OTH - 510 Final (specifically points covered on email)

transition planning helps students move from

school to post school activities

IDEA requires transition services begin by age

16

OT should identify _______ and ________ that align with vocational goals

interests and skills

consider ______ and _______ environment in potential work settings

physical and social environment

functional skills includes (3) skills required for employment

self care

independent living

transportation/travel

collaborate with ________, ______ _________, and ________ ________ _________ to develop transition plan

educators

case managers

vocational rehabilation counselors

teach _____- _________ skills such as self-advocacy and communication

self-advocacy skills

2 standardized assessments for transition planning

2 informal assessments

transition behaviors scale-3

life skills inventory

transition planning

collaborate with family, school, and community agencies to create transition plan

vocational skills

develop work related skills such as task sequencing, time management, and social interaction in a work place setting

self advocacy

teaching pt to communicate needs and preferences in work place setting

environmental adaptions

identify accomodations for job tasks (visual schedules, adaptive tools)

community integration

facilitate participation in community based vocational programs

Within these assessment areas, which individual skills would you want to evaluate as an OT to provide more information on strengths and weaknesses for future job placements?

the SFA is ______ referenced

criterion

the SFA assists in evaluating an elementary school student's

participation in school related activity settings

support needs

and performance in school-related functional activities

3 sections of the SFA

part I: participation

- one scale 6 ratings (participation extremely limited to full participation)

- theres 6 major school settings listed, you add their scores and get an overall raw score (reg. class room vs spec ed [where they are more often], playground, transportation, bathroom, transitions, mealtime)

part II: task supports

- looking at the extent to which their performance is supported by adults or adaptions beyond those of typically developing students (extensive to no assistance (1-4) theres two columns one ofr assistance and one for adaptions, find raw score for each, looking at physical and cog/behavioral tasks

part III: activity perforamnce

- theres 21 groups (physical or cog/behavioral tasks in which they get a score 1 to 4 on these 1 being not at all 2 is partial 3 is inconsistent so they can do it IND but they do not always vs 4 is a consistent performance - these are also seperated into cog/behavioral and physical tasks...

SFA scoring

find the total score for each part I-III, use appendices to find the criterion score and standard error score

here you will find the criterion cut-off score

criterion cut-off score

derived from performances of children in regular education classrooms ONLY

- 5% or lower are likely to score below the criterion cutoff score = can be used to establish need for servives when it is decided their score is below that of typically developing peers

functional profile (SFA)

can create a chart of the student's perforamnce using the criterion scores

scoring example and interpretation of SFA

say after adding the scores on Part I participation, my raw score is 15. then go to appendices find participation I in the class room they are often in most. raw score = 15 = criterion score of 45 = a standard error of 5. = Score below cutoff in class, participation is below and compared to other kids it can be considered limited (can be moderately, somewhat – this is compared to age and expectation of that age).

part II task supports: my raw scores are 17 for assistance and 25 for adaptions. 17 = criterion = 37 SE of 5 = Criterion score is below cut off score of 100, indicating additional need for assistance in physical tasks. His scores in setup and clean up and hygiene were a score of 1, indicating additional assistance required in these tasks. These were taken in consideration upon choosing sections in part III.

adaption raw score was 25, so find criterion in appendices = 55 w/ SE of 5. because the cut off score is 100, we know 55 is much lower than this indicating increased requirement for adaptions, " His score of 55 is much lower than the 100 cut off score from K-3rd grade. This indicates a requirement for adaption that exceeds that of what is expected of children of his same age."

then based on part I And II we selected physical tasks (part III) that were the most relevant so

example would be

maintaining and changing position, scores 1-4 (1 = does not do 2= partial 3= inconsistently 4= consistent) so my raw score was 36, go to appendices, part III, maintaining and changing positions criterion = 60 SE 4 = For maintaining and changing positions, his score is lower than the K-3rd cut off grade of 100. Most of his scores were ranging from 2-3, indicating a partial to inconsistent performance.

overall, find raw, find criterion and cutoff, then break it down and justify their need.

FCE

functional capacity evaluation

economic satisfaction

salary

retirement

health benefits

economic stability

psychological satisfaction

opportunity for advancement

desire to do well

yearning to find self-fullfilment thru meaningful work (important to note that you can get fulfillment from any job that is meaningful to you - not just healthcare)

occupational therapy uses

work related activities in assessment, treatment, and management of individuals whose ability to function in a work environment has been impaired by physical, emotional, or developmental illness or injury

OTs skilled in ______ ________ programs and _______ base

job specific programs

knowledge base

FCE is a form of ______ evaluation that conisists of a battery of tests focuing on

FCE is a form of work evaluation that conisists of a battery of tests focusing on selected work tolerance tests

evaluation of the FCE gathers data to determine (2)

consistency of effort

employability

FCE is a _____-term eval that focuses on

short-term eval that focuses on major tolerance abilites related to musculoskeletal strength, endurance, speed and flexibilty that is used to determine baseline physical abilites plus limitations and restrictions

2 types of FCEs

functional baseline

job specific

functional baseline FCE

an objective assessment of physical abillites to perform a variety of tasks related to the demands of work

job specific FCE

- job specific based on

- integral part of this?

- an evaluation of the individuals physical abilities to function within the parameters of an identified job.

- job specific FCE is based on critical physical demands of the essential functions of the job

- work simulation acitivies are often an integral part of job specific FCE

MMI

Maximum Medical Improvement

when you do an FCE (3)

- reached maximum medical improvement, but continues to have concerns with return to work or injury

- determination of disbility status

- when physical function needs measured prior to vocational search or return to work

one ethical dilemma of FCE

who is the referral source? could be physician, emploter, case manager, insurance rep., lawyer

whoever our client is is not going to change our results, but the person who we are testing very well may not be the one who made the referral. the documentation will meet the needs of the referral but our evaluation as well as the results should not change

common areas of measurement (9)

work and medical history (all the jobs they have had)

musculoskeletal evaluation

max strength

endurance

dexterity

materials handling (lifting)

positional tolerances (seat, stand, kneel, squat, crawl)

psychosocial status (motivation, anxiety, depression)

is there a match? (between their desired job and their abilites)

components of FCE (8)

history (written, chart review)

musculoskeletal eval

material handling (objective measures)

non material handling

endurances (why this is a 3 hr exam)

job specific assessments

reliability of client report/symptom magnification

max vs submax effort

critical to determine whether

the effort of the person you are evaluating accurately reflects their work capacity - do this through looking at consistency of effort. finding the coefficient of variation is a method (controversial and not well supported)

-- a high coefficient of variation indicates they may not be putting forth full effort - it is hard for someone to quantify sub max effort consistently

for the FCE, there is no

gold standard of certification - there are a lot of them

FCEs are

length (min 3 hours -can be 3, 6, or 8 hours and write ups are lengthy as well - most industries use a program to guide write ups

who controls the length of FCE?

the subject controls the length and the results of the FCE

home safety standards

4b - provide appropriate evaluation and plan of intervention for recipients of OT specific to their needs (beneficence)

4c - use, to the extent possible, evaluation, planning, intervention techniques, assessments, and therapeutic equipment that are evidence based, current and within recognized scope of OT practice (beneficience)

accessibility involves

making environments equally accessible to all people

decreasing/eliminating barriers to people with physical, cognitive, physical, or auditory losses

Purpose of OT home evaluations:

- collab with

- determine

- assess the need for

- determine

- assess for overall

collab with the clients on goals

determine supports and barriers to everyday living

assess the need for equipment

determine funding options

assess for overall safety with the performance of tasks in their natural environment

we are not

we are not judging living conditions unless unsafe or uninhabitable

items to consider around the home

- access (door, garage, elevator)

- driveway

- steps (inside and outside)

- doorbell or security system

- fire alarm system/detectors

- door knobs/handles

- railings

- floor surface

- lighting

- clutter

- cords

- furniture

- doorways

- ramps

- bathroom layout

safety in house, think about

fire extinguishers

smoke detectors

evacuation plan phone numbers in plain sight

clutter

access to water shut off

ability to exit

Safety with ADLs

- shower

- toilet seat

- laundry

- shower ...

- hand

- prior

- hot water

- temp

- tub shower or walk in shower

- raised or regular toilet seat?

- laundry location

- shower seat, TTB?

- hand rails

- prior equipment use

- hot water tank

-temperature regulator

HSSAT

home safety self assessment

HEAP

home environment assessment protocl

I-HOPE

In-Home Occupational Performance Evaluation

other assessments of home safety are

deficit dependent (vision, mobility, needs for devices.)

Ergonomics

the study of people's efficiency in their working environment - functional mobility and body mechanics

ethical considerations for practical, technical, and ethical issues with assessing functional mobility and body mechanics

1E - respect the practices, compentencies, roles, and responsibilities of your own profession and others to promote a collaborative envrionment reflective of IPE teams (fidelity)

2C - do not threaten, manipulate, coerce, or decieve clients to promote compliance to OT (autonomy)

functional mobility includes

bed mobility

transfers

ambulation

w/c mobility

monitor symptoms with

first mobility

OH

SBP drops >20mmHg w change in posture

allow patients to

accomodate to positions changes - consider garments in severe cases

bed mobility includes

rolling

scooting up

supine to sit

sit to suping

safety in bed mobility (4)

- prevent rolling off bed

- lines and tubes (prevent impeding or pulling lines/tubes reposition PRIOR to move

- lower bed such that feet are on the floor

- prevent sliding off of side of mattress

transfers steps

1. scoot to EOM

2. sit to stand

3. pivot or step over

4. stand to sit

Ensure they are wearing

If they are just sitting

use a

ensure wearing non slip footwear

if they are just sitting, use a towel on floor

use a gait belt

proper procedure for sit to stand

1. scoot to edge

2. lean forward (noes over toes) if appropriate

3. push up

when do you clear the floor?

once they're up

when returning to sit from stand (2)

clear BEFORE standing

once up - check status

when returning to sit from stand bring hands to reach back and feel target surgace on back of legs

helpful hints for transfer

position your self on their weak side (side!)

place foot in front of their feet, stabilize knee

when assisting in lift, forward = up importance

keep COG aligned w/ client's

safety for the therapist

body mechanics!!!:

- get help

- bend your knees

- avoid twisting

- keep COG aligned

- keep close

- yell for help

- rest BW of client on you

- lower to the ground

- go down w them, if necessary

some gait faciliters require these - can be helpful if...

some facilities require gait belts

- can be helpful if used right

- must be tight

- careful of placement

- does not replace proper biomechanics!!!

LOA with bed mobility and transfer

Determined by how much of Pt's weight YOU assist with - using your professional judgement as MIN A for someone who is 200lbs may be more work than DEP 90 lbs persons

- consider the lift over the entire activity (up and down)

PAC

physical assistance category - how much do you feel you provided - so you use % in this form of measurement ...

Ambulation includes

step off

stride size

turning

stopping

use of assistive device

wheeled mobility (3)

ability to propel chair

control direction

distance

ambulation safety (6)

- ensure device is properly adjusted

- non slip footwear

- therapist is close

- bring chair behind

- clear pathway

- use gait belt

LOA for ambulation and wheeled mobility

think about assistance and distanace

- if the person requires no help but can only go 50' it is a high level of assist

must consider both!!!

body mechanics (6)

- tuck your tail bone

- solid BPS

- engage core to protect back

- deepen squat

- slight bend in elbow

- head between ct. head and the target location (i.e. w/c)

Who can look at functional mobility?

Both PT and OT. Typically, OT is gonna look at tub and toilet transfer.

Typically, PT can select the mobility device, but OT must be able to facilitate safe use of that device.

quality of life

-OTPF: the dynamic appraisal of ones life satisfaction (perception of progress toward goals), self-concept (beliefs and feelings about oneself), health and functioning (health status), and SES factors (vocation, income, education0

- WHO - an individuals perception of their position in life in the context of their culture and value systems and in relation to their goals and expectation, standards and out comes

QOL is an _______ of therapeutic intervention

quality of life is an outcome of therapuetic intervention

life satisfaction

an indicator of psychological well-being, which can be described as a cognitive assessment or response that people make about their own lives - overall assessment of their own existence based on comparison of achievements and aspirations

self-concept

our personal knowledge of who we are, encompassing our thoughts and feelings about ourselves (physically, socially, and personally) & our knowledge about how we behave, our capabilites, and out individual characteristics

health

a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

QOL is a 1-4

broad concept:

- therapy can only intervene in some aspects

- many measures are disease specific

- comprehensive measures are broad and time intensive

- perception of QOL is insight dependent

WHOQOL-BREF

•WHOQOL (100 item assessment) WHOQOL-BREF is 26 item assessment.

•The WHOQOL-BREF should be self-administered if respondents have sufficient ability.

•Will derive four domain scores. Domain scores scaled in positive direction so higher score = higher QOL.

•Mean score of items in each domain are used to calculate the domain score.

•Can leave 1 blank only in each domain!

•Think about life in the past 2 weeks.

•Use the table on page 1 for scoring (says for office use only). Then put their score for each Q in the small box. For the ones that say 6-Q3, use the reverse score  - so if they put 2, answer is 4.

•Add up the scores to find raw score.

•Then go to page 11 table 4 to find transformed scores.

** client ranks 5 items on a 7 point scale

The goal of the KELS

provide info used to match a person's strengths and their living environment - allowing them to live safely in the LRE

- combines tasks and interview questions

KELS may be used for

D/C planning

identify problem areas for interention

used in court for determination of commitment and gravely disabled cases

KELs can be used in these settings (8)

IPR

IP mental health

IP burns

HH

OP

hands

SNF

acute care

Administration and before formal intro of the KELs

- must read word for word!!!! (standardized)

- stay on subject

- do NOT give feedback throughout evaluation

- client sit across or to the left

need to get background indo like where is the residence, who do they live with, does they use electronic banking, do they use a cell phone, etc.

Possible scores of the KELS and what does score reflect

the scores reflect current status

Independent = level of competency needed to perform basic living skills in a manner that maintains the client's safety and health without the direct assistance of other people

Needs assistance = should not be viewd as negative or abnormal - doesn't mean theyre incapable of living alone - requires or has assistance with some daily living skills

Not applicable = used for an item that doesnt pertain to ct

See note - cant be clearly scored IND or needs assistance

KELs explanation

- First give the reading and writing form, say first do this, then you'll do self care, money management, and safety health/etc.

- One each paper with the directions there are minimum standards and this is how you decide if theyre independent or need assistance, then you put it on the score sheet.

- making d/c plans and recommendations for the KELs

- Fill out the summary page based on the scoring form - then make justification as to why you choose this D/c plan - maybe they would benefit from leisure based occupational therapy if they only identified 1 leisure occupation - the book says 3 - so just look at what the booklet says and then make decisions based on the apparatus in which they "need assistance"

things to consider during playground evaluation

inclusivity

accessibility

ramps

surface

seating

play components

play is a primary occupation of children, OTs are experts in environment evaluation and modification, as well as activity analysis

ADA standards for playground

1. Must have an accessible route from parking to playground

2. Must be able to access ground and elevated components (independently or transfer system)

3. Water components must also have a transfer system (Not all w/c go in water, tho)

% regarding transfer systems?

only 25% of elevated equipment are to be accessed ONLY by transfer system

Accessible routes

accessible routes are to be a minimum width of 60''

However, can be decreased to 36" for a max distance of 60" as long as they are broken up by segments that are 60'' wide as well

Playgrounds less than

playgrounds less than 1000 sq ft can have accessible route minimum of 44" wide

routes connected to

routes connected to elevated play components must be 60" wide as well

- but these can be decreased to 32" wide for a distance of 24" as long as they are broken up by segments that are 48" at least

group level ramps slope

not to be steeper than 1:16

transfer stations

provided where transfer is intended from mobility device/w/c

- level

- 24" wide

- 14" deep

- 11-18" from ground

other play areas must have

adequate turning spaces

playtables

17 deep

24 high

30 wide

Reach ranges (high and low)

3-4: 36", 20"

5-8: 40", 18"

9-12: 44", 16"

Principles of Universal Design