2pt): 7mos

Scissors: 8mos

Fine Pinsor(tip to tip): 1 1/2yrs

1. Manipulation (open/close)

2. Snipping actions

3. Straight lines

4. Simple shapes

5. Circular lines

6. Circles

7. Figures

8. Designs

Young-Old: 65-74

Old: 75-84

Old-Old: >85

Ages for development of feeding:

4-5mos

6mos

7-8mos

9mos

12mos

24mos

4-5mos: munching via phasic bite on soft cookie.

6mos: strong up and down movt of tongue.

7-8mos: soft and mashed foods

9mos: lateral tongue movt, able to drink from cup.

12mos: jaw is firm, able to chew on hard cookie.

24mos: able to chew meat and most veggies.

Intervention for oral motor control:

Facilitate lip closure

Facilitate jaw closure

Facilitate swallow by lip closure

Facilitate chewing by placement of food

Facilitate lip closure: apply slight upward pressure of index under lip.

Facilitate jaw closure: apply firm upper pressure of middle finger under jaw.

Facilitate swallow by lip closure: slight downward pressure w/ spoon on tongue.

Facilitate chewing by placement of food: place b/t gum and teeth.

Intervention for oral motor control:

Inhibit tongue thrust

Inhibit tonic bite reflex

Decrease tactile sensitivity in mouth

Inhibit tongue thrust: index and middle finger hand placement.

Inhibit tonic bite reflex: apply firm pressure with spoon on tongue.

Decrease tactile sensitivity in mouth: apply firm pressure, rub gums, suck/chew on cloth and vary texture of foods.

_______ are easier to swallow and manage.

OT intevention for a caregiver for carryover at home:

Thicker foods

Assist caregiver by utilizing positioning and handling techniques to promote eye contact and bonding in a relaxed environment.

a. Close: daily, direct contact at site of work.

b. Routine: direct contact every 2wks w/ other methods of communication such as telephone or written communication.

c. General: atleast monthly contact with supervision as needed by other methods.

d. Minimal: only on an as needed basis and may be less than monthly.

Guidelines: 65yrs+, SS program for 24mos and those w/ permanent kidney failure, black lung disease and/or other long term disabilities.

Part A: pays for hospital, inpatient SNF, home health and hospice care.

Part B: pays for hospital outpatient, physician and other professional services including OT.

SCI levels and self-care abilities:

C1-C3

C4

C5

C1-C3: Depenent w/ self-care, can chew and swallow.

C4: Dependent w/ self-care, can drink from a glass with a long straw.

C5: Feeding requires s/u with suspension sling, dorsal wrist support w/ univ cuff, angled utensils, scoop dish and plate guard. Dsg w/ min to mod assist with upper body dsg, lbd dependent. Bathing min to mod assist. Groom/hyg w/ s/u- with splint and univ cuff can brush and comb hair.

SCI levels and self-care abilities:

C6

C7

C8-T1

C6: Independent w/ feeding using A.E. (univ cuff/tendonesis splint, rocker knife, cup w/ large handles), LBD independent in bed but max assist for socks andshoes, UBD indepedent using button hook and zipper pull, bathing with min assist using tub bench and sliding board.

C7: feeding independent, DSG indepndent w/ button hook, bathing and grooming same as C6.

C8-T1: Independent w/ self-care, can transfer from w/c to floor and back to chair w/ SBA.

P= permission.

LI= limited information w/ shared facts.

SS= specific suggestions; positioning alternatives, catheter care, hygiene concern and skin inspections.

IT= intensive therapy when the person requires intervention for long-standing relationship problems and/or enduring sexual problems.

Appropriate interventions for individuals with cognitive impairments that are essential to ensure safety and to protect from sexual abuse, assault and/or exploitation:

Assertiveness training, training/practice in physical self-protection techniques, role playing to simulate potential scenarios that can challenge their judgment, sex education, caregiver and family education.

SCI levels and play/leisure abilities:

C1-C4

C5

C1-C4: can use computer, phone, read, paint, control radios, TVs and other electronics using mouth stick, head pointer or ECU.

C5: Independently use computer, turn pages, play board games/crafts using a splint, univ cuff and typing splint.

SCI levels and play/leisure abilities:

C6-C7

C8-T1

C6-C7: Can use/hold a phone, typing stick and pen using tendonesis grasp, can play some w/c sports.

C8-T1: Can do same activities as C7 but with easier performance due to good functl use of both UEs.

-Interdisciplinary approach.

-Real/simulated work activities are used.

-Transition b/t acute care and return to work.

-Issues of productivity, safety, physical tolerance and worker behaviors are addressed.

-CARF accreditation required.

-One discipline provides service.

-Real/simulated work activities are used.

-Transition b/t acute care and return to work.

-Flexibility, strength, movt and endurance are addressed.

-Accreditation not required.

-Prevention is the main focus to fit the work place to the human body.

Program types include: ergonomic survey, job-site analysis, exercise and stretching programs, etc.

-Multidisciplinary or interdisciplinary approach used.

-Real work activites used.

-Participants are paid at piece-work rate in sheltered workshops.

Participants are paid at prevailing competitive wage for positions in TEP and supported employment programs.

-Accreditation not required.

Interior railings should be mounted _____ from the wall to ease grip.

Exterior railings should be _______ for those who walk,b/t _____-_____ depending on height.

Railings should be ____-____  in diameter with non-skid surfaces.

Interior railings: 1 1/2"

Exterior railings: waist high; 34"-38"

Railings: 1 1/2"-2"

Doorways:

Minimum of ___ needed for those using walkers.

Minimum of ___ needed for those using w/c's.

Walkers: 18"

W/c's: 26"

Doorways: min of 32", ideal is 36"

Halls: min of 36"

Standard adult W/C:

Width

Length

Height to push handles

Height to seat from floor

Height to armrest from floor

Width: 24 to 26" rim to rim

Length: 42 to 43"

Height to push handles from floor: 36"

Height to seat from floor: 19-19.5" excluding cushion

Height to armrest from floor: 29-30"

Maximal height for side reaching:

With obstruction

Without obstruction

With obstruction (counter/shelf): 46" 

Without obstruction: 48"

Maximal height for countertops:

Pathways/sidewalks should be:

Parking spaces should have ___ to allow w/c to maneuver.

Countertops: 31"

Pathways/sidewalks: 48" wide

Parking spaces: adjacent 4' aisle

Ramps should be a minimum of ___ wide and should have a ____ on upper a lower levels.

The ratio of slop to rise is:________.

36" wide, non-skid surface

1:12 (for every 1" of vertical rise, 12" of ramp is required)

Curbs on ramps should be atleast ____ high.

If the ramp is excessively long, ______ are required to allow for rest.

If the person has limited UE strength or decreased cardiopulmonary capacity _____ is required.

4" high

4x4

4x4

If there is a sharp turn in the direction of the ramp, landing are requied-

90 degree turn requires min of _____.

180 degree turn requires min of _____.

90 degree turn: 4x4

180 degree turn:4x8

Standard dimensions for w/c  for an adult and child:

Seat Width

Seat Depth

Seat Height

Adult                              Child

Seat Width: 18"                14"

Seat Depth: 16"                11.5"

Seat Height: 20"               18.75"

_______ allow a person with limited range in one upper extremity to independently manipulate the w/c brakes.

_________ ease independent propulsion in persons with weak handgrip.

Brake extensions

Handrim projections (make it harder to maneuver through narrow doorways)

Hillholder devices

W/C Measurement:

Seat Width

Seat Depth

Back Height

Seat Width: measure widest point across the hips and thighs to allow for max seating space and comfort, then add 2".

Seat Depth: measure both LEs from the posterior portion of the buttocks to the popliteal fossa then substract 2".

Back Height: measure seat surface (include cushion) depending on trunk control, activity level, strength and size: mid-back under scapula 1"-2", mid scapula or axilla, top of shoulder.

W/C Measurement:

Seat Height

Armrest Height

Low back height vs. High back height

Seat Height: knees/ankles at 90 (measure from distal thigh to heel), footrests clearance of 2" from floor. Standard height: 19.5, Hemi-height: 17.5, Superlow: 14.5

Armrest Height: Shldrs neutral, arms hang @ sides, elbows flexed at 90, measure under elbow to cushioned seat surface.

Low back height: increases functl mobility as in sports chairs. (can increase strain)

High back height: needed for poor trunk control.

Reclining back w/c: for those unable to independently maintain an upright sitting position.

Tilt in space w/c: for pressure relief or for a person with severe extensor spasms that may throw him/her out of the chair.

Lightweight w/c: ______lbs

Standard w/c:_______lbs

Lightweight: 25-40lbs

Standard: >50lbs

_______ facilitates pelvic and LE alignment, provides relief without changing support and is good for those who need increased stability.

_________ also provides pressure relief, requires good trunk control although minimal support is offered.

Fluid cushion

Air cushion

________ decrease effect of tonic labyrinthine reflex (TLR).

________ provide more support posteriorly.

_________ decrease effects of TLR and out hands in visual field.

________ decrease scissoring extensor pattern.

Prone standers

Supine standers

Sidelyers

ABD pads at hips

Orthotic devices (AKA braces) are used to prevent contractures and provide stability to joints involved; what do the following abbreviations mean:

AFO

KAFO

HKAFO

AFO: ankle-foot orthoses

KAFO: knee-ankle-foot orthoses

HKAFO: hip-knee-ankle-foot orthoses

Specific mobility/positioning techniques for:

Status-post THR

Status-post CVA

Status-post Amputation of LE

THR: may not be permitted to roll on non-operated side; requires ABD pillow b/t legs to prevent ADD of hips.

CVA: education for proper positioning of UE to increase awareness, minimize pain, decrease swelling and normalize tone by use of pillows b/t knees in sidelying.

Amputation of LE: training in use of pillows to prevent edema in LE, train in passive stretch to limb while in bed to prevent contractures.

______ were formerly known as ECU's and is defined as:

List a few types.

EADL's: Means to purposefully manipulate and interact with the environment by alternatively accessing on or more electrical devices via switch, voice activation, remote control, etc.

Phones, personal emergency response system, computers, electronically controlled door openers, etc.

________ for those with severe mobility impairments (e.g. ALS)

_______ ex enlarged letters and numbers for low vision; graphics and symbols for cognitive impairment.

_________ provide large keys for limited motor accuracy and control (e.g. ataxia).

Eye gaze

Programmable keyboards

Expanded keyboards

_______ provide smaller keys for those with limited ROM and functl motor control (e.g. arthritis)

_______ for those with decreased strength and/or mobility (e.g. MD)

_______ activation systems for tose wit poor motor control (e.g. athetoid movts)

________ consist of few keys that generate standard characters by pressing various combinations for those with 1 handed use (e.g. hemiplegia)

Miniature keyboards

Light-touch keyboard activation

Delayed touch keyboards

Chorded keyboards

1. Operation: the ability to steer, brake and turn.

2. Tactical: the ability to respond to changes in road conditions and traffic/driving risks.

An OT practitioner who performs on-the-road driver training must _____________.

An OT practitioner who practice driver rehabilitation should ________________.

Must become a state licensed driving instructor.

Should become certified driving rehabilitation specialists.

__________ can replace accelerators and brake foot pedals.

__________ for one-handed steering control which can include:

___ for a person w/ 1 intact UE.

___ to accomodate a prosthesis.

___ to accomodate absent or weak grasp.

Hand controls.

Steering knobs:

Standard round spinning knob

Ring

Tri-pin or cuff

____ can be added if feet do not reach standard foot pedals.

___ can accommodate for decreased range, strength and endurance.

____ can plae the steering wheel in atypical positions to allow for access.

pedal extensions

zero effort/reduced effort

steering wheel positioning adjustments

-Re-direct back to desired location, engage in an activity of interest, camouflage doors, exits and elevators with full-length mirrors, stop or no-crossing signs, wall paper, vertical blinds- put tape on floors or planters to mark end of hall, install locks or velcro doors, use personal alarm or monitorng devices.