Concepts for OCC 534 Midterm
Continuum of functioning
Level of Functioning | Typical Abilities | Typical Limitations/Risks | OT focus |
Physically elite | Performs high-intensity or competitive physical activities | May have overuse injuries but no functional limitations in daily tasks | Performance optimization, injury limitations |
Physically fit | Easily completes all ADLs/IADLs; can do moderate–vigorous activities (brisk walking, stairs) without difficulty | May not train at competitive levels; slight decrease in reserve with age | Maintain fitness, promote active lifestyle, prevent decline |
Physically independent | Manages self-care, household tasks, and community living without help; may do them more slowly, with pacing or minor mods | Limited reserve for high-demand tasks; at risk of moving into frailty with illness or inactivity | Energy conservation, environmental modifications, health promotion to preserve independence |
Physically frail | Can do some basic ADLs but needs help with more demanding tasks (IADLs, community mobility); may use device; low endurance and strength | High fall risk, easily deconditioned, vulnerable to hospitalization and loss of independence | Strength/ balance/ endurance training, fall prevention, compensatory strategies, caregiver education |
Physically dependent | Cannot safely perform some or most basic ADLs without assistance; often needs help with transfers and mobility; may be bed- or chair-bound | Fully dependent for many daily tasks; high risk of complications (pressure injuries, contractures) | Positioning, contracture/skin prevention, maximizing any remining function, meaningful engagement, caregiver training |
Symptoms for CVA to educate patients to look for
- FAST (Face, Arm, Speech, Time)
- Face: is the smile even?
- Arm: can they raise both arms?
- Speech: do they have speech difficulties?
- Time: call 911 immediately
Symptoms for MI to educate patients to look for
- Nausea
- Fatigue
- Chest pain
Balance/Falls assessments (refer to materials from lab on 3-18-26 - understand generally the procedures and indications for administering Berg, Tinetti, TUG, and Falls Efficacy Scale)
- Berg: 14-item scale designed to measure balance of the older adult in a clinical setting.
- You need, Yardstick, 2 standard chairs (one with arm rests, one without), Footstool or step,
- Stopwatch or wristwatch, 15 ft walkway
- Tinetti: Balane and gait
- You need a tape measure
- TUG (timed up and go): see how fast you can walk and get back to the start
- Falls Efficacy Scale (FES-I): measures the level of concern about falling (scale from 1–4 for 16 activities)
Intervention for chronic CVA when improvement in client factors is not noted
Adaptation and compensation:
- One-handed dressing techniques
- AE (button hook, sock aid)
- Visual scanning training
- Task simplification and repetition
Risk factors for falls (intrinsic vs. extrinsic)
Intrinsic
- Fear of falling
- Balance or gate problems
Extrinsic
- Rugs
- Bad lighting
Age-related vs abnormal changes in sensory, cognitive and their functional implications
Changes in the Sensory System
Sensation | Age-Related Changes | Abnormal Changes |
Vision | Slower visual processing and decreased acuity, especially near vision and low light Increased glare sensitivity, reduced contrast sensitivity | Cataracts AMD Glaucoma Diabetic retinopathy Parkinson’s & Alzheimer’s |
Functional impact: difficulty reading, recognizing faces, managing medications, driving, navigating environments, and detecting hazards; increased fall risk | ||
Hearing | Presbycusis: high-frequency sensorineural loss Reduced pitch discrimination Slower auditory reaction time Decreased speech perception (noisy environment especially) | Conductive, sensorineural, or mixed hearing loss Central auditory processing disorder Tinnitus |
Functional impact: communication breakdown, difficulty following instructions, social withdrawal, reduced participation, and safety risks from not hearing alarms, traffic, or warnings | ||
Taste & Smell | Higher smell detection thresholds Decreased oral mucosa thickness and moisture Reduced replacement of acini Decreased taste bud density and taste discrimination | More severe chemosensory loss can occur with disease, medication, or neurodegenerative conditions |
Functional impact: poor appetite, decreased enjoyment of food, weight loss, malnutrition, and safety risks from not detecting smoke, gas leaks, or spoiled food | ||
Touch, Skin, & Somesthesis | Thinner, drier, more fragile epidermis; thicker but less elastic epidermis Fewer sweat glands Less collagen, elastin, and sub-q fat Decreased tactile sensitivity and temperature discrimination | High risk for pressure injuries and skin breakdown with immobility Neuropathies can further reduce sensation and protection |
Functional impact: increased risk of skin tears, burns, and pressure ulcers; reduced awareness of harmful pressure or temperature; need for handling precautions, positioning, and regular skin checks | ||
Pain | Decreased pain perception in some older adults Altered pain presentations | Chronic pain from multiple conditions Under-recognized or undertreated due to beliefs (“pain is normal with aging”) or provider underassessment |
Functional impact: limits engagement in ADLs, therapy, and mobility; contributes to deconditioning, reduced independence, depression, and lower quality of life if not effectively managed | ||
Changes in the Musculoskeletal System
Age-Related Changes | Abnormal Changes | ||||
| Osteoarthritis (OA) Risk factors, signs, and symptoms - Nonmodifiable: age, genetics, sex - Modifiable: obesity, high physicality, high-impact sports
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Changes in muscle structure - Sarcopenia: gradual loss of muscle size and strength with aging - Disuse atrophy: muscle shrinks from not being used (inactivity, bed rest) Overall loss of muscle fibers - Increase in fat and connective tissues:muscle is replaced with fat and stiffness - Loss of motor units: fewer muscle cells, especially fast-twitch fibers (power) - Changes in protein metabolism: body is less efficient at building and repairing muscle - Decrease in number of capillaries: less blood flow to muscles - Changes in occupational performance: strong link between strength impairments and the development of activity limitations, ex… - Reaching for objects - Writing or grasping small objects - Functional mobility | Amputations Possible areas of occupational performance affected: - Functional mobility - Self-care - FM tasks - Work Management of limb amputation in older adults: - Critical that it begins immediately after surgery Interventions: - Pain and contracture management - Prosthetic management - Strength and ROM Compensatory strategies | ||||
Changes in muscle strength and power - Decreased maximal muscle strength | Osteoporosis, Falls, and Fx’s Key risk factors for falls: - Abnormal gait - Balance - Muscle strength - Cognition - Environmental hazards - LE OA | ||||
Changes in the skeletal system - Dependent on peak bone mass (PBM) - Changes in rate and extent of bone remodeling - Changes in quality of bone tissue |
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Changes in cartilage, joints, and tendons |
Functional implications: tasks that require strength, joint motion, stability, and impact tolerance (mobility, self-care, home management, work, and leisure) become slower, more effortful, more painful, and riskier, often requiring adaptation, assistive technology, or caregiver support
Changes in the Neuromotor System and Related Functions
Age-Related Changes | Neuromotor Health Conditions (Abnormal Changes) |
Proprioception - Changes in joint position sense in UEs & Les | Stroke Most common impairments: - Postural instability - Apraxia - Hemiparesis/plegia - Ataxia - Dysarthria - Changes in muscle tone - Shoulder subluxation |
Balance - Decreased postural stability and a higher sway velocity - Slowed simple reaction time (SRT) | TBI - Leading cause of morbidity and mortality in older adults |
Coordination - Changes in the ability to execute smooth, accurate, and controlled motor responses | Parkinson’s Disease Common motor features: - Rigidity - Bradykinesia Resting tremor |
UE Movement - Increase in tremors - Decreased efficiency in bilateral integration |
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Functional implications: slowed, less precise, and less coordinated movement, which impairs balance, gait, and fine motor control needed for everyday tasks. These changes increase fall risk, reduce independence in ADLs and IADLs, and often require environmental modification, assistive devices, and caregiver support to maintain safety and participation
Age-Related Changes to the Cardiovascular System
- Electrical behavior:
- Premature ventricular contractions (PVCs): early or extra heartbeats (skipped beat or fluttering)
- Atrial fibrillation (AFib)
- Heart blocks
- Mechanical behavior: amyloidosis
- Blood vessels:
- Decreased elasticity
- Decreased efficiency of contractions
- Decreased responsiveness to neurohumoral transmitters blood
- Decreased/diminished pumping volume
Functional implications: decreased endurance, decreased activity tolerance, decreased independence in ADLs or IADLs, decreased participation in work, decreased participation in leisure
Age-Related Changes to the Cardiopulmonary System
- Airways: decreased elasticity
- Lung parenchyma: reduced efficient gas exchange
- Alveolar capillary membrane: decreased diffusing capacity
- Chest wall: decreased compliance
- Respiratory muscles: decreased muscle mass
Functional implications: Effective use of accessory respiratory muscles, tidal volume, exercise-induced hyperpnea, force of cough, risk of aspiration or choking, surface area for gas exchange, elastic recoil, vital capacity, ventilatory flow rates
Metabolic syndrome (cluster of symptoms) and associated risks, and interventions to address those risks
Metabolic syndrome is a group of health conditions that occur together, increasing a person's risk for heart disease, Type 2 DM, and stroke. It is not just one problem—it’s a cluster of risks that put a lot of stress on the body.
Ex: diabetes, then stroke, then COPD (cluster of things that build upon each other)
Cluster of risks: central obesity, high BP, high blood sugar, abnormal lipids all increase risk for heart disease, Type 2 DM, and stroke
Interventions:
- Daily routines for meds, glucose checks, meals
- Activity: graded aerobic and strengthening within safety limits
- Habits: diet changes (less saturated fat/sugar, more fiber), less sedentary time, smoking cessation support
- Education: warning signs (e.g., MI, stroke), foot care, monitoring BP/glucose
Vision diagnoses and intervention (Macular Degeneration vs. Glaucoma and what type of intervention for each)
Diagnosis | Affects | Interventions |
AMD (Dry/Wet) | Central vision loss
Difficulty with reading, faces, and fine details | Teach eccentric viewing and visual scanning, increase contrast/lighting, enlarge print, use auditory tech, reorganize environment so key items are in intact peripheral fields. |
Glaucoma | Peripheral vision loss (tunnel vision)
Bumping into objects, fall risk | Safety and scanning for obstacles, contrast tape on edges/steps, wide and clear pathways, mobility training, lighting, education about adherence to eye drop/medicine regimen |
Stages of Parkinson’s Disease and interventions per stage
Stage | Typical Presentation | OT Focus |
I | Unilateral tremor, micrographia, poor endurance for previous occupations, fatigue | Work/role eval, work simplification for work/home settings, develop habit of taking frequent rest breaks, built-up utensils |
II | Bilateral motor disturbances, mild rigidity, difficulties with simultaneous tasks, difficulties with executive function | Energy conservation related to ADLs, develop daily flexible exercise (trunk rotation), driving assessment (alternatives for community mobility), task analysis to structure sequential tasks |
III | Balance problems with delayed reactions, difficulties with skilled sequential tasks | Environmental modifications including raised toilet seats, chairs with arm rests, removal of throw rugs; use of visual cues and supports for sequential tasks |
IV | Fine motor control severely compromised, oral motor deficits | Modifications to support participation in self-care tasks, changes in food textures |
V | Client severely compromised in regard to motor skills, dependent with ADLs (mostly WC or bed-bound) | Use of environmental controls to allow access to environment |
Stages of Alzheimer’s Disease
(not on the study guide, but was on the Jeopardy)
Stage | Typical Presentation | OT Focus |
I — Very mild to mild cognitive decline | Mild memory loss; may misplace items; difficulty with complex tasks; still physically intact and independent in BADLs | Encourage exercise and wellness; help est. daily routine and post it somewhere visible |
II — Mild to moderate cognitive decline | Increasing forgetfulness; difficulty with complex IADLs; needs SPV for some ADLs; possible paranoia and behavioral changes | Simplify tasks; adapt environment to support safety; train CG to give cues and structure; avoid new learning, use repetition; maintain socialization and meaningful activities |
III — Moderate to moderately severe cognitive and physical decline | Marked memory loss; disorientation; impaired judgment; needs help with most ADLs; may wander or show agitation | Provide highly structured, familiar, repetitive activities; maximize remaining abilities in self-care; increase environmental safety and visual cues; support CG in managing behaviors and daily routines |
IV — Severe cognitive decline and severe physical decline | Severe memory and communication loss; may not recognize family; dependent in all ADLs; limited mobility and swallowing issues | Positioning and comfort; safe feeding and dysphagia management; simple sensory stimulation (music, touch); CG training in transfers and total care; facilitate dignity and QOL |
Pedretti’s, 8th ed. (pp. 881–882)
Subjective vs. objective tracking of cardiopulmonary exertion during activities
Subjective: Patient Report
- If overexerted: SOB, dizziness, nausea, “I feel like I’m gonna faint”
- Assessment: Perceived Exertion Scale, Modified Borg
Objective: Clinical Observations
- Vitals: HR, BP, Pulse Ox
- Nausea
- Fatigue
AOTA ethical principles (non-maleficence vs. beneficence vs. autonomy vs. justice)
Nonmaleficence | “Do no harm”; avoid actions that cause physical, emotional, financial, or other harm. Includes avoiding exploitation, unsafe practice, and addressing impaired practice. |
Beneficence | Act for the good of clients; promote their health, safety, and well-being. Provide evidence-based, timely, and appropriate services and advocate for needed resources. |
Autonomy | Respect the client’s right to self-determination, privacy, confidentiality, and informed consent. Involves shared decision-making and honoring the right to refuse services. |
Justice | Provide fair, equitable services and uphold laws, policies, and institutional rules. Includes social and procedural justice: addressing discrimination, promoting access, and honest billing/documentation. |
Veracity | Tell the truth; provide accurate, complete, and objective information. Accurately represent credentials, document honestly, and avoid fraud or deception. |
Fidelity | Be loyal, respectful, and fair to clients, colleagues, students, and the profession. Maintain professional boundaries, manage conflicts of interest, and follow through on commitments. |
Policy/procedure for reporting abuse and the individuals most at risk of experiencing abuse
- First report to clinical supervisor
- You don’t have to have proof, but notify and document
Criteria for qualifying for Medicare, differences between Parts of Medicare (with a focus on Part A vs. Part B), and the general difference between Medicare and Medicaid in terms of qualifications
Qualifying Criteria for Medicare
- At least 65 years old
- U.S. citizen or permanent resident for at least 10 years
- To get Part A without a premium, must have paid Medicare taxes (or had a spouse who did) for at least 40 quarters
- Under age 65 can qualify if:
- Permanently disabled and have received Social Security disability benefits for at least the previous 2 years
- Have end-stage renal disease (ESRD) requiring dialysis or transplant
- Have ALS and receive Social Security disability benefits
Types of Medicare (focus on A and B)
- Type A: covers hospitalization (inpatient), skilled nursing home care (post-acute, short term), some home health care, and hospice
- Type B: covers outpatient physician and other health providers (OT/PT/SLP), some DME
- Type C: Medicare advantage plans (private) that replace original Medicare but must cover at least Parts A and B services (often adds extras, e.g., vision, dental)
- Type D: prescription medication
Medicare vs. Medicaid
Feature | Medicare | Medicaid |
What it is | National health insurance plan for elders (later expanded for people with ESRD and ALS) | Joint federal-state program for the indigent (those with low income, limited resources) |
Who runs it | Fully federal; rules and payment policies set by federal law and regulations | Federal-state partnership; federal rules set the framework, each state designs and runs its own program |
Main basis for eligibility | Age (65+), disability (ESDR/ALS), plus citizenship/residency and work history Not income-based | Income and assets plus residency/immigration and citizenship documentation; must meet federal and state financial criteria Income-based |
Typical role in elder care | Covers acute and post-acute care (hospital, short-term SNF, some home health, hospice, outpatient and therapy) | Covers LTC in nursing homes and long-term services for those who have no financial resources (after “spend down”), in addition to other mandatory and optional medical benefits (set by federal and state govs.) |
Relationship between them | Largest single payer: its policies often influence private insurance Many older adults also have Medicaid for LTC and cost coverage | Often secondary for people who have both: helps with LTC and with costs Medicare doesn’t fully cover when the person is poor enough to qualify |
Main constructs of the different theories of aging (Biological Theories vs. Psychological Theories vs. Sociological Theories vs. Environmental Theories)
Biological Theories address aging processes at the organism, molecular, and cellular levels. (Described in the OTPF as performance skills and client factors.)
- Programmed theories: The body degrades through mechanisms that fail due to programmatic deterioration throughout life course
- Programmed longevity theory
- Error theories: Aging because of accumulated “insults” from the environment
- Somatic mutation theory
- Genetic theories: Illustrate aging and age-related morbidities as associated with inherited genetics and acquired genetic mutations
- Epigenetics
Psychological Theories seek to explain changes in individual behavior in the middle and later years of life span.
- Life-Span Development Theory: Development happens across the whole life, with gains and losses in many areas, shaped by context.
- Selective Optimization with Compensation Theory: Older adults focus on key goals, build strengths in those areas, and use strategies/tools to make up for losses.
- Socioemotional Selectivity Theory: As people see time as limited, they invest in close, meaningful relationships and positive emotions over new information.
- Personality and Aging Theories: Personality is mostly stable; certain traits (like being organized and adaptive) support better adjustment and “successful aging.”
- Cognition and Aging Theories: Some thinking skills (like speed and new problem-solving) decline with age, while knowledge, experience, and strategy use can stay strong or improve.
Sociological Theories consider the social structure, culture, and context in which aging occurs
- Disengagement theory
Environmental Theories view behavior as a direct function of the person and their environment
- Ecological model of aging:
- Function depends on the balance between:
- Personal ability (strength, cognition)
- Environmental demands (stairs, noise, complexity)
- If the environment is too demanding → stress and decline
- If the environment matches ability → better functioning
Simple idea: “Good fit between person and environment = better aging.”
Sociocultural determinants of health (SDOH)
Non-medical factors that influence health outcomes
- Education
- Health care
- Neighborhood and built environments
- Economic stability
- Social and community context
Effects of SDOH can be exacerbated for older adults
- Contributes to risk for frailty, mental health concerns, oral health, vascular disease, cognitive impairment
Health Literacy principles
- Lower education level: at a disadvantage for understanding instructions, not knowing signs and symptoms of a stroke, etc.
- Health literacy level determines how apt you are to go and get help
- How can we adapt to literacy and education to those with lower educational levels
- Step by step
- Small words - simple and understandable
- Review instructions and terminology multiple times
- Handouts/ simplify things
- Visuals
- Teach back method
Understand that a client is allowed to continue receiving OT services even if their status with client factors isn’t expected to remediate
Jimmo vs Sebelius!!!
Progressive diseases: OT services for MS, Parkinson’s, and Alzheimer’s/dementia are still covered by insurance even though improvement is not expected.
Indications/contraindications for cryotherapy, thermotherapy, E-Stim, Ultrasound
Modality | Indications | Contraindications |
Cryotherapy | Acute inflammation, edema, pain, arthritic flare, acute bursitis/tendonitis, spasticity, myofascial trigger points, muscle spasm, maintain stretch. | Impaired circulation, cold hypersensitivity/Raynaud’s, early wounds, over superficial nerves, cryoglobulinemia/ischemia, cardio‑resp issues; watch BP. |
Thermotherapy | Stiff joints, spasm, neuroma, scars, chronic arthritis, soft tissue contracture, subacute/chronic inflammation, CTDs, warm‑up before stretch/function. | Circulatory impairment, undetermined edema, impaired sensation or thermal regulation, tumor/cancer, acute inflammation, DVT, pregnancy (immersion), bleeding, infection, fresh tendon/ligament repair, advanced cardiac disease, impaired cognition. |
E-Stim | Pain, edema, ↓ inflammation, post‑exercise pain/edema, spasm, joint contracture, disuse atrophy, muscle re‑ed, ↑ ROM/strength. | Pacemaker, pregnancy near uterus, carotid sinus, larynx/pharynx, chest, temporal region, malignancy, infection, pain of unknown origin, areas where contraction worsens injury, sensory loss, thrombosis/embolus, bleed‑prone vessels, near heart/eyes/ears. |
Ultrasound | Joint contracture, spasm, neuroma, scars, SNS disorders, trigger points, warts, spasticity, post‑acute myositis ossificans, acute (pulsed) or chronic (cont/pulsed) inflammation, soft‑tissue tightness, bone/wound healing. | Ischemia/poor circulation, DVT, anesthetic areas, tumor, infection/sepsis, over spinal cord/plexus, stress fx/osteoporosis site, penetrating metal, eyes/heart/skull/genitals, thorax with pacemaker, pregnancy pelvis/lumbar, unhealed fx, pelvic/lumbar during menses, sensory loss, malignancy, joint replacements. |
From OTHD—Physical Agent Modalities (Resource Library)
Wheelchair measurements and considerations for different diagnoses (like amputation, bariatric, pelvic obliquity)
Position of the Axle on a Wheelchair - Having the majority of body weight positioned over the rear axle improves the ease of wheelchair propulsion, due to assisting with unweighting the front caster wheels during mobility.
- Bariatric clients
- Center of mass is more forward
- Move axle forward
- Helps keep body weight properly over the axle
- Lower extremity (LE) amputation
- Loss of leg weight shifts center of mass
- Move axle back (posteriorly)
- Helps improve balance and propulsion
- Other considerations
- Anti-tippers for safety
- Residual limb supports for positioning and protection
Intervention for LE amputation (consider pre-prosthetic vs. prosthetic training phase; understand the factors that would help determine if a client would be a good candidate for a prosthesis or not)
Pre-Prosthetic Phase:
- Desensitization: if wound is closed AND healed (scarring)
- Needs to be fully healed before starting prosthetic training
- ADVANCED ADULTS POWERPOINT
Prosthetic Training Phase:
- Look for redness, swelling, drainage through the dressing with the amputation
- Seated ADL training, transfers (using the sliding board, decreasing risk for shearing)
- ALSO CHECK THE LAB POWERPOINT
Diabetes: Understand the signs of hypoglycemia vs. hyperglycemia vs. ketoacidosis
Hypoglycemia | Shaking or tremors Sweating Confusion Dizziness Irritability Weakness Rapid HR |
Hyperglycemia | Increased thirst Frequent urination Blurred vision Fatigue Dry skin Headache |
Ketoacidosis | High blood sugar Fruity (acetone) breath Nausea and vomiting Abdominal pain Rapid, deep breathing Confusion or decreased alertness Severe fatigue |
Diabetes: Understand the general intervention process to address impairment areas
- Educate:
- on skin inspections, blood sugar management, establish routines for taking medication and meals
- Promote healthy lifestyles and healthy habits
- Eating fewer fatty foods, eating cleaner
- Preventing falls due possible slower recovery risk
- Due to other risk factors clients will be at a higher risk of slow recovery
Understand the difference between criterion vs. norm-referenced assessments (with a focus on when it may be appropriate to use one type vs. the other)
- Criterion-referenced: compares performance to a fixed standard or checklist (“can they do X, yes/no?”)
- Good for tracking individual change over time, goal attainment, teaching specific skills (e.g., task-specific ADL checklists)
- Norm-referenced: compares performance to a reference group (uses percentiles and T- or Z-scores)
- Good for determining how impaired someone is relative to peers, eligibility for services, or diagnosis-related questions (e.g., cognitive screens)
Understand the types of assessment reliability and validity
- Reliability = consistency and dependability
- Test-retest reliability: how consistent a test’s scores are over time when it is the same test, same person, similar condition, and the client’s status hasn’t changed
- High test-retest reliability is demonstrated when the client gets very similar scores each time the test is repeated
- Intra-rater reliability: same clinician gets similar scores when repeating the test on the same client
- High intra-rater reliability is demonstrated when you administer the Berg to a client on Monday and again on Wednesday and the scores are similar
- Inter-rater reliability: different clinicians score the same client similarly
- High inter-rater reliability is demonstrated when you and another clinician both watch the same client do the Berg, and you both score similarly.
Test-retest reliability vs. intra-rater reliability: Test-retest = stability of the test over time; intra-rater = consistency of one clinician’s scoring
- Validity = does it measure what it claims?
- Construct/criterion validity: scores truly reflect the construct or outcome
- Ecological validity: resembles real-world occupational performance
Understand the types of incontinence and strategies to address the major types of incontinence
Type | Description | Intervention |
Urge Incontinence | Sudden, strong urge to urinate = can’t make it to the bathroom in time | Bladder diary, scheduled voiding, quick-relax/breathing, easy bathroom access |
Overactive Bladder (OAB) | Frequent urgency and urination (may or may not include leakage) | Fluid/caffeine management, urge-suppression strategies, schedules, pelvic floor exercises |
Stress Incontinence | Leakage with pressure (coughing, sneezing, laughing, lifting) | Pelvic floor strengthening, teach proper breathing/lifting, activity modification |
Mixed Incontinence | Combination of urge and stress symptoms | Blend of scheduled voiding and pelvic floor exercises; trigger management |
Overflow Incontinence | Bladder doesn’t fully empty = constant dribbling or leakage | Voiding schedule, positioning, refer to MD for catheter/retention issues |
Functional Incontinence | Bladder is normal, but can’t get to the bathroom in time due to mobility, cognition, or environment | Improve mobility, clear path, grab bars, clothing simplification, bed/chair commodes, cueing |
Understand alternatives to the use of restraints to manage behavioral concerns, and what is required for a restraint to be used.
Restraints
- If a client cannot independently remove it, it is considered a restraint
- Must have a physician’s order; use only after exploring alternatives
Alternatives to Restraints
- Environmental changes
- Activity engagement
- De-escalation
- Supervision
Understand the three tiers of interventions to support caregivers
Jeopardy Practice Questions
Continuum of Functioning
- A 65-year-old retired firefighter who now competes in Masters CrossFit competitions, regularly lifts weights, and participates in endurance races like marathons or triathlons.
- Answer: Physically elite
- An 85-year-old with advanced Parkinson’s disease who lives in a nursing home. They require full-time assistance with dressing, bathing, and eating, as well as help with mobility due to significant physical limitations.
- Physically dependent
- A 75-year-old with controlled diabetes who lives alone, enjoys gardening, volunteers at a local community center, and takes daily walks with friends but no longer engages in intense physical activities.
- Answer: Physically Independent
- A 70-year-old teacher who still plays in a local tennis league, enjoys hiking with younger family members, and maintains a regular gym routine for strength and mobility.
- Answer: Physically Fit
- An 80-year-old who lives alone but needs a walker to move around safely. They require assistance with heavy housework and home maintenance but can still prepare simple meals and manage personal hygiene independently.
- Answer: Physically Frail
Wheelchair
- What should be done when measuring the width of the seat for wheelchair custom measurements?
- Answer: Measure across the client’s hips, and add 1 inch on either side to gain a measurement of seat width
- When a caregiver is assisting a client with maneuvering their wheelchair down a steep ramp grade, how should the caregiver be instructed to assist?
- Answer: Descend the ramp backwards. Because the ramp is steep, the caregiver should descend backwards, with the client assisting with keeping control of the large wheels at the back of the chair
- An OT is working with a client who has experienced an above knee lower extremity amputation. What is an important consideration for this client as it relates to his wheelchair and the associated adjustments that should be made to the position of the rear axle?
- Answer: The axle should be moved posteriorly on the chair
- A client presents for a wheelchair evaluation. The evaluation determines that the client has impaired trunk control and could benefit from a cushion that will provide optimal pressure relief, while also being low maintenance. What type of wheelchair seat cushion will best fit this client’s needs?
- Answer: Gel wheelchair cushion
- A client who presents with a flexible deformity of a right pelvic obliquity secondary to scoliosis has been referred for OT services as it relates to seating and positioning needs. What is appropriate for the client’s seating surface secondary to the presence of the obliquity?
- Answer: Build up the cushion on the right side of the chair
Age-Related Changes
- During a session focused on functional mobility, the client has trouble placing their foot accurately on a step without looking down. In relation to sensory impairments, this might indicate age-related deficits in:
- Answer: Proprioception
- True or False: Lung compliance increases with age.
- Answer: True
- Name some age-related vision changes:
- Potential Answers: Problems with seeing clearly in low light settings, problems with light and dark adaptation, decreased contrast sensitivity, and increased sensitivity to glare.
- An older adult reports difficulty following multi-step cooking tasks and frequently forgets to return to a task after being interrupted (leaves the stove on after answering the phone). Which age-related cognitive changes are MOST likely contributing:
- Answer: Declines in working memory, prospective memory, and task switching
- An older adult demonstrates slower sit-to-stand transfers, decreased ability to carry groceries, and increased fatigue during ADLs. Which underlying age-related musculoskeletal changes may BEST explain this presentation?
- Answer: Sarcopenia, loss of Type II muscle fibers, and decreased capillary density, leading to reduced strength and endurance
Theories
- This theory states that oxidative stress that can accumulate from normal metabolism, lifestyle behaviors such as smoking, and highly processed foods leads to cellular and organ dysfunction.
- Answer: Free Radicals Theory
- The primary phenomenon to be explained by a theory of cognition is the age-related decline in these types of cognitive abilities, which represents the efficiency or effectiveness of performing tasks requiring new problem solving:
- Answer: Fluid cognitive performance
- This theory states that individuals reduce interactions with some people as they age and increase emotional closeness with significant others:
- Answer: Socioemotional Selectivity Theory
- This results from restriction of the range of adaptive potential and becomes operative when specific behavioral capacities are lost or are reduced (hint: part of the Selective Optimization with Compensation (SOC) theory)
- Answer: Compensation
- A SNF resident who is physically able to complete part of dressing and grooming is routinely dressed and groomed entirely by staff without being given the opportunity to participate. As a result, the client is experiencing learned helplessness. Which theory of aging BEST correlates with this scenario?
- Answer: Ecological Model of Aging. In this case, the environmental press is too low because the environment is not placing enough demand on the resident to use their remaining abilities. According to the ecological model of aging, this can lead to boredom, reduced engagement, learned dependence, and further functional decline over time.
Miscellaneous
- This type of diagnosis impairs vision and typically results in loss of peripheral vision:
- Answer: Glaucoma
- For a client who has experienced a new below knee amputation, what areas might you initially work on with the client as part of the OT intervention process?
- Potential Answers: Body image/psychosocial adjustment; Wound care; Wrapping/shaping; Desensitization; Mirror Therapy; Documentation of circumference; Education – skin care and sensibility; ROM, Strength, endurance; ADLs
- A client experiences macular degeneration. These types of strategies may be taught to the client to compensate for impairments in central vision:
- Answer: Eccentric viewing techniques
- A client experiences an exacerbation of COPD with resultant hospitalization. Due to functional deconditioning, the client was referred to receive short-term rehab services at a skilled nursing facility. PT and OT services were consulted. Which form of Medicare will cover these services in this scenario: Part A or Part B?
- Answer: Part A
- When using Physical Agent Modalities, which client factor should be considered first prior to the use of ANY modality?
- Answer: Cognition
- A client completes the Nine-Hole Peg Test twice in one week with no change in condition and receives nearly identical scores both times. What does this indicate about the assessment?
- Answer: Test-retest reliability
- A client presents with Alzheimer’s Disease in Stage III. True or False: The MOCA would be an appropriate assessment to administer:
- Answer: FALSE
- An OT uses the 9-Hole Peg Test for a client with chronic Rheumatoid Arthritis to predict their performance on IADL tasks. True or False: This was an appropriate use of the assessment:
- Answer: FALSE: This is not a predictive assessment. Additionally, because the client demonstrates chronic RA, they have likely adapted their prehensile grasping patterns to be able to meet the demands of a task
- A client performs well on the MOCA but is unable to safely manage their medications at home. What is the most likely issue with the assessment?
- Answer: Low ecological validity - the assessment does not reflect real-world occupational performance.
- A client with limited formal education scores poorly on the MMSE. What would be a more appropriate next step for the OT?
- Answer: Use a cognitive screen or assessment that minimizes education/literacy demands (like a performance-based assessment)