PhysD2 Ex1

what is the OT process?

referral

screening

evaluation

intervention planning

intervention implementation

intervention review

outcomes

initiates the OT process

its a request (either oral or written) from physician or other qualified individual

may be required before initiation of service

referral

brief and does not cover all areas of occupation

determines whether further OT evaluation is warranted

screening

process of obtaining and interpreting data

use of assessments

two parts

• generation of occupational profile

• analysis of occupational performance

evaluation

prevent disability

promote health

establish or restore a skill or ability

adapt or compensate

maintain current functional abilities

intervention planning

therapeutic use of self

therapeutic use of occupations and activities

preparatory methods and tasks

group interventions

education and training

advocacy

intervention implementation

evaluation of the intervention plan

completed on regular basis to determine whether client’s goals are being met

may include re-evaluation of client’s status

intervention review

focuses on many factors to include:

• occupational performance

• client’s perceptions of goals/process of meeting goals

• well-being of caregiver

outcomes

used in the intervention process

five basic types of reasoning

1. procedural

2. interactive

3. conditional

4. narrative

5. pragmatic

clinical reasoning

what are the five basic types of reasoning?

procedural

interactive

conditional

narrative

pragmatic

concerned with getting things done, with what “has to happen next”

a connection between the problems identified and the interventions provided is sought using this form of reasoning

clinical reasoning (procedural)

concerned with the interchanges between the client and therapist

the therapist uses this form of reasoning to engage with, to understand, and to motivate the client

the therapeutic use of self fits well with this form of clinical reasoning as the therapist uses personal skills and attribures to engage the client in the intervention process

clinical reasoning (interactive)

concerned with the contexts in which interventions occur, the contexts in which the client performs occupations, and the ways in which various factors might affect the outcomes and direction of therapy

using this approach, the therapist imagines possible scenarios for the client

clinical reasoning (conditional)

requires teh understanding of the patient’s life stories

guides the therapist in evaluating the meaning that occupational performance limitations might have for the client

focuses on the person as an occupational being and provides a link between the founding values of the profession and current practice demands

clinical reasoning (narrative)

addresses the world in which occupational therapy occurs

forces the therapist to see things as they really are

clinical reasoning (pragmatic)

theories, models of practice, and frames of reference do what for the occupational therapy profession?

advance the profession

demonstrate evidence-based intervention

support occupation

enable development of effective treatment plans

relationship between concepts or ideas related to the phenomenon of interest (e.g., occupational performance)

suggestions on ways the phenomenon of interest can be changed or controlled, and how these relationships can predict behavior or events

theory

applications of theory of OT to practice

serves as a means to view occupation through the lens of theory

ex.: MOHO, ecology of human performance, PEO model, etc.

model of practice

links theory to intervention strategies

a narrower approach than model of practice

ex.: biomechanical, rehabilitation, sensorimotor

frame of reference

list and describe the three types of practitioners for OT.

OT - autonomous practitioner - providing all OT services

OTA - non-autonomous practitioner - requires verious levels of supervision from OT

OT aides - non-autonomous and requires direct/close supervision from OT practitioner

who do OTs collaborate with

just about everyone! some ex are:

physicians, PTs, SLPs, vocational counselors, psychologists, social workers, orthotists, prosthetists, and vendors of durable medical equipment

if you find yourself in an ethical dilemma, what are some resolution approaches?

review AOTA guidelines

seek guidance from ethics and review boards

approach and engage colleagues/peers/community

five common examples of ethical dilemmas include?

cost containment policies and treatment

inaccurate or inappropriate documentation

improper or inadequate supervision

unneeded provision of services

violation of client confidentiality

list and describe the three typical practice settings.

inpatient settings - client stays overnight

community based settings - client is in natural physical, social, and cultural environments

outpatient settings - hospitals and freestanding clinics

what are some examples of inpatient settings?

acute care inpatient

inpatient rehabilitation

acute rehabilitation

subacute rehabilitation

skilled nursing facilities

what are some examples of community based settings?

home-based settings

community based settings

intermediate care facilities (residential care)

assisted living unites or residence

home health

what are some examples of outpatient settings?

outpatient clinic

day treatment

work site therapy

also referred to as telehealth or teleconferencing

provision of services electronically from a distance

telemedicine

client goes from one setting to the next in sequence (e.g., from acute care to acute rehab to community home healthcare)

sequential

client enters healthcare at any point and does not follow a direct progression through settings

non-sequential

involves the integration of research-based techniques (critical, analytic, scientific thinking, and action processes) into all phases and domains of OT practice

systematically guides practitioners in determining which interventions will be effective at producing desired outcomes

uses:

• thinking processes

• action processes

• evidence

systematic OT practice

involves selecting a theory on which the OT plans the steps needed to assess problems, evaluates intervention, specifies the desired outcomes, and plans a strategy to determine and/or demonstrate which outcomes were met via OT service

thinking processes

specific behaviors involved in implementing thinking processes; behavioral steps

action processes

information used to support a claim

evidence

why is SOTP critical?

the location of service delivery and the time allowed for service delivery are in flux

OTPs can provide evidence-based rationale for treatment to consumers, other professionals, insurers, and policy makers

systematic inquiry provides a common forum and language for cross-disciplinary communication

what are the types of reasoning for SOTP?

inductive

abductive

deductive

approaches the combine abduction and/or induction with deduction constitute what?

mixed methods of research

thinking process in which a person begins with seemingly unrelated data and then links these data by discovering relationships and principles within the data set

inductive

data is analyzed for patterns and concepts (which in some cases may relate to available theories and in other cases may not)

abductive

begins a theory and reduces the theory to its parts, which are then verified or discounted through examination

deductive

what are the steps of systematic OT practice (SOTP)?

1. identification and clarification of the problem to be addressed by the intervention

2. understanding of need - what is needed to resolve all or part of the problem?

3. setting of goals and objectives to address the need

4. reflexive intervention to achieve the goals and objectives

5. outcome assessment

a specific claim of what is not desired or of what should be changed

problem mapping may help identify/clarify the problem statement

• upstream (what caused the problem)

• downstream (what are the consequences of the problem)

problem statement

a systematic, evidence-based claim, linked to all or part of a problem, that specifies what conditions and actions are necessary to resolve the part of the problem to be addressed

need statement

criterion referenced

credible, especially as an outcome measure

client-perceived problems in area of self-care, productivity, and leisure

Canadian Occupational Performance Measure (COPM)

statements developed by clients and relevant others identifying the client’s desired outcome of the service

goals

statements about how to reach a goal and how to determine whether all or part of the goal has been reached

objectives

list and describe the two types of objectives

process - define concrete steps necessary to attain the goal

outcome - define the criteria used to determine whether all or part of the goal has been reached

systematic thinking does not stop during the implementation of interventions

the OT systematically monitors the client, the collaboration, the professional practice, setting-based resources, the therapeutic use of self, and other internal and external influences

reflexive intervention

a set of thinking and action processes conducted to ascertain and document treatment outcomes

assessed by using quantitative, naturalistic techniques and mixed methods, and by applying systematic inquiry to examine whether objectives have been attained

outcome assessment

what are the three types of arthritic conditions?

rheumatoid arthritis

osteoarthritis

gouty arthritis

chronic, systemic, inflammatory, autoimmune D/O'; inflammation of the joints; between ages 40-60, women are 2-3 times more commonly affected by men

rheumatoid arthritis

what are some common signs/symptoms of rheumatoid arthritis?

fatigue, weight loss, loss of appetite, overall ache or stiffness, low-grade fever

give a few examples of the common sites of rheumatoid arthritis

PIPs, MCP, and thumb joints of the hand

wrists, elbows, ankles, MTP, and TMJ joints

hips, knees, shoulders, and cervical spine

flexion of the MCP, hyperextension of PIP, and flexion of DIP

swan-neck deformity

(hyper)extension of MCP, PIP flexion, DIP hyperextension

boutonniere deformity

caused by a nodule or thickening of the tendon at the entrance of the tendon sheath

trigger finger

what is a characteristic of RA?

ulnar drift or deviation of MCPs

what are the most common sites of subluxation in RA?

wrist and MCPs

is there a cure for rheumatoid arthritis?

no

what are some ways to manage RA?

reducing pain, swelling, and fatigue

improving joint function and minimizing joint damage and deformity

preventing disability and disease-related morbidity

maintaining physical, social, and emotional function while minimizing long-term toxicity from medications (NSAIDs, corticosteroids, and DMARDs)

list and describe some of the surgical management strategies for RA?

synovectomy - surgical removal of the disease synovium

tenosynovectomy - surgical removal of the diseased tendon sheath

tendon surgery

tendon transfers and peripheral nerve decompression

what is another name for osteoarthritis?

degenerative joint disease (DJD)

caused by breakdown of cartilage in joints leading to joint pain, stiffness, tenderness, and limited ROM

non-inflammatory

wear and tear disease due to age and overuse

more common in men before the age of 50 years; beyond the age of 50, more common in women

osteoarthritis/ DJD

what is the breakdown of joint tissue in OA?

1. smooth cartilage softens and loses its elasticity

2. large sections of cartilage wear away completely

3. joint loses its normal shape

4. ends of bones hypertrophy, spurs (osteophytes) are formed where the ligaments and capsule attach to the bone

5. joints become stiff or unstable and motion becomes restricted and painful

OA can affect any joint but its most frequently seen where?

weight-bering joints such as the hips, knees, and spine

MTP joint of the big toe

DIP, PIP of hand and CMC of thumb

heberden’s node is located where?

DIP joint

Bouchard’s node is located where?

PIP joint

is there a known cure for osteoarthritis?

no

what are some ways to manage OA?

relieve symptoms

Improve function

limit disability

avoid drug toxicity (analgesics, NSAIDs, corticosteroids, DMARDs)

what are some surgical management techniques for OA?

arthroscopic joint debridement

bone grafts

joint fusion

joint replacement

metabolic disease marked by uric acid deposits in joints and tissue that causes recurrent episodes of arthritis; occurs in middle-aged men (40-50 y/o), exact cause is unknown, causes severe inflammation, acute onset is very rapid, inflamed joints will display: extreme heat, pain, redness, and swelling within hours

gout

where does gout usually affect?

typically the big toe

seen in both RA and OA; occurs as the joints degenerates

crepitation

what are the psychological factors seen in arthritic conditions?

depression, denial, anxiety

what are some OT intervention techniques for arthritic conditions?

energy conservation techniques, joint protection principles are essential in all areas of ADLs

what are the treatment objectives for arthritic conditions?

maintain or increase joint mobility and strength

increase physical endurance

prevent, correct, or minimize the effect of deformities

maintain or increase ability to perform ADLs

increase knowledge about the disease and best methods of dealing with the physical, psychological, and functional effects

assist with stress management and adjustment

what are some treatment methods for arthritic conditions?

sleep/rest, positioning, PAMs, TA and TE, splinting, energy conservation, adaptive equipment, assistive devices, joint protection, client/family education, communication resources

when should discharge planning occur for arthritic conditions?

as soon as the patient is referred to OT

effective way of reducing inflammation

rest

position against patterns of deformity to prevent contractures

positioning

heat, TENs, biofeedback

physical agent modalities

promote joint function, muscle, strength, and endurance

therapeutic activity and exercise

limited movement, pain, and tenderness at rest, weakness, tingling or numbness and hot, red joints

acute stage

when and what kind of exercise should be done for a patient in the acute stage?

active assistive exercises and exercises with gravity eliminated may be performed within the limits of pain tolerance. exercise should be performed at the ebst time of day for the patient

gentle PROM and AROM to the joint in the acute stage should be done how many times a day?

2x a day

limited movement and tingling remains, decrease in pain and tenderness indicates inflammation is subsiding, stiffness is limited to morning stiffness and. joints appear pink and warm

subacute stage

AROM and PROM exercises during the subacute stage include what?

a gentle passive stretch, isotonic exercises and graded isometric exercises may be done with minimal stress to joints

reduced tingling, pain, and tenderness, increased activity tolerance, endurance remains low

chronic-active stage

during ROM exercises in the chronic-active stage, what may be included?

stretch at the end of the range as well as isotonic and isometric exercises may be done as long as they do not overstress the joints

support joint in optimal position for function and reduce inflammation by providing rest or support to the joint, dynamic ___________ are used to correct deformity

splinting

instruct in techniques to help patient complete daily actviities

energy conservation

use only when necessary, use when there is a flare up; when flare up has subsided, return to own ROM and muscle power

assistive devices

joints affected by arthritis have increased potential for potential damage, __________________ teaches patients to minimize their risk of injury during daily activities

joint protection

what are some joint protection techniques?

respect pain

maintain muscle strength and joint ROM

avoid positions that put stress on involved joints

avoid staying in one position for a long time

use strongest joints and muscles available

distribute workload over several joints

if pain lasts more than 1-2 hours after completing a task, what would you deem most appropriate to tell the patient?

respect pain

using each joint to maximum available ROM and strength during daily activities; use long movement with arms

maintain muscle strength and joint ROM

avoiding hand positions that involve tight pinching, squeezing, or twisting motions; open objects toward thumb to avoid ulnar drift

avoid positions that put stress on involved joints

causes excess fatigue and stiffness; never begin an activity than cannot be stopped if pain or fatigue sets in

avoid staying in one position for a long time

using the larger joint reduces stress on smaller joints; keep weight under control to avoid stress on weight-bearing joints

use the strongest joint available for the job

use two hands to lift a mug; carrying heavy loads close to body in arms instead of holding them with your hands

distribute workload over several joints