Adults final exam study guide

CVA Evaluation areas of occ

• Focus on areas of concern identified by patient

• Direct observation of task performance & activity analysis

  • Identify factors affecting performance

• Use standardized & nonstandardized methods

• Standardized assessments for evaluating areas of occupation:

  • Activity Card Sort,

  • Canadian Occupational Performance Measure,

  • Barthel Index, and

  • Functional Independence Measure.

CVA eval balance & mobility

• Assess during task performance in sitting & standing positions

• Standardized assessments:

  • Postural Assessment Scale for Stroke Patients (PASS),

  • Timed Get Up and Go, 

  • Berg Balance Scale, 

  • Functional Reach Test,

  • Trunk Control Test, and 

  • Tinetti Test 

stroke eval UE function

• Performance tests which involves rating (or timing) UE movements during task performance.  Additional standardized assessments:

•  

  Standardized  Performance Assessments	Self-Report  Assessments
  Action Research Arm Test	30-, 28-, and 14-item Motor Activity Log
  Jebsen-Taylor Test of Hand Function	Hand & ADL subsections of the Stroke Impact Scale
  Wolf Motor Function Test  Functional Test for the Hemiparetic UE	36-item Manual Ability Measure
  Assessment of Motor and Process Skills (AMPS)	23-item ABILIHAND

stroke eval UE client factors

Once UE capacity for engagement in daily activities  is determined, may need to evaluate relevant underlying client factors:

• Somatosensory function,

• Joint alignment & mobility, and

• Muscle tone, strength, & selective motor control.

stroke eval cognition & perception

• Great variability in symptoms 

• Require OT familiarity with variety of assessments 

• Examples of assessments measuring impact of cognition and perception on daily occupation.  

  • Kettle Test: Uses IADL task to assess cognition within functional context

  • ADL-focused Occupation-based Neurobehavioral Evaluation (A-ONE) identifies cognitive & perceptual impairments during basic ADL & functional mobility

  • Domain specific tests: Executive Function Performance Test, Multiple Errands Test & Weekly Calendar Planning Tests  

  • Unilateral neglect—Catherine Bergego Scale (CBS), Kessler Foundation Neglect Assessment Process (KF-NAP)

stroke eval vision

• Visual screening-baseline before testing visual processing

  • Near & far acuity

  • Visual fields

  • Oculomotor ROM & control

  • Contrast sensitivity

  • Visual motor skills (fixation, pursuits, saccades, accommodation & convergence)

• Brain Injury Visual Assessment Battery for Adults (biVABA)—example of a standardized assessment of vision

stroke eval psychosocial status

• The Beck Depression Inventory—widely used screening to measure depression severity 

• The Patient Health Questionnaire (PHQ)-2 and PHQ-9 (screens major depression) screen for psychosocial impairment.

• Hospital Anxiety and Depression Scale (HADS)— self-administered measure, screens for presence of depression & anxiety.

stroke Ix focus

 

Acute (Hospital)	Rehabilitation (In-Patient  Rehab Center)	Subacute-Chronic (Home & community)
Positioning for prevention; remediation client factors affecting performance	Restoration/compensation  performance skill deficits	Maximize independence in IADL
Dysphagia management	Maximize independence ADL & IADL	Address skill for return to work
Fall prevention	Discharge planning to community	Resume driving and community mobility
Early mobilization & self-care training	Adaptation, compensation & environmental modification	Promote engagement in leisure & socialization

stroke Ix motor

• Compensatory strategies

  •  One Handed Dressing 

• Motor: Task-oriented training: Practicing functional tasks that are graded to challenge the patient’s current motor capabilities. 

  • Using involved UE to place dishes in the cabinet, while noninvolved UE helps support balance

• Constraint-induced movement therapy (CIMT) or modified CIMT (mCIMT): Form of task training that involves:

  • Restraint of the unimpaired limb, forcing use of the impaired limb during daily activities, 

  • Repetitive task practice with the affected limb in the form of whole task practice and “shaping,” and 

  • Requires approximately 6 hours a day for 2 weeks.

• Bilateral upper limb training. Involves:

  • Patient engaging both limbs, and

  • Simultaneous execution of identical activities.  

• • 
    

stroke Ix “Task Practice + Cognitive Strategies”

• Task Practice + Cognitive Strategies

  • Mental Practice (MP)

    • Patient cognitively rehearses activity with movement

    • Positive evidence for improving UE function, balance, mobility, activity, & participation

  • Action observation (AO):

    • Patient first watches another person perform an activity (most often on a prerecorded video) and then performs activity.

    • Evidence suggests that AO may improve UE function  

  • Robotic therapy: 

  • Mirror Therapy (MT)

    • Patient performs movements/activities with the unimpaired limb while watching its mirror reflection superimposed  over the (unseen) impaired limb

    • Positive for UE function, and activity & participation

• Virtual Reality

Stroke Interventions: Cognitive, Visual, & Perceptual Impairments

• Apraxia

  • Cognitive Strategy Training

  • Gesture Training

• Executive Dysfunction

  • Time Pressure Management

• Unilateral neglect—several effective approaches

  • Visual scanning training: Teaching systematic and organized visual scanning patterns  

  • Limb activation: Active or passive limb movements contralesional to the brain lesion

  • Prisms/prism adaptation: Use of prismatic lenses to induce an optical shift  

  • Vibration: Vibratory stimulation to neck muscles

Stroke Interventions: Psychosocial Impairments

• Exercise training help reduce anxiety & depression

  • Resistance, tai chi, walking, 

• Behavioral therapy

  • Problem solving, motivational interviewing, & cognitive–behavioral therapy

• OT led community-based programs

  • Leisure education, community mobility, community integration

Stroke Ix Prevention of Future Strokes

• Prevention education

  • Identification of modifiable risk factors

  • Medication management

  • Reduction of unhealthy life style choices, for example:

    • Diet management,

    • Exercise,

    • Sleep hygiene,

    • Smoking cessation, and 

    • Signs & symptoms of stroke (F.A.S.T.)

agnosia

the inability to recognize objects, persons, smells, or sounds despite having normal sensory functions (e.g., vision or hearing).

aneurysm

a weakening of an artery wall, resulting in a bulge or distension of the artery.

aphasia

a disorder that affects how you communicate. It can impact your speech, as well as the way you write and understand both spoken and written language

dysphagia

difficulty swallowing

Dysphagia eval

• Clinical assessment

  • History, nutrition, and respiratory considerations

  • Cognitive, perceptual, and physical abilities

  • Oral and pharyngeal abilities

  • Feeding trial

Dysphagia imaging eval

• Instrumental evaluation

  • Imaging and diagnostic studies provide critical information about the unseen parts of the oral, pharyngeal, and esophageal stages of swallowing.

  • Videofluoroscopy and fiberoptic endoscopy studies provide important information about the quality of the swallow and the efficacy of compensatory techniques used during swallowing.

Dysphagia Ix

• Remedial treatment

  • Restoring a normal level of swallowing function

• Compensatory treatment

  • Alternative strategies and techniques are taught to achieve safe, functional swallow prior to recovery of normal swallowing.

• Indirect therapy

  • Range of motion

  • Strengthening

  • Coordination exercises for weak or hypotonic oral and pharyngeal musculature

  • Manipulation of the environment

• Direct therapy

  • Rehabilitates prerequisite abilities during therapeutic snacks or meals

ADA ramps and slopes guidelines

• ADA guidelines state—any change in level over ½” should be ramped @ 5° or less.

  • For every 1 inch of rise, ramp must have 12” of length (1:12 slope). 

• Ramps in public have:

  • Surface with detectable texture for persons with visual impairments. 

  • Railings and curb to prevent rolling over edge. 

  • 4-feet level landing at top of ramp.

Product:
The 4 P’s and Marketing Strategy Development

• Product

• Our product is what we do as occupational therapy practitioners. 

• Ideal goal: offer a product line

• Package product in a professional manner 

• Professional appearance for paperwork including brochures, business cards, stationary 

• Understand client needs and wants through direct surveys, projective tests, focus group discussions, and letters and complaints received 

Place:
The 4 P’s and Marketing Strategy Development

• Place

• Analyze aspects of the service location

• Consider the hours the program is offered 

  • Is your program open during hours convenient to your markets and your staff?

Price:
The 4 P’s and Marketing Strategy Development

• Price

• Fee schedule for occupational therapy services (products) based on:

  • Cost

  • Competitive factors

  • Geographic area

  • What the consumer is willing to pay 

• Price commensurate with perceived value 

Promotion: 4 P’s and Marketing Strategy Development

• Promotion

• Communicating information to your markets about the product’s merits, place, and price 

• Instruments of promotion

  • Advertising: a paid message to inform, persuade, and remind 

  • Sales promotion: incentives to encourage purchases

  • Publicity: press release, or news story.  Develop rapport and personally contact newspaper, radio, and television stations. 

  • Personal selling: word-of-mouth recommendation, conference exhibits, speakers’ bureau and continuing education workshops, open house

Effective Marketing Techniques 

• Social Marketing: marketing to create a positive social change 

• Social Media: social networking sites used for marketing 

• Focus Groups: feedback on current program efforts and recommendations for future program modifications 

Execution of the Marketing Plan 

• Select your target market, develop a specific marketing mix (product, price, place, and promotion), and then delineate an action plan.

  • Timeline

    • To measure objectives and goals 

    • Assign actions to specific individuals with exact completion dates 

  • Dynamic and changing as new opportunities and problems arise   

Parkinson’s evaluation

• Early stages

  • OT rarely indidacted unless there are functional limitations or psych issues

• Brief hisotry

• ID occ perf problems related to reduced mobility, safety, swallowing, incoordination, slowed mvmts, cogwheel ridgidity, depressed affect

• Screening tool, eg Parkinson Disease Questionnaire-39 based on 8 dimensions of wellness

  • fine motor activities at home and work (writing, eating, shaving, fastening)

  • safe mobility (walking, stair climbing, driving, move sit to stand)

  • fatigue in most actiities

  • work eval at early stages of PD to reduce risk of unemployment or early retirement

  • bradykinesia, postural instability, and ridgity that can limit ADL and IADL participation

  • swallowing, or other mealtime probs that prolong eating and reduce intake

  • cog probs affecting activities asso w usual roles

  • sexual activity limitations related to bradykinesia, fatigue, dep, and psychosocial issues

  • sleep disturbances

• note occs that have been eliminated

Parkinson’s intervention

• Interventions Related to Decreasing Isolation and Communication Problems

  • Modify leisure activities to encourage participation and decrease isolation.

  • Educate caregivers about modifying communication and activities to support engagement. .

  • Provide home exercise program to maintain facial movement and expression for socializing.

• Interventions Related to Safety

  • Manage motoric “freezing” while walking,

  • Prescribe walking aids

  • Recommend good, uniform lighting, particularly in narrow spaces and at doorways.

• Interventions to Maintain Independence and Participation

  • Recommend use of adult absorbent underwear to reduce embarrassment should a bathroom be difficult to access.

  • Recommend that sexual activity be engaged in following rest and urination and when medications are most effective.

  • Reduce/ eliminate the need for fine-motor control, such as minimal or no clothing fasteners.

cogwheel ridgidity— PD

limbs move with small jerky movements. It's intermittent and ratchet-like. You might feel a click or catch in your muscle as you move your arm in a circular motion

bradykinesia— PD

slowness of movement and speed

SWOT analysis

•  assess strengths, weaknesses, opportunities, and threats 

  • Self-audit: Prepared or poorly prepared to meet market demands?

  • Consumer Analysis: Potential consumers of your services within your catchment area 

  • Analysis of Other Providers of Similar Services

  • Environmental Assessment

Where/what environments should you provide info to clients/CGs?

• Provide education in an environment where client:

  • Feels safe

  • Is free to ask questions

  • Is able to admit lack of understanding 

  • Can ask for repetition

• Provide education in a quiet space with as few distractions as possible

• If client is reading material:

  • Be sure there is adequate lighting 

  • Keep material in place client can access

• When Should You Communicate Information with clients and CGs?

• Consider the time of day

  • When possible, first address internal distractions such as hunger, pain, bathroom needs, etc.

  • Does the client have a preference?

• Consider the timing within recovery process 

  • Is the client ready to hear certain information?

Communicating Health Information: General Guidelines #1

• Establish rapport

• Use plain language

  • Use consistent word choice

  • Use client preferred word choice

  • Define new words

  • Explain acronyms

• Sequence information logically 

• Use higher number to represent better quality or more of something (1=weak and 10 = strong; 1=no pain and 10 = a lot of pain)

• Integrate demonstrations, models, and pictures

• Provide specific vs. general suggestions 
  

• Use multiple teaching methods 

  • Demonstrations, models, explanations, handouts

• Communicate in client’s primary language, using interpreters and translators as needed

• Verify understanding (e.g., use teach-back technique)

Educating in person

• Face-to-face communication is most effective as it:

  • Provides opportunity for conversation; 

  • Facilitates rapport building; and 

  • Allows interpretation of nonverbal cues to determine comprehension

• When communicating in person:

  • Assure client can hear you

  • Use client’s preferred language

  • When client and practitioner’s primary language differ, use a trained healthcare interpreter

• If wearing a mask:

  • Assure client’s attention before speaking

  • Speak a bit louder and a bit slower

  • Use gestures

Educating With Written Materials— why use them

• Written materials allow the reader to control pace of obtaining information. 

• Written materials allow the reader to review as needed.

• With written material, information presented first or last is most often remembered. 

Written Material: Word Choice, Style, and Reading Level

• Use an attention grabbing opening statement

• Use positive terminology 

• Use active rather than passive wording 

• Use short sentences and one- or two-syllable words—a simple strategy to keep the reading level low

• Use plain language and a trained healthcare translator if needed

Written Material: Font, Paper, and Color

• Use a minimum of 12 point (larger for persons with low vision) 

• Avoid fancy fonts

• Do not use all CAPITALS

Written Material: Organization

• Bold, when appropriate, to highlight headings or important information 

• Include appropriate amount of white space 

• Make materials interactive/personalized  

Visuals: “A picture is worth a thousand words” only if it is:

• Easy to understand

• Familiar and identifiable to the client

• Shown with simple captions 

• Positive

Written Material for the Web: Consider person’s:

• Information technology knowledge 

• Information technology motivation and interest

• Usability of any application

• Costs of implementation and use

• Infrastructure and support

• Device person will be using to read the material (e.g., cellular phone, tablet, laptop)

• Primary language

Written Material for the Web: Strategies to Increase Access

• Write actionable content

• Display content clearly on the page

  • Consider use of links

  • Assure screen readers and other assistive technology can read site, if needed

• Organize content

  • Place information in multiple places

  • Use a linear format

• Simplify navigation: Provide multiple ways to navigate material (e.g., scroll, link, search)

• Engage users: provide videos, testimonials, etc.

Assessing Written Material

• There are several published assessments to use to ensure that written materials are developed well.

• The best way to assess printed material is to ask potential users for feedback.

Communicating Virtually: Social Media

To effectively develop/use social media:

• Have a clear plan or social media strategy

• Make key messages relevant and accessible

• Identify key performance indicators

• Use plain language

• Use voice/faces/images viewers can identify with

• Present key information first

development of resources for clients and caregivers to use outside of skilled therapy time

• Use universal design for all health educational materials

• Share health information in both print and digital formats

• Use plain language and guidelines throughout the chapter

1. Describe safety concerns for interventions and evaluations of a variety of clients/conditions. 

• Discharge planning: when is it safe for someone to go home or safe to move to the next level?

• safe transfer techniques, safety precations

• feeding and swallowing safety, safe diet, positioning, supervision, nothing by mouth, risk of aspiration pnemonia

• visual, spatial deficits or cog impairments impact safety

• Per ASA/AHA, adaptive/assistive devices should be used for safety and function when: 

  • Other methods of activity performance are unavailable, or 

  • Cannot be learned, or 

  • When patient safety is a concern.

Demonstrate an understanding of the complexity present in the evaluation of  clients, particularly with ADLs, IADLs:

list eval tools

Occupational Profile:  The initial step in the evaluation process that provides an understanding of the client’s occupational history and experiences, patterns of daily living, interests, values, and needs.

Occupational therapy evaluation tools that measure occupational performance and capture the client’s perspective on performance:

• Canadian Occupational Performance Measure

     (COPM) 

• Occupational Self-Assessment (OSA)

• Child Occupational Self-Assessment (COSA)

• Occupational Performance History Interview

• Assessment of Motor and Process Skills (AMPS): evaluates performance skills duringthe natural context of ADL and IAD

• Functional Independence Measure (FIM)

  • measures functional ability/degree of disability and detects change over time by rating the performance across three different domains (self-care, motor, and cognitive)

Demonstrate an understanding of the complexity present in the intervention of  clients, particularly with ADLs, IADLs

• Clinical reasoning

• Effective use of strategies and approaches

• Appreciation of contextual issues on occupational performance.

• Address each component of the domain of occupational therapy

  •  Client factors 

  • Performance patterns 

  • Contextual issues 

Demonstrate an understanding of the complexity present in the evaluation of  clients, particularly with work, sleep, rest, and leisure

• Evaluation begins with assessment of role changes clients have experienced or may experience when discharged.

• therapists engage in evaluation of activity demands and client skills needed to support role resumption.

• Functional work assessments:

  • Job analysis: systematic evaluation of physical, cognitive, social, and psychological work requirements.

  • Functional capacity evaluation (FCE): performance-based measure of a person’s ability to participate in work

    • Compares a person’s health status, body functions, and body structures with demands of a job.

Goals of work rehabilitation: (Ix)

• Maximizing work function, 

• Facilitating safe and timely return to work through remediation,  

• Assisting workers to retain or resume their worker role, and 

• Preventing future impairments following injury or illness.

Intervention for Quiet & Active Leisure or Recreational Pursuits

• Use basic principles of compensation & adaptation

  • Quite leisure—use approaches described for previous activities.

  • Active leisure—in addition to using general approaches, may need to:  

    • Facilitate participation in community groups,

    • Support access to specialized adaptive equipment, and

    • Educate about precautions to consider during activity

Ix plan

• Objectives

• Expected time frame for goal completion

• Practitioner role

• Evidence-based intervention approach within the chosen model of practice or frame of reference 

• Evaluation of plan efficacy 

  • functional progress

  •  effectiveness of changes to available resources and performance context 

How to design an Ix activity

• Identify ADL or IADL task

• Select limitation

• Develop intervention plan to address that limitation

• Intervention plan must be directly related to ADL or IADL task

• Utilize different approaches and levels of intervention

• What evidence do you have that this approach will work?

list and briefly describe the 5 Intervention approaches

Select one or use in combination:

• Create or promote: enhance health and function 

• Establish or restore: remediation

• Maintain: delay decline

• Modify: adapt to decrease the demands of the environment and task 

• Prevent: reduce risks

OT role with feeding: Assessment

• Clinical assessment

  • History, nutrition, and respiratory considerations

  • Cognitive, perceptual, and physical abilities

  • Oral and pharyngeal abilities

  • Feeding trial

• Instrumental evaluation

  • Imaging and diagnostic studies provide critical information about the unseen parts of the oral, pharyngeal, and esophageal stages of swallowing.

  • Videofluoroscopy and fiberoptic endoscopy studies provide important information about the quality of the swallow and the efficacy of compensatory techniques used during swallowing.

OT role feeding: recommendations and plan

• After clinical assessment is completed, recommendations and a plan are formulated.

  • Whether eating by mouth is advised

  • Whether an instrumental evaluation is advised

  • Whether a nutritional consultation with a dietitian is needed

  • Recommended diet type

  • Mealtime positioning and supervision

  • Adaptive equipment needs

  • Type and amount of assistance

OT role dysphagia Ix

• Remedial treatment

  • Restoring a normal level of swallowing function

• Compensatory treatment

  • Alternative strategies and techniques are taught to achieve safe, functional swallow prior to recovery of normal swallowing.

• Indirect therapy

  • Range of motion

  • Strengthening

  • Coordination exercises for weak or hypotonic oral and pharyngeal musculature

  • Manipulation of the environment

• Direct therapy

  • Rehabilitates prerequisite abilities during therapeutic snacks or meals

Dysphagia Patient and Caregiver Training

• Intervention plan includes patient, nursing staff, and caregivers.

• Education provided

  • Cause of and prognosis for patient’s dysphagia

  • Importance of strategies to be carried out at home

  • Patient and caregiver should view videofluoroscopy or fiberoptic endoscopy.

  • Mealtime positioning

  • Adaptive equipment

  • Type and amount of assistance

  • Compensatory techniques

  • Meal preparation practice and community outings to reinforce diet modifications