Occupational Therapy Strategies for Stroke, TBI, MS, Parkinson's, ALS, Alzheimer's, and SCI

What should an OTA ensure when training a patient with spasticity from a stroke in self-range of motion (SROM)?

Performs motions in a slow, controlled manner.

What are possible interventions for a stroke patient with a subluxed GH joint?

Taping of the shoulder, temporary use of sling during transfers or gait training, and proper handling techniques.

How can an OTA encourage the development of sense of movement in a stroke patient?

Instruct the individual to clasp hands together to lift the leg during LE dressing.

What should an OTA teach an individual with stroke who has significant paralysis on the dominant side during grooming?

Squeeze the toothpaste onto the toothbrush with the nondominant hand and use one-handed techniques.

What suggestion should an OTA make for a stroke patient with mild neglect?

Wear jewelry on the affected side.

What assistance should an OTA provide to a stroke patient having difficulty organizing and initiating the task of washing her face?

Step-by-step assistance.

What should an OTA plan for a stroke patient who is unaware of limitations and unreceptive to feedback?

Intervention that initially addresses caregiver training related to safety awareness.

How should an OTA structure treatment for a stroke patient to maximize carryover of new learning?

Structure treatment so that the individual performs tasks in various contexts.

What type of intervention would benefit a stroke patient with impaired attention?

Activities of high interest in a quiet environment.

What should an OTA do for a spouse of a stroke patient who is having difficulty adapting?

Provide resources and ask the spouse to participate in the therapy process.

What should an OTA provide to a stroke patient who repeatedly brushes his teeth during morning grooming?

Verbal and tactile cues.

What focus should an OTA have for a stroke patient who missed buttoning several buttons on a shirt?

Recognizing and correcting errors and checking quality.

What should an OTA plan for a stroke patient who attempts to put on a jacket before a blouse or bra?

Begin activities using simple short steps progressing to multiple steps.

What should an OTA provide for a stroke patient who has difficulty learning new concepts?

Simple explanations for doing things a certain way.

What intervention should an OTA provide for a stroke patient lacking insight related to deficits?

Nonthreatening information and training in real-life situations.

What should an OTA do for a stroke patient with cognitive deficits who becomes angry and refuses therapy?

Ask the family to provide information on previous behavior and prior coping methods.

What should an OTA explain to the family of a stroke patient experiencing uncontrolled emotional outbursts?

It is common with stroke, and the condition will likely improve with time.

What should an OTA do if they notice an individual pocketing food and having problems swallowing during a lunch group?

Notify the treatment team so a modified diet can be established and provide adequate supervision.

What instructions should an OTA provide for a stroke patient with edema in the affected hand living alone?

Elevating the extremity and AROM that involves reaching upward.

What should an OTA focus on when working with a stroke patient in an acute care setting?

Graded exercise, basic self-care, and preventing further complications.

What positioning techniques should an OTA emphasize for a restorative aide working with stroke patients?

Alternating between supine and side lying every 2-4 hours and trunk symmetry.

What should an OTA provide for an individual with stroke and global aphasia who responds to gestures?

A communication device to increase accuracy.

What should interventions for a TBI patient in an acute care setting focus on?

Tone normalization, purposeful activity, optimize positioning, graded self-care tasks.

What might a patient with severe spasticity require if they do not respond to positioning techniques?

Oral baclofen, injections of a neurotoxin (Botox), dynamic splinting or serial casting.

What should an OTA suggest for a TBI patient who is hypersensitive to noise?

Wearing ear plugs.

What should an OTA provide to the family of a TBI patient who has difficulty swallowing?

Education and training on dietary restrictions/guidelines.

What should an OTA provide to a disoriented TBI patient initially?

Basic information in a matter-of-fact tone.

What should an OTA provide for a TBI patient who cannot read words?

A cue sheet with pictures of the individual performing ADL.

What should an OTA do for a TBI patient who has difficulty with new learning?

Provide interventions with low expectations and grade the activity accordingly.

What should an OTA use when communicating with a TBI patient who has difficulty processing auditory information?

Visual cues.

What should an OTA plan for a TBI patient who becomes frustrated during treatment sessions?

Plan short, relevant, successful activities.

What areas should an OTA focus on for a TBI patient preparing for discharge to home?

Coping with challenges, awareness of TBI symptoms, improving problem-solving skills, developing a positive outlook.

What should an OTA do before moving a TBI patient from lying to sitting after extended bed rest?

Grade the program to prevent a drop in blood pressure.

What should an OTA do before moving a person with TBI from lying to sitting?

Grade the program to prevent a drop in blood pressure.

What should an OTA initially teach a family member of an individual with TBI?

Basic skills first and introduce complex skills later.

What should an OTA do for a TBI patient having problems swallowing?

Ask the OT to develop a dysphagia program with the SLP.

What cues should an OTA provide for a TBI patient who has difficulty initiating tasks?

Tactile cues, verbal cues, written cues.

What should an OTA ensure when teaching a TBI patient to move up and down in bed?

Make sure the bed is flat.

What activity can improve social behavior in a group treatment session for TBI?

Playing a board game.

Where should a TBI patient be referred after reaching maximum independence in a hospital?

A community reintegration program.

At what Rancho Los Amigos level does localized response begin to develop?

Level III: localized response: total assistance.

What level of cognitive function is characterized by confusion and inappropriate behavior?

Level V: confused-inappropriate, nonagitated: max assist.

What level of cognitive function is a patient at if they are oblivious to their mother's emotions?

Level VII: Automatic-Appropriate: Minimal assist for Daily living skills.

What level of cognitive function is indicated by a patient needing standby assist while sorting laundry?

Level IIX: purposeful and appropriate: standby assist on request.

What should an OTA focus on during a home evaluation for an individual with multiple sclerosis?

Fall prevention, adaptive devices, and simple modifications.

What should an OTA plan for an individual with MS regarding intervention?

Allow for variable and unpredictable changes in the individual's functional ability.

What should an OTA recommend for planning evening social activities for individuals with MS?

Planning events after adequate rest and limiting exercise for that day.

What should an OTA provide for an individual with MS feeling depressed due to role loss?

Emotional support and community resources.

What should an OTA stress in a home exercise program for an individual with MS?

Increasing repetitions rather than increasing weight.

How can an OTA assist an individual with MS who has visual loss in making a collage?

Placing photographs on a contrasting color cloth and using a magnifier.

What should an OTA provide to help an individual with MS apply energy conservation during cooking?

Repeated opportunities to practice the techniques.

What may benefit an individual with MS who experiences fatigue?

Wearing a cooling garment.

What should an OTA do for a patient with Parkinson's disease who stops while walking?

Use short, firm, auditory cues to initiate movements.

When should an OTA schedule treatment for a patient with Parkinson's disease taking medications?

During periods of optimal and nonoptimal drug response.

What should an OTA suggest for a patient with PD who has tremors during tea?

Propping the elbow on the table and keeping arms against the trunk.

What should an OTA recommend for a patient with PD who has difficulty putting on a shirt?

Ask the individual to purchase a shirt one size larger.

What should an OTA instruct a patient with PD who is fearful of falling while dressing?

Use adaptive equipment and sit while dressing.

What should an OTA use to help a patient with PD experiencing difficulty initiating movement?

Use rhythmic music and counting.

What should an OTA encourage for a patient with State 3 PD who prefers to lie in bed?

Encourage the individual to stand and reposition to prevent pressure sores.

What should an OTA develop for a patient with PD who has lost interest in social activities?

A schedule that includes social contacts and refer to a support group.

What should an OTA provide for an individual with ALS who has upper extremity weakness?

Adaptive equipment to carry objects and teach energy conservation techniques.

What should an OTA suggest for an individual with ALS who wants to continue exercising?

Exercise over several short periods throughout the day.

What should an OTA do for an individual with ALS who has lost the ability to speak?

Fabricate equipment and a switch to summon help.

What should an OTA consult about for a patient in later stages of ALS requiring a wheelchair?

Consider a reclining motorized wheelchair.

What information should be gathered first for a new ALS patient wanting to assist at home?

Durable medical equipment needs for ADL.

What should an OTA use to guide an individual with Alzheimer's disease who has difficulty sequencing tasks?

Task segmentation.

What should an OTA provide to a family of an Alzheimer's patient left alone during the day?

Information related to potential safety hazards.

What should activities in a day treatment setting for Alzheimer's patients focus on?

Music, simple games, and reminiscence.

What should an OTA do if an Alzheimer's patient becomes agitated during group therapy?

Redirect the individual in a calm voice.

What is the most effective behavioral intervention for an agitated Alzheimer's resident?

Move the treatment session to a quiet location, away from other residents.