Pocket Prep/True Learn: NBCOT Domain 1: Assessment and Evaluation

Erhardt Prehension Developmental Levels

Natal: no voluntary grasp or visual attention to object

3 Months: no attempt to grasp but visually attends to obect

6 Months: raking or contacting object

7 Months: inferior-scissors grasp

8 Months: scissors grasp

9 Months: inferior pincer grasp

10-12 Months: Fine Pincer grasp

Muscles that contribute to scapular downward rotation

rhomboids, serratus anterior, latissimus dorsi

Muscles that contribute to scapular upward rotation

-serratus anterior

-upper + lower trapezius

Location of CVA: Right Middle Cerebral Artery presentation

-hemiplegia

-homonymous hemianopsia

-unilateral neglect

-impaired spatial awareness

Location of CVA: Left Middle Cerebral Artery presentation

-hemiplegia

-loss of sensation in affected limb

-homonymous hemianopsia

-aphasia

-apraxia

Location of CVA: Anterior Cerebral Artery Presentation

-hemiplegia

-incontinence

-confusion

-inability to speak

Location of CVA: Posterior Cerebral Artery Presentation

-impaired sensation in affected limb

-homonymous hemianopsia

-alexia

Volumeter

Assesses hand size in order to determine presence of edema.

Rotator Cuff Muscles (SITS)-assists with should ABD and flexion

Supraspinatus

Rotator Cuff Muscles (SITS)-assist with shoulder external rotation

infraspinatus and teres minor

Rotator Cuff Muscles (SITS)-assist with internal rotation

Subscapularis

Ecology of Human Performance

interaction between person, context and task performance

Radial Digital Grasp

-at 8-9 mo of age

-object is held between the fingers and opposed thumb

-fingers are stronger and more coordinated to support object away from palm

Mature Pincer Grasp

-12 mo of age

-isolated index finger and thumb to pick up object with increased precision

-improved finger isolation

Palmar Supinate Grasp

-12-18 mo of age

-gross grasping pattern

-does not require finger movements

-writing occurs on ulnar side of hand and gross movements from elbow and shoulder

Digital Pronate Grasp

-2-3 years

-wrist rotates to aim palm of hand down

-begins to involve fingers with finger wrapping

-active movement continues from elbow and not the hand and fingers

Occupational Outcomes

planned therapy interventions including occupational performance and participation in desired occupations

-result of interventions

Occupational Profile

summary of information that describes that clients occupational history, experiences, patterns of daily living, interests, values, and needs

Occupational History

portion of occupational profile which provides information regarding the history of desired occupations and previous skills level

Occupational Performance

human actions in response to occupational engagement

GM/Mobility Developmental milestones: Ages 2-3 yrs

-rides tricycle

-catches large ball against chest

-jumps from step

-begins to hop on one foot

GM/Mobility Developmental milestones: Ages 3-4 yrs

-jumps, climbs, runs

-begins to skip and hop

-stands briefly on one foot

-alternates feet walking up stairs

-jumps from step with 2 feet

GM/Mobility Developmental milestones: Ages 4-5 years

-throws ball

-hops for long sequences

-climbs on playground equipment

-skips for long distances

-walks up and down stairs reciprocally

GM/Mobility Developmental milestones: 5-6 years

-hops well for long distance

-skips with good balance

-catches ball with two hands

-kicks with accuracy

-stands on one foot for 8-10 seconds

Glaucoma

-peripheral field losses while central vision is spared

-may have difficulty using the environmental context

-interventions should focus on use of scanning to detect items, people and obstacles

CVA-Upper Trunk Middle Cerebral Artery-Sx Presentation

-Broca aphasia: slow labored speech

-contralateral hemiplegia

-neglect

-ataxia

CVA-Distal Basilar Artery Stroke-Sx presentation

-double vision

-drooping eyelid

-bilateral weakness

Pediatric Reflexes: Rooting reflex

-Appears: birth

-Integrates: 3-4 mo

-Retention signs: sucking thumb, poor eating habits, speech challenges, swallowing and chewing deficits, oral hypersensitivity

Pediatric Reflexes: Moro Reflex

-Appears: birth

-Integrates: 2-4 mo

-Retention signs: hypersensitivty to one of sensory systems, poor reactions to sensory input, lowered immunity, fatigue, challenge with change

Pediatric Reflexes: ATNR

-Appears: birth

-Integrates: 6 mo

-Retention signs: difficulty crossing midline, poor handwriting, gait and coordination and balance issues, visual motor tracking, math and reading delays

Pediatric Reflexes: Babinski

-Appears: birth

-Integrates: 2 yrs

-Retention signs: challenges with grounding, stability, poor balance, gross motor coordination

Modified Independent

-client is completely independent

-may require extra time or adaptive equipment to complete task

Minimum Assistance

-client requires up to 25% physical or verbal assistance from one person to safely complete task

Moderate Assistance

-client requires 26% to 50% physical or verbal assistance from one person to safely complete the task

Maximal Assistance

-Client requires 51% to 75% physical or verbal assistance from one person to safely complete the task

Dependent

-client requires more that 75% assistance to complete the task

Cluster A Personality Disorders: Paranoid, schizoid, schzotypal-characteristics

-discomfort in interpersonal situations and relationships

-emotional distant

-distrustful and suspiscious

Cluster B Personality Disorders: Antisocial, borderline, histrionic, narcissistic-characteristics

-excessive unstable expression of emotions

-maladaptive interpersonal relationships

-disregard for needs of others

Cluster C Personality Disorders: Avoidant, dependent, OCD- characteristics

-anxiety

-fear or rejection

-social discomfort

-sense of helplessness

-perfectionism

-inflexibility

Reaching skills milestones

Newborn: swiping/batting at object with closed hand

4 months: hands come together at midline for bilateral reaching

6 months: unilateral reaching

Occupation Adaptation Model (OA)

1. press of mastery 2. context 3. Occupational Adaptation 4. Occupational Participation

PEOP Model

1. Person 2. Environment 3. Occupation 4. Performance

Model of Human Occupation (MOHO)

1. volition 2. habituation 3. performance capacity 4. environment

Canadian Model of Occupational Performance and Engagement (CMOP-E)

1. Person 2. Environment 3. Occupation

De Quervain's Tenosynovitis

pain and swelling along the radial styloid of the wrist

-positive finkelstein's test

Dupuytren's Disease

-thickening of the fascia in the palm

-flexion contractures in the fingers as it progresses

Skier's Thumb

injury to the ulnar collateral ligament of thumb

Regulating behaviors milestones

-Early infancy: quiets when picked up

-6-12 mo: learns to self soothe

-12-18 mo: enjoy messy play

-18-24 mo: solitary activities

Summary of Functional Motor Performance of Children with Cerebral Palsy

Level I: child walks without limitations

Level II: child walks with limitations

Level III: child walks with handheld mobility device

Level IV: use methods of mobility that require physical assistance

Level V: child is transported to locations in manual wheelchair

Attentional Switching

to transfer focus between tasks, not completed simultaneously

Divided attention

concentrating on more than one activity at the same time

Sustained attention

ability to maintain focus on task when environmental distractions are present

Pediatric GM milestones

Muscle that performs elbow flexion when forearm is positioned in neutral

brachioradialis

Muscle that completes elbow flexion with supination

biceps

Muscle that completes elbow flexion with pronation

brachialis

Cranial Nerve I

Olfactory nerve smell

Cranial Nerve II

Optic Nerve providing vision

Cranial Nerve III

Oculomotor nerve, opening and moving your eyes and adjusting pupil width

Cranial Nerve IV

Trochlear nerve, looking down and moving eyes toward nose or away from it

-cranial nerve IV palsy most common in pediatric population, infants with torticollis

Cranial Nerve V

Trigeminal nerve, provide sensations in eyes, most of face and inside mouth. Allows you to chew food

Cranial Nerve VI

Abducens Nerve, Moving eyes from left to right

Cranial nerve palsy- double vision, strabismus

Cranial Nerve VII

Facial nerve, control several facial muscles to make facial expressions and provide sense of taste in part of tongue

Bell's palsy

Cranial Nerve VIII

Vestibulocochlear nerve, provide sense of hearing and balance

Cranial Nerve IX

Glossopharyngeal, taste sensations to part of tongue, control muscles for swallowing, plays a role in blood pressure and saliva

Cranial Nerve X

Vagus Nerve, regulate several automatic body functions, digestion, BP, HR, breathing, mood,

-Main nerve of parasympathetic nervous system

Cranial Nerve XI

Accessory nerve, control shoulder and neck movement

Cranial Nerve XII

control tongue movement, speaking eating and swallowing

MMT Grade: 0/zero

no tension palpated

MMT Grade: 1/trace

tension palpated in muscle, but no motion occurs

MMT Grade: 2-/poor minus

less than full ROM in gravity eliminated

MMT Grade: 2/Poor

Full ROM in gravity eliminated

MMT Grade: 3-/Fair minus

Less than full ROM against gravity

MMT Grade: 3/Fair

Full ROM, no resistance

MMT Grade: 3+/Fair Plus

Full ROM, minimal resistance

MMT Grade: 4-/Good Minus

Full ROM, less than moderate resistance

MMT Grade: 4/Good

Full ROM, moderate resistance

MMT Grade: 5/Normal

Full ROM, Maximal resistance

MET Values: 1.5-2

-functional transfers

-performing self care while seated

-walking 1 mph

MET Values: 2-3

-take seated sponge bath or warm bath

-dressing/undressing

-avoid a lot of overhead movements

-dusting

-washing dishes

MET Values: 3-4

-take a standing warm shower

-bowel movement

-climbing stairs

-making bed

-Most household chores: sweeping, mopping

MET Values: 4-5

-have a HOT standing shower

-changing bed linen

-bowel movement on bed pan

-raking and weeding

-gardening

MET Values: 5-6

-sexual activity can begin

-shoveling and digging

MET Values: 6-7

-brisk walking 5mi/hr

MET Values: 7-8

-jogging

MET Values: 8-9

-running 5.5 mi/hr

MET Values: 10

-fast running 6 mi/hr

Neurodevelopmental Intervention Approach

-restoration of function through identifying and correcting underlying impairments that interfere with movement

-regaining normal movement and postural control

-proximal to distal patterns

Sensory Integration Intervention Approach

-assumes behaviors, emotions, perceptions are regulated by brain mechanisms

-sensory modulation is essential in sensory responsiveness

Cognitive Behavioral Intervention Approach

-address coping strategies for chronic conditions

Rehabilitative Intervention Approach

-focus on adaptation, compensation, and environmental modification to promote engagement and participation

Pediatric Reflex: Spinal Galant Reflex

Appears: birth

Integrates: 3-9 mo

Retention signs: poor attention to task, poor bladder control, poor motor coordination, slouched posture, cause scoliosis

Pediatric Reflex: Landau Reflex

Appears: 4-5 mo

Integrates: 1 year

Retention signs: poor posture, low tone, challenges, overall delays in motor development

Pediatric Reflex: Stepping Reflex

Appears: Birth

Integrates: 2-3 mo

Retention Signs: delayed walking or motor development

Pediatric Reflex: Traction

Appears: Birth

Integrates: 2-5 mo

Retention signs: limited head control, difficulty holding on to caregivers

Pediatric Reflex: Tonic Labyrinthine Reflex (TLR)

Appears: birth

Integrates: 6 mo

Retention signs: poor posture, weak muscle tone, stif or jerky movements

Palmar Grasp

-4-6 mo

-early grasp pattern where object is stabilized against palm with fingers curled around object

-thumb does not oppose

Immature Pincer grasp

-9 mo

-isolation of fingers and thumb opposition to grasp object

-may utilize raking pattern to pick up object

Radial Palmar grasp

-6-7 mo

-thumb becomes more involved

-object stabilized against palm

-fingers and thumb support object

-improving precision with grasping

Full Thickness Burns: Considerations and tx

-all laters of skin affected

-burn area is usally painless due to nerve damage

-skin grafts required

-severe scarring and contractures