Final Review 23

Summer 2023

Occupation based

as a means

engaged in life-relevant task performance

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Occupation focused

As an end

focus on occupation rather than body function or environment/contextual factors

Three continua to asses occupation centeredness

personal relevance

contextual relevance

occupational relevance

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Personal relevance 1

therapist driven w/out rationale

no client input or collab or link to occupation

Personal relevance 2

therapist driven with rationale

shared rationale w client but no choice offered

Personal relevance 3

Client adopted meaning or purpose

choice of interventions chosen by therapist

Personal relevance 4

Client driven meaning or purpose

therapist-client collab

client communicates meaning and purpose

Contextual relevance 1

unfamiliar

foreign to client

Contextual relevance 2

Contrived

1-3 modifications to match setting

Contextual relevance 3

Contrived/naturalistic

4 or more modifications and use of a mock environment

Contextual relevance 4

Naturalistic

natural to client

home, school, community, etc

Occupational relevance 1

Passive

therapist provides intv

Occupational relevance 2

Exercise or rote practice

improve strength

repetition of performance skills

Occupational relevance 3

Contrived

element of pretend

Occupational relevance 4

Occupation

area of occupation

OCIA Scoring

Total 10-12: Occupation and purposeful activity

Total 6-9: performance skills

Total 3-5: Body functions

In sensory diets for IDD, what sensations are given to brain stem

tactile, vestibular, proprioception

Omnibus Budget Reconciliation Act (OBRA) of 1987

Persons with dementia have the right to function at max level without unavoidable decline, participate in physical and social environments, receive functional maintenance therapy in long-term care settings

Focus of intervention for training care partners in CDM

Understand BPSDs

How to approach loved ones, cue, communicate, modify environment

Activity setup and removing distractors/clutter

Activities for dementia should be ____,__ ____,__ ______

meaningful

simple

safe

Which ACL require supervision

ACL levels 3 and below

When should driving be removed per ACL>

Level 4

What level should money be restricted

Level 4

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At what level should you teach caregiver to give single-step cues for ADL?

Level 4

At what level is step by step assistance reccommended

Level 3

At what level are rote or procedural memory tasks recommended to simplify leisure activities?

Level 3

In addition to other environmental simplifications, at what level is removing mirrors and covering windows with curtains recommended?

Level 3

What level includes safety recommendations for fall risks?

level 2

What level includes safety recommendations for apraxia?

Level 2

What activities are recommended at level 2?

Music, dancing, simple exercise, colorful and textured objects, lotions, massages

What level is max to total assist for self-care, total for IADLs, and may not be able to ambulate?

Level 2

Restlessness and agitation are common at what level?

Level 2

What are complications in end-stage dementia?

Sepsis, UTI, aspiration, pneumonia, ulcers

Hospice recommendations are included at what level

level 1

What level responds to internal (sensory) cues only and may be unaware of external stimuli?

Level 1

Recommended activities you do for someone at Level 1?

Music, gentle wash cloth, stuffed animals, lotions, massages

Activities to elicit safety and familiarity

Environmental modifications at level 1

training w DME and techniques

placing enjoyable objects in the line of sight and reach

Keeping environment stimulation low

What level uses sensory vest and requires frequent repositioning?

Level 2

What level exhibits reduced nutritional and fluid intake?

Level 2

Conditioning used to tap into engagement with dementia

Errorless learning

alarms to deter

Tapping into engagement w dementia through info processing uses…

Sensory input: a multi-sensory experience with appropriate balance of hearing, seeing, sensation, touching, tasting, smelling

Tapping into engagement w dementia through implicit memory uses..

*Cuing* through purposeful rooms where cues have opportunity to “happen along”

Safe ways to rummage

cues through posted schedule

name tags for cues of familiarity

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*Procedural* memory (lifetime familiarity)

*Conditioning*

Environment is the client’s ______________

Silent partner!

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\*Environmental press

What do outdoor experiences provide for clients w dementia

Regulation of days and nights, soothing, reminds of home

T or F: Design features of Psych Units including private space per pt., higher level of comfort, and greater visibility on ward decreased risk of being secluded

True!!

What are preventive strategies for de-escalating aggressive behaviors among adult psych pts.

Develop a calm environment

Perform risk assessments at admission

Provide opportunities for applying learned strategies (therapy room, sensory room, common lounge areas, gardens)

Safe staff to pt ratio

Specific staff training programs

Group interventions

Ingredients for sensory reduction in inpatient psych unit

Music, yoga, meds, ambient lighting, sensory diet activities, reduced speech volumes

T or F: components of PBS is modification of the physical/social environment to decrease problem behaviors, positive reinforcement and descriptive feedback, and teaching new skills

True

How are new skills taught in natural settings for PBS?

Prompting, guidance, and reinforcement

What is the purpose of conducting a FBA?

determine the function of the problem behavior

identify factors that predict and maintain problem behaviors (antecedents and consequences)

What is the first step in the FBA process?

Identify, prioritize, and operationally define target behaviors

What is included in the behavior intervention plan (BIP)

A replacement behavior goal and any skill development or supports needed to help them achieve behavioral goals

three core concepts of Self-determination skills approach

Personal values

Self-knowledge

Engagement in Meaningful occupations

Four key components of self-determination skills approach

Knowing and valuing oneself

making and meeting goals

communicating and dealing with conflict

learning from outcomes

More intentional and focused attention with high energy usage, requires a high degree of mental energy, directly attending to challenge with full consciousness

Primary energy

More automatic (less focused and intentional) and sophisticated with low energy usage , brain processes info in a less direct yet efficient way

Secondary energy

T or F: it is likely that all behaviors of concern would be categorized as existing

TRUE

through intervention we are wanting client to develop modified and new adaptive response modes

Adaptive Response Mode- Existing

Already in repertoire- “go to solutions”

Adaptive Response Mode- Modified

Involve changes in an existing mode

adjusting an existing response to meet an occupational challenge

Adaptive Response Mode- New

Emerge because existing and modified are not working for a particular need

Requires one to expend effort and adaptation energy (often primary)

Often occurs when facing a challenge they have never attempted

Adaptive Response Behavior - Primitive

frequent when experiencing extreme difficulty or stress in responding to challenge

often w being overwhelmed and resulting in ‘stuckness’ ( \*hyperstabilized)

Adaptive Response Behavior - Transitional

frequently follows primitive behavior to help become ‘unstuck’

Characterized by random, active, and not well modulated (hypermobilized) attempts to respond

Adaptive Response Behavior - Mature

well-modulated, goal-directed, solution-focused responses

Chad slumps in chair and becomes non-responsive during math worksheet time. Then, he starts crumpling paper and throwing it. What adaptive response behaviors are used?

Primitive -slumping (stuck and hyperstabilized)

Transitional - crumpling paper and throwing it (trying another way to deal with challenge)

\*NOTE: moving from hyperstabilized (primitive) to hypermobilized (transitional) states

Hypermobilized may be more unpredictable and harder to manage (may seem worse than before) - environment (ex. teacher or OT) may prefer hyperstabilized to reduce stress

\*See hypermobilized as a behavior capable of moving to a more mature response with appropriate help

Step 1 and 2 during Evaluation of OT-EBD

1 - Explore/observe person within the environment

2- analyze adaptive responses

Steps of Intervention for OT-EBD

3- Provide role-shifting experiences

4- encourage self-determination

5- Promote adaptive functioning

T or F:

Step 1 rationale for OT-EBD - cannot plan effective intervention to engage client in adaptive process until expectations and activities in the environment from the therapists’ perspective is understood

FALSE

…from the Person’s perspective \*

What is analyzed in step 2 of OT-EBD?

Adaptation energy

adaptive response modes

adaptive response behaviors

adaptation gestalt

In OT-EBD, what step uses a just-right challenge as a method?

Step 3 - provide the role shifting experience within the person’s competency

In OT-EBD, what is the purpose of encouraging self-determination?

to place the person as the agent of change and move into internal control from the external they are accustomed to

During what step of OT-EBD do you use the method of only providing the most necessary rules to maintain therapeutic and safe environment, feedback, and directions?

Step 4 - person as agent of change by intervening only to the point that is absolutely necessary

In step 5 of OT-EBD, what should you quickly assess to identify the initial therapeutic approach?

Adaptation gestalt

For break set strategies in OT-EBD, what part of gestalt and therapeutic mode are often optimal?

Sensorimotor often is key (i.e., walking, sitting further away)

Problem solving

T or F:

avoid attending to emotional reaction in attempt to correct behavior or make them feel better

TRUE

it is counter-therapeutic to engaging them in internal adaptation process

During what steps of Cole’s 7 step group process should interaction be encouraged

Sharing, processing, generalizing, and application

What activities are not recommended for groups of geriatric clients?

fine motor coordination and high levels of physical demands

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Ex try VB balloon bat, trivia, familiar cooking (may need adaptive equipment)

What should activities include in group w cognitive deficits?

Should be more physical and concrete

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Ex. simple 3-5 ingredient recipe for cooking (w visual aides), simple crafts, games

When is the directive style used for groups?

For lower functioning clients

cannot make decisions for themselves

should provide choices within selected activity

In what group leadership style does the leader define the group, select activities, and structure the in a way they know is therapeutically appropriate?

Directive Leadership

(session is well-structured- very directive)

What models rely on facilitative leadership style to promote indpendence?

MOHO and DLM

In what group leadership style is the leader a resource to provide needed info, initial structure, equipment, supplies, and identification of purpose and goals of the group?

Facilitative leadership

What is the most passive leadership style used most appropriately with professionals or community groups, families, caregivers, and self-help groups?

Advisor style

What leadership style is for focus of problem solving or attitude change but doe snot provide structure or goals?

Advisor style

Where would setting the mood, leadership style, motivation, and co-leadership strategies fall in RTSS?

Ingredients!

Diathesis Stress Model

People are predisposed (i.e., genetics, background factors) that make some more vulnerable than others to challenges in life

Generalized Adaptation Syndrome

common symptoms during illness represent body’s physiological reaction to unfavorable conditions

Homeostasis

body goes through allostasis when responding to stressors to maintain favorable physiological balance (homeostasis)

Mind-body connection

association b/w abnormal life circumstances and illness

Major consequences of stressful life are emotional, which triggers physiological response

T or F: there is a dynamic link b/w mental illness and stress and the ability to cope is influenced by personal and contextual factors

True

What are the 5 categories of coping strategies?

Behavioral

Avoidance

Cognitive

Emotions-focused

Problem-focused

What category of strategies requires an action to manage stress?

behavioral

Utilizing distractions or substances to cope is within what category?

Avoidance

What category of coping strategies analyzes the situation to understand the threat and then focuses on positive appraisal?

Cognitive

What category of coping uses strategies to reduce the source\* or fear and anxiety?

problem-focused

What category uses strategies to reduce the sense\* of anxiety or fear?

Emotions-focused

What theoretical framework for intervention helps clients to develop insight and understanding to facilitate adaptive behaviors?

Psychodynamic/ object relations

What theoretical framework for intervention includes importance of mental state, conscious/unconscious thoughts that effect behavior, and the use of symbols to aid in understanding and recall?

Psychodynamic/ object relations

What theoretical framework for intervention works well with those who need structure and do not require a change in thinking?

Behavioral

What theoretical framework for intervention assesses role of thoughts on emotions/behaviors and identifies maladaptive behaviors/thinking patterns to restructure them into adaptive thoughts and actions?

Cognitive-Behavioral