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Glossary of NBCOT

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Rancho Los Amigos Level I
No Response

No response to sounds, sights, touch, or movement

Rancho Los Amigos Level II
Generalized Response

- Begin to respond to sounds, sights, touch or movement
- Respond slowly inconsistently or after a delay
- Response in the same way to what he hears, sees, feels
-Response includes chewing, sweating, breathing faster, moaning, moving, or increasing BP




Rancho Los Amigos Level III
Localized Response

- Be awake on and off during day
- Make more movements
- React more specifically to what he sees, hears or feels
- React slowly and inconsistently
- Begin to recognize friends/family
- Follow some simple directions - "look at me"
- Begin to respond inconsistently to simple questions with yes or no head nods







Rancho Los Amigos Level IV
Confused-Agitated

- Be very confused and frightened
- Not understand what he feels, or what is happening
- Overreact due to confusion
- Be restrained so he doesnt hurt himself
- Highly focused on his basic needs
- May not understand that people are trying to help him
- Not pay attention or able to concentrate for a few seconds
- Have difficulty following directions
- Recognize friends and family some of the time
- With help, be able to do simple routine activities such as ADLs










Rancho Los Amigos Level V
Confused-Inappropriate, non-agitated

- Be able to pay attention for only a few minutes
- Be confused and have difficulty making sense of things outside himself
- Not know the date, where he is, or why he is in the hospital
- Not be able to start or complete everyday activities, even when physically able
- become overloaded and restless, have poor memory, and remember things from before accident better
- Confabulate
- Perseverate
- Focus on basic needs








Rancho Los Amigos Level VI
Confused-Appropriate

- Be somewhat confused because of memory/thinking problems, will remember main points but not details
- Follow schedule with some assist
- Know month and year
- Pay attention for about 30 minutes, but have trouble when noisy or involving too many steps
- Complete ADLs with help
- Know when he needs to use the bathroom
- Do or say things too fast, without thinking first
- Know he is hospitalized, but not know the problems he is having
- Be more aware of physical problems than thinking ones
- Thinks he will be fine as soon as he goes home










Rancho Los Amigos Level VII
Automatic-Appropriate

- Follow set schedule
- ADL routine with help
- Have problems planning, starting, and following through with activities
- Have trouble paying attention in distracting or stressful situations
- Not realist how his thinking and memory problems may affect future plans and goals
- Continue to need supervision due to decreased safety awareness and judgment
- Think slower in stressful situations
- Be inflexible, stubborn, or rigid
- Be able to talk about doing something, but will have problems actually doing it









Rancho Los Amigos Level VIII
Purposeful-Appropriate

- Realize that he has a problem in his thinking/memory
- Begin to compensate for his problems
- Be more flexible and less rigid in his thinking
- Be ready for driving/job training eval
- Be able to learn new things at a slower rate
- Still become overloaded with difficult, stressful situations
- Show poor judgment in new situations, may require assistance
- Need some guidance making decisions
- Have thinking problems that may not be noticeable to others









Mosey's Evaluation Groups
- Designed to gather info about the individuals talk and group interaction skills that can be used to establish goals and plan treatment
- Primary purpose is assessment, however they are often therapeutic through process or content
Mosey's Task-oriented Groups
The purpose is to assist the members in becoming aware of their needs, values, ideas, and feelings through the performance of a shared task
Mosey's Developmental groups
The purpose is to assist the members to acquire and develop group interaction skills

- Parallel
- Project
- Egocentric
- Cooperative
- Mature





Parallel Group
Uses individual tasks with minimal interaction required
Project Groups
Consist of common, short-term activities requiring some interaction and cooperation
Egocentric cooperative groups
Require joint interaction on a long-term tasks; however completion of the task is not the focus. The members are beginning to express their needs and address those of others
Cooperative groups
Learn to work together cooperatively, not specifically to complete a task, but to enjoy each other's company and meet emotional needs
Mature Groups
Responsive to all member's need and can carry out a variety of tasks. There is good balance between carrying out the task and meeting the needs of the members
Total Assistance
The need for 100% assistance by one or more persons to perform all physical activities and/or cognitive assistance to elicit a functional response to an external stimuli
Maximum Assistance
The need for 75% assistance by one person to physically perform any part of a functional activity and/or cognitive assistance to perform gross motor actions in response to direction
Moderate Assistance
The need for 50% assistance by one person to perform physical activities or provide cognitive assistance to sustain/complete simple, repetitive activities safety
Minimum Assistance
The need for 25% assistance by one person for physical activities and/or periodic, cognitive assistance to perform functional activities safely
Standby Assistance
The need for supervision by one person for the patient to perform new activity procedures that were adaped by the therapist for safe and effective performance. A patient requires standby assistance when errors and the need for safety precautions are not always anticipated by the patient
Independent Status
No physical or cognitive assistance is required to perform functional activities. Patients at this level are able to implement the selected courses of action, consider potential errors, and anticipate safety hazards in familiar and new situations
Self-care abilities with SCI at C1-C3
Totally dependent in self-care but can instruct others in preferences for care.

Can chew and swallow.

Self-care abilities at SCI level C4
Totally dependent in self-care but can instruct others in preferences for care.

Can drink from a glass with a long straw.

Feeding abilities at SCI level C5
Requires assistance with set-up, equipment includes suspension sling or mobile arm support, dorsal wrist splint with u-cuff, dycem to prevent slippage of plate, scoop dish or plate guard, and angled utensils
Dressing abilities at SCI level C5
Requires minimal to moderate assistance with upper body dressing, dependent with lower body dressing
Bathing abilities at SCI level C5
Requires mod to min assistance
Grooming abilities at SCI level C5
Requires assistance assistance with setup; however, with splint and u-cuff can be independent with brushing teeth and combing hair.
Independent using electric shaver that fits around the hand.
Feeding abilities at SCI level C6
Independent using adaptive equipment, including u-cuff or tenodesis splint, rocker knife, and cup with large handles
Dressing abilities in SCI level C6
Independent in lower body dressing performed while in bed. Requires max assist with socks and shoes. Independent with upper body dressing using button hook and zipper pull.
Bathing abilities in SCI level C6
Minimal assistance using tub bench and sliding board transfer
Grooming abilities at SCI level C6
Independent using tenodesis grasp or splint
Self-care abilities at SCI level C7
Feeding - independent
Dressing - independent, but may need button hook
Bathing - min assist using tub bench and sliding board transfer
Grooming - independent using tenodesis grasp or splint




Self-care abilities at SCI level C8-T1
Independent with self-care, performs depression transfers, can transfer from wheelchair to floor and back to chair with standby assist
Play/leisure skills at SCI level C1-C4
Can play computer games and access the internet and email using a mouthstick, head pointer, or electronic page turner to turn pages. Can paint with a mouthstick or head pointer. Can control radios, TVs, and other electronic devices through use of a mouthstick, head pointer, or voices activated ECU
Play/leisure skills at SCI level C5
Can independently play computer games, access the internet and email, use a speaker phone and ECU, turn pages for reading, play board games, and do some crafts using a splint, universal cuff, and typing splint
Play/leisure abilities in SCI level C6-C7
Can hold a phone, typing stick, and pen using a tenodesis grasp. Can independently use computer using a tenodesis grasp or u-cuff to hold a typing stick. Can play board games and some wheelchair sports. Can do some crafts
Play/leisure skills at SCI level C8-T1
Can do the same as C7 but performance is easier due to good functional use of both upper extremities
Work hardening program characteristics
- An interdisciplinary approach is used
- Real or simulated work activities are used
- Transition between acute care and return to work is provided
- Issues of productivity, safety, physical tolerance, and worker behaviors are addressed


Work conditioning program characteristics
- One discipline is the provider of services
- Real or simulated work activities are used
- A transition between acute care and return to work is provided
- Flexibility, strength, movement, and endurance are addressed


Ergonomic program characteristics
- Prevention is the main focus to fit the work place to the human body
- Types:


Types of ergonomic program characteristics
- Ergonomic survey
- Specific job site analysis
- Manager and employee training
- Educational seminars
- Exercise and stretching programs



Sheltered workshops, supported employment programs, and transitional employment programs
- A multidisciplinary or interdisciplinary approach is used
- Real work activities are used - participants are payed per piece at sheltered workshops, paid at competitive wage for supported employment and TEPs
- A transition between program participation and competitive employment is provided according to each clients functional level
- Can be the final/permanent employment goal for a client
- Considered as employees with supports as needed





Standard dimensions for typical wheelchair
Seat width: 18"
Seat depth: 16"
Seat height: 19.5-20"

Muscle grade 0
Zero - No muscle contraction can be seen or felt
Muscle grade 1
Trace - contraction can be felt, but there is no motion
Muscle grade 2-
Poor minus (P-) - part moves through incomplete ROM with gravity decreased
Muscle grade 2
Poor - part moves through complete ROM with gravity decreased
Muscle grade 2+
Poor Plus (P+) - part moves through incomplete ROM against gravity or through complete ROM with gravity decreased against slight resistance
Muscle grade 3-
Fair minus - part moves through incomplete ROM against gravity
Muscle grade 3
Fair - part moves through complete ROM against gravity
Muscle grade 3+
Fair plus - part moves through complete ROM against gravity and moderate resistance
Muscle grade 4
Good - part moves through complete ROM against gravity and moderate resistance
Muscle grade 5
Normal - part moves through complete ROM against gravity and full resistance
Development of Self-dressing skills at 1 year
- Cooperates with dressing (holds out arms and feet)

- Pulls off shoes and removes socks

- Pushes arms through sleeves and legs through pants



Development of Self-dressing skills at 2 years
- Removes unfastened coat

- Removes shoes if laces are untied

- Helps pull down pants

- Finds armholes in pullover shirt





Development of Self-dressing skills at 2.5 years
- Removes pull-down pants with elastic waist

- Assists in pulling on socks

- Puts on front-button coat or shirt

- Unbuttons large buttons





Development of Self-dressing skills at 3 years
- Puts on pullover shirt with min assist

- Puts on shoes without fasteners (may be on wrong foot)

- Puts on socks

- Independently pulls down pants

- Zips and unzips jacket once on track

- Needs assistance to remove pullover shirt

- Buttons large front buttons











Development of Self-dressing skills at 3.5 years
- Finds front of clothing

- Snaps or hooks front fastener

- Unzips front zippers on jacket, separating zipper

- Puts on mittens

- Buttons 3-4 buttons

- Unbuckles shoe or belt

- Dresses with supervision (help with front and back)











Development of Self-dressing skills at 4 years
- Removes pullover garment independently

- Buckles shoes/belt

- Zips jacket zipper

- Puts on socks correctly and shoes with assistance in tying laces

- Laces shoes

- Consistently identifies front and back of garment









Development of Self-dressing skills at 4.5 years
- Puts belt in loops
Development of Self-dressing skills at 5 years
- Ties and unties knots

- Dresses unsupervised

Development of Self-dressing skills at 6 years
- Closes back zipper

- Ties bows

- Buttons back buttons

- Snaps back snaps





Typical Developmental Sequence of Toileting at 1 year
- Indicates discomfort when wet or soiled

- Has regular bowel movements

Typical Developmental Sequence of Toileting at 1.5 years
- Sits on toilet when placed there and supervised (short time)
Typical Developmental Sequence of Toileting at 2
- Urinates regularly
Typical Developmental Sequence of Toileting at 2.5 years
- Achieves regulated toileting with occasional daytime accidents

- Rarely has bowel accidents

- Tells someone he needs to use the bathroom

- May need reminders to go

- May need help with getting on the toilet







Typical Developmental Sequence of Toileting at 3 years
- Goes to bathroom independently; seats himself on the toilet

- May need help with withing and fasteners/difficult clothing

Typical Developmental Sequence of Toileting at 4-5 years
- Is independent in toileting - tearing toilet paper, flushing, washing hands, managing clothing
Developmental Sequence for Household Management Tasks up to 2 years
13 months - Initiates housework

2 years - Picks up and puts toys away with parental reminders
- Copies parents' domestic activities


Developmental Sequence for Housework Management Tasks at 3 years
- Carries things without dropping them

- Dusts and dries dishes with help

- Gardens with help

- Puts toys away with reminders

- Wipes up spills







Developmental Sequence for Housework Management Tasks at 4 years
- Fixes dry cereal and snacks

- Helps with sorting laundry

Developmental Sequence for Housework Management Tasks at 5 years
- Puts toys away neatly

- Makes a sandwich

- Takes out the trash

- Makes bed

- Puts dirty clothes in hamper

- Answers phone correctly









Developmental Sequence for Housework Management Tasks at 6 years
- Does simple errands

- Does household chores without redoing

- Cleans sink

- Washes dishes with help

- Crosses street safely







Developmental Sequence for Housework Management Tasks at 7-9 years
- Begins to cook simple meals

- Puts clean clothes away

- Hangs up clothes

- Manages small amounts of money

- Uses telephone correctly







Developmental Sequence for Housework Management Tasks at 10-12 years
- Cooks simple meals with supervision

- Does simple repairs with appropriate tools

- Beings doing laundry

- Sets table

- Washes dishes

- Cares for pets with reminders









Developmental Sequence for Housework Management Tasks at 13-14 years
- Does laundry

- Cooks meals

Development of self-feeding at 5-7 months
- Takes cereal or poured baby food from a spoon

- Puts object in mouth

- Plays with caregivers at meals at engages in interactive routine



Development of self-feeding at 6-8 months
- Attempts to hold bottle but may not retrieve it if it falls (object permanence is emerging)

- Needs to be monitored for safety reasons

- Is easily distracted by stimuli in environment



Development of self-feeding at 6-9 months
- Holds and tries to eat cracker but sucks on it more than bites

- Consumes soft foots that dissolve in mouth

- Grabs at spoon but bangs on it or sucks on either end

- Seeks novelty and is anxious to explore objects

- Recognizes strangers and has emerging sense of self







Development of self-feeding at 9-13 months
- Finger feeds self a portion of meals consisting of soft table foods and objects if fed by an adult

- Uses various grasps on objects of different sizes

- Prefers to act on objects rather than be a passive observer



Development of self-feeding at 12-14 months
- Dips spoon in food, brings spoonful of food to mouth, but spills food by inverting spoon before it goes into mouth

- Likely to use pronation grasp on spoon

- Recognizes that objects have a function and uses tools appropriately

- Has interest in watching family routines





Development of self-feeding at 15-18 months
- Scoops food with spoon and brings it to mouth

- Shoulder and wrist stability demonstrate precise movements

- Experiments to learn rules of how object works and solves problems

- Internalizes standards imposed by others for how to play with objects





Development of self-feeding at 24-30 months
- Demonstrates interest in using a fork, may stab at foods such as pieces of fruit

- Proficient at spoon use and eats cereal with milk or rice with gravy with utensil

- Tolerates various textures in mouth, adjusts movements to be efficient

- Expresses wants verbally

- Increase desire to copy peers, looks at adults to see if they appreciate his success and is interested in household routines







Cranial Nerves I, II, VIII
Pure sensory - carry special senses of smell, vision, hearing, and equilibrium
Cranial Nerves III, IV, VI
Pure motor - controlling eye movements and pupillary constrictions
Cranial Nerves XI and XII
Pure motor - innervating sternocleidomastoid, trapezius, and tongue
Cranial Nerve V, VII, IX, X
Mixed motor and sensory - involved in chewing (V), facial expression (VII), swallowing (IX, X), vocal sounds (X), sensation from head (V, VII, IX), alimentary tract, heart, vessels, and lungs (IX, X) and taste (VII, IX, X)
Cranial Nerves III, VII, IX, X
Carry parasympathetic fibers of ANS, involved in control of smooth muscles of inner eye (III), salivary and lacrimal glands (VII), parotid gland (IX) and muscles of heart, lung, and bowel (X)
Foods and substances that should be avoided with MAOIs
Pickled hearing, liver, sausages, sauerkraut, cheeses, yogurt, beer and wine, yeast and meat extract, smoked food products, excessive amounts of chocolate and caffeine

Cough and cold preparations, decongestants, hay-fever and sinus medications, asthma inhalants, anti-appetite and weight reducing preparations, "pep" pills, L-tryptophan, and other certain prescription drugs

Spinal Segment CN V
Dermatome: anterior facial region

Muscle facilitated: mastication

Function: ingestion



Spinal segment C3
Dermatome: neck region

Muscle facilitation: sternocleidomastoid, upper trap

Function: head control



Spinal segment C4
Dermatome: Upper shoulder region

Muscles facilitated: trapezius (diaphragm)

Function: head control



Spinal segment C5
Dermatome: lateral aspect of shoulder

Muscles facilitated: deltoid, biceps, rhomboid major and minor

Function: Elbow flexion



Spinal segment C6
Dermatome: thumb and radial forearm

Muscles facilitated: extensor carpi radialis, biceps

Function: shoulder abduction, wrist extension



Spinal segment C7
Dermatome: middle finger

Muscles facilitated: triceps, extensors of wrist and fingers

Function: wrist flexion, finger extension



Spinal segment C8
Dermatome: little finger, ulnar forearm

Muscles facilitated: flexor of wrist and fingers

Function: C8 finger flexion



Spinal Segment T1
Dermatome: axilla and proximal medial arm

Muscles facilitated: hand intrinsics

Function: abduction and adduction of fingers



Spinal Segment T2 - T12
Dermatome: Thorax

Muscles facilitated: Intercostals

Function: Respiration



Spinal Segment T4 - T6
Dermatome: Nipple line

Muscles facilitated: Intercostals

Function: Respiration



Spinal Segment T11
Dermatome: midchest region, lower rib

Muscles facilitated: abdominal wall, ab muscles

Function: T5-T7 superficial abdominal reflex



Spinal Segment T10
Dermatome: umbilicus

Muscles facilitated: psoas, illacus

Function: leg flexion



Spinal Segment L1 - L2
Dermatome: inside of thigh

Muscles facilitated: cremasteric reflex, accessory muscles

Function: elevation of scrotum



Spinal Segment L2
Dermatome: proximal anterior thigh

Muscles facilitated: illipsoas, adductors of thigh

Function: reflex voiding



Spinal Segment L3 - L4
Dermatome: anterior knee

Muscles facilitated: quads, tibialis anterior, detrusor urinae

Function: hip flexion, extensors of knee, abduction of thigh



Spinal Segment L5
Dermatome: great toe

Muscles facilitated: lateral hamstrings

Function: flexion at knee, toe extension



Spinal Segment L5 - S1
Dermatome: foot region

Muscles facilitated: gastrocnemius, soleus, extensor digitorum longus

Function: flexor withdrawl, urinary retention



Spinal Segment S2
Dermatome: narrow band of posterior thigh

Muscles facilitated: small muscles of foot

Function: bladder retention



D1 flexion
Scapula: abducted and upwardly rotated
Shoulder: flexed, adducted, externally rotated
Elbow: slightly flexed
Forearm: supinated
Wrist: flexed towards radial side
Fingers: flexed, adducted
Thumb: flexed, adducted





D1 Extension
Scapula: adducted, downwardly rotated
Shoulder: extended, abducted, internally rotated
Elbow: extended
Forearm: pronated
Wrist: extended toward ulnar side
Fingers: extended, abducted
Thumb: extended, abducted





D2 Flexion
Scapula: adducted and upwardly rotated
Shoulder: flexed, abducted, externally rotated
Elbow: extended
Forearm: supinated
Wrist: extended toward radial side
Fingers: extended, abducted
Thumb: extended, abducted





D2 Extension
Scapula: abducted and downwardly rotated
Shoulder: extended, adducted, internally rotated
Elbow: towards flexion
Forearm: pronated
Wrist: flexed toward ulnar side
Fingers: flexed, adducted
Thumb: flexed, abducted, opposed





Flexor Synergies
Shoulder girdle elevation and retraction, shoulder abduction and external rotation, elbow flexion, forearm supination, hand variable, hip flexion, abduction, and external rotation, knee flexion, ankle dorsiflexion, root inversion
Extension Synergies
Shoulder girdle depression and protraction, shoulder adduction and internal rotation, elbow extension, forearm pronation, hand variable, hip extension, adduction and internal rotation, knee extension, ankle plantar flexion, foot inversion
Olfactory
CN 1: Sensory
- Carries impulses for sense of smell
- Person is asked to sniff various aromatic substances

Optic
CN 2: Sensory
- Carries impulses for vision
- Eye chart testing, visual field testing

Oculomotor
CN 3
- Motor: Fibers to the superior, inferior, and medial rectus muscles of the eye and to the smooth muscle controlling lens shape, medial and vertical eye movements
- Sensory: Proprioception of the eye
- Pupil sizes are compared for shape and equality, pupillary reflex is tested, visual tracking is tested


Trochlear
CN 4
- Proprioceptor and motor fibers for superior oblique muscle of the eye, downward and inward movement of the eye
- Tested with cranial nerve 3 relative to following moving objects

Trigeminal
CN 5
- Motor and sensory for face, conducts sensory impulses from mouth, nose, eyes, motor fibers for muscles of mastication, control of jaw movements
- Pain, touch, and temp are tested with proper stimulus, corneal reflex tested with a wisp of cotton, person is asked to move jaw through full range

Abducens
CN 6
- Motor and proprioceptor fibers to/from lateral rectus muscles, lateral eye movements
- Tested in conjunction with cranial 3 relative to moving eye laterally

Facial
CN 7
- Mixed sensory and motor - sensory fibers to taste buds and anterior 2/3 tongue; motor fibers to muscles of facial expression and to salivary glands
- check symmetry of face, ask person to attempt various facial expressions; sweet, salty, sour, and bitter substances are applied to tongue to test tasting ability

Vestibulocochlear
CN 8: Sensory
- Transmits impulses for senses of equilibrium and hearing
- Hearing is checked with tuning fork

Glossopharyngeal
CN 9
- Motor fibers for pharynx and salivary glands, sensory fibers for pharynx and posterior tongue, taste sensation for sweet, bitter, sour
- Gag and swallow reflexes are checked, posterior one third of tongue is tested for taste

Vagus
CN 10:
- Sensory motor impulses for larynx and pharynx, parasympathetic motor fibers supply smooth muscles of abdominal organs; sensory impulses from viscera
- Tested in conjunction with CN 9

Spinal Accessory
CN 11
- Sensory/motor fibers for sternocleidomastoid, traps, muscles of soft palate, pharynx, and larynx; movement of neck and shoulders
- Sterno and trap muscle testing

Hypoglossal
CN 12
- Motor/sensory fibers to/from tongue, movement of tongue
- Ask person to stick out tongue, positional abnormalities are noted

Glascow Coma Scale - Best eye response
4 - Eyes opening spontaneously
3 - Eyes opening to speech
2 - Eyes opening in response to pain
1 - No eye opening


Glascow Coma Scale - Best verbal response
5 - Oriented - responds coherently/appropriately to questions such as the patient's name, age, month, year, where they are, and why
4 - Confused - pt. responds to questions coherently but has some confusion/disorientation
3 - Inappropriate words - random or exclamatory speech, not conversational exchange
2 - Incomprehensible sounds - moaning, no words
1 - None



Glascow Coma Scale - Best motor response
6 - Obeys commands - person does simple things as asked
5 - Localizes to pain - purposeful movements towards changing painful stimuli
4 - Withdrawls from pain - pulls part of body away when pinched
3 - Flexion in response to pain - decorticate response
2 - Extension to pain - decerebrate response
1 - No motor response




Individual Intervention
- Learning capacity of the person
- Amount of attention and skill required from the OT owing to body structure and function impairments
- Need for privacy
- Need for greater control over the environment
- Difficulty or complexity of occupation and activity demands, performance skills, and patterns
- Innappropriate or dangerous behavior of the person




Group Intervention
- Developing interpersonal skilled
- Engaging in socialization
- Receiving feedback from people experiencing similar conditions
- Being motivated by peer role models
- Learning from other people
- Placing ones own condition into perspective
- Developing group normative behavior for successful performance in shared occupations (work study leisure)





Entry-level OT
- No supervision required, close supervision by an intermediate or advanced level OT is recommended
- Supervises aides, technicians, all levels of OTAs, Level I and II FW students
Intermediate level OT
- working on increaseing skill development, mastry of basic role functions, demonstrates ability to respond in situations based on previous exp.
- Supervision not required, routine or general recommended
- Supervises aides, techs, all levels of OTAs, FW students and entry level OTs

Advanced level OT
- Refining specializing skills with ability to understand complex issues affecting role functions
- Supervision not required, min supervision by another advanced OT recommended
- Supervises everyone

Entry-level OTA
- Working on initial skill development or entering new practice
- Close supervision by all levels of OTs, or intermediate or advanced level OTA which is under supervision of an OT
- Aides, techs and volunteers

Intermediate-level OTA
- Working on increased skill development and mastery of basic role functions, demonstrates ability to respond to situations based on prev experiences
- Routine or general supervision by all levels of OTs, advanced level OTA, who is under the supervision of an OT
- Aides, techs, entry-level OTAs, volunteers, level I OT students, and Level I and II OTA students

Advanced-level OTA
- Refining specialized skills with ability to understand complex issues affecting role functions
- General supervision by all levels of OTs or advanced level OTA, under OT supervision
- Supervises aides, techs, OTAs, volunteers, level I OTs and level I and II OTA students

Medicare Part A
- Pays for inpatient hospital, SNF, home health, hospice care
- Auto provided for all who are covered by SS and meets criteria
- Prospective, predetermined rate based on Diagnostic Related Groups - fixed dollar amount, supplies included
- Have specific time limits and require deductible/coinsurance benefits paid by patient; 20% of home health paid by patient


Medicare Part B
- Pays for hospital outpatient physician and other professional services including OT services provided by indep. practitioners
- Supplemental Medical Insurance Program, must be purchased
- No time limit, 20% co-pay

Primary difference between Parts A and B
- The frequency in which the individual relieves services, - Part A coverage requires services for a minimum of 5 days per week, Part B covers 3 day per week outpatient
Rooting Reflex
Onset: 28 weeks gestation
Integration: 3 months
Stimulus: stroke the corner of the mouth, upper lip and lower lip
Response: movement of the tongue, mouth, and/or head toward stimulus
Relevance: allows searching for and locating feeding source



Suck-swallow Reflex
Onset: 28 weeks gestation
Integration: 2-5 months
Stimulus: place examiners index finger inside infant's mouth with head in midline
Response: strong, rhythmical sucking
Relevance: allows ingestion of nourishment



Traction Reflex
Onset: 28 weeks gestation
Integration: 2-5 months
Stimulus: grasp infants forearms and pull-to-sit
Response: complete flexion or upper extremities
Relevance: enhances momentary reflexive grasp



Moro Reflex
Onset: 28 weeks gestation
Integration: 4-6 months
Stimulus: rapidly drop infant's head movement
Response: first phase - arm extension/abduction, hand opening; second phase - arm flexion and adduction
Relevance: facilitates ability to depart from dominant flexor posture; protective response



Plantar Grasp Reflex
Onset: 28 weeks gestation
Integration: 9 months
Stimulus: apply pressure with thumb on the infant's ball of the foot
Response: toe flexion
Relevance: increases tactile input to sole of foot



Galant Reflex
Onset: 32 weeks gestation
Integration: 2 months
Stimulus: hold infant in prone suspension, gently scratch or tap alongside the spine with finger, from shoulders to buttocks
Response: lateral trunk flexion and wrinkling of the skin on the stimulated side
Relevance: facilitates lateral trunk movements necessary for trunk stabilization



Asymmetric Tonic Neck Reflex
Onset: 37 weeks gestation
Integration: 4-6 months
Stimulus: fully rotate infants head and hold for 5 seconds
Response: extension of extremities on the face side, flexion of extremities on skull side
Relevance: promotes visual hand regard



Palmar Grasp Reflex
Onset: 37 weeks gestation
Integration: 4-6 months
Stimulus: place examiners finger in infants palm
Response: finger flexion, reflexive grasp
Relevance: increases tactile input on the palm of the hand



Tonic Labyrinthine-Supine Reflex
Onset: >37 weeks gestation
Integration: 6 months
Stimulus: place infant in supine
Response: increased extensor tone
Relevance: facilitates total-body extensor tone



Tonic Labyrinthine - Prone Reflex
Onset: >37 weeks gestation
Integration: 6 months
Stimulus: place infant in prone
Response: increased flexor tone
Relevance: facilitates total-body flexor tone



Labyrinthine/optical (head) Righting Reflex
Onset: birth - 2 months
Integration: persists
Stimulus: hold infant suspended vertically and tilt slowly to the side, forward, or backward
Response: upright positioning of the head
Relevance: orients head in space, maintains face vertical



Landau Reflex
Onset: 3-4 months
Integration: 12-24 months
Stimulus: hold infant in horizontal prone suspension
Response: complete extension of head, trunk, and extremities
Relevance: breaks up flexor dominance, facilitates prone extension



Symmetric Tonic Neck Reflex
Onset: 4-6 months
Integration: 8-12 months
Stimulus: place infant in the crawling position and extend the head
Response: flexion of hip and knees
Relevance: breaks up total extensor posture, facilitates static quadruped position



Neck Righting on Body Reflex
Onset: 4-6 months
Integration: 5 years
Stimulus: place infant in supine and fulling turn head to one side
Response: log rolling of entire body to maintain alignment with the head
Relevance: maintains head/body alighnment; initiates rolling



Body Righting on the Body Reflex
Onset: 4-6 months
Integration: 5 years
Stimulus: place infant in supine, flex one hip and knee toward the chest and hold briefly
Response: segmental rolling of the upper trunk to maintain alignment
Relevance: facilitates trunk/spinal rotation



Downward Parachute (protective extension downward) Reflex
Onset: 4 months
Integration: persists
Stimulus: rapidly lower infant toward supporting surface while suspended vertically
Response: extension of the lower extremities
Relevance: allows accurate placement of lower extremities in anticipation of a surface



Forward Parachute (protective extension forward) Relfex
Onset: 6-9 months
Integration: persists
Stimulus: suddenly tip infant forward toward supporting surface while vertically suspended
Response: sudden extension of the upper extremities, hand opening, and neck extension
Relevance: allows accurate placement of upper extremities in the anticipation of supporting surface to prevent a fall



Sideward Parachute (protective extension sideward) Reflex
Onset: 7 months
Integration: persists
Stimulus: quickly but firmly tip infant off balance to the side while in seated position
Response: arm extension and abduction to the side
Relevance: protects body to prevent a fall; supports body for unilateral use of opposite arm



Backward Parachute (protective extension backward) Reflex
Onset: 9-10 months
Integration: persists
Stimulus: quickly but firmly tip infant off balance backward
Response: backward arm extension or arm extension to one side
Relevance: protects body to prevent a fall; unilaterally facilitates spinal rotation



Prone Tilting Reflex
Onset: 5 months
Integration: persists
Stimulus: after positioning infant in prone, slowly raises one side of the supporting surface
Response: curving of the spine toward the raised side, abduction/extension of arms and legs
Relevance: maintain equilibrium without arm support; facilitate postural adjustments in all positions



Supine tilting and Sitting tilting Reflexes
Onset: 7-8 months
Integration: persists
Stimulus: after positioning infant in sitting or supine, slowly raise one side of the supporting surface
Response: curving of the spine toward the raised side; abduction/extension of arms and legs
Relevance: maintain equilibrium without arm support; facilitate postural adjustments in all positions



Quadruped Tilting Reflex
Onset: 9-12 months
Integration: persists
Stimulus: after positioning infant on all fours, slowly raise one side of the supporting surface
Response: curving of the spine toward the raised side, abduction/extension of arms and legs
Relevance: maintain equilibrium without arm support; facilitate postural adjustments in all positions



Standing tilting Reflex
Onset: 12-21 months
Integration: persists
Stimulus: after positioning infant standing, slowly raise one side of the supporting surface
Response: curving of the spine toward the raised side, abduction/extension of arms and legs
Relevance: maintain equilibrium without arm support, facilitate postural adjustments in all positions



Left Hemisphere
Movement of right side of body
Processing of sensory information from right side
Visual reception from right side
Visual verbal processing
Bilateral motor praxis
Verbal memory
Bilateral auditory reception
Speech
Processing of verbal/auditory information







Right Hemisphere
Movement of left side of body
Processing of sensory info from left side
Visual reception from left field
Visual spatial processing
Left motor praxis
Non-verbal memory
Attention to incoming stimuli
Emotion
Processing of non-verbal auditory information
Interpretation of abstract information
Interpretation of tonal inflections









Stage 1 Cardiopulmonary
ADL/mobility: in sitting self-feeding, wash hands, bed mobility, transfers, progressively increase sitting tolerance
Exercise: supine, all extremities 10-15 times; sitting, all extremities, progressively increasing the number of reps - no isometrics!
Stage 2 Cardiopulmonary
ADL/mobility: Sitting: self-bathing, shaving, grooming, dressing; unlimited sitting; ambulation in room as tolerated
Exercise: to all extremities, progressively increasing number of reps - no isometrics
Rec: crafts

Stage 3 Cardiopulmonary
ADL: showering sitting in warm water, homemaking tasks with brief standing periods to transfer light items, ironing
Exercise: wheelchair mobility, exercise to all extremities/trunk, balance exercise, light mat activities without resistance, ambulation at 0%, comfortable pace
Rec: card playing, crafts, piano, machine sewing, typing

Stage 4 Cardiopulmonary
ADL: standing washing, dressing, shaving, grooming, showering, IADLs with ECTs, unlimited walking at 0% grade in or out
Exercise: increase number and speed of repetitions, ambulation up to 15-20 minutes, may begin slow stair climbing, treadmill at 1 mph, cycling up to 5 mph
Rec: candlepin bowling, canoeing, golf putting, gardening, driving

Stage 5 Cardiopulmonary
ADL: standing to wash dishes, clothes, ironing, hanging light clothes, making beds
Exercise: up to 4.0 MET with 7-10 lbs, ambulation up to 2.5 mph on level surfaces, increasing stairs, treadmill 2.5 mph at 2% grade > 1.5 mph at 4% grade > 2.5 miles at 0% grade, cycling up to 8 mph
Rec: swimming, light carpentry, golfing, light home repairs

Stage 6 Cardiopulmonary
ADL: showering in hot water, hanging and/or wringing clothes, mopping, stripping, and making beds, raking
Exercise: ambulation up to 3.5 mph, stairs, treadmill 1.5 at 5-6% grade > 3.5 mph at 0% grade, cycling up to 10 mph, 10-15 lbs of weight
Rec: swimming, slow dancing, ice/roller skating, volleyball, badminton, table tennis, light calisthenics

MET 1.5-2
Occupational: desk work, driving, typing, electric calculating machine operation
Recreational: standing, walking 1mph, flying, motorcycling, playing cards, sewing, knitting
MET 2-3
Occupational: auto and tv repair, radio, janitorial work, typing, manual, bartending
Recreational: level walking (2mph) and biking (5mph), riding lawn mower, billards, bowling, shuffleboard, woodworking, golf, canoeing (2.5 mph), horseback riding, playing piano/music
MET 3-4
Occupational: bricklaying, plastering, wheelbarrow, machine assembly, trailer trunk in traffic, welding, cleaning windows
Recreational: walking (3mph), cycling (6mph), horseshoe pitching, volleyball, golf, archery, sailing, fly fishing, horseback, badminton, pushing light power mower, energetic musician
MET 4-5
Occupational: painting, masonry, paperhanging, light carpentry
Recreational: walking (3.5mph), cycling (8mph), table tennis, golf, dancing, badminton singles, tennis doubles, raking leaves, hoeing, many calisthenics
MET 5-6
Occupational: digging garden, shoveling light earth
Recreational: walking (4mph), cycling (10mph), canoeing (4mph), horseback, stream fishing, ice or roller skating (9mph)

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