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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
Bio-mechanical
Neuro-developmental
Rehabilitative / compensatory
Psycho-dynamic
Cognitive behavioural
Behavioural
What are the 3 enabling strategies
Remediation
Compensation
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
Scientific
Narrative
Pragmatic
Ethical
Conditional
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
client files and records
standardised and assessment protocols
non-standardised assessments
client interviews
ecological measures
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
Low Tech - simple devices
Medium Tech - simple mechanical operations
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
Translatory: movement in a straight line
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
Stance Phase (60%)
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
Rubrospinal tract
Tectospinal tract
Vestibulospinal tract
Medullary (lateral) reticulospinal tract
Pontine (medial) reticulospinal tract
What are the categories that brain recovery can be known as
Spontaneous recovery
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
Intention Tremor (occurs during voluntary movements, seen in MS)
Resting Tremor (occurs at rest and subsides when voluntary movements occurs, seen in Parkinsons)
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
Filtering information from the environment
Combing filtered streams of information to provide global description of stimulus
Comparing the result with previously stored information
What are the 4 major sensory modalities
Pain
Temperature
Touch
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
Cortical injury
Spinal cord injury
Peripheral nerve injury
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
Light touch (mono-filaments)
Pain
Temperature
What are the 5 functional test for sensory assessment
Touch localisation
2-point discrimination
Stereognosis
Propropception
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
Acknowledging changes within the family
Building on family strengths
Working in collaborative partnerships
Respecting and accepting family diversity
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
Spastic CP (70-80%) - hypertonia and hyperreflexia present, localised to one body or across all body
Dyskinetic CP (6%) - hypotonia, very primitive reflexes, facial and oral motor involvement
Ataxic CP (6%) - lack of muscle coordination during voluntary movements
What are the 3 distributions of Cerebral Palsy
Hemiplegia (primarily one side of the body)
Diplegia (legs more affected than arms)
Quadriplegia (arms and legs more affected than trunk)
What are the 4 frames of reference in Paeds care
Biomechanical
Adaptation and compensation
Neurodevelopmental Treatment (NDT)
Motor Learning