OT2015 Exam

What is the purpose of Assessments?

To gather information about the person, the occupations that concern them and the environments in which the occupations occur.
It is analysed and interpreted to identify person, environment and or occupational factors that underlie the clients occupational issue

Define Bottom-Up Assessment Approach

Focuses on performance components and impaired skills to understand persons abilities and limitations. It suggests that body functions and structures support occupational performance and by improving impaired skill or ability there will be a corresponding improvement in occupational performance. Assesses components of function such as strength, tone, range of motion, balance

Define Top-Down Assessment Approach

Evaluation of the clients life roles, occupations, activities and tasks. It is a function based assessment of the task and activities the client needs, wants or is expected to accomplish and is having difficulty performing

What is the Occupational Performance Analysis

The structured evaluation process that uses observation of an individual to identify and define factors that support or hinder occupation performance and prevent that person from being a full participant in life

What are the Occupational Performance Areas

Self-care, leisure and productivity

What are the 6 different frame of reference

1. Bio-mechanical
2. Neuro-developmental
3. Rehabilitative / compensatory
4. Psycho-dynamic
5. Cognitive behavioural
6. Behavioural

What are the 3 enabling strategies

1. Remediation
2. Compensation
3. Education

Define Remediation

Strategies that focus on making a change in the PERSON that remediate, restore or establish skills. Aimed at enhancing personal performance skills and or diminish constraints

Define Compensation

Strategies directed at adapting the ENVIRONMENT or TASK to match the persons abilities. May also include not changing the person or adapting the environment but making the best person environment fit

Define Education

Imparting knowledge to enable clients to change their behaviour, attitude, beliefs, confidence, skills and decision making abilities. Educating the client and supports to be able to self manage and able them to change. It is client centres and occupation based

Define Professional Reasoning

The thinking process we use to to decide what knowledge applies to which clients and in which settings it is appropriate to use different tools. Considering research and reflective practice

What are the 6 different types of professional reasoning

1. Scientific
2. Narrative
3. Pragmatic
4. Ethical
5. Conditional
6. Interactive reasoning

Define Scientific reasoning

Understanding the condition and problems affecting the client and using that to decide interventions
Diagnostic: clinical problem sensing and problem definition that clearly states what problem will be addressed in OT
Procedural: thinking about the condition, impairment or disability and then deciding on which activities you may use.

Define Narrative reasoning

Thinking in a "story" and understanding the meaning of the condition or disability has to the client. Gaining understanding of the client through empathy and collaboration and using client centred practice and enabling skills

Define Pragmatic Reasoning

Addressing the setting in which therapy is occurring, it is not focused on the client or their condition.
Practice Context: everyday issues that impact therapy process which need to be considered
Personal Context: The ot's personal situation influencing their reasoning

Define Ethical Reasoning

Asks "What should be done?"
Used to chose morally defensible actions given competing actions, benefits & risks to the client, what is the fairest way to prioritise care and balance client goals.

What are the 6 categories for gathering patient data

1. client files and records
2. standardised and assessment protocols
3. non-standardised assessments
4. client interviews
5. ecological measures
6. skilled observation

Define Standardised Assessment

Has a set of specific procedures, instructions, task and questions. Must be administered and results recorded in a prescribed way.
Reliability and validity data published and normative data available.

Define Non-Standardised Assessment

The OT is responsible for what is being assessed, the assessment procedure and the trustworthiness of the findings. Flexibility is often the key and is often locally developed.

What is the focus of intervention

To use occupations, activities and tasks which are meaningful to the person in order to promote occupational performance and engagement, prevent occupational problems and resolve occupational problems

What is intervention based on

Clients information, assessment of capacities and problems, understanding what is possible, defining and setting goals and sharing information and agreeing on a plan

What are the principles of intervention

Client-centred
Context driven
Occupation based
Evidence based
Interrelated with ongoing assessment

What is the purpose of prescribing Assistive Technology

To maximise the fit between the person, demands of the occupation and the demands of the environment. It is also to enhance, enable and maintain participation in occupation

What are the 3 levels of AT

1. Low Tech - simple devices
2. Medium Tech - simple mechanical operations
3. High Tech - Electronic and computerised components

How to evaluate the outcome measures of AT

- How well does the device meet the goals of the client
- How well does it match the skills and abilities of the client
- The ease of use and the appearance of the device
- Persons overall satisfaction with the device

Define Bio-mechanical Frame of Reference

Concerned with movement, muscle strength and endurance during occupations.

What is the Aim of the Bio-mechanical Frame of Reference

To address the quality of movement in occupations

What are the objectives Bio-mechanical Frame of Reference

To prevent deterioration and maintain existing movement, restore movement if possible and compensate / adapt for loss of movement

Treatment Approaches for Bio-mechanical Frame of Reference

ROM Testing
MMT - Strength
Grip and pinch strength
Endurance testing

Define the 2 types of motion

1. Translatory: movement in a straight line
2. Rotary: movement around the pivot point/fixed axis

Define Force

Something that causes a change in motion/shape of an object or the body
Can be internal (muscle) or external (gravity)

Define Torque

Turning effect where a force applied off centre from centre of rotation

What are the 3 types of Levers

1st class
2nd class
3rd class

What are the 2 phases of the gait cycle

1. Stance Phase (60%)
2. Swing Phase (40%)

Define "Good Posture"

Position in which the body segments are balanced and in position of least strain and maximum support which the individual uses as least energy expenditure as possible. It helps internal organs to assume a favourable position for proper function.

What are the clinical issues associated with Anterior Pelvic Tilt

ASIS lower than PSIS.
Tight hip flexors, tight spinal extensors, trunk extension, weakened abdominals, increased lumbar lordosis, obesity and shoulder retraction

What are the clinical issues associated with Posterior Pelvic Tilt

ASIS higher than PSIS
Low trunk tone, decreased lordosis in lumbar spine, reduced hip flexion, increased thoracic kyphosis, tight hamstrings, extensors reflex/spams and muscle imbalance

Define Motor Control

The ability to make dynamic postural adjustments and direct body and limb movement in a purposeful activity

What components are necessary for 'motor control'

-Normal muscle tone
-Normal postural tone and postural mechanisms
-Selective movements
-Co-ordination

What is the responsibility of the Brain Stem

to control posture and stabilisation of muscles during movement. integrates visual and vestibular information with somatosensory input to modify movements initiated by the cortex

What is the responsibility of the Spinal Cord

Neurons mediate automatic reflexes i.e. stretch reflex

What is the responsibility of the Cerebellum

Projects to both brain stem and thalamus and improves the accuracy of movement

What is the responsibility of the Basal Ganglia

Receives input from all cortical ares and projects to the thalamus and then to areas of the cortex involved in motor planning

What are the 2 descending motor pathways

Direct and Indirect

Define the direct descending motor pathway

The most direct motor pathways extend from the cortex of the brain to skeletal muscle. It controls voluntary motor impulses from the motor cortex to voluntary motor neurons

What are the 2 sets of neurons of the Direct Descending motor pathway

Upper motor neurons and Lower motor neurons

Define the indirect descending motor pathway

Pathways include synapses in the basal ganglia, thalamus, reticular formation and cerebellum

Define the Upper Motor Neuron System

This system facilitates or inhibits the other system.

What are some common diagnoses associated with upper motor neuron damage

- Cerebrovascular accident (CVA)
- Traumatic Brain Injury
- Brain Tumours
- Cerebral Palsy
- Multiple Sclerosis

What are some potential movement impairments associated with upper motor neuron damage

- Upper and/or lower limb impairment/paralysis
- spasticity
- impaired balance
- impaired co-ordination

Define the Lower Motor Neuron System

make up the final common pathway for determining muscle action, automatic functions of movements, responsible for posture and movement and is diminished or absent in deep tendon reflexes and muscle flaccidity

What are some common diagnoses associated with lower motor neuron damage

- lesions i.e. tumours involving the spinal cord
- Poliomyelitis
- Motor Neuron Disease
- Guillian Barre Syndrome

What are some potential movement impairments associated with lower motor neuron damage

Partial:
- Weakness or paresis of
muscle
Complete:
- Paralysis
- Hypotonicity /
flaccidity of muscles
- Absence of spinal
reflexes

What are the 5 indirect nerve pathway tracts

1. Rubrospinal tract
2. Tectospinal tract
3. Vestibulospinal tract
4. Medullary (lateral) reticulospinal tract
5. Pontine (medial) reticulospinal tract

What are the categories that brain recovery can be known as

1. Spontaneous recovery
2. Reorganisation or neural mechanisms

Define Spontaneous recovery

The reparative processes occurring immediately following the lesion or damage

Define Reorganisation or neural mechanisms recovery

Recovery influenced by use and experience

Define abnormal muscle tone

presence of flaccidity, hypotonicity, hypertonicity, spasticity, clonus, rigidity and dystonia

Define Ataxia

Presents as delayed initiation of movement responses, errors in range and force of movement. Poor coordination between the agonist and antagonist muscle groups, resulting in jerky, poorly controlled movements

Define Dysarthria

Slurred speech caused by incoordination of speech mechanism

Define Nystagmus

Involuntary movement of the eyeballs in an up and down, back and forth or rotational direction. Can occur as a result of vestibular system, brainstem or cerebellar lesion

Define Chorea

Irregular, purposeless, involuntary, coarse, quick, jerky and dysrhythmic movements of variable distribution i.e Huntington's disease

Define Dystonia

Results in the persistent posturing of the extremities often with concurrent torsion of the spine and association twisting of the trunk i.e TBI

What are the 3 different types of tremors

1. Intention Tremor (occurs during voluntary movements, seen in MS)
2. Resting Tremor (occurs at rest and subsides when voluntary movements occurs, seen in Parkinsons)
3. Essential Familial Tremor (inherited as a dominant trait, visible during fine precision task)

What are interventions used for motor control injuries or disabilities

- Motor relearning - repetitive task specific retraining
- Functional Electrical Stimulation
- Constraint Induced Movement Therapy
- Neurodevelopmental Techniques (PNF)

Explain Motor Relearning - Repetitive Task Specific Retraining

Method utilised with a person following brain injury where the key principles of therapy intervention include exercises that are based on functional movements and are directed towards a clear goal i.e. reaching to comb your hair rather than reaching overhead for no reason.
Use of grading and manual guidance

Explain Constraint Induced Movement Therapy (CIMT)

Involves the restraint of the unaffected limb to increase use of the affected limb. Aim is to discourage "learned non-use". Mass practice is for 2 weeks wearing restraint for 6 hours day on unaffected side although you must consider the patients cognition, support and safety

Explain Functional Electrical Stimulation (FES)

Electrical stimulation is a technique that uses short bursts of electrical pulses to generate muscle contraction by stimulating motor neurons or reflex pathways. Peripheral nerve pathways must be intact for contraction to occur. It can be used to improve motor recovery, reduce pain and spasticity, strengthen muscles and increase ROM

What are the 3 main functions of the sensory system

1. Filtering information from the environment
2. Combing filtered streams of information to provide global description of stimulus
3. Comparing the result with previously stored information

What are the 4 major sensory modalities

1. Pain
2. Temperature
3. Touch
4. Proprioception

Define Stereognosis

The ability to localise and perceive the size, shape and texture of an object by palpitation

Define Proprioception

The ability to sense the position of a body part from information received from that part. Can be vibratory, static or dynamic

Define Kinaesthesia

The ability to sense movement and balance

Define Paresthesia

Abnormal sensations i.e. pins and needles

Define Hypersensitivity

Heightened sensation or discomfort in response to ordinary stimuli

Define Hyposensitivity

Dullness or reduced intensity of sensation

Define Sensory Processing

A function of the CNS. Ability to interpret the incoming sensory stimuli to ensure an appropriate response.

What are the 4 types of sensory impairments

1. Cortical injury
2. Spinal cord injury
3. Peripheral nerve injury
4. Sensory processing disorder

Explain Sensory Processing Disorders

Sensory information from the environment and from within our bodies does not get organised and interpreted correctly and efficiency by the brain into appropriate responses

Describe how you know whether an injury is more CNS sensory related

More likely to have deficits in proprioception, sterognosis and temperature awareness

Describe how you know whether an injury is more PNS sensory related

More likely to have deficits in pain, touch, pressure awareness and 2 point discrimination

What are the 3 threshold test for sensory assessment

1. Light touch (mono-filaments)
2. Pain
3. Temperature

What are the 5 functional test for sensory assessment

1. Touch localisation
2. 2-point discrimination
3. Stereognosis
4. Propropception
5. Kinesthesia

Explain sensory re-education as a remediation strategy for sensory intervention

For loss of protective sensation or discrimitive sensation i.e. pain, temp, pressure and is often used following CVA. It is self-administered for 10 to 15 minutes a day 4 to 5 x/day utilising everyday activities. The program is graded from gross to fine motor

Explain de-sensitisation as a remediation strategy for sensory intervention

To reduce hypersensitivity and aims to elicit habituation to decrease the pain and discomfort of hypersensitivity and improve function and use. Used following nerve damage i.e. amputation, re-attachment of digits, burns/scarring, crush injuries

What is the difference between high threshold and low threshold stimuli

High threshold is slower to respond whereas Low threshold is fast to respond

define Habituation (high threshold)

Process of recognising familiar stimuli that do not require additional attention

define Sensitisation (low threshold)

Processes that enhances awareness of importance stimuli around you

define Modulation

Balance between habituation and sensitisation

Define a a sensory bystander

A child misses sensory input, misses more cues, may not notice their name called, not bothered by what is going on around them. High neurological threshold and passive self regulated

Define a a sensory seeker

Always wanting more, touch everything, tap pens, want to chew on things, generating new ideas, always needing to stay busy. High neurological threshold and active self regulation

Define a a sensory sensor

Keep tracks of everything, will ask others to be quiet, put their hands over their ears, try to participate but get overwhelmed. Low neurological threshold and passive self-regulation

Define a a sensory avoider

Child is bothered by sensory input, will move away from activities and choose to work alone, great at creating routines and want more of the same thing. Low neurological threshold and active self regulation

What are common conditions that influence children's participation

Developmental disabilities
Neuromotor disorders
Mental Health Conditions
Disease and / or medical conditions
Traumatic Injuries
Genetic / Chromosomal abnormalities

What are the key principles of Family Centred Practice

Parents must have the ultimate responsibility for the care of their children. All family members are treated with respect and as an individual with all needs being considered. Families must decide on the level on involvement they wish in decision making for their child and the involvement of all family members are highly encouraged.

What are the 5 features of Family Centred Practice

1. Acknowledging changes within the family
2. Building on family strengths
3. Working in collaborative partnerships
4. Respecting and accepting family diversity
5. Focusing on enabling and empowering families

What are the 3 categories of Cerebral Palsy

Type, Distribution and Severity

What are the 3 types of Cerebral Palsy

1. Spastic CP (70-80%) - hypertonia and hyperreflexia present, localised to one body or across all body
2. Dyskinetic CP (6%) - hypotonia, very primitive reflexes, facial and oral motor involvement
3. Ataxic CP (6%) - lack of muscle coordination during voluntary movements

What are the 3 distributions of Cerebral Palsy

1. Hemiplegia (primarily one side of the body)
2. Diplegia (legs more affected than arms)
3. Quadriplegia (arms and legs more affected than trunk)

What are the 4 frames of reference in Paeds care

1. Biomechanical
2. Adaptation and compensation
3. Neurodevelopmental Treatment (NDT)
4. Motor Learning