phys dis 1 exam

OT process

evaluation, intervention, outcomes

domains of OT

client factors, occupations, contexts, performance patterns, performance skills

modified ashworth measures

spasticity and hypertonicity

UMN damage leads to

weakness/paralysis, increased muscle tone, increased reflex strength and + babinski sign, muscle mass being maintained

coordination assessments

9-hole peg, purdue, minnesota

C in COAST

client

O in COAST

occupation

A in COAST

assist level

S in COAST

specific conditions

T in COAST

time bound

ADL activities

bathing/showering, toileting/toilet hygiene, dressing, swallowing/eating, functional mobility, personal device care, personal hygiene/grooming, sexual activity

procedure for assessing ADL

observation in environment and context, start with specific tasks then progress to more complex tasks, maintain privacy, standardized tests, non-standardized tests

standardized tests assessing ADL

klien-bell ADL scale, barthel index and modified barthel index, FIM, OASIS

FIM typical settings

hospital and acute care

OASIS typical settings

home health

home management

cleaning, laundry, heavy household activities, miscellaneous, shopping, financial management

meal prep

planning meals, preparing meals, serving meals, cleaning up food and utensils after meals

safety

recognizing hazards, having emergency response procedures in place

what IADLs are needed to return home alone

meal preparation/retrieval, safety/good judgement, medication management, get emergency aid

standardized tests for assessing IADLs

executive function performance test, performance assessment of self-care skills, COPM, lawton IADL scale, KELS

3 components taken into consideration when deciding what IADL to assess

social factors, environment, occupational profile

lower level visual processes

acuity, contrast sensitivity, visual field, visual attention/scanning, oculomotor function

visual acuity

ability to see visual detail

20/20

perfect vision

20/40

required to drive day/night in PA

20/200 or less

legally blind

contrast sensitivity

ability to see objects that are not outlined clearly or do not stand out from their background

how is contrast sensitivity evaluated

hamilton-veale CS chart

example of contrast sensitivity

impacts driving: white car in white snow storm

normal visual field

60 degrees up, 75 degrees down, 60 degrees toward center/nose, 100 degrees side

how do OTs test visual fields

simple tests and observations; static confrontation test & dynamic confrontation test

visual attention and scanning

the ability to observe objects closely and carefully; the ability to shift visual focus from one object to another

visual attention and scanning evaluations

cancellation x, line bisection, circle all of the "the" in an article

oculomotor function

the ability of the eye muscles to help the eyes move and focus

red flags that there is an oculomotor issue (questions to ask)

double vision, difficulty focusing, transitioning near to far, tracking objects

red flags that there is an oculomotor issues (observations)

eyelids, pupils, eye position, eye movement, convergence

perception is the gateway to cognition

senses + perception + cognitive processes = optimal functioning during occupations

agnosia

unable to recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses

visual agnosia

lesion in the parietal, occipital cortex or bilateral inferior occipitotemporal cortex

color agnosia

inability to recognize colors for common environmental objects

color agnosia lesion

left occipitotemporal region

prosopagnosia

inability to recognize and identify familiar faces

prosopagnosia lesion

inferior temporal cortex in the fusiform gyrus

simultagnosia

inability to recognize and interpret a visual array as a whole

simultagnosia lesion

left inferior occipital area

auditory agnosia

inability to recognize sounds despite intact hearing

auditory agnosia lesion

right side temporal

phonagnosia

inability to recognize familiar voices; they can recognize words

tactile agnosia

inability to recognize objects by touch; they can name objects by sight

anomia

language specific disturbance arising after brain damage whose main symptom is the inability of retrieving known words

color anomia

inability to name the color of an object

color anomia lesion

left occipital lesion

metamorphopsia

affects central vision and distorts the appearance of linear objects

mircopsia

objects appear smaller than they are

macropsia

objects appear larger than they are

figure ground

skill that allows client to perceive foreground from the background from a visual array

form constancy

recognition of various forms, shapes, and objects, regardless of their position, location or size

position in space

skills that allow a client to perceive the position of an object in relation to themselves

right-left discrimination

the ability to accurately use the concepts of right and left

steropsis

inability to perceive depth in relation to the self or various objects (depth perception)

stereognosis

skill that enables you to identify objects by touch only

graphesthesia

ability to recognize numbers, shapes, and letters written on the skin

body schema perception

the ability to perceive one's own body, shape, position, and capacity

apraxia

inability to plan and perform purposeful movements

ideational apraxia

using objects appropriately

ideomotor apraxia

carry out a motor act on a verbal command

dressing apraxia

plan motor actions required to get dressed

constructional apraxia

organize parts into a whole

mental functions are

affective, cognitive, perceptual

affective

referring to moods, feelings, and attitudes

cognitive

process of acquiring knowledge and understanding

perceptual

discrimination of senses

cognitive skills are

deficit awareness, attention, memory, executive function

lack of deficit awareness

lack of self-awareness, poor insight, anosognosia (physical only), denial (more psychological than cognitive)

non-impaired deficit awareness

ability to perceive the self in relatively objective terms while maintaining a sense of subjectivity

impaired deficit awareness

client does not seem to be aware of impaired functions that are obvious to the therapist or other individuals

three level model of self awareness fleming and strong

1. self awareness of injury related deficits themselves 2. awareness of the function implications of deficits for independent living 3. ability to set realistic goals

self awareness of injury related deficits themselves example

i have a weak left arm

awareness of the functional implications of deficits for independent living example

i will have trouble mowing my lawn

ability to set realistic goals example

i will need to hire someone to mow my lawn

attention prerequisite for

other cognitive skills

attention

being able to select and manipulate information briefly or for sustained periods

selective attention

choosing relevant information from irrelevant information (ignoring distractions)

sustained attention

attention over time (movie)

attentional switching

switching attention from one concept to another

divided attention

attending to 2 or more tasks at a time

distractability

inability to block out external or internal stimuli when concentrating (hunger)

field dependent behavior

distracted by items in your visual field that are irrelevant to the current activity

short term memory

storage of information for a limited amount of time

working memory

actively manipulating information that is in short term memory storage using short term memory

long term memory

permanent storage of information

episodic memory

autobiographical memory or personally experienced events

metamemory

awareness of your own memory abilities

executive functions

unbrella term that refers to complex cognitive processing.. requires the coordination of several sub-processes to achieve a particular goal

subprocesses of executive functions

initiation, organization, decision making, problem solving, planning, sequencing

standardized cognitive assessments: attention

paced auditory serial addition test, trail making test, moss attention rating scale, wisconsin card sorting task

standardized cognitive assessments: executive functions

the executive function performance test, the kettle test, clox 1 and 2

non standardized cognitive assessments

observe (during ADLs/leisure/other occupations), discover what the client is having trouble with (attention, memory, executive functions, deficit awareness), document # of verbal cues need for which cognitive skill

environment in OTPF4

physical and social