midterm

OTPF

*Occupational Therapy Practice Framework*

*Domain* (defines focus of OT)

*Process* (describes delivery of OT)

OT process

Referral → Screening → Evaluation → Intervention Planning → Implementation → Review → Outcomes (non-linear — can jump/repeat stages)

can a client be seen without a referral?

yes but OT does need one before starting interventions

OTA

supports evals/interventions under OT supervision

CVA

sudden onset of neurological defects caused by disruption of blood flow to the brain, decreasing oxygen to surrounding cells and leads to brain death/infarction

Ischemia

Most common CVA

Obstruction of circulation to brain (lack of blood flow)

Irreversible tissue damage within 5-10 minutes

ischemia 3 types

embolis, thrombolus, lacunar

Embolus

moving clot/plaque (most common)

(Embolus → escapes - moving)

Thrombus

build up clot/plaque on arterial wall

(Thrombus → trapped - built up and sticks to artery wall)

lacunar

occlusion of 1 artery that provides blood to deep brain structures

(Lacunar → little/lone - 1 small, single artery feeding deep brain)

hemorrhage

Rupture of cerebral blood vessel

Blood increases outside of vascular space → compresses brain

(higher mortality rate than ischemia)

intercerebral vs subarachnoid hemorrhage

Intercerebral: bleeding INTO brain

Subarachnoid: surrounding brain

ischemia is a ... problem while hemorrhage is a ... problem

blockage ... bleeding

OT focus for CVA

One handed techniques

Incorporate hemiplegic (affected) U/LEs

Mental: orientation, short term memory, problem solving, sequencing

Sensory: awareness of hemiplegic side, compensation

Neuromuscular: posture control, voluntary movement, strength, endurance, edema

Voice/speech: adaption for aphasia

hemi walker

for those who do not have the ability to use two hands (CVA equipment)

quad cane

footed cane (CVA equipment)

single point cane

one projection to the ground (CVA equipment)

hoyer lift

a piece of equipment designed to raise a patient slowly above a surface to assist in transferring the patient to another surface (CVA equipment)

arm trough

positions and supports a flaccid UE and prevents edema through elevation (CVA equipment)

GivMohr Sling

A supportive orthotic that addresses subluxation (partial dislocation) of the glenohumeral joint related to hemiparesis after a stroke. (CVA equipment)

Bioness

Device for neurological rehab using electrical stimulation for mobility and independence.

Device sends electrical pulses to nerves and muscles for contraction (prevents atrophy) (CVA equipment)

arm skate

Device for supporting/mobilizing the arm (CVA equipment)

TBI

Sudden trauma that causes brain damage

Effects are based on nature/severity, type of BI, location & client age

closed head TBI

no skull penetration

open head TBI

skull penetration & enters brain tissue

non trauma brain injury

Tumors, anoxia, infections, substance abuse, etc.

glasgow coma scale (GCS)

a scale used to assess the consciousness and severity of TBI in a patient

motor functions affected in TBI

spasticity, rigidity (decorticate or decerebrate)

Spasticity (TBI)

involuntary increase in muscle resistance - hypertonicity

Decorticate rigidity

FLEXOR posturing

(deCORticate: COR=curled--flexor posture)

Decerebrate rigidity

extensor posturing

(decErebrate: E=extend)

Ranchos Los Amigos Scale

Stages of cognitive and behavioral recovery after brain injury, ranging from severe unresponsiveness to more purposeful, appropriate behavior.

- Guides intervention and determine appropriate stimulation/support.

OT services lower level TBI client (Ranchos 1-3)

Increase responsiveness, awareness, simple commands, sensory stimulation, positioning, splinting, cognition, caregiver education

OT services intermediate level TBI client (Ranchos 4-8)

Positioning, UE ROM/tone, ADLs, ataxia, cognition/safety, vision, home management

OT services higher level TBI client (Ranchos 8-10)

Community reintegration, driving, work

ROM

amount of possible movement at joint

ROM record on eval form example ( left elbow flexion @ 130 degrees)

L Elbow Flexion AROM 130 d

Vital signs include

pn, BP, HR, RR, body temp

pyrexia

over 100 degrees FEVER

Hyperexia

life threatening fever, 106 degrees

pulse

60-100 BPM

- Higher in newborns & children

- Taken on radial artery at wrist

blood pressure

Relationship between cardiac output (PUMP) & peripheral vascular resistance ("TIGHTNESS")

- systolic/diastolic

- norm = 120/80

mean arterial pressure (MAP)

Average pressure during 1 cardiac cycle

MAP should be 70-100mmHG

MAP formula and ex with 130/80 BP

MAP= ((2* diastolic) + systolic)/3

- Ex: 130/80 BP → ((2*80)+130)/3 → 96.7 MAP

respiration (RR)

12-18 breaths/minute

- infants more

Pain

1-10 grading scale, faces for children (subjective)

cramping/aching pain

muscle

sharp, shooting pain

nerve root

sharp, lightning like pain

nerve

burning, shining pain

sympathetic nerve

deep, dull pain

bone

Sharpe, severe pain

fracture

throbbing, diffuse pain

vasculature

SOAP

subjective, objective, assessment, plan

S

subjective

- What client tells you

- Pn, feelings, attitudes, goals, plans

O

objective

- Results of assessment tools - measurable data

- ADLs, IADLs, ROM, MMT, balance, tone, edema, tolerance

A

assessment

- Therapist's interpretation of date (from objective)

- Progress, barriers, impairments, deficits that impact engagement

P

plan

- Summary of intervention plan

- If client achieves one or more STG may write another STG or move on to LTG

parkinson's

slowly progressive degenerative movement disorder

- Not fatal

- Substantia nigra deteriorates → decrease in functional ability

(SN: receives input from basal ganglia & corpus (hence why movement is impaired))

(More common than ALS and MS combined)

3 class systems of Parkinson's

tremor, rigidity, bradykinesia

symptoms of Parkinson's

Dysfunction of voluntary and involuntary movement

Tremors, rigidity

Decreased quality of movement & balance

Bradykinesia (SLOW movement)

Rigidity (STIFF)

Resting tremor (pill rolling)

Festinating gait (shuffling)

Dysarthria

Dysphagia

At risk for falls

measuring symptoms of parkinson's

Unified Parkinson's Disease Rating Scale (UPDRS)

- Evaluates motor skills, functional status & disability

OT focus Parkinson's

- Breathing/relaxation education

- Medication

- Keep them moving/talking

ALS

Amyotrophic Lateral Sclerosis (ALS)

Destruction of nervous system

- UMN, LMN, or both

- Rapid

- Causes are unknown

medical management ALS

Inform client of diagnosis

Support for invasive/noninvasive ventilator options

Dysphagia: feeding tube

Saliva/pn management

Hospice

Medication

symptoms: beginning ALS

Focal weakness: one site of body

Emotional liability

symptoms: progression ALS

Muscle atrophy

Decrease in weight

Spasticity

Cramping

Fasciculations (involuntary muscle fiber contractions)

symptom's: end ALS

Tube feeding

Ventilator

Hospice

OT focus ALS

Occupation:

- Adapt & compensate

Education:

- Disease

- DME (durable medical equipment

- Caregivers

Acceptance of death

MS

Multiple Sclerosis (MS): progressive degeneration of myelin sheath in CNS

Includes exacerbations (lesions) & remissions

symptoms MS

Vary **

Fatigue

Vertigo

Sensory: numbness/tingling

Decreased balance

Decreased bladder and bowel control

Vision dysfunction

Pn

Cognitive dysfunction

Emotional changes - depression

Spasticity

because MS symptoms vary and every case is unique requires

re-evaluation and different interventions

OT focus MS

ADL/IADL retraining

Home/environment modifications

Energy conservation

Adaptive equipment training

Sleep evaluation

Adaptive equipment training

Visual perception retraining

Caregiver education

Comprehensive Workplace Clinical assessment (CWC)(Evaluates progression of disease)

scapular mobilization

Technique used to move scapula through different directions to improve mobility, ROM, and function.

scapular mobilization may be helpful for clients with...

Stroke

Shoulder pain

Ortho injuries

RC issues

Limited UE ROM

SLUMS assessment

Cognitive screening tools that assesses cognitive impairment and dementia

- Primarily for older adults or adults with suspected cognitive dysfunction

SLUMS assessment may be helpful for clients with

Dementia

Stroke

Neurological conditions

functional reach test

Measures dynamic standing balancing by determining how far a person can reach forward without losing balance or taking a step.

- can help identify fall risk and postural control limitations.

functional reach test could be helpful for

Older adults

People at risk for falls

Parkinson's

Balance/vestibular impairments

Canadian occupation performance measure

Client-centered interview that identifies occupations the client wants or needs to improve.

- client rates their performance and satisfaction with those occupations, helping OT establish meaningful goals.

- Helpful for any OT population

ranchos los amigos

Stages of cognitive and behavioral recovery after brain injury, ranging from severe unresponsiveness to more purposeful, appropriate behavior.

- Guides intervention and determine appropriate stimulation/support.

ranchos los amigos could be helpful for clients with

TBI

Other acquired brain injuries (non-trauma)

modified ashworth scale

Measure of muscle tone/spasticity.

- Therapist moves a limb passively and rates the amount of resistance felt, helping determine the severity of increased muscle tone.

modified ash worth scale may be helpful for clients with

Stroke

TBI

Cerebral palsy

Other neurological conditions

procedural clinical reasoning

- focuses on client diagnosis and performance

- IMPAIRMENT FOCUSED

interactive clinical reasoning

Client-centered, individualizing therapeutic approach (views issues from client's perspective)

- CLIENT RAPPORT

- therapeutic use of self

conditional clinical reasoning

-Combo of other types of reasoning, focus on the whole person, emphasizes "realistic hope"

- CONTEXT (conditions) SENSITIVE

(Used as you gain more experience in OT)

Narrative clinical reasoning

Consider the persons occupational story

Consider roles/activities/habits

- LIFE STORY UNDERSTANDING

pragmatic clinical reasoning

-Not focused on client or client-centered condition but on physical and social context

- PRACTICAL (pragmatic) CONSTRAINTS

SCI causes

traumatic and non-traumatic (disease)

SCI from trauma include

MVA, injuries, falls, accidents

SCIs from disease include

tumors, spina bifida, disorders, MS, ALS

results of SCI

-tetraplegia (quadraplegia)

-paraplegia

Tetraplegia (quadriplegia)

all 4 limbs affected & trunk (TETRA/QUAD=4)

paraplegia

paralysis of both legs and some trunk (PARA=2)

Complete SCI

total paralysis & sensation loss, includes ascending and descending nerve tracts below lesion level

Incomplete SCI

preservation of sensory and/or motor nerves below lesion level

Central Cord Syndrome (CCS)

cell damage in center of cord, paralysis and sensory loss in UEs (nerve roots for UEs are more central than LEs)

older adults with cervical osteoarthritis commonly have

central cord syndrome

Brown-Sequard Syndrome (BSS)

rare neuro condition , lesion in SC leads to weakness and paralysis, motor paralysis and decreased proprioception ipsilaterally below level of injury, decreased pain , temp, touch contra laterally