Clinical Skills B Final

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

Week 22 Functional Mobility Screens and Falls Prevention

Older adults (65 years of age plus)

1 out of every 3 older adults falls each year
Rates of deaths from falls increased 31% from 2007-2016

Environment: Home Assessment (Extrinsic) considerations

Proper footwear
Floors and walkways
Height of transfer surfaces
Lighting that is easily accessible
Access to a phone or life alert type button

Client factors (intrinsic)

Advanced age
Muscle weakness
HX of falls
Fear of falls
Visual deficits

Balance Assessments used by varying disciplines

Morse Fall Scale: Nursing in acute care

Berg Balance Scale PT simulate stair walking looking over shoulder functional movements incorporated, assess balance and fall risk in adults 18+

6 minute walk PT children and adults walking endurance

Egress PT or nurse for bariatric patients. Readiness to stand

5 time sit to stand: PT transfers for adults 18+. No UE support allowed. More outpatient

3 common OT Fall assessments

Timed up and go (TUG) mobility balance fall risk 65+ and neuro population 3 meters. 9.8 feet, circle around a cone.

Functional reach test. Tests ability to reach outside BOS for 18+. Can be done seated or standing

30 second chair stand test 30CST 18+, assess functional LE strength. AKA 30 Second Sit to Stand Test. Get credit for any standing.

Interventions for decreasing fall risk

Functional, task-specific balance training: Transfer training, use of assistive device

Environmental modifications: Lighting, walkways

Appropriate footwear, supportive shoes preferable
Education

Used to describe a single device. A rigid or semi rigid device that supports a weak or deformed body member or restricts or eliminates motion in a diseased or injured part of the body. An orthosis can be custom fabricated, custom fit or prefabricated.

Orthosis

Used for billing purposes by physicians when casts are applied. Casts and strapping applied for the purpose of reducing fractures and dislocations.

Splint

A semirigid or rigid device fabricated and applied to support a weak or injured body part, or to restrict or eliminate motion of a body part. Used for billing purposes by therapists.

Orthosis

Who can make orthosis \*** (\***hint hint by Jesci)

OTs
OTAs
PTs
PTAs
Dentists
Nurses with addition special training usually seen on hospital burn units
Certified orthotists

Goals of immobilizing orthosis

Symptom relief
Protection and positioning
Maximizing function
Improve/preserve joint alignment
Contracture management
Block or transfer muscle forces

Goals of mobilizing orthosis

Remodel long standing dense mature scar tissue

Elongate soft tissue contractures

Increase PR of joint motion

Substitute for weak or active muscles

Provide resistance for exercise

Orthosis types 5

1. Static: To immobilize, no moveable parts

2. Serial static: Position the tissue to allow a low load prolonged stress, remolded at intervals

3. Dropout: Allows motion in one direction, while blocking another

4. Static progressive: Mobilizing force with no moving parts

5. Dynamic: To mobilize. Provide controlled movement. Uses one or more moveable parts.

Approaches of orthosis fabrication

Biomechanical: Applies principles of kinetics and forces acting on the body e.g., dynamic orthosis to apply forces in order to increase ROM

Sensorimotor: Inhibit or facilitate normal motor responses in persons with damaged CNS e.g., orthosis for managing spasticity

Rehabilitative: Focus on abilities rather than disabilities with goal of maximizing function within their abilities e.g., tenodesis orthosis to facilitate grasp/release

Heats up between 135-180 degrees F, hardens when cooled

Thermoplastic material, low-temperature thermoplastic most commonly used, will expire. LTT.

Memory
Elasticity
Drape & contour
Bonding time
Self-finishing edges
Other considerations: Heating time, working time, shrinkage

are all examples of

Handling characteristics