Placement 3 prep

Subjective assessment

Subjective assessment

• Definition: Gathering information about the client's feelings, perceptions, and experiences regarding their condition or occupation-related issues.

• Purpose: Understand the client's perspective, emotions, and goals to tailor interventions effectively.

• Example: Asking a client about their pain levels, daily routines, and challenges they face due to their condition.

Objective Assessment:

• Definition: Collecting measurable and observable data through tests, measurements, and observations.

• Purpose: Obtain quantifiable information about the client's physical abilities and limitations.

• Example: Measuring range of motion, strength, or endurance through standardized assessments.

Basic Respiratory Assessment/Treatment:

• Assessment: Evaluating a client's respiratory function, identifying any difficulties or abnormalities in breathing.

• Treatment: Interventions aimed at improving respiratory function and promoting lung health.

• Example: Teaching breathing exercises, postural techniques, and energy conservation strategies.

.SOAP Documentation:

• Assessment: Analyzing the information to make clinical judgments about the client's condition and progress.

• Recording the client's reported information, such as symptoms, concerns, and goals.

Objective

Documenting measurable data obtained from assessments and observations.

.Assessment:

.Analyzing the information to make clinical judgments about the client's condition and progress.

.Plan

Outlining the interventions, goals, and strategies for the client's ongoing care.

Procedural Reasoning:

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• Definition: Planning and selecting interventions based on knowledge of treatment techniques and their effectiveness.

• Example: Choosing specific upper limb exercises to improve fine motor skills in a stroke patient.

Interactive Reasoning:

• Definition: Collaborating with the client to understand their needs, preferences, and goals.

• Example: Discussing with a stroke patient their desired level of independence in activities of daily living (ADLs) post-discharge.

Conditional Reasoning:

• Definition: Considering how contextual factors and environment influence a client's performance and participation.

• Example: Evaluating the stroke patient's home environment to recommend modifications that enhance safety and accessibility.

.Pragmatic Reasoning:

• Definition: Integrating practical aspects such as reimbursement, resources, and time constraints into decision-making.

• Example: Selecting assistive devices for the stroke patient based on insurance coverage and availability.

Narrative Reasoning:

• Definition: Understanding the client's story, values, and life experiences to guide intervention planning.

• Example: Learning about a stroke patient's hobbies and interests to incorporate meaningful activities into their therapy plan.

Diagnostic Reasoning:

• Definition: Analyzing assessment data to identify the client's condition, impairments, and potential barriers.

• Example: Identifying muscle weakness and sensory deficits in the stroke patient's affected arm through thorough assessment.

Scientific Reasoning:

• Definition: Applying research evidence and scientific principles to support intervention choices.

• Example: Using studies to determine the most effective interventions for improving gait in stroke patients.

Ethical Reasoning:

• Definition: Considering ethical dilemmas and making decisions that respect the client's autonomy, confidentiality, and well-being.

• Example: Balancing the stroke patient's right to make decisions about their treatment with safety concerns.

Conditional Reasoning:

• Definition: Forecasting the potential outcomes of different interventions and making decisions based on likely results.

• Example: Predicting how a stroke patient's balance and mobility may improve with intensive therapy versus a slower-paced approach.

SWOT analysis

.Strengths (S):

• Clinical knowledge gained during studies.

• Strong communication skills for patient interactions.

• Ability to adapt to fast-paced acute care environment.

• Experience in using various assessment tools.

Weaknesses (W):

• Limited experience in acute stroke settings.

• Less exposure to complex stroke cases.

• May need more familiarity with specific hospital protocols.

Opportunities (O):

• Learning from experienced therapists in the acute stroke unit.

• Exposure to diverse stroke cases for skill enhancement.

• Opportunities to observe and participate in interdisciplinary teamwork.

Threats (T):

• High-pressure environment may impact decision-making.

• Limited time for in-depth assessment and intervention.

• Possibility of encountering emotionally challenging situations.

1. Understanding Hemiplegia in Acute Stroke: ( Steps to follow)

• Hemiplegia: paralysis on one side from stroke damage.

• Rapid intervention by OTs to minimize deficits.

2. Assessment in Acute Stroke: (Steps to follow)

• Quick assessment of motor, sensory, cognitive issues.

• Collaborate with medical team for brain damage insight.

• Prioritize safety and basic self-care needs.

3. Early Mobilization and Functional Training: (Steps to follow)

• Passive/active exercises for range of motion.

• Prevent contractures with bed mobility techniques.

• Focus on sitting, bed transfers in acute care.

4. Task-Specific Training: (Steps to follow)

• Replicate vital daily tasks for independence.

• Grasping, reaching, self-feeding for motor skills.

• Problem-solving tasks to address cognition.

..5 Adaptive Equipment and Aids: (Steps to follow)

• Temporary tools for self-care facilitation.

• Modified utensils, grooming aids, dressing tools.

• Train patients for effective tool use.

..6 Psychosocial Support and Coping: (Steps to follow)

• Address emotional challenges post-stroke.

• Therapeutic communication for anxiety, depression.

• Stress management, social interaction promotion.

.7 Involving Caregivers: (Steps to follow)

• Educate on care, safety, mobility assistance.

• Balance support with encouraging independence.

• Prepare caregivers for post-discharge roles.

.8. Preparation for Discharge and Transition:

• Plan for rehab/home transition with team.

• Recommend post-discharge adaptive equipment.

• Share community resources, support groups.

.9. Documentation and Progress Tracking:

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• Document baseline, functional goals.

• Update progress, intervention response.

• Use objective measures for improvement.

.10. Interdisciplinary Collaboration:

• Collaborate with physio, speech therapists.

• Unified approach for optimal outcomes.

• Comprehensive care plans for acute stroke.

Term: Cerebral Cortex

• Description: Divided into frontal, parietal, temporal, and occipital lobes.

• Functions: Decision-making, sensory processing, memory, visual processing.

• • Term: Brainstem

• Description: Connects brain to spinal cord, controls breathing, heart rate, consciousness.

• Components: Midbrain, pons, medulla oblongata.

Term: Cerebellum

• Description: Located at back of brain, coordinates movement, balance, posture.

• Functions: Motor learning, cognitive functions.

Left Hemisphere Back of card

• Description: Controls right side of body.

• Functions: Language processing, speech production, logical reasoning.

• Areas: Wernicke's (comprehension), Broca's (production).

Right Hemisphere

• Description: Controls left side of body.

• Functions: Spatial perception, emotions, creativity.

• Abilities: Nonverbal cues, metaphorical language.

Carotid Arteries Back of card

• Description: Supply blood to face, neck, and brain.

• Types: External (face, neck), Internal (brain).

.Term: Vertebral Arteries

• Description: Form basilar artery, supply brainstem, cerebellum.

Circle of Willis

• Description: Arterial network at base of brain.

• Role: Provides collateral circulation, prevents severe ischemia

• Term: Ischemic Stroke

• Description: Clot blocks blood vessel, causes infarction.

• Consequences: Tissue death, neurological deficits.

Term: Hemorrhagic Stroke

• Description: Caused by brain bleeding.

• Types: Intracerebral (within brain), Subarachnoid (between brain layers).

.Neuroanatomy in Strokes

• Importance: Predict deficits, plan rehab for specific impairments.

• Knowledge: Identify functional consequences, design targeted interventions.

Occupational Therapy Frame of Reference for Acute Stroke: Neurodevelopmental Treatment (NDT) Approach

• Focus: Enhance optimal movement patterns, function, and quality of life.

• Application in Acute Stroke:

  • Motor Control: Address movement impairments, coordination, muscle tone.

  • Task-Specific Training: Mobilize early, practice functional tasks for recovery.

  • Handling Techniques: Hands-on guidance for safe movement, positioning.

  • Environment: Consider impact of surroundings on mobility.

  • Collaboration: Multidisciplinary teamwork for holistic care.

• Holistic Approach: Address physical, cognitive, emotional aspects.

• Individualized Care: Tailor interventions to unique needs and goals.

• Goal-Oriented: Set functional goals, immediate ADLs and mobility

.Communication Challenges:

1. Aphasia:

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• Expressive Aphasia: Trouble expressing thoughts.

• Receptive Aphasia: Difficulty understanding language.

• Strategies: Boards, gestures, simple sentences.

communication challenges: Apraxia

• Motor speech disorder affecting coordination.

• Trouble planning and executing speech sounds.

• Techniques: Therapy, slower speech.

.Fall Prevention:

1. Balance Exercises:

• Tai Chi, heel-to-toe walking, one-leg stands.

• Strengthen muscles, improve balance.

Fall prevention:

1. Home Modifications:

• • Remove clutter, secure rugs, bright lighting.

  • Grab bars, railings for safety.

.Fall prevention

• Assistive Devices:

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• Canes: Walking stability.

• Walkers: More support, some with wheels.

• Orthotics: Correct foot drop.

.Cognitive Impairment

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1. Cognitive Rehabilitation:

   • Memory exercises, problem-solving tasks.

   • Boost memory, mental agility.

2. Structured Routines:

   • Set schedules, use visual cues.

   • Enhance memory through routine.

Bathing

• Grab Bars: Provide stability.

• Shower Chair: Prevent falls.

• Handheld Showerhead: Easy reach.

Dressing

• Velcro Closures: Simplify fastening.

• Dressing Stick: Manage buttons.

• Zipper Pulls: Independent dressing.

.Toileting:

• Raised Toilet Seat: Easier sitting/standing.

• Commode Chair: Alternative option.

• Handrails: Enhance stability

.Grooming:

• Adaptive Handles: Brushes, combs, toothbrushes.

• Electric Toothbrush/Razor: Simplify tasks.

• Handheld Mirror: Assist with reach.

.Feeding:

• Non-Slip Placemats: Prevent spills.

• Adaptive Utensils: Larger grips.

• Cups with Lids/Straws: Safety in eating/drinking.

• Ischemic Stroke:

Caused by a clot blocking blood flow.

• Hemorrhagic Stroke:

Result of bleeding in the brain.

.3. FAST Assessment:

• "Face": Look for one-sided drooping.

• "Arms": Weakness in one arm.

• "Speech": Slurred or inappropriate speech.

• "Time": Treatment urgency based on symptom onset.

.Thrombolytic Therapy:

• tPA: Clot-dissolving drug, time-sensitive use.

• Risk: Bleeding concern, especially for hemorrhagic strokes.

.. Rehabilitation Principles:

• Acute: Monitor vitals, prevent complications.

• Subacute: PT (motor skills) & OT (daily tasks).

• Chronic: Reintegration, address residual deficits.

.7. Assessment Tools:

• NIH Stroke Scale: Measures impairment severity.

• Barthel Index: Rates independence in activities.

• NIH Stroke Scale:

Measures impairment severity.

.Barthel Index:

Rates independence in activities.

.8. Dysphagia Management:

• Risk: Aspiration pneumonia.

• Speech therapy, modified diets.

.11. Psychosocial Support:

- Depression risk, counseling referral. - Family involvement, support groups.

.15. Family Education:

- Monitor condition, manage meds. - Participate in therapy, home practice.

.19. Patient Safety:

- Pressure ulcer prevention, repositioning. - Deep breathing exercises for lungs.

20. Discharge Planning:

- Home modifications, smooth transition. - Clear instructions, follow-ups, caregiver training.

Advocating Mode:

• Definition: Ensuring clients have necessary resources for participation in occupations.

• Acute Stroke Example: Assisting stroke patients in obtaining adaptive equipment for safe mobility and self-care.

.. Collaborating Mode:

• Definition: Facilitating autonomy and clients' ownership of the therapy process.

• Acute Stroke Example: Collaborating with stroke survivors to set functional goals and plan therapy activities based on their preferences.

.3. Empathizing Mode:

• Definition: Understanding and validating clients' lived experiences.

• Acute Stroke Example: Expressing empathy towards stroke patients' frustrations with mobility limitations and assisting them in coping with emotional challenges.

.4. Encouraging Mode:

• Definition: Fostering hope and willingness to engage in therapy.

• Acute Stroke Example: Providing positive reinforcement as stroke patients make progress in regaining motor skills and self-care abilities.

.5. Instructing Mode:

• Definition: Offering clear expectations and explanations about the therapy process.

• Acute Stroke Example: Explaining the purpose and benefits of therapeutic exercises to stroke patients and their families.

.6. Problem-Solving Mode:

• Definition: Using reasoning and strategic questions to identify solutions.

• Acute Stroke Example: Collaboratively strategizing with stroke patients to overcome challenges in performing activities of daily living and suggesting adaptive techniques.

.Hypertension Management:

• Definition: High blood pressure that can impact vascular health and increase stroke risk.

• Relevance in Acute Stroke OT:

  • Monitor blood pressure during therapy sessions.

  • Adapt activities to prevent blood pressure spikes.

  • Educate patients on lifestyle modifications for hypertension control.

.Diabetes Management:

• Definition: Chronic condition affecting blood sugar levels and vascular health.

• Relevance in Acute Stroke OT:

  • Monitor blood sugar levels during therapy.

  • Consider glucose levels when planning activities.

  • Collaborate with diabetes care team for comprehensive care.

.Lifestyle Modifications:

• Hypertension:

• • Encourage low-sodium diet, balanced nutrition.

  • Promote regular physical activity.

  • Discuss stress reduction techniques.

Lifestyle modifications: Diabetes

• • Educate on balanced carbohydrate intake.

  • Encourage consistent physical activity.

  • Highlight importance of blood sugar monitoring.

.Medication Management: Hypertension

• • Understand antihypertensive medications.

  • Coordinate therapy sessions around medication schedules.

medication management: .

• Diabetes:

• • Familiarize with diabetes medications (oral/insulin).

  • Monitor blood sugar before and after therapy.

.Preventing Complications:

• Hypertension:

• • Address risk factors for cardiovascular events.

  • Modify activities to prevent blood pressure spikes.

Preventing complications: Diabetes

• • Prevent hypo-/hyperglycemia during therapy.

  • Encourage foot care to prevent complications.

.Interdisciplinary Collaboration:

• Hypertension:

• Hypertension:

  • Communicate with medical team about blood pressure readings.

  • Align therapy with medical recommendations.

• Diabetes:

  • Coordinate with diabetes care team.

  • Ensure therapy complements diabetes management.

.Functional Implications:

• Motor Impairments:

• • Weakness, paralysis on one side (hemiplegia).

  • Challenges in fine and gross motor movements.

• Functional implications: Cognitive Impairments:

• • Memory deficits, impaired attention, problem-solving difficulties.

  • Impact on participation in daily tasks.

.Sensory Changes:

• Loss of Sensation:

  • Decreased sensation on affected side (hemianesthesia).

  • Impaired body awareness.

• Perceptual Deficits:

  • Visual, spatial, and proprioceptive issues.

  • Difficulty with depth perception and spatial relationships.

sensory chnages

• Loss of Sensation:

  • Decreased sensation on affected side (hemianesthesia).

  • Impaired body awareness.

• Perceptual Deficits:

  • Visual, spatial, and proprioceptive issues.

  • Difficulty with depth perception and spatial relationships.

.Dysarthria:

Speech difficulties due to muscle weakness.

Occupational Therapy Management:

• Task-Specific Training:

  • Focus on functional activities for independence.

  • Grading activities to match patient's abilities.

Occupational Therapy management 2

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• Constraint-Induced Movement Therapy:

  • Encourage use of affected side by constraining unaffected side.

  • Enhance motor recovery.

.Assessment and Diagnosis: (RCP)

• Early Identification: Rapidly identify stroke symptoms.

• Imaging: Utilize brain imaging for accurate diagnosis.

• Stroke Scales: Use standardized scales for severity assessment.

Acute care management (RCP)

• Thrombolysis: Administer clot-dissolving treatment as appropriate.

• Multidisciplinary Team: Collaborate for comprehensive care.

• Brain Imaging: Monitor changes and tailor interventions.

Secondary Prevention: RCP

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• Risk Factor Management: Address hypertension, diabetes, etc.

• Antiplatelet Therapy: Prescribe antiplatelet medications.

• Lifestyle Changes: Promote healthy behaviors.

.Rehabilitation and Recovery:

• Early Mobilization: Initiate gentle movement and therapy.

• Functional Goals: Set individualized functional targets.

• Patient-Centered: Focus on patient's needs, preferences.

CPR

• Purpose: Emergency life-saving technique for cardiac arrest.

• Steps: Check responsiveness, call for help, start compressions and rescue breaths.

• Compression Rate: 100-120 compressions per minute.

• Depth: 2-2.4 inches for adults; 2 inches for children; 1.5 inches for infants.

• Compression-to-Breath Ratio: 30 compressions followed by 2 rescue breaths.

.Automated External Defibrillator (AED):

• Purpose: Restore normal heart rhythm in cardiac arrest.

• Use: Attach pads, follow AED prompts, ensure safety.

• Follow-Up: Continue CPR after AED shock for 2 minutes.

.Choking:

• Conscious Adult/Child: Perform abdominal thrusts (Heimlich maneuver).

• Unconscious Adult/Child: Combine CPR with chest thrusts.

• Infant: Perform back blows and chest thrusts.

.Using Slings and Hoists:

1. Assessment: Assess the client's needs and abilities.

2. Select Appropriate Sling: Choose a sling based on client's condition and transfer type (e.g., standing, sitting).

3. Position the Sling: Place the sling under the client, ensuring it's properly aligned.

4. Attach Hoist: Attach the hoist's hooks to the sling's attachment points.

5. Check Safety: Ensure hooks are secure and sling is well-fitted.

6. Lift Smoothly: Operate the hoist to lift the client, maintaining stability.

7. Transfer: Move the client to the desired location smoothly.

8. Lowering: Gently lower the client, then detach and remove the sling.

.Using Transfer Boards:

1. Assessment: Evaluate client's mobility and transfer needs.

2. Prepare Environment: Position the transfer board between surfaces (bed to chair).

3. Assist Client: Guide the client to the edge of the starting surface.

4. Position Transfer Board: Place one end of the board under the client's starting point.

5. Assist Client to Slide: Assist the client to slide across the board.

6. Monitor Safety: Ensure stability and comfort during the transfer.

7. Guide Movement: Support client's movement as they slide.

8. Complete Transfer: Assist the client to the desired position, ensuring safety.

.Using Assistive Devices (e.g., Walking Aids):

1. Assessment: Assess client's mobility needs and abilities.

2. Select Appropriate Device: Choose the appropriate walking aid (cane, walker, etc.).

3. Size and Fit: Adjust the device's height for optimal posture and support.

4. Educate the Client: Teach proper use and weight-bearing techniques.

5. Grip and Stance: Instruct the client on holding the device and maintaining balance.

6. Initiate Movement: Encourage the client to take small, controlled steps.

7. Observe and Guide: Monitor the client's movement for safety.

8. Gradual Progression: Assist the client in practicing and improving mobility.