NBCOT Study Pack: Domain 2 Flashcards

goniometer

Measurement instrument for evaluating joint range of motion; accuracy is ensured through following standardized procedures

goniometer standardized procedures

• client position

• positioning of the instrument

cervical spine ROM (flexion)

0-45

cervical spine ROM (extension)

0-45

cervical spine ROM (lateral flexion)

0-45

cervical spine ROM (rotation)

0-60

thoracic and lumbar spine ROM (flexion)

0-80

thoracic and lumbar spine ROM (extension)

0-30

thoracic and lumbar spine ROM (lateral flexion)

0-40

thoracic and lumbar spine ROM (rotation)

0-45

shoulder ROM (flexion)

0-170

shoulder ROM (extension)

0-60

shoulder ROM (horizontal ABduction)

0-40

shoulder ROM (horizontal ADDuction)

0-130

shoulder ROM (internal rotation)

0-70

shoulder ROM (external rotation)

0-90

elbow and forearm ROM (flexion)

0-135/150

elbow and forearm ROM (supination)

0-80/90

elbow and forearm ROM (pronation)

0-80/90

wrist ROM (flexion)

0-80

wrist ROM (extension)

0-70

wrist ROM (ulnar deviation)

0-30

wrist ROM (radial deviation)

0-20

thumb ROM (MP flexion)

0-90

thumb ROM (IP flexion)

0-80/90

thumb ROM (ABduction)

0-50

finger ROM (MP flexion)

0-90

finger ROM (MP hyperextension)

0-15/45

finger ROM (PIP flexion)

0-110

finger ROM (DIP flexion)

0-80

finger ROM (ABduction)

0-25

manual muscle testing

Structured approach to measure muscle strength and apply a muscle grade to the maximal effort put forth

manual muscle testing grading scale

Zero (0/5) to Normal (5/5)

MMT grade 0/5

• no active movement noted
• no muscle contraction observed or palpated

MMT grade 1/5

• trace movement observed and palpated
• no active movement noted, but muscle contraction is observed or palpated

MMT grade 2/5

• poor strength observed where movement is noted only in a gravity-minimized plane

• incomplete ROM in gravity-minimized plane

MMT grade 2-/5

able to initiate movement in gravity-minimized plane

MMT grade 2+/5

complete ROM in gravity-minimized plane

MMT grade 3/5

• fair strength observed where movement is noted against gravity

• full ROM against gravity with no resistance applied

MMT grade 3-/5

incomplete ROM against gravity

MMT grade 3+/5

full ROM against gravity and slight resistance

MMT grade 4/5

good strength observed with full ROM against gravity and moderate resistance

MMT grade 5/5

normal strength observed with full ROM against gravity and maximal resistance

dependent

Level of assistance where a client needs >75% verbal or physical assistance to complete a task or is unable to perform any component of the task

maximal assistance

Level of assistance where a client needs 50-75% verbal or physical assistance to complete a task

moderate assistance

Level of assistance where a client needs 25-50% verbal or physical assistance to complete a task

minimal assistance

Level of assistance where a client needs <25% verbal or physical assistance to complete a task

stand-by assistance

Level of assistance where a client requires caregiver or practitioner assistance to be within arm’s reach to safely complete a task

independent

Level of assistance where a client requires zero physical or verbal assistance to safely complete a task

supervision

Level of assistance where a client requires occasional verbal assistance to safely complete a task

modified independence

Level of assistance where a client requires use of adaptive equipment or increased time to complete a task

ASIA impairment scale (AIS)

American Spinal Cord Injury Association neurological classification system used to determine level of impairment to the spinal cord after an injury.

ASIA impairment scale (AIS) results are based on

• sensory testing of each dermatome for right and left sides

• manual muscle testing for right and left sides

ASIA impairment scale (AIS A)

complete lesion with NO motor or sensory function preserved in the sacral segments S₄-S₅

ASIA impairment scale (AIS B)

incomplete lesion with sensory but NO motor function preserved below the neurological level; includes the sacral segments S₄-S₅

ASIA impairment scale (AIS C)

• incomplete lesion with motor function preserved below the neurological level

• more than half of key muscles below the neurological level have a muscle grade less than 3 (fair)

ASIA impairment scale (AIS D)

• incomplete lesion with motor function preserved below the neurological level

• at least half of key muscles below the neurological level have a muscle grade of 3 (fair) or more strength

ASIA impairment scale (AIS E)

normal motor and sensory function

Ranchos Los Amigos Level of Cognitive Functioning (Level I) =

no response: total assistance

Ranchos Los Amigos Level of Cognitive Functioning (Level I) characterized by

No change in behavior when presented with any form of stimuli

Ranchos Los Amigos Level of Cognitive Functioning (Level II) =

generalized response: total assistance

Ranchos Los Amigos Level of Cognitive Functioning (Level II) characterized by

• generalized reflex response to painful stimuli

• responses may be delayed

• responds to repeated auditory stimuli with increased or decreased activity

Ranchos Los Amigos Level of Cognitive Functioning (Level III) =

localized response: total assistance

Ranchos Los Amigos Level of Cognitive Functioning (Level III) characterized by

• response to discomfort by pulling tubes or drains

• blinks when bright light crosses visual field

• inconsistent response to simple commands

Ranchos Los Amigos Level of Cognitive Functioning (Level IV) =

confused/agitated: maximal assistance

Ranchos Los Amigos Level of Cognitive Functioning (Level IV) characterized by

• alert and in a heightened state of activity

• absent short-term memory

• purposeful attempt to remove restraints or tubes

• may exhibit aggressive behavior

Ranchos Los Amigos Level of Cognitive Functioning (Level V) =

confused, inappropriate nonagitated: maximal assistance

Ranchos Los Amigos Level of Cognitive Functioning (Level V) characterized by

• not oriented to person, place, or time
• may wander
• unable to learn new information
• inappropriate use of objects without redirection

Ranchos Los Amigos Level of Cognitive Functioning (Level VI) =

confused, appropriate: moderate assistance

Ranchos Los Amigos Level of Cognitive Functioning (Level VI) characterized by

• inconsistent orientation to person, place, and time

• supervision needed for old learning (e.g. self-care tasks)

• may attend to a familiar task in a distraction-free environment for up to 30 minutes with moderate redirection

Ranchos Los Amigos Level of Cognitive Functioning (Level VII) =

automatic, appropriate: minimal assistance of daily living skills

Ranchos Los Amigos Level of Cognitive Functioning (Level VII) characterized by

• minimal supervision for new learning

• may attend to a familiar task in a distraction-free environment for up to 30 minutes with minimal redirection

• overestimates abilities

• minimal supervision for safety in home and community routines

Ranchos Los Amigos Level of Cognitive Functioning (Level VIII) =

purposeful, appropriate: stand-by assistance

Ranchos Los Amigos Level of Cognitive Functioning (Level VIII) characterized by

• stand-by assistance for daily living skills to take corrective action when impairments interfere with task completion

• independently attends to and completes familiar tasks for one hour

• independent once a new activity is learned

Ranchos Los Amigos Level of Cognitive Functioning (Level IX) =

purposeful, appropriate: stand-by assistance on request

Ranchos Los Amigos Level of Cognitive Functioning (Level IX) characterized by

• stand-by assistance on request when impairments interfere with task completion

• can shift between tasks and can attend for a minimum of 2 hours

• uses assistive memory devices

• able to monitor appropriateness of social interactions with stand-by assistance

Ranchos Los Amigos Level of Cognitive Functioning (Level X) =

purposeful, appropriate: modified independent

Ranchos Los Amigos Level of Cognitive Functioning (Level X) characterized by

• can independently handle multiple tasks simultaneously, but may require occasional breaks

• accurately estimates skills and abilities and independently adjusts task demands

• social behaviors are consistently appropriate

ACL Level 1 (automatic actions)

• reflexive responses

• responsive to internal stimuli

• impaired awareness of time and place

• global cognition impaired

• maximum assistance for ADL

ACL Level 2 (postural actions)

• awareness of gross motor movements

• global cognition impaired

• may benefit from 1-step verbal instructions

• requires 24-hour nursing care

ACL Level 3 (manual actions)

• ability to manipulate objects with hands
• responsive to tactile cues
• repetitive actions that are not goal directed
• short attention span and unpredictable behaviors

ACL Level 4 (goal-directed actions)

• global cognition moderately impaired
• responds to tangible, visual motor cues
• some goal-directed behaviors
• can pay attention for up to 1 hour

ACL Level 5 (exploratory learning)

• global cognition mildly impaired
• trial-and-error method used during activities
• decreased ability to plan ahead and anticipate errors
• poor judgement and occasionally impulsive

ACL Level 6 (planned actions)

• abstract thinking is intact

• carry-over of learning from one session to another

• anticipates errors and demonstrates ability to plan ahead

• judgement and problem-solving is intact

outcome measure

Objective evaluation of the influence of interventions on the client’s performance

When possible and applicable, measurement should be taken at the beginning, during, and at the end of intervention

advantages of standardized testing

• scores can be understood by interprofessional team
• tools are often widely available
• uniform administration, scoring, and interpretation of results
• can help monitor progress over time
• can contribute to quality improvement and evidence-based practice

disadvantages of standardized testing

• must be combined with qualitative and other assessment methods to complete a comprehensive evaluation
• multiple internal and external variables can impact performance on test and affect results
• rigidity of administration may negatively influence the results

standardization sample

A large sample of people who represent the intended population for a test

Also referred to as the norm group

standard score

A score used in standardized testing, also referred to as z-values and z-scores, that is used to make comparisons across variables and across populations or individuals

scales of measurement

Classification system used for quantifiable data

Types include:
• nominal scale
• ordinal scale
• interval scale
• ratio scale

scales of measurement (nominal scale)

categorizes data into distinct categories or groups.

Examples: gender (male/female), eye color (blue/green/brown), and marital status (single/married/divorced).

scales of measurement (ordinal scale)

categorizes data into distinct categories or ranks based on their relative order or position

Examples: rankings, ratings, and Likert scales.

scales of measurement (interval scale)

• represents data with equal intervals between values

• allows for the comparison of both the order and the difference between values

• does not have a true zero point.

• Examples: temperature in Celsius or Fahrenheit.

scales of measurement (ratio scale)

• has a meaningful zero point and equal intervals between values

• allows for the comparison of both the magnitude and the ratio of values

• Examples: height, weight, time, and temperature in Kelvin.

descriptive statistics

Provides insight into the general characteristics of data collected during a study

Types include:
• measure of central tendency
• measure of variability

descriptive statistics (measure of central tendency)

• statistical value that represents the center point or average of a set of data

• provides a single value that summarizes the entire dataset

• The three commonly used measures of are:

  • Mean: also known as an average score, that is calculated by finding the sum of all scores within a data set then dividing the sum by the total number of scores in the data set

  • Median: also referred to as middle value, that is determined by placing all scores in numerical order and locating the number in the middle

  • Mode: refers to the value that occurs most frequently within a data set

descriptive statistics (measure of variability)

• statistical value that represents how much the group varies from the mean, and the degree to which the data spreads across the distribution

• provides information about how much the values in a dataset differ from each other

• Common measures of variability include:

  • Variance: measures the average squared deviation from the mean

  • Standard deviation: measures the distribution and variation of data points around the mean

error variance

Factors or variables that cause a difference in standardized test scores (e.g., environmental conditions, motivation, fatigue)

developmental index score

• Score used in developmental testing with the following features:

  • mean score is 100

  • standard deviation of 15 or 16

  • intervention often beneficial if scores are 2 standard deviations below the mean

developmental index score (mean)

100