OCTY2210 Revision

Remediation vs Compensatory approach?

Remediation - aims to improve underlying impairments through repeated structured graded interventions/practice. (task analysis, errorless learning, repetition)

Compensatory approach - adapting the task, environment or method to help the individual achieve their goals. (education, enviornment adaptations)

Ideomotor v Ideational apraxia

Ideomotor (production)- Knowing what to do but having difficulty carrying out the movement. (trying to pick up a tool but doing an incorrect hand movement)

Ideational (conceptual) - May have difficulty understanding how individual actions fit together to complete a task (messing up steps in a task)

Considerations for a power wheel-chair

P - physical abilities, communication, body, comfort, preferences, cognition

E - indoor and outdoor terrain, space, transport, weather, supports

O - What is it being used for? community access, transfers, task-specific requirements

What is PTA? (post-traumatic amnesia)

Post-traumatic amnesia is the period after a brain injury when a person experiences confusion, disorientation and difficultly forming new memories.

The PTA scale is completed daily to assess orientation and memory. The person answers questions about their surroundings and attempts to remember info, each assessment is scored out of 12.

A person is considered to have emerged from PTA when they score 12/12 for three days.

Bottom-up v Top-Down approaches

Bottom-Up: assesses underlying components to identify impairments that may affect occupational performance. (using a memory test to recall words or pictures for memory)

Top-down: Examining how difficulties affect a person’s performance in meaningful activities and occupations (observation of a routine)

3 Topics for driving or accessing the community with neurological conditions

1. Impact of the condition: symptoms such as fatigue, reaction time, coordination and cognition can affect safety

2. Strategies to maintain safety: energy conservation, planning trips around symptom fluctuations, vehicle adapdatations

3. Alternative community access options: exploring accessible public and community transport, support services to help maintain independence

Difference between AIS A and AIS B C D injuries

ASIA A - Complete injury: No sensory of motor function is preserved below level of injury

AIS B - sensory Incomplete

AIS C - Motor incomplete at least half of the key muscles are grade 0 to 2

AIS D - at least half are grade 3 to 5

What are the 5 stages of the recognition model?

What is the Modified Barthel Index (MBI)

The Modified Barthel Index (MBI) is a standardised assessment used to measure a person's level of independence in completing basic activities of daily living (ADLs). It is commonly used in rehabilitation following conditions such as traumatic brain injury (TBI) and stroke.

When moving a hypertonic upper limb, the resistance felt is due to

1. Spasticity

2. Muscle stiffness

3. Soft tissue contractures

What are positive symptoms in hypertonicity?

Abnormal increases in activity or responses that are added to normal movement.

• Spasticity

• Spasms

• Hyper reactive reflexes

• Clonus (repeated rythmic contractions)

What are negative symptoms in hypertonicity?

Loss or reduction of normal motor function

• Muscle weakness (paresis)

• Changes in motor unit number

• Muscular imbalance

What are the aims of splinting in hypertonicity?

At rest:

• Reduce tone

• Prevent organic contracture

• Maintain Joint Alignment at rest

Functional:

• Position and stabilise joints for function

• Promote mechanical advantage of weak muscles

Describe 3 key aspects of CIMT constraint induced movement therapy

Constraint of the unaffected arm

Intensive, repetitive practice

Transfer of skills into everyday life

When may splinting not be enough for hypertonicity?

When there are joint changes (surgery)

When hypertonicity is increased so much that you cannot make a well-fitting splint (inhibitive casting of Botulinum toxin)

When there is an organic contracture (serial casting)

3 Stages of motor learning

Cognitive - learning what to do

Associative - Improving technique with feedback and repetition

Autonomous - Becoming automatic and less attention required

Open v Closed tasks

Open: changing environment in which individual must adapt

Closed: Predictable environment, allowing person to perform without needing to respond to environmental changes

What is the OT task-oriented approach?

Helping clients adjust to role and task limitations, creating an environment that has common challenges, providing opportunities for practice, and minimising ineffective and inneficient movement patterns

What are practice conditions in OT?

Conditions: Variable = change conditions OR Constant = keep conditions the same

Task: Whole = entire task OR Part = components separately

Order: Blocked = repeat one skill OR Random = mix different skills

Rest: Massed = little rest OR Distributed = regular rest

What is important to include in feedback?

Intrinsic and extrinsic

Knowledge of performance (extrinsic or intrinsic)

Knowledge of results (extrinsic)

and consider if too much feedback

How are TBI’s classified

Primary: occurs at the moment of impact OR Secondary: subsequent complications

Open: Breaches the skull and exposes the brain OR Closed: does not breach the skull

Focal: confined to one are of brain OR Diffuse: involves multiple areas

Contusion: haemorrhaic necrosis when blunt force crushes CNS OR Laceration: a tear produced by injury to CNS tissue

Glasgow Coma Scale Dimensions

1. Eye opening - 4 grades

2. Verbal response - 5 grades

3. Motor response - 6 grades

What is a hemianopia or quadrantanopia?

Loss of visual field resulting from damage to visual pathway. Aware that half of the world is missing

What is inattention and neglect?

Inattention is difficulty maintaining focus on stimuli, can affect information either side of the body - losing track of task

Spatial neglect is not responding to one side of space, often effects one side (can be peripersonal or extrapersonal)

What is important in shoulder sublaxation?

1. Careful positioning for stability

2. Education for transfers, mobility and changes

3. Do not pull the limb

4. Avoid ROM beyond 90 degrees

5. Use firm support devices

When do you use slings in shoulder sublaxation?

When transferring, mobilising, showering or toileting. Conflicting evidence on efficacy

Ask

1. Does this sling cause or reduce pain?

2. Does the sling prevent active movement?

3. Can the client don and doff the sling?

4. Does the sling reduce the subluxation?

What are important things to keep in mind with wheelchairs powered or manual?

Seat width and height

Backrests

Pressure cushions

Armrests

Storage

Thermoregulation

Incontinence

What are 3 topics to include about driving for adults with a progressive neurological condition?

1. Changes in ability and fitness to drive - how vision, reaction time, cognition, attention can all be affected and understanding when to seek advice.

2. Maintining community mobility and indepence - alternative transport, planning ahead, identifying barriers, developing strategies.

3. Driving cessation, adjustment - The emotional impacts of stopping driving and strateiges to support adjustment.