Final practicum (written portion/fall 2025)

Mirror therapy

-rehad technique used to help stroke survivors regain movement

-developed in the 1990's

-believed that mirrors could be useful in understanding the brain, funtions, and neuroplasticity

Important considerations:

-remove any jewelry/tattoo scar coverage

-similiar positioning of affected and non-affected limbs

-mirror placement and size

Functional Electrical Stimulation (FES)

-electrical currents to nerves in the muscles that assist with muscle contraction during functional activity

-assist with muscle control and it can strengthen the muscle contraction

Saebostim micro:

-increases the amount of spasticity in the arm, reduce edema, improve neglect on affected side, temp reg, increase sensation, assist with motor functioning, etc.

Additional FES machines:

-bioness h200

-saebo avivastism

-xcite

Repetitive practice

-execution of a specific task or skill to improve performance

-used to determine whether it improves UE function/research and lower limb function

-focuses on specific tasks that the individual wants to perform

Graded Repetitive Arm Supplementary Program (GRASP)

Program designed to increase arm and hand strength, coordination, and ability to use your stroke affected arm in daily tasks

Exercises included:

-strengthening

-coordination

-arm strengthening

Bilateral Arm Training (BAT)/strength training

-involves repetitive practice of arm movements using both sides of the body, either in symmetrical or alternating patterns

-non-affected arm us supporting affected arm during bilateral arm training movements

Strength training

-form of exercise aimed at enhancing muscle strength

-involved fatiguing the muscle through repetitive movements which increase strength over time

SLUMS (Saint Louis University Mental Status Examination)

-screens for cognitive impairment which helps identify individuals who may need further evals for conditions like dementia

-evaluates domains: orientation to time and place, memory, attention and concentration, language and verbal fluency, executive function and visuospatial skills

Scoring (did not complete HS)

-normal: 25-30

-mild cognitive disorder: 20-24

-dementia: 1-19

Scoring (did complete HS)

-normal: 27-30

-mild cognitive disorder: 21-26

-dementia: 1-20

Short Blessed Test

-5-10 min screening tool for healthcare providers to assess memory and concentration in adults who may be at risk for dementia

-questions include identifying the correct date, remembering a name and address, telling the time, and counting backwards from 20 or months of the year is reverse

Scoring

-normal: 0-8

-mod impairment: 9-19

-severe impairment: 20+

MOCA (Montreal Cognitive Assessment)

-10 min screening test to evaluate cognitive function in adults who may have mild cognitive impairments

Assess

-attention and concentration

-language

-visuospatial skills

-memory

-executive functions

-orientation

Scoring

-normal: 26/30

-below 26 may be a cognitive impairment

Mini-Mental State Examination (MMSE)

-10 min test to assess cognitive function

Assess

-orientation: awareness of date, day, year

-attention and calculation: ability to focus by spelling backwards or subtraction

-registration: repeat 3 words immediately after hearing them

-recall: recall 3 words after time has passed

-language: name objects, repeat phrases, follow commands

Scoring

-normal: 25/30

-below 25 may have cognitive impairment

KELS (Kohlman Evaluation of Living Skills)

-tool used to measure an individual's ability to perform basic living skills needed for independent functioning

Assess

-self care: grooming, hygiene, dressing

-safety and health: evaluates awareness of potential household dangers, knowledge of emergency procedures, and ability to find emergency and medical contact info

-money management: test ability to use money for purchases, make change, understand income and budgeting

-transportation and telephone: assess mobility in the community, knowledge of public transit, ability to use a telephone for tasks like making a call

-work and leisure: evaluates plans for future employment and involvement in leisure activities

Kessler Foundation Neglect Assessment Process (KF-NAP)

-Procedure used to help clinicians detect, measure, and track the severity of spatial neglect in individuals performing everyday life activities. Based on the direct observation of the patients spontaneous behavior during ADLs

Assessed in 10 categories of behavior that are observed during a single session:

-gaze orientation

-limb awareness

-auditory attention

-personal belongings

-dressing

-grooming

-navigation

-collisions

-meals

-cleaning after meals

Scoring

-no neglect: 0

-mild neglect: 1 (pt typically explores one side first, but slow to move toward the neglected side)

-moderate neglect: 2 (constant and clear omissions or collisions, pt able to cross midline, but performance is incomplete)

-severe neglect: 3 (pt only explores one side and ignores the neglected side)

Medi-cog assessment

-assess functional cognition including memory, literacy, and a persons ability to manage medications safely

-mini cog: three word recall and a clock drawing test

-medication transfer screen (MTS): assessment of the ability to organize and fill a pillbox

Scoring

-scored out of 10

-7 or lower can indicate concerns about cognitive impairment

Allen diagnostic module (ADM)

-Purpose: assess a persons functional cognitive capacity in relation to the

Allen cognitive disabilities model

-methodology: uses standardized craft-based activities to observe how individuals learn and solve problems

-assessment: evaluates a persons ability to complete tasks that are new, require problem solving, and have a useful recognizable end product

-application: used with populations who have cognitive impairments

-scoring: scores are criterion

referenced to the levels and modes on the Allen cognitive scale

-examples: activities include making a placemat, building a frog note holder, or creating felt turtles

Executive Function Performance Test (EFPT)

-assess a persons ability to perform 4 common daily tasks

-the administrator observes the person attempting: to make oatmeal, taking simulated meds, making a phone call, and paying simulated bills

-tests 5 components of executive function: initiation, organization, sequencing, safety/judgment, completion

Kettle test

-purpose: to assess cognitive abilities like attention, problem solving, executive function, and working memory

-how it works: clinician observes a person making 2 different hot beverages. Task includes preparing the drinks, managing the ingredients, and using a kettle

Weekly Calendar Planning Activity

-a personal time management task or a formal performance based assessment of executive function skills

-purpose: to better control one's time, reduce stress, and increase productivity

Menu Task Assessment

-a quick performance based screen tool used to identify potential deficits in functional cognition

-pt is given a simulated menu and a set of instructions to follow when choosing breakfast, lunch, and dinner items

Performance Assessment of Self-Care Skills (PASS)

-tool used to measure a persons ability to perform daily tasks safely and independently

-assessment includes 26 core tasks grouped into 4 domains: functional mobility, ADLs, physical IADLs, and cognitive IADLs

NDT principle (hand over hand)

-physical guiding technique where the therapist places their hand over the clients hand to guide movement during an activity

-this provides maximum support and proprioceptive input to help the client feel the correct movement pattern

NDT principle (weight shifting)

-movement of the center of gravity over a base of support. It requires controlled dynamic stability and dissociation of movement between body segments

-facilitates the righting and equilibrium reactions necessary for balance and smooth transitions (reaching, walking)

NDT principle (weight bearing)

-refers to placing the body weight through an affected extremity in a stable position

-inhibits abnormal tone to facilitate to-contraction around joints for stability and provide proprioceptive input to the brain to normalize sensory awareness

NDT principle (bilateral movement)

-coordinated use of both sides of the body together

-facilitates functional interdependence of the two sides of the body, improving trunk control, and encourage the affected side to participate in motor tasks

Visual Perception

Ability to interpret, understand, and define incoming visual information

Form constancy

Ability to identify objects despite their variation of size, color, shape, position, and texture

Functional exercises:

-locating various brands and sizes of items on a grocery store shelf

-locating utensils and correct size bowls for baking tasks

-reading directions to a game when words are in different fonts and colors

Figure ground perception

Ability to distinguish foreground from background

Functional exercises used:

-locating correct change during a money management activity

-locating puzzle pieces

-locating classroom objects in a pencil box (glue stick, eraser, blue crayon)

Visual closure

Ability to accurately identify objects that are partially covered or missing

Functional exercises used:

-completing partially drawn pictures or stencils

-identifying 10 common objects in an overlapping array of 30 items

Spatial orientation

Ability to recognize personal position in relation to opposing positions, directions, movement of objects, and environmental locations

Clinical screen used:

-OT adult perceptual screening test

-baking tray test

Unilateral inattention

is a phenomenon that causes one to experience an inability to orient and respond to contralateral visual information

Clinical screens used:

-click drawing test

-line bisecting test

-bells test

-star cancellation test

Depth perception

the ability to perceive relative distance in environmental objects

Functional exercises used:

-navigating a therapy gym, hallway, or playground with obstacles

-estimating common distances

-pouring liquids into measuring cups

Visual memory

The ability to take in visual stimulus, retain in details, and store for later retrieval

Functional exercises used:

-study a photograph for 30 seconds and describe the photo and items included

-display an array of items or words, remove visual and report as many items as they can remember

Visual motor integration

accurate and quick communication between the eyes and hands

Functional exercises used:

-write name or copy a sentence on paper

-copy simple line drawing

-scissor along various dotted lines

Visuocognition

The ability to use visual information to solve problems, make decisions, and complete planning and organizational tasks through mental manipulation

Functional exercises used:

-sequence a recipe based on pictorial steps

-sequence a grooming task with displayed items

Executive functioning

Ability to reason, plan, problem solve, make inferences, and or evaluate results of actions and decisions

Clinical screens used:

-logic puzzles

-packing a medication box

-problem solving picture cards

Memory

Taking new information, holding onto information, and recalling information when needed

Clinical screens used:

-remembering 3/3 items immediately and after 5 mins

-asking about current medications and precautions

-asking to recall previous meal

Information processing

Taking environmental stimulation in through the 5 senses, interpreting it, and responding to it

Clinical screens used:

-trailmaking A

-complete a following directions task

-time cancellation task

-game of speed

Attention/concentration

Staying awake, alert and ready, focusing, and keeping a train of thought

Clinical screens used:

-trailmaking A&B

-basic meal prep activity

-grocery shopping exercise

-reading medication labels

Remediation approach

-The remedial or developmental approach is typically initiated based on the premise that the brain can acquire or reacquire function through environmental stimulation

-choosing activities that have multiple levels of difficulty, the ability to alter speed requirements, and offer the opportunity to adjust levels of attention complexity are important to consider for grading activities up or down to foster meeting the clients goals while considering his or her just right challenge

compensatory approach

-treatment approach that aims to maximize existing visual function by providing strategies to enhance the patients ability to assimilate visual information efficiently

-rather than focusing on one task specific skill, the client should gain the ability to use the learned strategies in various situations

Apraxia: Ideomotor

Inability to plan or perform a motor skill. The pt may understand the concept, may even be able to describe the intended motion, but cannot execute the motor act at will

Apraxia: Ideational

Breakdown of knowledge of what is to be done to perform or the loss of a mental representation of the concept required for performance. Pt may seem confused and display hesitant motor actions or may not be able to initiate the task at all

Astereognosis (tactile agnosia)

Person is unable to perceive identity of objects due to the loss of capacity to sense or organize shape, texture, temperature, or weight

Hemianopsia

The loss of vision on the same side of each eye

dysarthia

difficult poorly articulated speech resulting from interference in the control over the muscles of speech

dysphagia

difficulty swallowing

ataxia

Abnormal movement and disordered muscle tone seen in clients with TBI due to damage to the cerebellum. Ataxia can affect movement of the head, neck, and trunk but usually affects the extremities

Domain specific training

May he sued for the client who has global memory deficits. This client may be able to learn new skills to be used in a particular situation but the client may not be expected to transfer or generalize these learning processes or skills to a new environment

Adiadochokinesia

inability to perform rapidly alternating movements such as forearm supination and pronation

-ex: client has difficulty washing windows

Dysmetria

Inability to estimate the ROM necessary to reach the target of movement. It is evident when touching the finger to the nose or placing an object onto a table

-ex: client may knock over a cup trying to teach for it

Dyssynergia

Decomposition of movement in which voluntary movements are broken into their component parts and appear jerky

Rebound phenomenon of Holmes

inability to stop a motion quickly to avoid striking something

-ex: if clients arm is bent against the resistance of the therapist and the resistance is suddenly and unexpectedly removed, the clients hand will hit the face or hody

Nystagmus

Involuntary rapid eye movements

Choreiform

repetitive/rapid/jerky/involuntary movements that appears well coordinated

Athetoid

Movements without stability, are worm like, slow, arrhythmic movements that primarily affect the distal portions of the extremities

Ballismus

Violent, involuntary flailing of the extremities