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Week 1
Products and technologies that facilitate a client's ability to maneuver through space, including seating and positioning; improve mobility to enhance participation in desired daily occupations; and reduce risk for complications such as skin breakdown or limb contractures
Wheeled mobility
These are examples of what?
"Is the trunk upright and midline? Is pelvis in neutral position without tilt, obliquity or rotation?"
Screening for someone with a WC
Wheelchair seating system categories least supportive to most
sling upholstery, short periods of time, transport chair or fleet wheelchair
Captain's seat, scooters or consumer PWCs
linear seating, flat surfaces
generic contoured seating,
aggressively contoured seating, increased postural support and pressure distribution
molded seating, most contact with client, significant orthopedic asymmetries
Localized injury to the skin or underlying tissue usually over a bony prominence, as a result of pressure or pressure in combination with shear and or friction. Formerly called pressure sores, bed sore or pressure ulcers
Pressure injury
Heat, moisture, poor pressure distribution, lack of sensation, immobility, friction, shearing, incontinence are examples of,
Increased risk for pressure injury
Some cushions may be good for pressure distribution, but provide less postural control
Contoured shape: Better for pressure distribution, but more challenging for transfers
Reduce heat and moisture with certain materials
Dependent WC Weight over 35 lb Limited sizes, adjustments and modifications Sling seat and back
Standard WC. Most basic. Manual WC
Dependent WC
Lower seat to floor height (allows for foot propulsion) ONLY difference
Similar weight/lack of adjustments to standard WC
For clients who had a stroke
Standard hemi WC Manual WC
Two options. Weighs less than 36 lbs, weighs less than 34 lbs.
More sized options Limited frame adjustments and accessories
Not for long-term use or extensive self-propelling
Lightweight WC Manual WC
Weights less than 30 lbs
Greatest degree of options
Maximize self-propulsion efficiency and reduce repetitive stress injury risk
Rigid and folding frame options. Rigid is lighter and more durable
Custom lightweight and ultra lightweight WC Manual WC
Other types of manual WCs
Recliner: Angle of 90 not maintained, can cause shearing forces Standing frame Tilt in space Bariatric
Types of power WCs
Scooter aka power-operated vehicle
Power WC
Shear forces Disrupt alignment Increase pressure over sacrum Could set of spasms
Disadvantages of recline
Joy stick Head array Sip and puff are examples of,
alternative drives for power WCs
Foam and honeycomb
Types of solid cushions
Easy to clean cushion, molds around bony prominences, conducts heat away from skin, heavy, can leak, contents inside may need to be redistributed
Gel cushion
ROHO is a type of gas cushion
Solid cushions are more functional for transfers
Gel and gas cushions are better to prevent pressure injuries and for pressure distribution
Solid cushions are usually less expensive
Lightweight cushion, less expensive, not moisture resistant, may be warm, cut to size, easy to transfer, difficult to clean, wears out, not for long term use
Foam
Lightweight cushion, can be cleaned, air flow, very firm, material compression may occur
Honeycomb
Lightweight cushion, easy to clean, difficult to use for transfers (unstable), may leak if punctured, monitor pressure level, compartmentalized
Gas cushion ROHO is a brand
Clinical eval in WC best for testing..
Endurance/speed Perception Cognitive status Active ROM
Week 2 Types of interventions page 59 in OTPF 4
Components of occupations that are objective and separate from the client's engagement or contexts. Activities as interventions are selected and designed to support the development of performance skills and performance patterns to enhance occupational engagement
Activities
Address part of an occupation Work on practice & problem solving out of context of a task
Performance skills and performance patterns
Broad and specific daily life events that are personalized and meaningful to the client
Occupations
Methods and tasks that prepare the client for occupational performance are used as part of a treatment session in preparation for or concurrently with occupations and activities or provided to a client as a home-based engagement to support daily occupational performance
Interventions to support occupations
PAMS physical agent modalities Orthotics Assistive tech Wheeled mobility Self regulation
Facilitation of the acquisition of concrete skills for meeting specific goals in a real life, applied situation. In this case, skills refers to measurable components of function that enable mastery.
Example: Education client on hip precautions (education) before engaging in transfer training or LB dressing (training)
Use of tech such as videoconferencing, teleconferencing, or mobile telephone application technology to plan, implement, and evaluate occupational therapy intervention, education, and consultation
Virtual Interventions
Joint protection presentation
Addressing human performance in relation to occupational performance
Applying the most efficient use of equipment, tools, and environment to promote health and safety
Joint protection, energy conservation, body mechanics
Ergonomics
Aims to reduce loads on joints and reduce deforming forces, thus minimizing risk of injury
Goals of this approach Reduce pain Reduce forces on joints Reduce secondary inflammation Reduce loading to preserve joint integrity Reduce pain from overuse Reduce fatigue
Joint Protection
Joint protection principles were primarily developed for arthritis management. OA or RA
Strategies are used to help Reduce inflammation Decreases inflammation of joint Redistributes stress on joints Preserves joint integrity over the long term Reduce fatigue
Limits positions of deformity
Hand ergonomics
Reduce the force and effort
How?
Use Built up handles Levers Splints Rearrange the environment
Conserve energy resources so an individual can perform tasks at a higher level of function without expending more energy
Clients with RA, MS, cardiopulmonary deficits
Energy Conservation Techniques
Ergonomics Principles
Pace activities, balance rest and activity, alternate heavy and light tasks.
Use work simplification: plan, prioritize, problem solve
ADLs
Bathing and showering Toileting and toilet hygiene Personal hygiene and grooming Eating and swallowing Feeding Sexual activity dressing Functional mobility
observable, goal-directed actions that result in a client's quality of performing desired occupations. Skills are supported by the context in which the performance occurs, including environmental and client factors.
Performance skills
represent small, observable actions related to moving oneself or moving and interacting with tangible task objects (e.g., tools, utensils, clothing, food or other supplies, digital devices, plant life) in context.
Motor skills
small, observable actions related to communicating and interacting with others in context
Social interactions skills
small, observable actions related to selecting, interacting with, and using tangible task objects (e.g., tools, utensils, clothing, food or other supplies, digital devices, plant life); carrying out individual actions and steps; and preventing problems of occupational performance from occurring or reoccurring in context.
process skills
Reside within the client and influence the client's performance in occupations
Client factors
Values, beliefs, spirituality, body functions, body structures are examples of what?
Client factors
Perceptions, motivations, and related meaning that influence or are influenced by engagement in occupations
Values, beliefs and spirituality
aspects of the physical, social, and attitudinal surroundings in which people live and conduct their lives
Environmental factors
Problems statement progression, potential justification for continued services
Week 3 Transfers on context progression of transfers most to least
Transfer board Squat pivot/bent pivot Stand pivot with or w/o device Functional mobility level transfers with device, without device
Patients' pivot point are their hips
Week 4 Neuro Based Transfers
Shoulder shrug present
High cervical C2-4
Deltoid C5, biceps C5, wrist extensors C6 present
Mid cervical C5-6
Triceps C7, digit flexion and extension C8 present
Low cervical C7-8
Lower injury (below T12)=more hypotonic legs usually
Week 6 Health Literacy
"Apply written material to occupational performance"
Functional literacy
What is the client's level of education?
What is the impact of reading level on different areas of occupation such as health management?
Functional literacy
Education about disease process, health promotion
Finding reliable sources of information
Know when to find health info.
Roles of healthcare team
What questions to ask
Know where to find health info
Assertiveness, self-advocacy skills training within healthcare
What questions to ask
Communications skills, social participation, self-advocacy
Following instructions
Habits and routines
Scheduling a healthy routine each week
Application
Educational materials should be no higher than a 5th grade reading level
A resource that helps individuals to see what reading level their text is (readability formula, helps you write clearly)
Gunning Fog Index (FOG)
Way a person activates a target that is an important part of meeting an occupation-based goal e.g., phone icon, key on keyboard
Access method
Ask Me 3. Does Your Client understand?
What is my main problem?
What do I need to do?
Why is it important for me to do this?
How to improve accessibility and comprehension
Teach-back method, client restates info in their own words
Two types of access to tech
Direct access: Able to spontaneously select any available target
Indirect access: Connecting steps between person and desired target to select/activate. Less strenuous BUT slower.
Week 9 Assistive Technology
"Methods and tasks that prepare the client for occupational performance are used as part of a treatment session in preparation for or concurrently with occupations and activities or provided to a client as a home-based engagement to support daily occupational performance"
Interventions that support occupations
Under this category is Assistive tech and environmental considerations
According to AOTA, "the term assistive technology device means any item, piece of equipment or product system whether acquired commercially off the shelf, modified or customized that is used to increase, maintain or improve functional capabilities of individuals with disabilities"
Assistive technology
Can be used for remediation or compensation
Range of motion, strength, endurance, cognitive skills
Remediation
Technology bridges the gap between what the individual can do and what he/she/they need to do
Compensation
Usability Aesthetics Durability Prognosis
Reasons why the person might not use the equipment (equipment abandonment)
This acts as an electricity conductor or interrupter. Used with direct or indirect access
Switch
Direct vs indirect access
Direct: Efficient and intuitive Digits, voice or eye gaze to directly activate target Eye gaze: Requires more caregiver support and tech knowledge, but effective for people with little physical movement May require addition tools such as a stylus or key guard
Indirect access Switch scanning: Provide a person with limited physical movement access to multiple selections by activating one target via a software or hardware interface. Scan may be automatic or manual.
Two main categories for positioning and mounts
Flexible: Adjustable, best for lightweight devices or those that use portrait and landscape position. Often NOT funded by insurance
Fixed: Require tool adjustment to change position. Support heavy devices. May be funded by insurance for speech-generating device.
The way a person moves around computer display-mouse, touch screen
Navigation
Primary mouse or touchscreen actions
Selection
Enables a person with physical, cognitive, psychosocial deficits to control electronics in his/her/their own environment
EADLs Electronic Activities of Daily Living
Indirect access examples navigation/selection methods
Disability-specific joysticks and trackballs Head-controlled mouse Mouth-controlled mouse Eye gaze
Communicates between the switch and the target/appliance
e.g., Jellybean to computer monitor via interface
Interface
Switch use and indirect access navigation/selection methods examples...
Joystick, trackball, USB switch adaptor/jellybean switch, head-controlled mouse, Jouse 3
Enable a person to control electronics in their physical environment, including appliances, home theater system, lights, doors, etc.
Electronic Aids to Daily Living (EADLs)
Executes two actions such as turn appliance on/off
Discrete control method
Increased flexibility such as adjusting volume on TV
Continuous control method
EADLs are usually not funded by health insurance because it is not considered medically necessary....worker's comp, VA may fund if it's needed for employment
Areas of Occupation (9)
ADLs IADLs Health management Rest and sleep Education Work Play Leisure Social Participation