Adults Process Final

Adulthood

Defines as beginning at 18 and spans through end of life. Divided into young adulthood (20-40), middle adulthood (40-65), and late adulthood (65 and older)

Primary forms of occupation in adulthood

Work/ Productivity, leisure, and self care

OT Screening

Reviewing information concerning a prospective patient to determine if further evaluation and services are needed. Start with chart review and go to brief interview. Common in acute care

Evaluation Report

Detailed summary of findings, your interpretation, estimated outcomes of therapy/ therapy goals, and treatment plan

ICD-10 Codes

Diagnostic coding system

CPT Codes

Common procedural terminology. Uniformed process for coding medical services and required for billing

3 levels of OT evaluation

Low, moderate, and high complexity

Progress report

Summary of clients progress towards achieving goals

Time codes

1st unit of CPT code= 8 minutes. Units after are in 15 minute increments

Measuring Pulse rate

Normal at resting is 60-100 BPM. Find pulse on wrist, count number of beats in 15 seconds, multiply by four

Measuring O2

Normal is 95% or above

Blood pressure

Normal= diastolic 80 over systolic 120

Elevated= less than 80/120-129

Hypertension stage 1= 80-89/ 130-139

Hypertension stage 2= 90 or higher/ 140 or higher

Hypertensive crisis= higher than 120/ higher than 180

Steps to measuring BP

Wrap cuff 1-1.5 inches above antecubital space, cuff should be wrapped smoothly and firmly around arm, palpate brachial pulse on medial aspect, place stethoscope over pulse, close valve, inflate cuff 20 mm Hg greater than point where you hear pulse obliterates, slowly open valve, first heard sound is systolic, continue until pulse sounds muffle, when pulse disappears this a diastolic pressure

Sensations of primary somatosensory system

Light touch, pain, temperature, pressure, vibration, proprioception, kinesthesia (limb awareness). Lesion to this area leads to a loss of sensation of the contralateral body

Sensations of cortical/ secondary somatosensory system

2-point discrimination, stereognosis, graphesthesia, and simultaneous stimulation (both sides of the body). More perceptual (making sense of info). Lesions to this area leads to tactile agnosias

NLI

Lowest part of the spinal cord where sensory and motor are both intact with MMT of at least 3

Dermatomes and key muscles to test

C5- Biceps

C6- Wrist extensors

C7- Triceps

C8- Finger flexors

T1- Small finger abductors

Complete SCI

Total absence of sensation below level of lesion. No sacral sparing. Greatest loss of function occurs in individuals with lesions in the highest cervical regions

Incomplete SCI

Partial preservation of sensory and/or motor function below the NLI and there is sacral sparing

ASIA A complete

Total absence of sensory and motor function in the lowest sacral segments

ASIA B Incomplete

Sensory function preserved below NLI including sacral sparing. Motor function not preserved and no motor function is preserved on either side more than three levels below NLI (usually do not walk)

ASIA C Incomplete

Motor incomplete, motor function preserved below NLI, person may walk

ASIA D Incomplete

Motor incomplete, same as level C and at least half of key muscle function below NLI have a muscle grade (person will likely walk)

Central Cord Syndrome

UE impairment is greater than LE. It comes from narrowing of the column. Can result in shoulder subluxation, dropping, decreased sensation in hands, and some decreased walking. Caused by falls or cervical stenosis

Brown- Sequard Syndrome

Half of the cord is damaged. Loss of touch/ sensation and proprioception on the ipsilateral side. Loss of pain on contralateral side. Caused by GSW or stab wounds

Cauda Equina Syndrome

Herniated disc, lumbar stenosis, and trauma. Can cause bowel and bladder control issues

Autonomic Dysreflexia

Symptoms are increased BP, pounding headache, sweating above injury level, and spotty vision. Important to check operation of bladder/ bladder equipment, tight clothing, skin irritation, pressure ulcers, DVT, and injuries

Respiration SCI

Complete injuries above C4 on ventilator. C4-C8 level may require suctioning and assisted cough

Skin integirty

Pressure ulcers. Pressure relief for 2 min every hour in a wheelchair and every 2 hours in bed. Need to be careful of shearing during transfers.

Spasticity SCI

Experienced when initial period of spinal shock subsides. Treatment includes PROM, positioning, and medication

Spasms SCI

Triggered by sensory stimuli. Occasional spasm can be good- helps maintain muscle size, promote circulation. Spasms may alert person to a medical condition.

Orthostatic hypotension

Extreme drop in BP. Symptoms include being light-headed, feeling faint, and spotty vision

DVT

Blood clot, pulmonary embolism

Heterotopic Ossification

Abnormal bone growth

Key OT assessments for SCI

Cognition, self care, sensory screening, ROM/ MMT, grip/ pinch strength, MAS

OT with C1-4 Tetraplegia

Patient/ family education (respiratory), home modifications, assistive tech, UE splints, and patient needs to be able to direct their own care

OT with C5 tetraplegia

Teaching patients to direct their own care, assistive technology, UE splints, home modification, might be able to drive

OT with C6-C8 tetraplegia

Tenodesis grasp, functional mobility and use of adaptive equipment

OT with paraplegia

Becoming modified independent, mobility, and return to work, leisure, home maintenance, etc

Assessing sensation

Light touch, proprioception, tactile localization, stereognosis, graphesthesia, temperature, and pain

General process of motor control

Process sensory information, select a motor plan, modify motor plan, perform desired action

Motor learning

The acquisition or modification of motor skills resulting from practice. Enhanced by an enriched environment and training/ use

Neuroplasticity

Ability of neurons to change their function, chemical profile, or structure. Repetition and the "just right challenge" is key (10 principles)

Common causes of motor neuron damage

Tumors, infections ,degenerative disorders, and vascular disorders

Cortical lesion examples

Hemiplegic posture, hypo/hypertonia, clonus, weakness, apraxia, lead pipe rigidity, clasp knife, loss of fractionation

Cerebellar lesion examples

Intention tremor, dymetria, decomposition of movement, dysdiadochkinesia, adiadochokinesia, ataxia, ataxic gait

Lesions of the basal ganglia

Tremors (at rest), cogwheel rgidity, hypokinesia, festinating gait, athetosis, dystonia, choreo, hemiballismus

Neurophysiological approach to motor

CNS is hierarchically organized. Repetition of movement results in positive permanent changes in CNS and recovery from CNS damage follows predictable sequence

Systems model

Motor emerges from persons multiple systems, interacting with unique tasks and environments (influenced by dynamic systems theory

Ischemic Stroke

Thrombus (in brain) and embolus (outside of brain) blood clots

Hemorrhagic stroke

Bleeding on or in the brain

MCA

Most common area for ischemic stroke. Contralateral hemiplegia, sensory deficits, contralateral homonymous hemianopia, and aphasia. Perceptual deficits include anosognosia, unilateral neglect, visual spatial deficits, and perseveration

ACA

Middle and superior aspects of frontal and parietal lobes. Contralateral hemiplegia (greater in LE), apraxia, mental/ behavioral changes, incontinence, etc

PCA

Medial and inferior aspects of temporal and occipital lobes. Sensory and motor deficits, involuntary movement, memory loss, astereognosis, topographic disorientation, visual agnosia, etc

CA

Ipsilateral ataxia, contralateral loss of pain/ temp, dysphagia, dysarthria, contralateral hemiparesis

OT & acute care

Bottom up assessment approach. Priorities= early movement, improving functional abilities, preventing further decline, and coordinating care

OT & inpatient rehab

Combined bottom-up and top-down approach. Priorities= self care, functional mobility, functional communication, social cognition, IADL, community reintegration, discharge planning, and recs for continued services

OT & outpatient

Focus on chronic disease management, medication management, improving function, community reintegration

Modified Ashworth Scale

Describes muscle tone and spasticity. Subjective test

Modified Ashworth Scale Grades

0= no increase in tone

1= slight increase in tone, manifested by catch or minimal resistance at end of ROM

1+= slight increase in tone manifested by catch and minimal resistance through remainder of ROM (less than 1/2)

2= Marked increase in tone through most of ROM but parts are easily moved

3= considerate increase in tone and passive movement in difficult

4= Rigid in flexion or extension and not able to move

Praxis

The skills behind motor function. 2 steps= conceptualization/ ideation (knowing what to do), and production/ planning (knowing how to do it)

Apraxia

Without motor planning

Ideational apraxia

Not knowing what needs to be done, lack of conceptualization. Ex: Using familiar objects/ tools incorrectly

Ideomotor aproaxia

Not knowing how to do something. Ex: Difficulty sequencing movement to get dressed

Perception

Process by which the brain interprets sensory information received from the environment

Visual perception skills

Visual analysis, visual motor integration, and visuospatial

Visual analysis

Includes object constancy, visual discrimination, figure ground, and form closure. Impairment leads to agnosia

Agnosia

Disorder of recognition. Inability to recognize using a specific sense even though the sense is intact. Sensory information is not being processed

Visual motor integration

Allows people to direct body in space. Essential for hand eye coordination

Visuospatial skills

Judging bodies position in space. Includes depth perception, right/ left discrimination, topographic orientation, body scheme (understanding bodies relationship to itself)

Hemi-inattention

Inattention to visual field information. Can occur in the personal space, peripersonal space, or extrapersonal space

Perceptual/ Representational hemi-inattention

Impaired visual searching such as not shaving one side of their face. Biggest strategy is to increase patients awareness of the problem

Motor/ Exploratory hemi- inattention

Difficulty actually turning eyes, head, and body past midline

Motivational hemi-inattention

Think the information on that side is irrelevant or has no value

Examples of assessment/ screening for body scheme disorders

Star cancellation, letter cancellations, line bisection, clock drawing

Warrens Visual Perceptual Hierarchy

Oculomotor control/ visual fields/ visual acuity, attention, scanning, pattern recognition, visual memory, visuocognition, and adaptation through vision. Need the first skills of the hierarchy to move up and use/have the higher skills

Near acuity

Clearly seeing, identifying and understanding objects within arm lengths

Distance Acuity

Clearly seeing, identifying, and understanding objects at a distance

Acuity recognition of the peripheral field

Recognizing the "where"

Acuity recognition of the central field

Recognizing the "what"

Assessing acuity

Pupillary response to light

Oculomotor control

The ability to move the eyes together and coordinate. Includes smooth pursuits, convergence, and saccades

Smooth Pursuits

Ability of the eye to move smoothly across a pritned page or while following a moving object

Convergence

Bringing eyes together. Reflexive response elicited when attending to something moving closer to you

Saccades

Quick movement of both eyes between two or more phases of fixation in the same direction (watching a train move)

Diplopia

Double vision

Visual Fields

Ensures the presence of vision or that all of the environment is represented in the visual picture

Field cut/ Hemianopia

Loss of vision somewhere in the visual field

Homonymous hemianopia

Loss of vision on the same side in both eyes

Certified orientation mobility specialist

Community based professional who works with people with low vision to train them how the get around their environment

Certified vision rehabilitation therapist

Instruction and guidance for living skills for people with low vision

Optometrists

Clinical services in vision therapy and rehabilitation

Ophthalmologist

Medical degree. Treatment of diseases and conditions of the eye and the visual system

Frontal lobe function (cognition)

Executive functions and attention

Parietal lobe function (cognition)

Attention

Temporal lobe function (cognition)

Memory and speech

Occipital lobe function (cognition)

Perception and vision

Functional cognition

Cognitive ability to perform daily life tasks. Incorporates metacognition, executive functioning and other domains. Pain, distractions, and fatigue will impact functional cognition.

Cognitive Dysfunction

Functioning below expected normative levels or the loss of an ability in any area of cognitive functioning

Cognitive functional evaluation framework

Starts with cognitive occupational narrative, then looks at cognitive factors, and then examines the impact on occupational performance, self-awareness/ beliefs, and environmental factors