Neurodegenerative Conditions Correct

Interest in social and leisure activities

For a client in the early stages of Parkinson’s disease, which area should the OTR® focus on FIRST when completing an occupational profile?

Guide the caregiver in assisting the client with ADLs

A client diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago is admitted to the hospital because of worsening mobility at home. Before the hospitalization, the client was independent with ADLs but required assistance for IADLs, including cooking, shopping, and home management. Which approach is MOST likely to be the priority for this client in the acute care setting?

The client should use safety bars and a shower chair.

A client with early-stage Huntington’s disease is displaying excessive involuntary movements. The client prefers to bathe in the shower. What recommendation would be appropriate to improve the client’s ability to bathe as independently as possible?

Creation of a first-floor setup and increased accessibility to a wheelchair or durable medical equipment

An OTR® is performing a home evaluation for a client with Stage III amyotrophic lateral sclerosis (ALS). The client lives in a two-story home with the bedroom on the second floor. On what will the OTR’s recommendations MOST LIKELY focus?

A bed alarm system

An OTR® in home health care is seeing a client in the middle stage of Alzheimer’s disease who lives with an adult daughter. The client likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client’s daughter is determined to have the client remain at home with her as long as possible. To prevent the client from getting out of bed unnoticed at night, what would the OTR MOST likely recommend?

-Assess environmental barriers present in the home

-Ask family about interventions family members have already implemented to maintain the client’s safety at night

-Ask the family about the client’s daily routine when the client is not attending the adult day care program

A client with middle-stage dementia lives with family and recently fell down the stairs while wandering in the middle of the night. The client was uninjured, but family members are concerned about the client’s safety. Locks have been installed on all the doors to prevent the client from leaving the home in the middle of the night. The client has been attending adult day care, but the center is allowing the client to sleep all day.

Question

What information about the client’s current occupational performance should the OTR® gather during the evaluation process? Select the 3 best choices.

-Install door alarms that will sound when the door is opened

-Ask the day care center to provide the client with structured activity during the day, including exercise and time outside, instead of letting the client sleep

-Establish a nighttime sleep hygiene routine  

A client with middle-stage dementia lives with family and recently fell down the stairs while wandering in the middle of the night. The client was uninjured, but family members are concerned about the client’s safety. Locks have been installed on all the doors to prevent the client from leaving the home in the middle of the night. The client has been attending adult day care, but the center is allowing the client to sleep all day.

Question

Family members have placed a baby monitor in the client’s bedroom so that they can listen for movement during the night. What other strategies can the OTR® suggest to ensure the client’s safety at night? Select the 3 best choices.

Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day.

A client with middle-stage dementia has maintained the ability to complete repetitive tasks common in middle adulthood. For example, if given a basket of socks, the client will reflexively fold them until the task is complete. Given this information, what recommendation would be appropriate for the OTR® to give caregivers?

Frontotemporal dementia

A client with a recent diagnosis of dementia is receiving occupational therapy. The caregivers are distressed about the client’s increasingly inappropriate and tactless behavior, and the client has become increasingly impulsive and difficult to redirect. What type of dementia does this client MOST LIKELY have?

Do grocery shopping in the morning.

As part of an intervention plan, a client with multiple sclerosis has had training in strategies to limit energy expenditure on meaningful activities. The client reports increased fatigue when grocery shopping in the afternoon. Which of the following items is a recognized energy management strategy to address this fatigue?

-Observe as the client performs ADLs

-Interview caregivers about the client’s ADL performance

-Interview caregivers about the client’s ADL performance

A client with middle-stage dementia lives with family and recently fell down the stairs while wandering in the middle of the night. The client was uninjured, but family members are concerned about the client’s safety. Locks have been installed on all the doors to prevent the client from leaving the home in the middle of the night. The client has been attending adult day care, but the center is allowing the client to sleep all day.

Question

Which assessment options will provide the most useful information to guide intervention for this client? Select the 3 best choices.

Change to lighter bedding to decrease resistance during bed mobility.

A client with Parkinson's disease complains of difficulty with bed mobility resulting in difficulty changing position during the night. Which environmental modification BEST addresses this client's difficulties with bed mobility?

External cues and repetition for resuming task completion

A client with Parkinson’s disease has difficulty initiating performance of ADLs. Which intervention is BEST for this client?

-Schedule a home evaluation

-Interview the client and complete an occupational profile

-Observe the client performing basic ADLs

An OTR® is evaluating a 60-year-old client with multiple sclerosis who has been referred to the occupational therapy clinic because of recent falls at home. The client’s spouse indicates that the client’s most recent falls have occurred in the evening while showering and when transferring to bed. The client reports difficulty paying attention during tasks and increasing lack of endurance but states that it is a priority to complete self-care activities independently and without using adaptive equipment.

Question

What are the MOST appropriate initial actions for the OTR® to take regarding this referral?

-Move the client’s shower to the morning

-Suggest trialing use of a tub bench during showering

-Incorporate physical activity and a multicomponent intervention for falls reduction

An OTR® is evaluating a 60-year-old client with multiple sclerosis who has been referred to the occupational therapy clinic because of recent falls at home. The client’s spouse indicates that the client’s most recent falls have occurred in the evening while showering and when transferring to bed. The client reports difficulty paying attention during tasks and increasing lack of endurance but states that it is a priority to complete self-care activities independently and without using adaptive equipment.

Question

The OTR® finds that the client’s fatigue is having a significant impact on safety during transfers and on the client’s ability to complete desired occupations. Which interventions should the OTR include as part of the intervention plan to INITIALLY address the client’s fatigue?

Cue cards or signs in key places

A client presents with decreased memory resulting from dementia. What is the MOST EFFECTIVE strategy for an OTR® to implement to intervene with this cognitive impairment?

Recommend that the caregiver contact a local adult day care to inquire about its services.

Which recommendation should an OTR® make to the caregiver of a client with dementia who is suffering from caregiver stress?

An OTR® wishes to prioritize the focus of intervention for a client with Guillain-Barré syndrome in the acute inflammatory phase. Which factors should the OTR evaluate?

An OTR® wishes to prioritize the focus of intervention for a client with Guillain-Barré syndrome in the acute inflammatory phase. Which factors should the OTR evaluate?

Continue with gentle stretching, and determine pain by asking clear questions that require a one- or two-word response.

An OTR® is evaluating a client with Stage 4 Parkinson’s disease (PD), who presents with cogwheel rigidity. During ROM and manual muscle testing, the client is mostly quiet with an occasional moan. What would be the BEST action for the OTR to take?

Recommend modified workouts that consist of endurance and light strengthening with education on how to prevent overexertion.

A client with early-stage amyotrophic lateral sclerosis (ALS) wants to remain physically active and continue to go to the local gym. Which action would the OTR® take?

Stating that assistance is needed to change position in bed

An OTR® is working with a client in the acute phase of Guillain-Barré syndrome. Which client action demonstrates the ability to direct care?

Using a poster to camouflage the back door and the door knob

An OTR® in home health care is seeing a client who has Stage III Alzheimer’s disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client’s daughter is determined to have the client remain at home with her as long as possible. The daughter has expressed fear that the client might fall down the stairs at the back door while wandering. To prevent the client from using the back door, what would the OTR MOST likely recommend?

Resting tremor, rigidity, oral motor deficits

A client in the late stage of Parkinson's disease presents for an occupational therapy evaluation. Which of the following symptoms can the OTR® expect to see?

-Provide information to the client and spouse about how they might benefit from further services in the future

-Provide the client with information about support groups and other community resources.

-Discontinue occupational therapy services

A client with early-stage Huntington’s disease (HD) has become increasingly frustrated by difficulty with self-feeding and self-care that requires fine motor control. The client wants to continue to perform all daily tasks with the least amount of assistance possible from caregivers. The client’s spouse states that the client is increasingly agitated with the support they provide.

Question

The client has responded well to intervention thus far. The client’s spouse has noticed less frustration during feeding and other fine motor tasks. Initial goals have been met. What should the OTR® do next? Select the 3 best choices

-Observe the client performing daily living skills

-Assess problem-solving skills

-Gather information for an occupational profile

A client with early-stage Huntington’s disease (HD) has become increasingly frustrated by difficulty with self-feeding and self-care that requires fine motor control. The client wants to continue to perform all daily tasks with the least amount of assistance possible from caregivers. The client’s spouse states that the client is increasingly agitated with the support they provide.

Question

During the evaluation process, how can the OTR® gather applicable information about this client’s current occupational performance? Select the 3 best choices.

-Assess emotional stability and determine other behavioral difficulties that might affect the client’s occupational performance

-Assess fine motor manipulation skills

-Assess strategies used to date for stress management and relaxation

A client with early-stage Huntington’s disease (HD) has become increasingly frustrated by difficulty with self-feeding and self-care that requires fine motor control. The client wants to continue to perform all daily tasks with the least amount of assistance possible from caregivers. The client’s spouse states that the client is increasingly agitated with the support they provide.

Question

The client demonstrates chorea that seems to increase while attempting to complete fine motor tasks. It gets worse as the client’s frustration level increases and decreases once at rest. The client reports frequently dropping items, which sometimes break. What additional information might the OTR® gather from this client? Select the 3 best choices

-Train the client in a home exercise program to address flexibility and endurance

-Recommend that the client use unbreakable dinnerware and avoid placing items on high shelves

-Instruct the client in energy conservation and self-management techniques to incorporate into daily routine

A client with early-stage Huntington’s disease (HD) has become increasingly frustrated by difficulty with self-feeding and self-care that requires fine motor control. The client wants to continue to perform all daily tasks with the least amount of assistance possible from caregivers. The client’s spouse states that the client is increasingly agitated with the support they provide.

Question

What interventions would be MOST appropriate to reduce the impact of motor disability on occupational performance? Select the 3 best choices. 

Caregiver assistance with ADLs

An OTR® is working with a client with Stage III amyotrophic lateral sclerosis (ALS). Which strategy is BEST to help this client maintain the current level of participation in daily activities?

-Perform a home safety assessment

-Perform ROM testing

-Perform a dysphagia screen

A home-based OTR® receives a physician’s order to evaluate and treat a client whose amyotrophic lateral sclerosis (ALS) with lower motor neuron symptoms has caused the client to stop working and attending college and to move back in with the client’s parents. The OTR meets with the client and the parents in their two-story home. The client’s father states that he carries the client up the stairs and is happy to do so. The family states that the client is also receiving speech therapy services related to swallowing problems. The client feels like a burden to the parents and does not like asking for assistance.

Question

Which steps should the OTR include in the evaluation? Select the 3 best choices.

-Educate the family on local and online caregiver support groups

-Validate the stress of both the caregivers and the care recipient and provide coping strategies

-Ask the client about a leisure activity that he and his parents like to engage in

A home-based OTR® receives a physician’s order to evaluate and treat a client whose amyotrophic lateral sclerosis (ALS) with lower motor neuron symptoms has caused the client to stop working and attending college and to move back in with the client’s parents. The OTR meets with the client and the parents in their two-story home. The client’s father states that he carries the client up the stairs and is happy to do so. The family states that the client is also receiving speech therapy services related to swallowing problems. The client feels like a burden to the parents and does not like asking for assistance.

Question

The OTR® arrives at the client’s home for a subsequent visit, and the parents exhibit symptoms of caregiver burnout. The client notices it and is very quiet during the session. Which intervention strategies are MOST appropriate for this session? Select the 3 best choices.

-Provide instruction in comfort care, including positioning, splinting, and skin integrity

-Suggest environmental modifications to provide relaxing and familiar stimuli

-Review daily routine and caregiver strategies 

A home-based OTR® receives a physician’s order to evaluate and treat a client whose amyotrophic lateral sclerosis (ALS) with lower motor neuron symptoms has caused the client to stop working and attending college and to move back in with the client’s parents. The OTR meets with the client and the parents in their two-story home. The client’s father states that he carries the client up the stairs and is happy to do so. The family states that the client is also receiving speech therapy services related to swallowing problems. The client feels like a burden to the parents and does not like asking for assistance.

Question

The client is rapidly deteriorating and becomes short of breath during all movements, including passive. A  ventilator is now required to assist with breathing. The family is considering in-home hospice. Which interventions will MOST likely make up the OTR®’s final occupational therapy sessions? Select the 3 best choices.

-Interview the client and complete an occupational profile

-Interview the client using the Modified Fatigue Impact Scale

-Assess functional fine motor skills by having the client perform the self-care task of

A home-based OTR® receives a referral to evaluate and treat a client whose home physical therapist has recommended occupational therapy services because of impaired ADLs. The client has secondary progressive multiple sclerosis (MS) with relapses. The OTR meets with the client and the client’s partner in their fourth-floor apartment. The client no longer cooks and wishes to focus therapy on basic ADLs. The client worked full time as a paralegal, was in a bowling league, and was totally independent before diagnosis. The client tells the OTR, “I haven’t been the same. Since I left my job, I feel like I’ve lost a part of myself.” Additionally, the client and partner state that they prefer to manage all needs without outside assistance.

Question

Which steps should the OTR include in the evaluation? Select the 3 best choices.

-Collaborate with the client to simplify steps in required daily activities 

-Recommend use of and training with adaptive equipment and strategies for bathing, toileting, and dressing.

-Provide the client with energy conservation and fatigue management strategies during self-care and household mobility

A home-based OTR® receives a referral to evaluate and treat a client whose home physical therapist has recommended occupational therapy services because of impaired ADLs. The client has secondary progressive multiple sclerosis (MS) with relapses. The OTR meets with the client and the client’s partner in their fourth-floor apartment. The client no longer cooks and wishes to focus therapy on basic ADLs. The client worked full time as a paralegal, was in a bowling league, and was totally independent before diagnosis. The client tells the OTR, “I haven’t been the same. Since I left my job, I feel like I’ve lost a part of myself.” Additionally, the client and partner state that they prefer to manage all needs without outside assistance.

Question

Evaluation results show impaired strength in the bilateral lower extremities, impaired dynamic balance, spasticity and tremors in the bilateral upper extremities, fatigue, and depression. The OTR® learns that the client’s goals are to bathe and dress with setup assistance; to be able to get on and off the commode; and to walk with a cane, not a walker. The client’s partner is retired and in good health and is able to provide assistance. Which interventions are MOST appropriate to address these client-centered goals? Select the 3 best choices.

-Review coping strategies to help deal with the stress of a relapse

-Educate the client and partner on how to prevent skin breakdown

-Ensure accessibility of frequently used items, such as cell phone, glasses, and remote control

A home-based OTR® receives a referral to evaluate and treat a client whose home physical therapist has recommended occupational therapy services because of impaired ADLs. The client has secondary progressive multiple sclerosis (MS) with relapses. The OTR meets with the client and the client’s partner in their fourth-floor apartment. The client no longer cooks and wishes to focus therapy on basic ADLs. The client worked full time as a paralegal, was in a bowling league, and was totally independent before diagnosis. The client tells the OTR, “I haven’t been the same. Since I left my job, I feel like I’ve lost a part of myself.” Additionally, the client and partner state that they prefer to manage all needs without outside assistance.

Question

The OTR® arrives at the client’s home for a subsequent visit to learn that the client has relapsed. The client is lying in bed and complains of exhaustion, numbness and tingling in the hands, painful spasticity when trying to move, and bladder incontinence. The client and partner say that when the client tried to stand, spasticity of the trunk and lower extremities nearly led to a fall. The client is tearful and emotionally labile. Which intervention strategies are MOST appropriate for this session? Select the 3 best choices.

-Ensure carryover of how to do gentle ROM exercises and stretching to prevent contractures

-Recommend environmental modifications to ensure safety during all mobility and self-care

-Review appropriate bed positioning to maximize occupational performance, protect skin and safe transfer techniques to avoid falls or injury.

A home-based OTR® receives a referral to evaluate and treat a client whose home physical therapist has recommended occupational therapy services because of impaired ADLs. The client has secondary progressive multiple sclerosis (MS) with relapses. The OTR meets with the client and the client’s partner in their fourth-floor apartment. The client no longer cooks and wishes to focus therapy on basic ADLs. The client worked full time as a paralegal, was in a bowling league, and was totally independent before diagnosis. The client tells the OTR, “I haven’t been the same. Since I left my job, I feel like I’ve lost a part of myself.” Additionally, the client and partner state that they prefer to manage all needs without outside assistance.

Question

The client has not made many gains since the beginning of this relapse and has reached a new functional level of minimal to moderate assistance for all ADLs and mobility tasks, and the client’s safety deficits and impaired balance put the client at high risk of falling. Which interventions should make up the OTR’s final occupational therapy session? Select the 3 best choices.

Middle stage

At what stage of Alzheimer's disease (AD) will procedural memory impairments FIRST be noticed?

That the client maintain at least 90° of hip flexion on a shower chair

A client with multiple sclerosis (MS) presents with balance deficits and impaired lower body ADLs resulting from increased spasticity in the bilateral lower extremities. The OTR® wants to promote safety during bathing tasks. What might the OTR FIRST suggest?

The client's steps are small and rapid.

An OTR® is reviewing the medical chart of a client who has Parkinson's disease. The neurologist has indicated that the client has a festinating gait. What does the client's gait look like?

Declines in judgment of distance, direction, and ground surfaces may increase risk of falls.

Why should fall prevention strategies be implemented with clients with middle-stage dementia?

Creation of a first-floor setup and increased accessibility to a wheelchair or durable medical equipment

An OTR® is performing a home evaluation for a client with Stage III amyotrophic lateral sclerosis (ALS). The client lives in a two-story home with the bedroom on the second floor. On what will the OTR’s recommendations MOST LIKELY focus?

Provide appropriate arm support using a sling or wheelchair device

A client with amyotrophic lateral sclerosis requires significant assistance with ADLs because of limited upper extremity function and fatigue. The client reports an increase in shoulder pain, and the OTR® observes edema in the hand. The client uses a wheelchair, and during the occupational therapy evaluation the OTR observes the client’s arm hanging at the side of the wheelchair. Which intervention is BEST to address the shoulder pain and hand edema?

Schedule bathroom visits based on the client’s behavior.

A client with middle-stage dementia is starting to wander when needing to use the bathroom, which is creating strain for the caregiver. What is the BEST recommendation the OTR® can give the caregiver to assist the client with this task?

External cues and repetition for resuming task completion

A client with Parkinson’s disease has difficulty initiating performance of ADLs. Which intervention is BEST for this client?

Interview the spouse and caregivers to update the client’s occupational profile.

A client with middle-stage Alzheimer’s disease (AD) in a long-term care facility presents with new behavioral concerns. The client’s spouse expresses concerns to the staff, and the OTR® is asked to evaluate the client and make recommendations. The OTR observes the client during routine activities in the facility. What should the OTR do next?

Do grocery shopping in the morning.

As part of an intervention plan, a client with multiple sclerosis has had training in strategies to limit energy expenditure on meaningful activities. The client reports increased fatigue when grocery shopping in the afternoon. Which of the following items is a recognized energy management strategy to address this fatigue?

Purdue Pegboard test

A client with amyotrophic lateral sclerosis reports functional limitations when completing his daily routine. The OTR® has completed ADL and IADL assessments as part of the evaluation and is considering how the client's upper-extremity motor control is affecting his functional ability. Which assessment would be MOST effective for assessing this client's upper-extremity ability?

Modification of clothing with minimal fasteners or hook-and-loop closures to reduce fine motor control demands

A client with middle-stage Parkinson’s disease demonstrates tremor and rigidity bilaterally in upper extremities, mild difficulties with executive functioning, and increased fatigue during ADL and IADL performance. Which is the BEST occupational therapy intervention to address the client’s fine motor control? 

Develop strategies to simplify familiar tasks

To facilitate independence in familiar daily living tasks by clients with dementia, what would be an appropriate INITIAL stage of intervention?

-Observe the client performing routine ADL and IADL tasks in the home environment

-Interview family members about concerns related to the client’s safety in the home environment

-Assess the home for any blatant environmental safety hazards. 

A client with early-stage dementia resides alone in the community. Family members, who visit the client frequently and drive the client to health care appointments, are becoming concerned about the client’s safety at home. The client does not drive and uses rideshare apps for community mobility when the family cannot provide transportation. The client enjoys cooking, especially baking cookies; playing card games online; and growing vegetables in a small garden. 

Question

The OTR® receives a referral from a home health agency to evaluate this client. What information about the client’s current occupational performance should the OTR gather during the evaluation process? Select the 3 best choices.

Pain, fatigue, swallowing problems

An OTR® wishes to prioritize the focus of intervention for a client with Guillain-Barré syndrome in the acute inflammatory phase. Which factors should the OTR evaluate?

A client who is confused by simple directions and recall of recent events.

Which of the following clients is MOST likely to be a person in the middle stage of Alzheimer's disease?

-Explore the client’s money management abilities

-Assess meal preparation skills

-Assess the home for signs of neglect 

A client with early-stage dementia resides alone in the community. Family members, who visit the client frequently and drive the client to health care appointments, are becoming concerned about the client’s safety at home. The client does not drive and uses rideshare apps for community mobility when the family cannot provide transportation. The client enjoys cooking, especially baking cookies; playing card games online; and growing vegetables in a small garden. 

Question

From the OTR®’s initial observations, the client appears to continue to complete dressing, bathing, and grooming independently with no safety concerns. The client is independent in routine ADLs. On the basis of the family’s initial concerns, the OTR determines that IADLs may be impaired and decides to assess specific IADLs. What areas of assessment would the OTR address next? Select the 3 best choices.

-Provide education to family members on supervision and the progression of dementia

-Train the client to use visual and auditory reminders in the kitchen that remind the client to turn off the stove when the client is done cooking

-Assess other safety concerns in the kitchen, such as use of hot water, knives and sharp objects, and presence of throw rugs

A client with early-stage dementia resides alone in the community. Family members, who visit the client frequently and drive the client to health care appointments, are becoming concerned about the client’s safety at home. The client does not drive and uses rideshare apps for community mobility when the family cannot provide transportation. The client enjoys cooking, especially baking cookies; playing card games online; and growing vegetables in a small garden. 

Question

The OTR® discovers that the client routinely forgets to turn off the stove when cooking. Which recommendations are appropriate? Select the 3 best choices.

-Provide the family with education about how to offer appropriate support

-Provide environmental supports, such as appropriately placed visual cues, that the client can use to maintain independence

-Work with the family to schedule daily visits during times that are best for the client and naturally fit with the existing daily routine. 

A client with early-stage dementia resides alone in the community. Family members, who visit the client frequently and drive the client to health care appointments, are becoming concerned about the client’s safety at home. The client does not drive and uses rideshare apps for community mobility when the family cannot provide transportation. The client enjoys cooking, especially baking cookies; playing card games online; and growing vegetables in a small garden. 

Question

The client’s family has decided to provide daily supervisory visits to the client. Which strategies can the OTR® recommend to decrease the client’s frustration with declining abilities in daily living tasks? Select the 3 best choices.

Maintain functional capacity.

What is a primary goal in treating clients with dementia?

Complete one task at a time and avoid multitasking

A client with multiple sclerosis (MS) reports decreased ability to pay attention to daily work-related tasks, including keeping track of documents and phone calls. Which strategy is the MOST appropriate for this client?

Break the task into manageable steps and provide them one by one to the client.

A client with dementia presents with decreased attention. What is the most effective strategy for an OTR® to implement to assist with this cognitive impairment?

Late stage

At what stage of Alzheimer's disease (AD) does nerve cell damage cause significant motor impairments that limit the ability to complete life tasks?

Support the arms and trunk against the table

The OTR® observes as a client with multiple sclerosis (MS) demonstrates ataxia in the upper extremities when reaching for an item on the table. Which intervention is BEST to modify tabletop activities to control ataxia in task performance?

Community mobility

A client with early-stage Alzheimer’s disease has increased difficulty with wayfinding. Which occupational performance area does this difficulty most likely affect?

Recommend modified workouts that consist of endurance and light strengthening with education on how to prevent overexertion.

A client with early-stage amyotrophic lateral sclerosis (ALS) wants to remain physically active and continue to go to the local gym. Which action would the OTR® take?

Energy conservation strategies

A client with multiple sclerosis indicates in the occupational profile that cleaning the home is an important IADL. The client has good balance and fair plus (3+/5) upper-extremity strength, is independent with self-care using adaptive equipment, and needs stand-by assistance for showering due to lack of endurance. The client easily becomes fatigued when cleaning. Which intervention is MOST important to include in the intervention plan?

Modalities, devices, and techniques to prepare the client for occupational performance

State laws vary with regard to use of physical agent modalities (PAMs) by OTRs. When explaining how PAMs fit within the scope of occupational therapy practice in their state, which description of PAMs should OTRs use, provided in the Occupational Therapy Practice Framework: Domain and Process?

-Assess the student’s feelings about and abilities relative to the trip

-Learn about the trip destination and the accessibility of the environment

-Observe the student moving around the school and outdoor environment to assess mobility skills

A teacher asks an OTR® working in a middle school to consult with an 11-year-old student who has cerebral palsy. The student’s class is going on a field trip to a historic site, and the family is worried about how the student will manage the distances and terrain using forearm crutches. Occupational therapy is not currently included in the student’s IEP. 

Question

Which steps are appropriate for the OTR® to take first? Select the 3 best choice

-Consult with the school physical therapist about safety tips for crutch walking on loose gravel surfaces 

-Collaborate with the student and parents to identify possible solutions to the few barriers identified at the site

-Assess the student’s willingness to use a wheelchair for the trail if necessary

A teacher asks an OTR® working in a middle school to consult with an 11-year-old student who has cerebral palsy. The student’s class is going on a field trip to a historic site, and the family is worried about how the student will manage the distances and terrain using forearm crutches. Occupational therapy is not currently included in the student’s IEP. 

Question

The OTR® researches the trip destination, a historic village re-creation, and learns that it has wooden plank sidewalks throughout the area and elevators in buildings that have stairs. Students will walk a short, quarter-mile walking trail with sand and small gravel to a picnic area and will carry their lunches to the location. The site has a manual wheelchair available to visitors. The OTR’s observations show that the student is adept at moving quickly using the forearm crutches along concrete sidewalks and in firm grassy areas. The student is more tentative on gravel surfaces and tires easily on full flights of stairs. The OTR meets with the teacher and student to discuss the results of the research about the destination site. What next steps are appropriate? Select the 3 best choices.

-The student will identify a friend willing to push the wheelchair if needed; the OTR will train the student and friend in safe wheelchair management on rough terrain. 

-The OTR will help the student practice carrying the equivalent weight of the lunch in a backpack before the trip.

-The OTR will address all strategies initially identified and then consult with the student and parents to determine whether they feel ready for the trip or have any additional concerns.

A teacher asks an OTR® working in a middle school to consult with an 11-year-old student who has cerebral palsy. The student’s class is going on a field trip to a historic site, and the family is worried about how the student will manage the distances and terrain using forearm crutches. Occupational therapy is not currently included in the student’s IEP. 

Question

The OTR® talks with the student, parents, and teacher. The student does not like being pushed in a wheelchair, especially on rough ground, but is willing to use one if necessary to keep up with peers. The OTR creates a plan to prepare the student for the field trip. What elements might this plan appropriately include? Select the 3 best choices.

-Check in with the student and teacher to ask for their assessment of how things went on the trip

-Document the consultation and close the case

-Thank the teacher for the referral and for collaborating in this case

A teacher asks an OTR® working in a middle school to consult with an 11-year-old student who has cerebral palsy. The student’s class is going on a field trip to a historic site, and the family is worried about how the student will manage the distances and terrain using forearm crutches. Occupational therapy is not currently included in the student’s IEP. 

Question

The student participates in the field trip and returns to school the following day. What actions should the OTR® take to close this case? Select the 3 best choices.

Motor skills

An OTR® is evaluating the occupational performance of a client newly diagnosed with Parkinson’s disease (PD). With respect to activities of daily living (ADLs), which performance skills are MOST relevant to assess?

Contextual and environmental factors that support the client's ability to adapt to the diagnosis

An OTR® is completing an initial evaluation with a client who has relapsing and remitting multiple sclerosis. Sensorimotor skills assessment indicates that the client's daily activities are limited by low endurance and decreased upper-extremity coordination. In addition, the client has been unable to remain in a job as a clerical worker. What additional information is MOST important to gather before developing an intervention plan?

Reduce the need for fine motor skills by eliminating clothing fasteners 

An OTR® observes that a client with Stage III Parkinson’s disease has fine motor difficulties when dressing. Which strategy is BEST for improving performance in dressing?

Aquatic fitness classes to reduce the effects of weakness while promoting gentle exercise

An OTR® and a client with multiple sclerosis (MS) collaborate to set client-centered goals; the client expresses interest in starting an exercise program but states that weakness and fatigue are barriers. What program should the OTR recommend FIRST?

Recommend that the spouse use simple verbal instructions

A client with Parkinson’s disease is experiencing difficulty in executive functioning. The client’s spouse would like the client to continue participating in leisure activities. Which intervention would be the MOST appropriate for this client?

Safety and emergency maintenance

An OTR® has received a referral to evaluate a client with dementia who lives alone in the community and is otherwise healthy. When the OTR arrives at the client’s home, the OTR notices that the client is well groomed but appears to have forgotten that the OTR had called earlier in the day to set up the appointment. Which area of occupation would be a priority to assess during the initial occupational therapy assessment?

Balancing a checkbook

Which task might a person with early-stage dementia have difficulty performing, in light of typical psychosocial and cognitive abilities present during this stage?

-Interview nursing staff regarding their concerns about the client

-Observe the client performing ADLs during the morning care routine

-Find out what clothing the client has available in the LTC setting

A client with middle-stage dementia resides in a long-term care (LTC) facility. Staff are having increased difficulty helping the client with morning care routines.

Question

What information about this client’s current occupational performance should the OTR® gather during the evaluation process? Select the 3 best choices.

-Determine which staff are present over the weekend

-Inquire what type of clothing is provided to the client to wear over the weekend

-Ask staff whether a different morning routine is followed on the weekend

A client with middle-stage dementia resides in a long-term care (LTC) facility. Staff are having increased difficulty helping the client with morning care routines.

Question

During the assessment process, the OTR® discovers that the client is least likely to complete the morning care routine on weekends. What might the OTR want to discover to target intervention and recommendations for this client? Select the 3 best choices

Canadian Occupational Performance Measure

An OTR® conducting an analysis of occupational performance of a client with multiple sclerosis needs to choose an assessment that allows consideration of the client’s self-perception of abilities. Which assessment would BEST be able to capture this information?

Observe the client for signs of dizziness, which increases potential for falls.

The caregiver of a client with Alzheimer's disease questions the home health OTR® about a recent increase in the client's dosage of donepezil (Aricept) prescribed by the physician. The caregiver is particularly concerned about potential consequences of the increased dosage. What is the OTR®'s most appropriate suggestion for the caregiver?

Suggest appropriate activities that can engage the client during unoccupied time and improve daily structure.

Which suggestion that an OTR® might provide to a caregiver who is living with a client who has Alzheimer's disease (AD) is the BEST?

A photograph of the client labeled with the client’s first name

What is an effective strategy to improve the ability of a client with dementia to find the client’s bedroom in a long-term care facility?

Managing finances

What skills might a client with middle-stage dementia have difficulty performing on the basis of typical psychosocial or cognitive abilities present during this stage of dementia?

Increased irritability

Which symptom might a client with early-stage dementia demonstrate?

The OTR should encourage the client to take frequent breaks during lower body ADL tasks.

A client with middle-stage Huntington's disease (HD) is displaying fatigue during lower body dressing tasks. What would be an appropriate intervention strategy for the OTR® to use with this client?

Instruct the caregiver in ways to assist the client’s participation in activities

A client with Parkinson’s disease has experienced a significant decrease in participation in activities in the home. The OTR® finds that this decrease in activity is related to the client’s postural instability and the caregiver’s fear that the client will fall. Which intervention is BEST to restore this client’s participation in home activities?

Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions.

What is an effective strategy to facilitate maximal independence in self-feeding with a client who has middle- to late-stage dementia and does not initiate feeding?

Break the task into manageable steps and provide verbal or visual cueing.

What is an effective way to assist a client who has early- to middle-stage dementia with a complex task?

Instruct the client in energy conservation and fatigue management strategies

An OTR® is working with a client with Guillain-Barré syndrome who is in the recovery phase. Which intervention BEST addresses the needs of the client in this phase?

Late

A client is able to say only "yes," "no," or "hello." This client is also incontinent of bladder and bowel and is unable to walk. In which stage of Alzheimer's disease (AD) is this client?

Sensation

An OTR® is evaluating a client with Guillain-Barré syndrome in a hospital setting. Which client factor should the OTR assess FIRST?

"It sounds like you're a little worried about that. You're already finished with high school. You don't have to go back."

An OTR® is approached by a client with Alzheimer's dementia who asks, "Do I finish high school next year, or am I already finished? I don't want to go back." What is the BEST response for the OTR® to make?

-Ask the family to bring in familiar grooming and hygiene supplies

-Address decreased endurance in therapeutic sessions and write a goal for this deficit area

-Develop a daily routine and schedule with other team members 

A client with dementia has been admitted to a skilled nursing facility as a result of a decline in functional status after a case of pneumonia. The admitting physician has ordered occupational therapy.

Question

The OTR® approaches the client later in the day, and the client is less agitated. The OTR is able to observe the client completing the evening grooming and hygiene routine, but the client has to take frequent breaks because of decreased endurance. The OTR completes the Allen Cognitive Level (ACL) Screen with this client and establishes that the client is at Mode 4.4. What interventions would the OTR prioritize? Select the 3 best choices.

-Recommend that the client be discharged home with someone who will stay with the client and provide a daily check on the environment and remove any safety hazards 

-Recommend that the client move to assisted living

-Provide the family with community resources for caregivers 

A client with dementia has been admitted to a skilled nursing facility as a result of a decline in functional status after a case of pneumonia. The admitting physician has ordered occupational therapy.

Question

The client has been in the skilled nursing facility for 4 weeks, and the team is discussing discharge planning with the client and family. What might the OTR® recommend for this client? Select the 3 best choices.

Perform cognitively demanding tasks in a setting with minimal distractions.

An OTR® is providing training in cognitive compensation strategies for a client with multiple sclerosis. Which of the following modifications would facilitate cognitive function?

A slide bolt lock high on the front door and back door

An OTR® in home health care is seeing a client who has Stage III Alzheimer's disease. The client lives with an adult daughter and likes to wander around the house; the client has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances and a fenced backyard. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client’s daughter is determined to have the client remain at home with her as long as possible. To provide a defined, safe environment for the client to wander in the house, what will the OTR MOST likely recommend?

Cover the doorknobs with cloth the same color as the doors so that the client cannot locate and open them easily.

A client with middle-stage dementia has been wandering outside the house in the middle of the night. The client’s caregivers have been using monitoring devices and recently added door alarms, but by the time someone can attend to the client’s wandering, the client is usually at the neighbor’s driveway. The weather has become colder, and the family is concerned that the client will get frostbite if the client wanders outside again. What would be the OTR®’s next appropriate recommendation?

Provide the client with a basket of socks at a set time each day, determined by the client's arousal level, to give structure to the client's day.

A client with middle-stage dementia has maintained the ability to complete repetitive tasks common in middle adulthood. For example, if given a basket of socks, the client will reflexively fold them until the task is complete. Given this information, what recommendation would be appropriate for the OTR® to give caregivers?

Yellow contrasting tape on the edge of each step

An OTR® in home health care is seeing a client who has Stage III Alzheimer’s disease. The client lives with an adult daughter and likes to wander around the house and has fallen twice in the middle of the night. The house is a single-level home with both front and back entrances. It has five steps at the back door leading to the garage, with railings on both sides, and has no step at the front entrance. The client’s daughter is determined to have the client remain at home with her as long as possible. The client requires close supervision on the stairs and seems to be very fearful when putting the foot down on each step. To further ensure the client’s safety in getting up and down the stairs at the back door, what would the OTR MOST likely recommend?

-Instruct the family in proper body mechanics during all functional transfers and mobility and have them demonstrate what they have learned

-Educate the family on fall prevention and safety with rolling walkers during self-care

-Ask the client and family about anticipated barriers to safety at home

An OTR® working on an inpatient rehabilitation unit receives a physician order to evaluate and treat an 80-year-old client with Stage IV Parkinson’s disease (PD) who sustained a fall at home. Hospital records indicate no acute injuries, but the client’s urinalysis was positive for a urinary tract infection and a course of antibiotics was started. Family members are present during the initial evaluation session, and they note that someone is usually home with the client because of impaired balance and decreased safety awareness. They describe the client’s home as having a first-floor hospital bed and commode, which the client uses at night. The first-floor bathroom toilet has a raised toilet seat and grab bars. The client uses a rolling walker but goes upstairs twice a week to shower. Before admission, the client received total care for IADLs but was independent with feeding, grooming, bed mobility, and toileting. The client requires a contact guard for walking with a rolling walker. Because of deconditioning and weakness, the client has not been participating in feeding and grooming or getting out of bed.

Question

The client is approaching functional baseline, and the rehabilitation team is preparing for discharge. The family, who have been supportive in the plan of care thus far, have scheduled caregiver training with the client. Which activities would be appropriate for the OTR® to include in this training? Select the 3 best choices.

Consistent use of rocking forward and backward each time the client needs to stand

A client with Parkinson’s disease is experiencing akinesia and reports decreased ability to move from sitting to standing. What strategy should the OTR® recommend?