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NBCOT Study Cards

Terms

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In infant development, which comes first: bilaterality or unilaterality?
__________ precedes unilaterality in infant development
When does hand dominance begin to develop?
Hand dominance begins to develop at 3 to 6 years, and is not fully defined until 6 years
Can someone with receptive aphasia participate in sensory testing?
Individuals with this disorder cannot comprehend spoken or written words or symbols. Individuals cannot understand verbal directions or respond to sensory stimuli.
What is agnosia?
Agnosia is a category of defecits where the patient lacks recognition of familiar object as perceived by the senses. This could involve all the senses and manifests with problems in body scheme, such as somatognosia and anosognosia.
What is somatognosia?
Lack of awareness of one's body parts.
What is anosognosia?
Anosognosia: Transient, severe form of neglect. Patient does not recognize the presence or severity of his paralysis.
What is prosopagnosia?
Face blindness. Inability to identify an individual by their face.
What is visual-spacial agnosia?
Affects perception of spatial relationship between objects, or between objects and self.
What is auditory agnosia?
Inability to recognize sounds, words and non-words.
What is visual agnosia?
Lack of ability to recognize common objects and demonstrate their use in an activity.
What is apraxia?
Loss of the ability to execute or carry out learned (familiar) movements, despite having the desire and the physical ability to perform the movements
What is ideomotor apraxia?
Inability to imitate gestures or perform a purposeful motor task on command, even though the patient is able to fully understand the idea or concept of a task. This is often associated with left hemisphere damage.
What is ideational apraxia?
The disability of carrying out complex sequential motor acts. Caused by a disruption of the conception, rather than execution. (Loss of tool function knowledge)
What is constructional apraxia?
Unable to produce designs in 2 or three dimensions by copying, drawing, or constructing.
What is oral apraxia?
Difficulty in forming and organizing intelligable words, though the musculature required to do so is in tact. Differs from disarthria because no muscles are affected and speech is not slurred.
What is a neuroma?
A complication of nerve structure or amputation. A traumatic ______ is an unorganized mass of nerve fibers resulting from accidental or surgical cutting of the nerve. Results in sharp, radiating pain.
By what age does an infant sit erect and unsupported for several minutes?
By 8 to 9 months, an infant can sit erect and unsupported.
What is reflex sympathetic dystrophy?
__________ is caused by trauma, post-surgical inflammation, infection, or laceration to an extremity. Characterized by pain, edema, shiny skin, blotchy skin, and excessive sweating or dryness.
What is another name for reflex sympathetic dystrophy?
Complex regional pain syndrome.
What is a symmetric tonic neck reflex?
When an infant's neck is extended, the elbows extend and the hips flex. When the head is lowered, the elbows flex and the hips extend.
What is a bunny hop pattern?
A bunny hop pattern is a result of symmetric tonic neck reflex utilization in order to elicit movement at the hips and elbows for mobility.
What sensory region does the radial nerve innervate on the hand?

Radial Nerve
What sensory region does the ulnar nerve innervate in the hand?

See image.
What sensory region in the hand is innervated by the median nerve?

Median Nerve
What stage is initiated by looking at and reaching for food?
The oral preparatory phase.
What behavior would a child with poor modulation of tactile input display?
Children with autism often are unpredictable, both craving and avoiding sensory stimuli at various times.
After swallowing a pureed substance, you notice the individual has a wet, gurgling voice. What might this indicate?
Possible aspiration. A videoflouroscopy is often times needed to determine is this is the case.
In an acute care psychiatric setting, which group treatment is the most appropriate for individuals with disorganized psychosis?
Directive group treatment: a highly structured approach used in acute care for minimally functional individuals.
What type of group structure would be most appropriate for individuals with substance abuse?
A task group is appropriate for substance abuse disorders.
What group format is most appropriate for eating and adjustment disorders?
Psychoeducation groups
What is a Laissez-Faire leadership style?
Laissez-Faire is a "hands off" approach. Goals are not stated, the purpose is not clear, members are not discouraged or encouraged. This is for a high-functioning group.
What is the optimum number of members for a therapy group?
Five to six.
What is the optimum number of members for a counseling group?
No more than eight members.
What would you do if you had ten people assigned to your group?
Divide them into two subgroups.
What is autocratic leadership?
The leader exerts complete control.
What is democratic leadership?
This style can be a problem-solving style.
Group members feel safe to express views, thoughts, and feelings.
According to the OT code of ethics, what is defined as beneficence?
Concern for the safety and well-being of the recipients of OT services.
According to the OT code of ethics, what is defined as nonmaleficence?
Ensure recipient’s safety and do no harm.
According to the OT code of ethics, what is defined as autonomy?
Respect patient rights, including confidentiality.
According to the OT code of ethics, what is defined as procedural justice?
Comply with laws
According to the OT code of ethics, what is defined as veracity?
Providing accurate information when representing the profession (don't lie)
According to the OT code of ethics, what is defined as duty?
Maintain credentials and continually learn craft
According to the OT code of ethics, what is defined as fidelity?
Treat colleagues and other professionals with respect, fairness, and integrity.
What are the normal ROM limits of cervical flexion, extension, and lateral flexion?
0-45 degrees
What are the normal ROM limits of cervical rotation?
0-60 degrees
What are the normal ROM limits of thoracic and lumbar spine flexion?
0-80 degrees
What are the normal ROM limits of thoracic and lumbar spine extension?
0-30 degrees
What are the normal ROM limits of lateral flexion of the spine?
0-40 degrees
What are the normal ROM limits of rotation of the spine?
0-45 degrees
What are the normal ROM limits of shoulder flexion?
0-170 degrees
What are the normal ROM limits of shoulder extension?
0-60 degrees
What are the normal ROM limits of shoulder abduction?
0-170 degrees
What are the normal ROM limits of shoulder adduction?
0 degrees
What are the normal ROM limits of horizontal adduction?
0-130 degrees
What are the normal ROM limits of horizontal abduction?
0-40 degrees
What are the normal ROM limits of shoulder internal rotation?
0-70 degrees in shd abduction
0-60 degrees in shd adduction
What are the normal ROM limits of shoulder external rotation?
0-90 degrees in shd abduction
0-80 degrees in shd adduction
What are the normal ROM limits of elbow flexion?
0-140 degrees
What are the normal ROM limits of elbow extension?
0 degrees
What are the normal ROM limits for pronation and supination?
0-80/90 degrees
What are precautions of neuroleptic medications?
Power tools and sharp instruments should be avoided, and sun exposure should be limited.
What is extrapyramidal syndrome?
Extrapyramidal syndrome is a neurological side effect of anti-psychotic medication that mimics the effects of Parkinson's disease. This can cause rigidity, bradykinesia, cogwheel and leadpipe rigidity, loss of postural mechanisms, and a resting, pill-rolling tremor.
What is tardive dyskinesia?
Tardive dyskinesia is a neurological syndrome caused by the long-term use of neuroleptic drugs. Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing, and rapid eye blinking. Involuntary movements of the fingers may appear as though the individual is playing an invisible guitar or piano.
What is ataxia?
______ describes a lack of coordination while performing voluntary movements. It may appear as clumsiness, inaccuracy, or instability.
What is bradykinesia?
Bradykinesia means "slow movement."
What is choreoathetosis?
____________ is a movement of intermediate speed, fluctuating between the quick, flitting movements of chorea and the slower, writhing movements of athetosis.
What is dystonia?
________ is a neurologic movement disorder characterized by sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions.
What is Huntington's Disease?
The classic signs of HD include the development of chorea–or involuntary, rapid, irregular, jerky movements that may affect the face, arms, legs, or trunk–as well as the gradual loss of thought processing and acquired intellectual abilities (dementia).
What is adiadochokinesis?
The inability to perform rapid alternating movements such as pronation/supination.
What is dysmetria?
Dysmetria is the inability to estimate the ROM necessary to meet the target. Evident when the individual tries to touch the nose.
What is nystagmus?
Involuntary movement of the eyeballs in an up/down, back/forth motion. Interferes with head control.
What is dysarthria?
Explosive or slurred speech caused by incoordination of muscles involved in speech. Classified as a neuromotor problem.
What is ballism?
Rare symptom that is produced by continuous, abrupt contractions of the axial and proximal musculature of the extremity.
What are intention tremors?
Occurs during voluntary movement. Intensified at the termination of the movement and often associated with MS.
What are resting tremors?
Occurs at rest and subsides when voluntary movement is attempted.
Seen in Parkinson's disease.
What is the first level of OT intervention?
Adjunctive methods. These are preliminary to the use of purposeful activities and may include exercise, facilitation and inhibition techniques, positioning, sensory stim, PAMs, and splints.
-OTs evaluate performance components (innate abilities)
What is the second stage of OT intervention?
Enabling activities. May not yet be considered purposeful activities, but are steps toward performance of purposeful activities.
-Performance components and areas (Dressing using adaptive equipment)
What is stage three of OT intervention?
Purposeful activities: Evaulate performance areas. Have inherent, autonomous goals and are relevant and meaningful to the patient, such as ADLs, IADLs, etc. Used to evaluate, facilitate, restore or maintain a person's ability to function in life roles. Can the person cook or work in a clinical setting?
What is stage four of OT treatment?
Occupations. The highest stage of treatment continuum engages the patient in natural occupations in their living environment and the community. Not all patients can achieve this stage.
What is the rehabilitation model?
The rehabilitation model goal is to help the patient learn to work arond or compensate for physical, cognitive, or perceptual limitations.
What is a FIM level of "Total Assistance," or level 1?
The person puts forth less than 25% of the effort necessary to do a task.
What is a FIM level of "Maximal Assistance," or level 2?
The person puts forth less than 50% of the effort necessary to do a task, but at least 25%
What is a FIM level of "Moderate Assistance," or level 3?
The person puts forth between 50% and 75% of the effort necessary to do a task, and requires no more than helping or touching.
What is a FIM level of "Minimal Contact Assistance," or level 4?
The person puts forth 75% or more of the effort necessary to do a task, and requires no more help than touching.
What is a FIM level of "Supervision or setup," or level 5?
The person only needs someone to standby and cue or coax him/her (without physical contact) so that he/she can do a task.
What is a FIM level of "Modified Independence," or level 6?
No helper is needed and the person needs an assistive device. This score can also be obtained when no help is needed but the person takes considerable time to do a task or may complete the task in an unsafe manner.
What is a FIM level of "Total independence," or level 7?
No helper is needed and the person performs the task safely, within a reasonable amount of time, and without assistive devices, aids, or changes.
What FIMS score would be given to a person who needs a helper to set up items or assistive devices?
A score of "5" or "Supervision or setup" can be obtained if a helper is needed to set up items or assistive devices for the person.
How tall should a door threshold be for wheelchair accessibility?
1/2" and should be bevelled-- should be removed if possible.
What is the standard height of a wheelchair seat?
18". Toilets are typically 15" and should be raised to accommodate transfers.
What is the minimum doorway width for a wheelchair?
32"
What is the National Alliance for the Mentally Ill?
Provides support groups open to clients & families with a focus on education and support for mental illness.
Which sensations return FIRST following a nerve injury?
Pain and temperature
What is occupational performance?
Ability to carry out ADLs. Evaluation looks at activity demands, client factors and environment.
What food consistency is most difficult to swallow?
Foods that have liquid and solid consistencies are hardest to chew and swallow.
In mental health, planning for discharge involves evaluating what?
Occupational performance
What is AC MRDD?
Accredidation Council for Services for Mentally Retarded and Developmentally Disabled
What is spinal shock?
Transient physiological reaction to depression of the cord below the SCI level. Associated loss of sensorimotor function and flaccid paralysis. Flaccid paralysis symptoms last several days.
What is functional skill training?
Focuses on mastery of a specific task. Requires client to repeatedly practice the substeps of a task with the # of cues for each task gradually faded out.
What is anterior cord syndrome?

Often associated with a lesion causing variable loss of motor and sensation function. Proprioception preserved.
When should continuous reinforcement be utilized?
When teaching new skills.
When should intermittant reinforcement be utilized?
When maintaining a behavior.
What is central cord syndrome?

Central injury to cervical spinal cord resulting in greater weakness in UEs than in LEs.
What is conus medullaris syndrome?
Assoc. with injury to the sacral cord and lumbar nerve roots. Patients present with areflexic bladder, bowel, and lower limbs. Sacral segments sometimes show preserved reflexes.
What is cauda equina syndrome?

Due to injury of lumbosacral nerve roots in spinal canal. Leads to areflexic bladder, bowel, and lower limbs.
What is Brown-Sequard syndrome?

A hemisection lesion of the cord resulting in ipsilateral motor loss and contralateral loss of sensitivity to pain and temp.
What is parasthesia?
Sensation of tingling, itching, numbness or burning caused by sustained nerve pressure or reduced blood flow.
What are the muscles of the rotator cuff?
Supraspinatus
Infraspinatus
Subscapularis
Teres Minor
Should you pass a Level II fieldwork student if they are functioning below the minimal entry level?
Students functioning below entry level should be failed.
What is "close supervision" defined as?
Close supervision is defined as "daily, direct contact at the site of work"
What is a program evaluation?
A program evaluation is the compilation of the intervention results for a population of individuals.
What is Durable Medical Equipment (DME)?
Items that can withstand repeated use, such as a wheelchair, medical bed, and walkers.
Is a shower chair considered a DME?
Adaptive equipment is not covered under Medicare as a DME. Items not included are shower chairs, reachers, hand-held showers.
What are the main goals of work hardening?
To return the individual to work. Focus on pain management and proper body mechanics is key.
What functionality does a person with C1-C3 SCI have?
-Individuals required to use a respirator
-Individuals might have limited head and neck movement
-Able to use "sip and puff" wheelchair
-Completely dependendent in ADLs and transfers
What functionality does a person with C4 SCI have?
-Person has full mobility of the head and neck
-Able to breathe independently with low stamina
-Complete body paralysis below neck
-Possibility of autonomic dysreflexia
-"Sip and puff" wheelchair required
-Completely dependent in ADLs and transfers
What functionality does a person with C5 SCI have?
-Good elbow flexion in order to self feed (with a mobile arm support)
-Supination available
-No finger or wrist movement
-Breathes independently with low stamina
-Electric wheelchair may be used with hand control
What functionality does a person with C6 SCI have?
-Complete paralysis of legs and torso.
-Able to extend wrist and flex the elbow.
-Independent in transfers from toilet to wheelchair.
-Able to reach forward.
-Benefits from splint to promote wrist tenodesis.
-Able to do some ADLs, such as shaving and dressing upper body.
-Assistance may be required to dress lower body.
-Needs assistance to transfer from bed to wheelchair.
What functionality does a person with C7 SCI have?
-Elbow extension available
-Wrist flexion available
-Finger extension available
-Mod I feeding
-Dress Mod I to min assist
-Bathing & Grooming Mod I
-Toileting Mod I
-Transfers Independent
What is Guillain-Barre syndrome?
An autoimmune disease in which the peripheral nerves become inflammed. Results in numbness and paralysis in the legs, upper body, and face. Level of independence depends on extent of paralysis.
What is the best way to obtain detailed information about an individual's job requirements?
By examing a job analysis. A job analysis is a detailed description of the physical, sensory, and psych demands of a job.
What postural stability must an individual demonstrate before being able to use a mobile arm support?
Lateral trunk stability
What is rotation?
A type of in-hand manipulation that is displayed when an individual turns a nut on a bolt.
What functionality does a person with C8-T1 SCI have?
-Full UE control, including fine coordination and grasp
-ADLs, mobility and communication are Mod I
What functionality does a person with T6 SCI have?
-Increased endurance
-Larger respiratory reserve
-Pectoral girdle stabilized for heavy lifting
-ADLs Independent (No assistive devices)
-Uses braces with great difficulty for ambulation
What functionality does a person with T12 SCI have?
-Improved endurance and trunk control.
-ADLs and IADLs and independent
-Mobility: Ambulates with long leg braces and crutches
-Uses wheelchair for energy conservation
What functionality does a person with L4 SCI have?
-Hip flexion and knee extension
-Independent in all activities plus ambulation
-Bowel and bladder control is not voluntary
What is Pes Valgus?

Pes Valgus (Pronated Foot)
What is pes varus?

Club foot (Supinated foot)
What is Ranchos Los Amigos Cognitive Scale Level I?
NO RESPONSE
Person does not respond to sounds, sights, touch or movement.
What is Ranchos Los Amigos Cognitive Scale Level II?
GENERALIZED RESPONSE
-Begins to respond to sounds, sights, touch or movement
-May open eyes, but does not focus on anything in paricular
-Respond slowly, inconsistently, or after a delay
-Responses may include chewing, sweating, breathing faster, increased BP, etc.
What is Ranchos Los Amigos Cognitive Scale Level III?
LOCALIZED RESPONSE
-Patients begin to move their eyes and look at specific people and objects
-Turn heads in the direction of loud voices of noise
-Can follow simple commands, such as "Squeeze my hand"
What is Ranchos Los Amigos Coma Scale Level IV?
CONFUSED AND AGITATED
-Patient is confused and agitated about where they are and what is hapening in the surrounding
-At the slightest provocation, patient may become restless, agressive, or verbally abusive
What is Ranchos Los Amigos Cognitive Scale Level V?
CONFUSED AND INAPPROPRIATE
-Patient is confused and does not make sense in conversations, but may be able to follow simple directions
-May get upset when stressed, but agitation is no longer a major problem
-Frustration as elements of memory may return
What is Ranchos Los Amigos Cognitive Scale Level VI?
CONFUSED BUT APPROPRIATE
-Speech makes sense
-Able to perform self care
-Poor initiation and termination in activities
-Learning difficult
What is Ranchos Los Amigos Cognitive Scale Level VII?
AUTOMATIC APPROPRIATE
-Patients are usually coherent
-ADLs independent
-Difficulty remembering recent events and discussions
-Difficulty with calculations, problem solving, judgment
-Aware of deficits
What is Ranchos Los Amigos Cognitive Scale Level VIII?
PURPOSEFUL AND APPROPRIATE
-Patients are independent and can process new information
-Able to remember distant and recent events, and can figure out complex and simple problems
At what Ranchos Los Amigos level do individuals begin to recognize family and friends?
Level III
At what Ranchos Los Amigos level do individuals begin to follow simple directions like "Squeeze my hand?" or "Look at me"?
Level III
At what Ranchos Los Amigos level do individuals begin to engage in simple, routine activities such as self feeding and dressing?
Level IV
At what Ranchos Los Amigos level do individuals begin to begin to remember events before the accident better than their daily routine?
Level V. At this level, patients also confabulate in order to fill in gaps in memory
An individual needs step-by-step instruction to perform self care. What Ranchos level are they at?
Level V
At what Ranchos level can a patient follow a schedule, but get confused by changes in the routine?
Level VI
You have a patient who is unable to step off of a curb or watch for cars. What Ranchos level are they at?
Level VI
At what Ranchos level can a patient pay attention for up to 30 minutes?
Level VI
At what Ranchos level are patients aware of the month and year?
Level VI
At what Ranchos level can an individual perform self care with minimal assist?
Level VI
At what Ranchos level is a patient independent in self care, but continues to need supervision because of safety awareness and judgment?
Level VII
At what Ranchos level is an individual ready for vocational and/or driving training?
Level VIII
What is retrograde amnesia?
Inability to remember events that occurred before the incidence of trauma or the onset of the disease that caused the amnesia
What is anterograde amnesia?
Inability to remember ongoing events after the incidence of trauma or the onset of the disease that caused the amnesia, but able to remember incidents that happened before the incident
What is the post-traumatic amnesia classification tool?
A classification tool used by clinicians to assess the severity of injury.
What is the Glasgow Coma Scale?
-A brain injury severity scale that assesses depth and duration of impaired consciousness and coma.
-Used by clinicians to gauge deterioration or improvement at the emergent and acute stages of brain damage or lesions.
-Predicts ultimate functional outcome.
What are the subtests of the Glasgow Coma Scale?
-Eye opening (E)
-Best Motor Response (M)
-Best Verbal Response (V)
-Minimum score of 1 in each subtest = 3
-Maximum score is 15

E+M+V=3-15
How is the Glasgow Coma Scale interpreted?
3-8: Severe injury (In a coma)
9-12: Moderate injury
13-15: Mild or no injury
What are the brain behavioral characteristics of temporal lobe damage?
Temporal lobes contain auditory reception and visual processing areas. Damage to temporal lobes may affect:
-Sound discrimination
-Voice Recognition
-Language and Comprehension
-Auditory and visual memory storage
-Wernicke's Aphasia
What are the brain behavioral characteristics of occipital lobe damage?
Occipital lobe contains visual reception areas. Damage can result in:
-Anopsia/quadrantanopsia
-Object recognition and visual scanning deficits
What are the brain behavioral characteristics of damage to the parietal lobe?
Contains reception areas for touch and body position. Damage includes deficits in:
-Sense of touch, proproception, temperature and pain
-Disorganization
-Distorted self perception
What are the brain behavioral characteristics of damage to the frontal lobe?
The frontal lobes order information and sort out stimuli. Damage to the frontal lobe affects:
-Concentration and attention
-Abstract thinking
-Concept formation
-Foresight
-Problem solving
-Broca's Aphasia
What is Broca's Aphasia?
-Characterized by frontal lobe damage resulting in speech apraxia and agrammaticism
-The individual has good auditory comprehension, but reading and writing are severely affected
What is Wernicke's Aphasia?
-Characterized by temporal lobe damage resulting in impaired auditory comprehension and feedback
-Have fluent, well-articulated paraphasic speech (word substitution errors)
What are the behavioral charcteristics of damage to the thalamus?
-Communications relay station for all sensory information
-Damage can alter states of arousal, memory defect, speech deficits, apathy, and disorientation
What are the behavioral characteristics of damage to the hypothalamus?
The hypothalamus regulates bodily functions such as thirst, hunger, body temperature, emotion, and circadian rhythm. Damage can result in:
-Uncontrolled eating or drinking
-Mood alteration
-Sleep disorder
What are the behavioral charcteristics of damage to the cerebellum?
The cerebellum regulates balance, and posture. Damage can cause problems with:
-Fine motor control
-Coordination
What are the behavioral characteristics of damage to the reticular formation?
The reticular formation is in the core of the brainstem. Contains fibers en route to and from the brain. Damage to the reticular activitating system results in:
-Sleeping longer periods at a time
What are the behavioral characteristics of damage to the limbic system?
Plays integral part in the expression of emotion. Damage can affect:
-Emotional behavior
Of Broca's and Wernicke's, which is expressive and which is receptive aphasia?
-Broca's: Expressive Aphasia
-Wernicke's: Receptive Aphasia
What can someone with an IQ range of 55-69 accomplish? What classification of MR is this?
Mild retardation:
-Social/verbal skills to 6th grade level
-Able to take care of self
What can someone with an IQ range of 40-54 accomplish? What classification of MR is this?
Moderate MR: 40-54:
-Can communicate & get vocational training
-Can only do unskilled or semi-skilled work in sheltered workshops
-Can handle routine daily functions
-Can only learn up to a second-grade level
-Require supervised living or group home
What can someone with an IQ range of 25-39 accomplish? What classification of MR is this?
Severe Retardation:
-Learns to communicate through gestures and some words
-Trained in basic health habits
-Require supervised living or group home
What can someone with an IQ range below 25 accomplish? What classification of MR is this?
Profound Retardation:
-Need caregiver assistance for basic survival skills
-Often have neuromuscular, orthopedic, or behavioral deficits
What falls under the umbrella of Pervasive Development Disorders (PDD)?
-Autism
-Asperger's Syndrome
-Rett's Syndrome
-PDD, not otherwise specified (Usually when autism is suspected, but not proven)
What is autism?
Symptoms include:
-Impairments of social interaction, social communication, social behavior
-Inability to relate to others
-Echolalia
-Flat affect and poor eye contact
-Aversion to physical contact
-Ritualistic and repetitve behaviors
-Intolerance to changes in routine
What is Asperger's Syndrome?
Has similar characteristics to autism. Sometimes referred to as high functioning autism.
What is cerebral palsy?
A permanent impairment affecting automatic postural control and movement as a result of a non-progressive brain disorder
What are the different types of cerebral palsy?
-Spastic CP
-Athetoid CP
-Flaccid CP
-Ataxic CP
What characterizes severe spastic CP?
Characterized by:
-Severe increased tone
-Flexion and extension cocontraction
-High tone always
-More proximal than distal
What characterizes moderate spastic CP?
-Near normal tone at rest
-Tone increases with excitement, movement, emotion, and speech
-More distal than proximal
What characterizes mild spastic CP?
-Has normal tone at rest
-Tone increases with effort and movement
What characterizes pure athetoid CP?
-Tone fluctuates from low to normal
-No or little spasticity
-No coactivation
What characterizes athetoid CP with spasticity?
-Tone fluctuates from normal to high
-Proximal stability
-Proximal spasticity
-Distal athetosis (slow, writhing, continuous, and involuntary mvmt of the extremities)
What characterizes athetoid CP with tonic spasms?
-Unpredictable tone
-Changes from low to very high
-All flexion or all extension
What is chorea?
Irregular, purposeless, involuntary, quick, jerky, and dysrhythmic movements of variable distribution.
What characterizes choreoathetosis CP?
-Constant fluctuation from low to high tone
-No cocontraction
-Jerky, involuntary movement
-More proximal than distal
What are the two types of chorea?
-Tardive dyskinesia
-Huntington's disease
What characterizes flaccid CP?
-Markedly low tone
-Seen at birth or toddler
-Later classified as spastic, athetoid, or ataxic
What is ataxic CP?
-Ranges from near normal to normal
-Increased tone usually involves lower extremity flexion
-Most functional form of CP
What is pulled elbow syndrome?
- common injury in children under five years
- dislocation of the elbow by a sudden jerk upwards of the arm
What is Valgus Stress Symdrome?
- valgus overload or overstress injury to the medial elbow
- occurs as a result of repetitive throwing motions
Brachial Plexus injury?
- Types are Traumautic and Obstetric
- Traumatic (Road Traffic Injuries/falling a motorcycle)
- signs
* a weakness in the arm
* diminished reflexes
* corresponding sensory deficits
What muscles does C5 innervate?
C5: Shoulder abduction, extension, and external rotation; some elbow flexion and supination
What muscles does C6 innervate?
C6: Forearm pronation and supination, some wrist extension
What muscles does C7 innervate?
C7: Consistently supplies the latissimus dorsi. Elbow extension, wrist flexion, finger extension
What muscles does C8 innervate?
C8: Finger extensors, finger flexors, hand intrinsics
What muscles does T1 innervate?
T1: Hand intrinsics
What is pronator teres syndrome?
- numbness in median nerve distribution
- entrapment (compression or pinching) of the median nerve at or about the level of the elbow
- Symptoms: median nerve compressed at or just above the elbow results in weakness of the pronator teres muscle
- Median nerve entrapment at the elbow is a rare, more commonly seen in children
What is medial epicondylitis?
-AKA Golfer's Elbow
-Caused by forceful and repeated flexion of the wrist and fingers
What is rotator cuff tendonitis?
-Acute, painful condition affecting the supraspinatus and sometimes infraspinatus tendons
-Pain with external rotation and mid-range abduction
What is a rotator cuff tear?
-Often requires surgical repair
-Tear to the supraspinatus tendon
-Surgery not usually performed unless more than 50% of the muscle is torn
What is bursitis and tendonitis of the shoulder complex?
-Affects the shoulder when the bursa and synovial sheaths become inflammed from overuse
What is adhesive capsulitis?
-AKA Frozen shoulder
-Painful condition caused by immobility and disuse
-Condition lends itself to formation of fibrous tissue inside joint capsule
What is cubital tunnel syndrome?
-Compression or entrapment of the ulnar nerve as it courses around the medial epicondyle of the elbow
-Cubital is behind the "funny bone"
-Numbness and tingling in the ring and small fingers
What is olecranon bursitis?
-When the olecrenon bursa of the elbow becomes inflammed due to contact pressure or overuse
What is lateral epicondylitis?
-AKA Tennis Elbow
-Insertion point of the extensor carpi radialis brevis becomes inflammed
-If left untreated, can tear requiring surgical repair
What is De Quervain's Syndrome?
-Tendonitis of the first dorsal compartment near the anatomical snuffbox
-Caused by overuse of the thumb
-Tested with finklestein's
What is carpal tunnel syndrome?
-Caused by inflammation of the median nerve at the wrist
-Causes numbness, tingling, and pain in thumb, index, and middle fingers
-May result in thenar atrophy
What is the Tunnel of Guyon?
-Similar to CTS
-Ulnar nerve becomes entrapped between the hook of the hamate, and the pisiform bones
What is trigger finger?
-Caused by a nodule or thickening of the flexor tendons of the finger or thumb as they pass through the digital pulleys
-Hinders gliding motion, resulting in catching or "triggering" during flx/ext
Which joint do you assess first?
Always check uninvolved joint first to establish a baseline.
If active ROM is less that passive ROM, what does that indicate?
Muscle weakness
When should isometric exercises be avoided?
-Cardiac patients
-Burns
-Rheumatoid arthritis
-Casts
When should sensory testing be avoided?
-Receptive aphasia
-Atrophic (aptropy) skin
What is Tinel's sign?
-Tapping skin over damaged peripheral nerve to elicit tingling or pins and needles
What is the Phalen's test?

Phalen's Test
What are the methods used to treat hypersensitivity, such as burns, amputations, PNS injuries, etc?
-Desensitization
-Compensation (Such as testing hot water with other hand)
What are the methods used to treat hyposensitivity?
-Sensory retraining
-Compensation (Such as testing hot water with the other hand, padding objects)
How do you treat anesthesia?
-Anesthesia is complete loss off sensation
-Precautionary techniques
-Compensatory techniques
How do you treat spinal cord patients with anesthesia?
-Pressure relief equipment
-Changing position throughout the day using timer
-Inspect skin with mirrors
What are the components of a goal?
-Person
-Behavior
-Condition
-Criterion
-Function
What is the first component of a goal?
Person: The person who will do the behavior
What is the second component of a goal?
Behavior: What the individual is expected to perform.
-Must be observable, measurable and functional behavior
What is the third component of a goal?
Condition: The environmental situation in which the behavior is performed (when, where, what, in what manner)
-Focus on what most affects function (ie - if a child cannot sit, "in sitting" would be the condition
What is the fourth component of a goal?
Criterion: Standard the client must meet.
-How well they must perform in order to achieve goal/objective.
-Has to be quatifiable (number or responses, degree of ROM, length of time, amount of assistance provided, etc.)
What is the fifth component of a goal?
Function: Similar to behavior, but justifies the reason for treatment. (ie - to open a door, use a computer, etc)
What are components of a biomechanical activity analysis?
-What is the activity?
-Positioning
-Precautions
-Steps
-Repetition
-ROM required
-Minimal muscle strength required
-Type of contraction
-Appropriate for short term or long term goal
What are SOAP notes?
-Subjective
-Objective
-Assessment
-Plan
What is the Subjective component of a SOAP note?
-What a patient or significant other states
-What the patient or significant other states about their medical history, emotions, lifestyle, home situation,
-Patient-stated goals "I want to work again"
-Complaints
-Patient's assessment of treatment
What is the Objective component of a SOAP note?
-Result of the therapist's objective measurements or observations
-IE: ROM, MMT, FIMs, evaluate speed of transfers and the movement of each body part and assistance required
What is the Assessment component of a SOAP note?
-Involves professional judgment
-Provides opportunity for OT to draw conlcusions from S and O
-Inconsistencies between patient's complaints and the objective findings can be discussed
-Comments can be made regarding patient's progress in therapy (ie - Pt. refused to participate in tx.)
-Reasoning for information not obtained can be listed (ie - too much pain to complete session)
What is the Plan component of a SOAP note?
- The Plan states the frequency of treatment (per day or week)
- Tx plan LTG & STG
- Discharge plan
- Referral to other disciplines
- DME & AE needed to order
- Plans for further assessment
What are orthosis?
Orthosis are permanent devices that replace or substitude for loss of muscle function
What are the general considerations of splinting?
- Comfort
- Function
- Cosmesis
- Patient acceptance and compliance
- Patient education
- Tratment plan integration
What are the objectives of static splinting?
The main purporse of splinting is to help the individual perfom ADLs through:
- positioning and maintaining alignment
- protecting or supporting or immobilizing
- inhibiting tone by positioning the extremity in a reflex inhibiting position
What are supportive splints?
Supportive splints are static splints used to:
- relieve pain
- position and maintain join alignment
- prevent adaptive shortening of soft tissues
What are corrective splints?
Corrective splints are static splints used to:
- maintain improvement obtained through therapy
- correct soft tissue contractures
What are protective splints?
Protective splints are static splints used to:
- immobilize a joint or limb following trauma are fracture and some post-surgical conditions
What are the objectives of dynamics splints?
- prevent progressive deforming changes as a result of muscle imbalance
- substitute for or assist lost or weakened muscles
- increase ROM
- minimize formation of adhesions
What is continuous quality improvement (CQI)
a system that seeks to improve the provision of services with an emphasis on future results.

Focus on prevention of mistakes

What is total quality management? (TQI)
empowerment of employees to take responsibility for their own tasks in a way that encourages both continuous learning and personal responsibility.
Often in the form of a committee
What are the spinal level reflexes, onset and integration ages?
flexor withdrawal, extensor thrust, crossed extension, and associated reaction. Assist with development of mobility patterns

birth-2 mo





What are the brainstem level reflexes? Onset and integration?
ATNR, STNR, tonic labyrinthine, positive supporting reaction. Used for posture and initiation of vestibular system.

Birth-4 to 6 mo.

What are the midbrain reflexes?
Onset and integration?
Neck righting, labyrinthine righting on body, body righting on head, body righting on body.
Related to righting reactions and motor milestone development.

birth-6 mo


What are cortical reflexes?
onset and integration?
optical righting, equilibrium reaction.
communication between brain centers for touch, vision, and vestibular.
Present throughout lifespan.

What are the contraindications for using PAMS?
Cancer, pacemaker, pregnancy, peripheral vascular impairment,cognitive impairment, sensory impairment
What is sustained attention? Give example of deficit.
Ability to maintain attention on required task. A person with deficits may not be able to complete tasks or start another task before completing the task at hand.
What is the function of the brainstem?
Functions necessary for survival (breathing, digestion, heart rate, blood pressure).

Arousal (being awake and alert)

Most cranial nerves



What is the function of the cerebellum?
Coordnation of movement
What is the function of the frontal lobe?
Premotor and motor areas,
Planning, organizing, problem solving, selective attention, personality and a variety of "higher cognitive functions" including behavior and emotions.
What is the function of the occipital lobe?
processes visual information

visual reception, visual recognition of shapes and colors

What is the function of the parietal lobe?
Right-visuo-spatial deficits (e.g., the patient may have difficulty finding their way around new, or even familiar, places).

Left-understand spoken and/or written language.



What is the function of the temporal lobe?
Right Lobe - Mainly involved in visual memory (i.e., memory for pictures and faces).

Left Lobe - Mainly involved in verbal memory (i.e., memory for words and names).

What is the focus of the Rivermead Perceptual test and who is it appropriate for?
Adults 16< with head injury. Tests figure ground, spatial relations, body image (unilateral inattention)
What is the focus of the Rivermead Behavioral Memory test?
Alterations with memory
What is the focus of the Rivrmead Inattention Test>
Activity based looking at how unilateral neglect impacts function
What is nonfluent aphasia
Difficulty with speech production. Stuttered or filled with pauses as person seeks intended words.
Symptoms of right hemisphere CVA
motor skills and sensation on left side
Emotionally labile
difficulty with visual-spatial processing
interpretation of abstract info
attention
non-verbal components of communication
Left neglect







Symptoms of left hemisphere CVA
Motor control and sensation on right side
reception and processing of speech
receptive or expressive aphasia
decreased right visual field
impulsivity



MCA stroke (left hemisphere) functional deficits
contralateral hemiplegia, contralateral hemiparesthesia, aphasia, cognitive involvement, affective involvement
MCA stroke (right hemisphere)
contralateral hemiplegia and hemiparesthesia
Preceptual deficits
apraxia
Contralateral involvement
Affective involvement



PCA stroke
Memory loss
Visual-perceptual deficits
Visual field cuts



ACA stroke deficits
Contralateral hemiplegia and hemiparasthesia, cognitive involvement, apraxia,affective involvement
Cerebellar stroke
intention tremors
Ataxia
incordination

brainstem stroke
ataxia
facial sensory loss
CN VIII, IX, X involvement
coma
altered taste, smell, vision, hearing
altered breathing




In using the biomechanical FOR what are the domains of concern?
Stability of bodily structures
Strength
Endurance
ROM
edema



Describe the RAPS assessment: components and population appropriate for using
Evaluates performance in: work, education, household tasks, relationships, leisure, hygiene, and ADL performance.

Appropriate for treatment planning with adult psychiatric population

What are the steps in ethical decision making?
ID the health problem
Define ethical issue
Gather info
Delineate the decision maker
examine ethical and moral principles
Explore ethical options
Implement decisions
Evaluate and modify actions






What constitutes negligence
unintentional; involving a breach of duty to meet a standard of care, causing potential harm
What constitutes malpractice
Based on negligence in which the health care professional is held accountable for a breach of duty of care involving special knowledge and skill
What are the developmental stages and ages of rolling?
Supine to sidelying (3-4 mo)
Rolls from prone to supine (5-6 mo)
Rolls from supine to prone (5-6 mo)
Rolls segmentally (6-14 mo)


Developmental stages for self feeding
1. takes cereal from spoon (5-7 mo)
2. attempts to hold bottle (5-6 mo)
3. holds and sucks on a cracker (6-9 mo)
4. finger feeds self small bits of soft food (9-13 mo)
5. Dips spoon in food but often spills (12-14 mo)
6. scoops food and brings to mouth (15-18 mo)
7. Tries to stab with fork uses spoon successfully (24-30 mo)





Developmental dressing 1 year
holds out arms and feet
pulls off shoes and socks
pushes arms through sleeves and legs through pants

Developmental dressing 2 years
removes unfastened coat
removes shoes
pull down elastic waist pants
finds armholes
assists with pulling on socks
puts on front button clothes
unbuttons large buttons





Developmental dressing 3 years
puts on shoes w/o fasteners
puts on socks
zips/unzips with components on track
buttons large buttons






Developmental dressing 3 1/2 years
finds front of clothing
snaps/hooks fasteners
unzips and separates zipper
puts on mittens
buttons series of buttons
unbuckles shoes or belt
dresses with supervision









Developmental dressing stages 5 years
ties/unties knots

Developmental dressing stages 6 years
closes back zipper
ties bows
buttons back buttons
snaps back snaps


Anti-deformity positioning for burns lower extremities
Hip-10-15 degrees abduction
Knee-knee extension,
anterior knee burn-mild flexion
ankle- 5 degrees dorsiflexion


Precautions for thermal agents
Edema
Diminished sensation
Compromised circulation
use of anti-coagulations




Contraindications for cryotherapy
peripheral vascular disease
cold sensitivity/ intolerance
multiple myloma, leukemia, systemic lupus



Contraindications for use of ultrasound
DVT
bleeding
edema
impaired sensation
very old/very young
cancer
near area of pacemaker
pregnancy
infection
growthplate
over heart, eyes, testes, head
spinal column












What are the 4 stages of motor control
1. reciprocal inhibition/innervation:governed by reflexes

2. Co-contraction: able to hold a position or object in space

3. Heavy work: distal stability with proximal mobility
3. Skill: proximal stability with distal mobility




Stage IV cardiac rehab
3-4 MET level
*standing to bathe, dress, groom
*homemaking with energy conservation
*unlimited ambulation on level surface, mild resistance

walking 3 mph, canoeing, golf putting, light gardening, driving, pushing lawn mower,






Cardiac rehab stage V
3.5-4 MET *wash dishes, clothes, ironing, hanging light clothes, making beds *swimming slowly, carpentry, golf with power cart, light home repairs ***
Cardiac rehab stage VI
*showering in hot H2O, hanging, wringing clothes, mopping, making beds, raking

*swimming, slow dancing, slow iceskating, vollyball, badmitton, table tennis

Cardiac rehab stage II
1.4-2 MET
*sitting ADLs, self bathing, shaving, grooming, dressing all in sitting
*slow pace ambulation, no isometrics, crafts in sitting

Cardiac rehab stage I
1.0-1.4 MET
*sitting ADLs, wash face hands, self feeding
*UE exercise with AA, reading, radio, table top activities

E-stim
indications/ contraindications
releves pain, decreased swelling, stimulates & strengthens muscles

cancer, pacemaker site, pregnancy

Ultrasound
relieves pain
decreases inflammation, increases ROM, decoreases adhesions

DO not use: over growth plate, skull, pacemaker site, cancer, pregnancy


Intervention strategies for memory loss
*use rehearsal strategies
*"chunk" information
*use memory aids
*use "temporal tags"- focus on when event to be remembered occured


Intervention strategies for sequencing and organization deficits
*use external cues
*grade tasks from simple to complex
Intervention strategies for body neglect
*use bilateral activities
*guide affected side through activity
*increase sensory stimulation to affected side

Intervention strategies for spatial relations deficits
*use activities that challenge underlying spatial skills (up/down, front/back, over/under)
*utilize tasks that require discrimination for right/left
Intervention strategies for aphasia
*decrease external auditory stimuli
*allow increased response time
*use visual cues and gestures
*use concise statements
*use augmentive communication if appropriate



Intervention strategies for spatial neglect
*graded scanning activities from simple to complex
*use anchoring to compensate
*use manipulative tasks with scanning activities
*use external cues


Intervention strategies for perseverance
*bring to a conscious level and train to inhibit bx
*redirected attention
*engage in tasks that require repetitive action

Intervention strategies or ideational apraxia
*provide step by step instruction
*HOH techniques
*provide opportunities for motor planning

Intervention strategies for ideomotor/ motor apraxia
*Use generalized cues
*decrease manipulation demands
*use HOH input
*use visual cues


Rood sequence of motor development
*Supine withdrawal
*roll over-used to elicit lateral trunk response for tonic reflex
*prone extension-isometric contraction of extensors/flexors
*neck cocontration-develop head control
*prone on elbows-inhibit tonic reflex
*quadreped-develop limb and trunk cocontration patterns
*standing-weight shift





What is the eval and tx of arthritis
Roles, ROM, strength, level of pain, edema

Tx: splint for rest and joint protection, heart modalities, AE

Avoidant personality disorder
*sensitivity to rejection
*show an extreme desire for companionship
*need unusually strong and repeated guarantees of acceptance
*inferiority complex




Typical w/c dimensions
width: 24-26 rim to rim
length: 42-43"
height from floor 36"
height to seat 29-30"








Deck Info

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