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A client in the burn unit sustained deep partial-thickness burns to the bilateral dorsal hands 1 week ago. What is the BEST position for splinting to prevent deformity?
A. Volar hand splint with wrist in neutral, metacarpals (MPs) in slight hyperextension, and interphalangeals (IPs) in full extension
B. Volar hand splint with wrist in 30° extension, MPs in 70° flexion, and IPs in full extension
C. Dorsal hand splint with wrist in neutral, MPs in 90° flexion, and IPs in 50°-70° flexion
D. Dorsal hand splint with wrist in 30° flexion and MPs and IPs in full extension
B. Volar hand splint with wrist in 30° extension, MPs in 70° flexion, and IPs in full extension
A COTA is treating a client who had a split-thickness skin graft 2 days ago on the left posterior axillary area. What postoperative occupational therapy intervention would be the BEST choice?
A. Perform gentle passive left shoulder ROM to pain tolerance twice daily
B. Perform active left shoulder ROM as tolerated, incorporated into daily activities.
C. Fabricate an axilla splint with left shoulder in 120° abduction and slight external rotation
D. Use a continuous passive motion machine to 120° shoulder abduction
A. Fabricate an axilla splint with left shoulder in 120° abduction and slight external rotation
A COTA® is providing intervention to a medically stable client who sustained upper-extremity partial-thickness burns of the dominant arm, 5% of the total body surface area, 2 days ago. Which intervention BEST represents a typical ADL intervention?
A. Instruct the client in the use of a long-handled spoon and fork and a built-up-handled knife for self-feeding.
B. Instruct the caregiver to assist the client in self-feeding and grooming tasks to prevent pain with movement.
C. Instruct the client in donning and doffing a pressure garment sleeve after applying lotion to the arm.
D. Encourage the client to independently self-feed without the use of adaptive equipment.
Instruct the client in the use of a long-handled spoon and fork and a built-up-handled knife for self-feeding.
A COTA® is treating a client who burned the bilateral lower extremities 10 days ago. The client refuses to participate in ADLs because of pain. The client rates the level of pain as 4 of 10 when resting in bed and 7 of 10 when standing. What actions are appropriate for the COTA to take? Select the 3 BEST choices.
A. Apply an elastic bandage wrap for vascular support before getting the client out of bed
B. Report the client's pain levels to the medical doctor and request stronger pain medication
C. Teach the client alternative pain control methods such as deep breathing and relaxation techniques
D. Allow the client to perform ADLs while lying in bed, and focus on bed mobility skills
E. Explain to the client that nonparticipation may lead to an early discharge from therapy
F. Determine, with the client's help, an acceptable length of time to be out of bed for ADLs, and alternate in-bed with out-of-bed activities
C. Teach the client alternative pain control methods such as deep breathing and relaxation techniques
F. Determine, with the client's help, an acceptable length of time to be out of bed for ADLs, and alternate in-bed with out-of-bed activities
A. Apply an elastic bandage wrap for vascular support before getting the client out of bed
A client sustained a deep partial-thickness burn to the anterior aspect of the right arm from the hand to the mid-upper arm. A split-thickness skin graft taken from the thigh was placed on the mid-forearm 3 days postinjury. The COTA® wants to minimize the risk of graft rejection in the surgical phase, which is up to 7 days postsurgery. What strategies should the client be instructed to perform? Select the 3 BEST choices.
A. Daily active pronation and supination exercises at least 5 times per day
B. Desensitization using ice to gently rub the burned areas from distal to proximal
C. Adaptations to allow ADLs using the left hand for eating and grooming
D. Retrograde massage followed by wrapping with elastic bandage
E. Immobilization using a wrist splint and avoidance of wrist and forearm movement
F. Immobilization using the elbow extension splint to avoid elbow and forearm movement
C. Adaptations to allow ADLs using the left hand for eating and grooming
E. Immobilization using a wrist splint and avoidance of wrist and forearm movement
F. Immobilization using the elbow extension splint to avoid elbow and forearm movement
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. When all the wounds are closed and the graft is stable, what is the BEST intervention to prevent hypertrophic scar development?
A. Jobst or other custom made pressure sleeve with inserts
B. Elastic bandage wrapping from distal to proximal
C. Scar massage 3-5 times per day
D. Frequent PROM and AROM
A. Jobst or other custom made pressure sleeve with inserts
A 4-year-old client sustained full-thickness burns on the volar surfaces of both elbows 4 months ago. In spite of using pressure garments and splinting for position, the client has developed thick scars across the volar elbows. Active and passive elbow extension is limited bilaterally. The COTA® would like to work on improving elbow extension and flexion. What treatment interventions are appropriate to improve elbow mobility? Select the 3 BEST choices.
A. Riding a scooter or tricycle
B. Crawling through a tunnel maze
C. Playing a bowling videogame
D. Drawing on a dry-erase board above shoulder height
E. Self-feeding at a waist-high table
F. Swinging on a bolster while holding onto the ropes out to the sides
B. Crawling through a tunnel maze
D. Drawing on a dry-erase board above shoulder height
F. Swinging on a bolster while holding onto the ropes out to the sides
A client in the burn unit sustained deep partial-thickness burns to the bilateral dorsal hands 1 week ago. What are appropriate positions for splinting to prevent deformity? Select the 3 BEST choices.
A. Volar forearm/hand splint with wrist in neutral, metacarpals (MPs) in slight hyperextension, interphalangeals (IPs) in full extension, and thumb in abduction
B. Volar hand splint with MPs in 70° flexion, IPs in full extension, and thumb in abduction
C. Volar forearm/hand splint with wrist in 30° extension, MPs in 70° flexion, IPs in full extension, and thumb in abduction
D. Dorsal forearm/hand splint with wrist in 30° flexion, MPs and IPs in full extension, and thumb in adduction
E. Volar forearm/hand splint with wrist in 15° of extension, MPs in 70° flexion, IPs in full extension, and thumb in abduction
F. Dorsal hand splint with MPs in 70° flexion, IPs in 50°-70° flexion, and thumb in abduction
B. Volar hand splint with MPs in 70° flexion, IPs in full extension, and thumb in abduction
C. Volar forearm/hand splint with wrist in 30° extension, MPs in 70° flexion, IPs in full extension, and thumb in abduction
E. Volar forearm/hand splint with wrist in 15° of extension, MPs in 70° flexion, IPs in full extension, and thumb in abduction
A COTA® is treating a client who sustained dorsal hand burns secondary to a work-related injury. In the intensive care unit phase of treatment, which technique for completing ROM of the hand is safest?
A. Passively range all digits and joints at once
B. Passively range each digit and joint individually
C. Instruct the client to actively flex and extend all digits
D. Instruct the client to wear a resting hand splint at all times
A. Passively range each digit and joint individually
A 4-year-old client sustained full-thickness burns on the volar surfaces of both wrists and forearms 4 months ago. In spite of using pressure garments and splinting for position, the child has developed thick scars across the wrists. Active and passive wrist extension and flexion are, respectively, as follows: right, 25/70 and 40/80; left, 30/70 and 50/85. Which activity would be MOST EFFECTIVE in improving wrist mobility?
A. Finger painting on a vertical surface
B. Crawling though a tunnel maze
C. Playing an X-Box bowling game
D. Throwing bean bags through vertical targets
B. Crawling though a tunnel maze
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. The client would like to return to softball practice as soon as possible. What would be the BEST activity during the initial phase of rehabilitation?
A. Elbow extension splint 2 hours on, 2 hours off
B. Upper arm rehab bike for 30 minutes, twice daily
C. Scar massage followed by interactive, virtual-reality computer sports games
D. Wall pulley and wall ladder followed by skin care regimen
C. Scar massage followed by interactive, virtual-reality computer sports games
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. To minimize the risk of graft rejection in the initial phase (7 days postinjury), what strategy should the client be instructed to perform?
A. Daily active pronation and supination exercises at least 5 times per day
B. Desensitization using ice to gently rub the burned areas from distal to proximal
C. Retrograde massage followed by elastic bandage wrapping from distal to proximal
D. Immobilization using the elbow extension splint and avoiding forearm movement
D. Immobilization using the elbow extension splint and avoiding forearm movement
A COTA® is treating a client who has second-degree burns to the left volar forearm, posterior upper arm, and posterior axilla. The client had a split-thickness skin graft 2 days ago on the left posterior axillary area. What postoperative occupational therapy interventions are appropriate? Select the 3 BEST choices.
A. Perform gentle passive left shoulder ROM to pain tolerance twice daily
B. Perform active left shoulder ROM as tolerated, incorporated into daily activities
C. Fabricate an axilla splint with left shoulder in 120° abduction and slight external rotation
D. Use a continuous passive motion machine to 120° shoulder abduction
E. Perform active left elbow ROM as tolerated
F. Perform active left forearm and hand ROM as tolerated
C. Fabricate an axilla splint with left shoulder in 120° abduction and slight external rotation
E. Perform active left elbow ROM as tolerated
F. Perform active left forearm and hand ROM as tolerated
A softball player sustained a deep partial-thickness burn to the anterior aspect of the right arm from the wrist, proximal to the ulnar styloid process, to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. What is the OPTIMAL intervention to prevent formation of elbow contracture?
A. A dorsal elbow flexion splint to position the elbow at 90° flexion and the forearm in supination.
B. A volar elbow flexion splint to position the elbow at 90° flexion and the forearm in neutral.
C. A dorsal elbow extension splint to position the elbow at extension and the forearm in neutral.
D. A dorsal elbow extension splint to position the elbow at extension and forearm in supination.
C. A dorsal elbow extension splint to position the elbow at extension and the forearm in neutral.
A client sustained partial-thickness and deep-thickness burns over a total body surface area of 60%, including the bilateral arms and legs. In the acute phase postburn, on which factor should the COTA®focus through intervention?
A. Fluid retention
B. Scar management
C. Sensory reeducation
D. Deformity prevention
D. Deformity prevention
A COTA® is treating a client who burned the bilateral lower extremities 10 days ago. The client refuses to participate in ADLs because of pain. The client rates the level of pain as 4 of 10 when resting in bed and 7 of 10 when standing. What is the BEST action for the COTA® to take?
A. Report the client's pain levels to the medical doctor and request stronger pain medication
B. Apply an elastic bandage wrap for vascular support before getting the client out of bed
C. Allow the client to perform ADLs while lying in bed, and focus on bed mobility skill
D. Explain to the client that nonparticipation may lead to an early discharge from therapy
B. Apply an elastic bandage wrap for vascular support before getting the client out of bed
A client in the acute burn unit sustained full-thickness chemical burns to the bilateral anterior and inner thighs. The client underwent grafting operations 2 weeks ago, and the surgeon has confirmed graft adherence. Initiating compression therapy is indicated. Which compression therapy is appropriate? Select the 3 BEST choices.
A. Custom-made compression garment
B. 6-inch elastic bandage
C. Elastic-fabric bicycle pants
D. Self-adherent wrap
E. Tubular bandage
F. Thromboembolism-deterrent (TED) stocking
B. 6-inch elastic bandage
C. Elastic-fabric bicycle pants
E. Tubular bandage
A client sustained a deep partial-thickness burn to the anterior aspect of the right arm from the hand to the mid-upper arm. A split-thickness skin graft from thigh to mid-forearm was performed 3 days postinjury. All the wounds are closed now, and the grafts are stable. What intervention should be used to prevent hypertrophic scar development? Select the 3 BEST choices.
A. Compression or other custom-made pressure sleeve with inserts
B. Scar massage 3-5 times per day
C. Application of cream or lotion 3-5 times per day
D. Application of silicone gel sheet to scars 22 hours a day
E. Application of pressure inserts and conformers
F. Frequent PROM and AROM
A. Compression or other custom-made pressure sleeve with inserts
D. Application of silicone gel sheet to scars 22 hours a day
E. Application of pressure inserts and conformers
A COTA® is working with a client who received significant burns to the elbow. The client presents with a soft-tissue contracture at the elbow and is noncompliant with wearing an anterior elbow extension splint. What alternative would be BEST for effective treatment of the soft-tissue elbow contracture?
A. Ace wrap the splint to hold it in place instead of using straps
B. Talk to the OTR® about discharging the client from secondary to noncompliance
C. Refer the client back to the plastic surgeon for surgery
D. Use serial casting to gradually and slowly stretch the tissue
D. Use serial casting to gradually and slowly stretch the tissue
A 10-year-old client sustained facial burns and arm and hand burns that required several grafting surgeries. A COTA® is seeing the client in an inpatient setting, and the client will be returning to school in the next month. The client is fearful of returning to school. What interventions are appropriate to benefit this client? Select the 3 BEST choices.
A. Advise the client to wear a facial pressure garment in public and practice putting it on and taking it off in the clinic
B. Have the client invite several friends and teachers to visit in the hospital to help them be advocates for the client when they return to school
C. Have the client participate in stretching activities to improve movement of the facial muscles
D. Have the client participate in recording a videotaped message for the classmates explaining what happened and the special garments and mask the client will be wearing
E. Provide a question-and-answer session and an opportunity to touch and handle a face mask and garments at the school with teachers and students before the client returns to school
F. Have the client participate in activities that can restore confidence and self-esteem, such as applying theater-type full-coverage makeup
B. Have the client invite several friends and teachers to visit in the hospital to help them be advocates for the client when they return to school
D. Have the client participate in recording a videotaped message for the classmates explaining what happened and the special garments and mask the client will be wearing
E. Provide a question-and-answer session and an opportunity to touch and handle a face mask and garments at the school with teachers and students before the client returns to school
A 2-year-old client was referred to an outpatient burn clinic for management of developing scar tightness in the left hand and wrist. The client's mother is the primary caregiver and has expressed severe guilt about the child being burned in a kitchen fire 6 months ago. The mother is feeling very overwhelmed with the postburn management program and has been having difficulty looking at the client's hand during therapy. What should be the INITIAL program for the mother to carry out at home?
A. Compression glove worn 24 hours per day with 20 minutes of deep scar massage every 2 hours during waking hours
B. Compression glove worn 24 hours per day with silicone gel pads inserted at all the web spaces and regular play time with play dough and toy building blocks
C. Coban™ self-adherent wrap on each individual finger during the day, deep scar massage 3 times per day, and antideformity hand splint at night
D. Coban™ self-adherent wrapping of each individual finger and elasticated tubular bandage 24 hours per day, regular PROM of left fingers and wrist
B. Compression glove worn 24 hours per day with silicone gel pads inserted at all the web spaces and regular play time with play dough and toy building blocks
A COTA® is providing intervention to a medically stable client who sustained a burn injury 2 days ago. The client has partial-thickness burns of both arms and legs consisting of 30% of the total body surface area. Which interventions best represent typical ADL interventions? Select the 3 BEST choices.
A. Instruct the client in the use of a long-handled spoon and fork for self-feeding
B. Instruct the client in light snack preparation
C. Instruct the client in use of a travel mug with a lid and straw and large handles
D. Instruct the client in tub and toilet transfers
E. Instruct the client in donning and doffing pants and a shirt
F. Instruct the client in use of adaptive call light and bed controls
A. Instruct the client in the use of a long-handled spoon and fork for self-feeding
C. Instruct the client in use of a travel mug with a lid and straw and large handles
F. Instruct the client in use of adaptive call light and bed controls
A COTA® is treating an outpatient client who has sustained burns to the face, neck, and hands. Customized pressure garments are being fitted to reduce hypertrophic scarring. Which item cannot be used under the pressure garments to increase conformity to the skin?
A. Silicone gel sheet
B. Neoprene sheet
C. Silastic elastomer
D. Dynamic splint
D. Dynamic splint
A client sustained facial burns that required several grafting surgeries. A COTA® is seeing the client in an outpatient setting 6 months post surgery. The client wishes to go out to lunch with a friend but is fearful of participating in this social activity. What treatment intervention would be MOST beneficial for this client?
A. Advise the client to wear a facial pressure garment in public and practice putting it on, eating, and taking it off in the clinic
B. Have the client participate in activities that can restore confidence and self-esteem, such as applying theater-type full-coverage makeup
C. Advise the client to wear a clear facial mask in public and carry a letter from the physician indicating that the client has facial burns
D. Have the client participate in stretching activities to improve movement of the facial muscles
B. Have the client participate in activities that can restore confidence and self-esteem, such as applying theater-type full-coverage makeup
A client sustained partial-thickness and deep-thickness burns over a total body surface area of 60%, including bilateral arms and legs. Which factors should the COTA® focus on in the acute phase of burn intervention? Select the 3 BEST choices.
A. Edema control
B. Deformity prevention
C. Scar management
D. Sensory reeducation
E. Fluid retention
F. ADL skills
A.Edema control
B. Deformity prevention
F. ADL skills
A patient with deep partial-thickness burns has an extremely edematous right hand. The patient has multiple open wound areas on the dorsum of the hand and between the web spaces. What is the BEST approach for assessing the effectiveness of treatment in reducing swelling?
A. Take circumferential measurements of the forearms, wrists, palms, and digits
B. Use a volumeter to measure water displacement of the forearms and hands
C. Ask the patient to elevate the right hand above the level of the heart
D. Compare differences in time in completing the Nine-Hole Peg Test
A. Take circumferential measurements of the forearms, wrists, palms, and digits
A client in the acute burn unit sustained full-thickness chemical burns to the bilateral anterior and inner thighs. The client underwent grafting operations 2 weeks ago, and the surgeon has confirmed graft adherence. What would be the COTA's BEST choice to initiate compression therapy?
A. Custom-made Jobst garment
B. Spandex bicycle pants
C. Coban™ self-adherent wrap
D. Thromboembolism-deterrent (TED) stocking
B. Spandex bicycle pants
A COTA® is treating a client who sustained second- and third-degree burns on the dorsal forearm and hand. Which splint would be appropriate for this client?
A. Resting hand splint
B. Intrinsic plus splint
C. Cone antispasticity splint
D. Dorsal flexor tendon repair splint
B. Intrinsic plus splint
A COTA® is working in the burn unit of a hospital. A client has undergone skin grafting to close wounds on the dorsum of the hand. What occupational therapy treatment is MOST appropriate for the 5 to 7 days post skin graft?
A. Instruct client in AROM of the wrist and hand but limit PROM until the staples are removed
B. Fabricate and fit the client with a safe position splint over the dressings
C. Involve the use of the grafted hand in ADLs that involve resistive grasp
D. Perform PROM to the wrist and hand but instruct the client to limit use of the hand outside of occupational therapy treatment sessions
B. Fabricate and fit the client with a safe position splint over the dressings
