Practice Skills Final Exam

Why complete a home evaluation?

-help transition from treatment facility to home

-optimize performance

-OT assess for safety, accessibility

-assess client fx

-provide caregiver training

What will an OT need to know before an in-person home eval?

-basic info about home environment

-willingness to adapt

-adaptive equipment pt may need

-prepare for emotional challenges

Standardized assessments for home evals:

-Safety Assessment of Function and the Environment for Rehabilitation

-Westmead Home Safety Assessment

-Housing Enabler

Key things to look for during a home eval:

-assess environment for safety hazardS, challenges, and barriers

-have client use equipment and demonstrate fx mobility tasks like ADL, iADL, entering/exiting, and transfers

-train caregivers

-education

What should an OT use as a reference when doing home evals?

-ADA regulations

Name some common home recommendations:

-ramps/railing

-removal of throw rugs

-lower clothing rods in closets

-lighting

Home Evals: Universal Design

-changes needed to work for everyone at home

Home Evals: Human factor

-personal habits/routines

-psychological effects of suggestions

Internal factors impacting falls:

-mobility and balance impairments

-medical conditions

-medications

-vision and hearing impairments

-cognitive decline

-footwear

External factors:

-flooring hazards

-lighting

-stairs

-furniture arrangement

ADA’s overall goal:

-reduce/prohibit discrimination based on an individual with a disability

ADA Title 1: Employment

-provide a foundation for OT intervention

-prohibits discrimination within private, nongovernmental employers who have more than 15 employees

-reasonable accommodations, essential job functions, undue hardship, pre-placement screenings, FCE

ADA Title 2: State and Local Government Services

-prohibits state and local government from denying an individual participation in services, programs, or activities provided to those without disabilities

-accessible design for public education, recreation, employment, health etc

-equal opportunities for benefits

ADA Title 3: Public Accommodations.

-prohibits discrimination against individuals with disabilities in places of public accommodation

-places of lodging, exhibition, service establishments etc

Title 4: Telecommunication

-deaf/hard of hearing requirements for companies

What did the 2008 amendment change?

-definition of disability

-disability is a physical or mental impairment that limits one or more major life activities

ADA ramp requirements:

-slope 1:12

-width: 36 inches with 3 feet between hand trails

-minimum landing size: 60 inches and at least as wide as the ramp

-if ramp changes direction, 60×60 landing is required

-ramps must have curbs, walls, or railings at least 2 inches high

ADA ramp length formula:

-Ramp Length (inches)=Vertical Rise (inch) x 12

Minimum amount of space needed for a wheelchair to turn around:

-60 inches in diameter

-T-shaped turn around: 36 inches wide, stem of T must extend at least 48 inches

Individuals covered under ADA:

-neurological, musculoskeletal, respiratory, cardio, intellectual disability, mental illness

-deaf, blind, mobility impairments requiring wheelchair, autism, cancer, CP, M.S.

-person must be able to complete essential job functions

Individuals not covered by ADA:

-temporary impairments

-ex: transvestites, homosexuals, pedophiles, illegal drug users, gamblers

Air Carrier Access Act

-prohibits discrimination for those with disabilities in air transportation

-services airlines must provide: accessibility in prep or eating, to/from lavatory, loading retrieving items from overhead

Fair Housing Act

-Prohibits discrimination in the sale, rental or advertising of housing dwellings

National Voter Registration Act

-all offices and state funded programs must provide applicants with voter registration forms to assist with completing and sending forms in

ADA restroom entrance:

-32 inch clear opening

-18 inches on latch side

-door hardware operable with one hand

-no more than 5 lbs of opening force

ADA restroom requirements: floor space

-60 inches of turning radius or T-turn

-clear floor space in front of fixtures 38 inches x 48

ADA restroom requirements: toilet

-centerline 16-18 from wall

-height: 17-19 inch from floor to top seat

-toilet paper dispenser: 7-9 inches from the toilet, 15 -48 inches above the floor

Toilet grab bar requirements:

Behind toilet: 36 inches long

Side wall: 42 inches long, 33-36 inches above the floor

ADA requirements: sinks

-height: no higher than 34 inches

-knee clearance: min 27 inches high, 30 inches wide, and 11-25 inches deep

-one hand faucets (lever, push electronic)

ADA restroom requirements: mirrors

-bottom edge of reflecting surface no more than 40 inches above the floor

ADA restroom requirements: Accessories

-mounted 48 inches max from the floor

-side reach: within 54 inches

ADA van parking regulations:

— van spots should be 11ft. Wide with access of 5 ft wide or 8 ft wide with 8 ft wide access aisle

Hand rail requirements:

-required on both sides if rise is greater than 6 inches or run is longer than 72 inches

-height: 34-38 inches above ramp surface

ADA general parking requirements:

-        Spaces at least 8 feet wide and an access aisle at least 5 feet wide

how wide should a parking stall be?

60 inches wide

ADA bathroom: how wide should the door opening be?

32 inches wide

ADA restroom: sink

- The sink should be clear floor space 30 inches wide by 40 inches long, no more than 34 inches above the floor, and 8 inches under the sink for knee clearance

ADA: grab bar height and length

- Grab bars at least 42 inches on the long side of the wall, no less than 33 inches and no more than 36 inches from the floor

ADA: toilet handle

- The handle of the toilet can’t be more than 48 inches above the floor

Example of ADA reasonable accommodations:

- Any change in the work environment or in the way that work is customarily performed that enables an individual with a disability to enjoy equal employment opportunity

- Physical changes to make facilities accessible, in addition to other nonenvironmental changes

- Availability of resources

- Modifications to policies, practices, procedures

- Removal of barriers

- Alternative forms of services

Internal factors impacting falls/transfers:

-           Strength

-           Endurance

-           Height

-           Vital signs

-           Medical Conditions

-           Medications

-           Psychological Factors

-           Balance and Coordination

-           Clutter, Area rugs

-           Perceived vs. Actual Ability

External factors impacting falls/transfers:

-           Where the car is parked (garage, driveway)

-           Precautions to follow

-           Type of vehicle

-           Where do they get in/out of the car

-           Weather (rain, snow, wind)

-           Time of day (amount of light available)

-           Affected vs. Unaffected side

-           What is in the room (furniture, stairs)

-           Pets

-           Lighting

-           Surface of the floor  

Things to remember with gait belt use:

- Used during certain activities like transfers or gait training practice

- Depends on who decides how often it’s being used (some places have policies) (PT, doctor, other team members can be involved)

Occupational therapies role in bariatric care: Examples

-          OT can help change lifestyle, engage in meaningful activities, and manage weight

• ADL

• activity tolerance

• mobility

• energy conservation/work simplification

• AE

• home mods

BMI below 18.5:

underweight

BMI: 18.5-25.9

healthy weight

BMI: 25-29.9

overweight

BMI: 30+

obesity

BMI: 40+

severe obesity

Ophthalmologist responsibility:

is a medical or osteopathic doctor who specializes in eye and vision care, diagnosis, and management of diseases of the eye, able to perform surgeries

Optometrist:

An optometrist is an eye doctor who has earned the Doctor of Optometry (OD) degree. Optometrists examine eyes for both vision and health problems and correct refractive errors by prescribing eyeglasses and contact lenses, nonsurgical interventions. (Behavioral or Developmental Optometrist, Vision development)  

Optician job:

person qualified to make and supply eyeglasses and contact lenses for the correction of vision

Tech job:

prepares pt for doctor

cataracts

- Blurred/cloudy vision

- Poor night vision

- Sensitive to light/glare

- Poor contrast sensitivity

- Possible diplopia (double vision)

- Slightly yellow

glaucoma

- Often, no symptoms until the condition is advanced

- Decreased peripheral vision (tunnel vision)

- Decreased awareness of surroundings; easily startled

- Slower walking speeds (cautious)

- Decreased contrast sensitivity

macular degeneration

- Central field loss

- Blurred vision

- Reduced vision acuity

- Diminished processing of color and detail

- Light sensitivity

- Decreased depth perception

- Scotomas (blind spots)

- Slow adaptation to light/dark

homonymous visual filed deficit

-           Loss of vision in the same side of each eye

-           Commonly from stroke in the adult population

diabetic retinopathy

- Damage to blood vessels in the retina leads to vision loss

- Floating spots, dark streaks, or red film blocking vision

- Blurred vision, poor night vision

Cortical Visual Impairment

- The area of the brain that impacts vision is affected

- Leading cause of visual impairment in children

- Learn to use remaining vision more efficiently; strategies to engage in their environment.

- May work with a teacher of the visually impaired (TVI) (some schools have access to TVIs or TBVIs), some call this vision therapy

Examples of low vision interventions:

- Help people with low vision function at the highest possible level by preventing accidents and injury (e.g., improving lighting), teaching new skills, modifying the task or environment, and promoting a healthy lifestyle (e.g., ensuring they can participate in their daily activites).

- Braille

- Image size or magnification

- Auditory-technology (voice to text, page readers)

- Compensatory strategies (scanning, turning head, using other senses)

- Modifications to the environment: lighting (decrease glare), decreasing pattern/visual stimuli, adding visual cues (bright tape on steps), and objects have consistent placement. Clear pathways

- Adaptive equipment/aids, assistive technology

oculomotor tools:

- Your hands, pencils, pencil toppers, finger puppets, and objects

- Marsden ball (pursuits)

- Brock string (convergence/divergence)

- Near/far charts, copying from the board (convergence/divergence accommodation)

- Oral motor activites (convergence)

- Balloon (pursuits)

- Ball activities

- Flashlights/laser pointers

contrast sensitivity:

- Often impacted by a low vision diagnosis

- Contrast can be used as an adaptation/compensatory technique

T or False?: our eyes see two different pictures (when covering one eye sees something different than when having both eyes open)

true

Describe what 20/20 vision means:

-           20/20 vision is 20 feet away. And the text size is 20

Who uses the Snellen chart?

- Used by optometrists, school nurses, and pediatricians as a vision screening tool

What should you watch for when using the Snellen chart?

- Watch for eye movement and compare the chart vs. what is being said by the patient

pursuits

following moving target

saccades

rapid movement of the eye between fixed points

convergence

eyes moving inward towards the nose

divergence

relaxing eyes apart (away from nose)

near point of convergence

maximum convergence ability

oculomotor dysfunction

difficulty controlling the eye functions

accommodation

focusing (ability to change the shape of the Lense to focus on objects at different distances

suppression

when the brain selectively ignores the visual input from one eye, it often reduces confusion or diplopia when the eyes are misaligned or have significant differences in refractive power

binocular vision disorder

occurs when the eyes are misaligned, making it difficult for the brain to process a single, clear image from both eyes

strabismus

disorder in which the eyes don’t look in the same direction at the same time

amblyopia

decreased eyesight due to abnormal visual development

give a few examples of visual symptoms:

headaches, words run together, low comprehension, poor depth perception, accident prone, poor handwriting

Things an OT can do to help with visual skills:

watch for red flags, follow finger screen, refer to developmental optometrist for eval

Things an OT may work on with visual skills:

primitive reflex integration, bilateral integration, oculomotor skills, visual motor, processing, and perceptual skills

Equipment that may help a person with vision impairments:

lenses, patches, colored filters, prisms, computer programs/tech

Anticipatory phase of eating:

begins before the client enters the room, an important precursor to successful eating

● Factors related to a successful phase:

○ Appetite/ hunger

○ Sensory qualities of food

○ Sensory qualities of utensils, cups, plates, environment

○ Client’s motivation

○ Cognitive awareness

Oral Preparatory Phase of eating:

- Lip closure

- Cheek tone

- Rotary and lateral jaw movement

- Rotary and lateral tongue movement

- Anterior bulging of the soft palate

- The tongue forms a bolus with the food

Oral Phase of eating:

- Tongue elevates and retracts, squeezing the bolus along the palate

- Voluntary (alert and active)

- Takes approximately 1 second with thin liquids and slightly longer for thick or solid liquids

Pharyngeal Phase of eating:

- Starts when food reaches the anterior faucial pillars (swallow response triggered)

- The velum (soft palate) closes off the nasal cavity

- Tongue base elevates to direct bolus into pharynx (throat)

- The hyoid and larynx elevate, and the epiglottis close to protect the airways

- The pharyngeal tube contracts to help squeeze the bolus toward the esophagus

- Upper esophageal sphincter opens, and food enters the esophagus (1 second)

Esophageal phase of eating:

- Peristaltic action pushes the food down into the stomach

- Lasts 8-20 seconds

- Ends when the lower esophageal sphincter opens and food is passed into the stomach

Thin liquid Ex:

water, ice chips, coffee, tea, milk, hot chocolate, fruit juices, broth, gelatin dessert, ice cream, sherbet

Nectar Ex:

nectar, extra thick milkshake, extra thick eggnog, strained creamed soups, yogurt and milk blended, V8 juice

Honey Ex:

nectar thickened with banana or pureed fruit, regular applesauce with juice, eggnog with baby cereal, creamed soup with mashed potatoes, commercial thickener

Pudding Ex:

commercial thickener

Pureed Ex:

homogenous, pudding-like consistency, no coarse textures, raw fruits or vegetables, no nuts, often high-caloric and nutrient-dense

Mechanical soft Ex:

increased proprioceptive input throughout the mouth, meats should be ground or minced and kept moist with gravies and sauces, must stay together as a cohesive bolus rather than crumbling and falling uncontrolled into the airway

What does level 3 food consistency require?

requires the client to be able to chew and have adequate oral motor skills to form a cohesive bolus of textured foods and move the bolus posteriorly in the oral cavity. A step down from a regular diet r

dysphagia

difficulty swallowing

What can cause dysphagia?

CVA, TBI, brain tumor, anoxia (lack of O2), Guillain-Barre syndrome, Huntington’s, Alzheimer’s, MS, ALS, Parkinson’s, quadriplegia

S+S of dysphagia:

o Drooling, loss of food/liquid from the mouth

o Coughing/throat clearing

o Wet/gurgling voice

o Changes in mealtime behaviors

o Food residue in the mouth

o Loss of appetite, weight loss, and dehydration

o Discomfort, pain, unusual movements

o May avoid social eating

o Prolonged mealtimes

o Recurrent pneumonia

Lvl 1 dysphagia diet:

pureed

Lvl 2 dysphagia diet:

mechanical soft

Lvl 3 dysphagia diet:

advanced