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Group Development
The stages groups typically go through from their initial beginnings to their imaginations
Origin phase
Involves the leader composing the group protocol and planning for the group
Orientation phase
Involved members learning what the group is about, making a prelim commitment to the group, and developing initial connections with other members
Intermediate phase
Involves members developing interpersonal bonds, group norms, and specialized member roles through involvement in goal-directed activities and clarification of group's purpose
Conflict phase
Involves members challenging the groups structure, purpose, and/or processes, and is characterized by dissension and disagreement among members

- Unsuccessful resolution = dissolution of group
- Successful resolution = modification to the group that are acceptable to all members, enabling it to proceed to next phase

Cohesion phase
Involves members regrouping after the conflict with a clearer sense of purpose and a reaffirmation of group norms and values, leading to group stability
Maturation phase
Involves members using their energies and skills to be productive and to achieve groups goals
Termination phase
Involves dissolution of the group due to lack of engagement by members, inability to resolve conflict, administrative constraints, goal attainment, and task completion
Group roles
Describe pattern of behavior that are typical in groups
Instrumental roles
Functional and assumed to help the group select, plan, and complete the group's task
Expressive roles
Functional and are assumed to support and maintain the overall group and to meet members needs
Individual roles
Dysfunctional and contrary to group roles, for the serve and individual purpose and interfere with successful group functioning
Group norms
Standards of behavior and attitudes that are considered appropriate and acceptable to the group
- Explicit and clearly verbalized or non-explicit and not verbalized
- Vary in groups and can change as group develops

Therapeutic norms
- Encourage self-reflection, disclosure, and interaction among members
- Reinforce the value and importance of the group by being on time and well-presented
- Establish atmosphere of support and safety
- Maintain confidentiality and respect
- Regard group members as effective agents of change by not placing the group leader in expert role

Group goals
Desired outcomes of the group that are shared by sufficient number of groups members
Group communication
The process of giving, receiving, and interpreting information through verbal and non-verbal expression
Group cohesiveness
Degree to which members are committed to a group and the extent of members liking for the group
Factors that contribute to group cohesiveness
- Extensive interaction between members
- Similarity or complementariness in members characteristics
- Perception of relevance of group to individual needs
- Members expectation of goal attainment and successful group outcome
- Democratic leadership and member cooperation

Group decision making
Process of agreeing on a resolution to a problem through unanimous decision, consensus, majority rule, and compromise
Directive leadership
OT is responsible for planning and structuring much of what takes place in the group
- When members cognitive, social, and verbal skills and limited engagement
- Select activities
- Group maintenance roles and feedback by leader
- Goal is task accomplishment

Facilitative leadership
OT shares responsibility for group and group process with members
- Skill level and engagement are moderate
- Collaborate with group members to select activities to be used
- Share instructions
- Roles and feedback provided by members with OT facilitating
- Goal is to have members acquire skill through experience

Advisory leadership
OT practitioner functions as the resource to members, who set the agenda and structure the groups functioning
- Members skill and engagement are high
- Members select and complete activities
- Feedback is a natural part of the group process
- Members understand and self-direct the process

Occurs when there is sharing of group leadership between two or more therapists
Advantage: share knowledge and skills, model effective behaviors, observation and objectivity can increase, provide and obtain mutual support, and assume different roles, tasks, styles
Disadvantage: splitting by group members, competition among members, and unequal responsibilities resulting in unbalanced work load among co-leaders

Giving of oneself to help others
Relieving of emotions by expressing one's feelings
Recognizing shared feelings and that one's problems are not unique
Existential factors
Accepting the fact that the responsibility for change comes from within oneself
Discovering and accepting the unknown parts of oneself
Family reenactment
Understanding what it was like growing up in one's family through the group experience
Comes from accepting advice from other group members
Benefiting from imitation of the positive behaviors of the other group members
Instillation of hope
Experiencing optimism through observing the improvement of others in the group
Interpersonal learning
Receiving feedback from group members regarding ones behavior (input)

Learning successful ways of relating to group members (output)

Complete: No sensory or motor function is preserved in sacral segments S4-S5
Incomplete: Sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5
Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have muscle grade less than 3
Incomplete: Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have muscle grade greater than or equal to 3
Normal: Sensory and motor functions are normal
Central Cord Syndrome
Associated with a cervical region injury and leads to greater weakness in the upper limbs than in the lower limbs, with sacral sensory sparing
Brown-Séquard Syndrome
Associated with a hemisection lesion of the cord, causes a relatively greater ipsilateral proprioceptive and motor loss, with contralateral loss of sensitivity to pain and temperature
Anterior Cord Syndrome
Associated with a lesion causing variable loss of motor function and sensitivity to pain and temperature; proprioception is preserved
Conus Medullaris Syndrome
Associated with injury to the sacral cord and lumbar nerve roots leading to areflexic bladder, bowel, and lower limbs, while the sacral segments occasionally may show preserved reflexes
Cauda Equina Syndrome
Due to injury to the lumbosacral nerve roots in the spinal canal, leading to areflexic bladder, bowel, and lower limbs.
Automatic actions - automatic motor reactions and changes in the autonomic nervous system, conscious response to external environment is minimal
Postural actions - movement associated with comfort, some awareness of large objects in environment and the individual may assist the caregivers with simple tasks
Manual Actions - begins with the use of hands to manipulate objects, the individual ay be able to perform a limited number of tasks with long term repetitive training
Goal directed actions - characterized by the ability to carry simple tasks through completion, the individual relies heavily on visual cues, he or she may by able to perform established routines but cannot cope with unexpected events
Exploratory Actions - characterized by overt trial and error problem solving, new learning occurs, may be the usual level of functioning for 20% of the population
Planned actions - characterized by the absence of disability, can think of hypothetical situations and do mental trial-and-error problem solving
- One or more members of one discipline evaluate, plan and implement treatment of individual
- Other disciplines not involved, communication is limited
- "Team" is at risk due to potential narrowness of perspective
- Comprehensive, holistic care questionable

- Number of professionals from different disciplines conduct assessments/interventions independent from each other
- Member's primary allegiance is to discipline, some formal communications between members
- Limited comm. may result in lack of understanding of different perspectives
- Resources/responsibilities individually allocated between disciplines, competition may develop

- All disciplines relevant to the case at hand agree to collaborate for decision making
- Eval/intervention conducted independently within defined areas of each profession's expertise, however, greater understanding of each discipline's perspective exists
- Members directed toward a common goal and not bound by discipline line-specific roles and functions
- Members tend to use group process skills effectively
- Exchange of info, prioritization of needs and allocation of resources and responsibilities are based on members expertise and skills, not on 'turf' issues

- Maintained and expanded roles of interdisc team
- Members support and enhance activities/programs of other disciplines to provide quality, efficient, cost-effective services
- Committed to ongoing communication, collaboration, shard decision making for the pts benefit
- Eval/intervention planned cooperatively, yet one member may take on multiple responsibilities, role blurring
- Ongoing training, support, supervision, cooperation, and consultation among disciplines are important to this model, ensuring that professional integrity and quality of care is maintained

Managing manic or monopolizing behavior
- Select or design highly structured activities that hold the individual's attention and require a shift of focus from patient to patient
- Thank the individual for their participation and redirect attention to another group member
- Refer to limit-setting

Managing escalating behavior
- Avoid what can be perceived as challenging behavior
- Maintain comfortable distance
- Actively listen
- Use cal, but not patronizing tone
- Speak simply, clearly and directly, avoid miscommunication
- Clearly present what you would like the person to do
- Avoid positions where either you or the patient feels trapped
- If pt continues to escalate, remove other patients from area, get or send for other staff

Managing the lack of initiation/participation in a group
- With the individual, identify the reasons for lack of participation
- Motivational hints: more likely to participate when of interest or concern to them, the more ownership the pt has of the activity the more they will participate, success and fun are motivating, positive feedback and rewards, everyone has motivators, it is important to ID them, curiosity, and food
Managing offensive behavior
- Set limits and immediately address the behaviors during session
- Reasons that the behavior is not acceptable should be clearly presented in a manner that is not confrontational or judgmental
- The consequences of continued offensive behavior should be clearly communicated
- Required for all staff to protect patients from the threat for harm or abuse by another patient, needs of the entire unit/group must be kept in mind

- Allow the person to move around as needed if it can be done without causing disruption to the goals of the group
- Keep in mind that participation on many levels and in many forms can be beneficial to the individual
- Whenever possible, select gross motor activities over fine motor or sedentary ones

Managing delusions
- Redirect the individuals thoughts to reality-based thinking and actions
- Avoid discussions and other experiences that focus on and validate or reinforce delusional material
Managing hallucinations
- Create an environment free of distractions that trigger hallucinatory thoughts and interfere with reality-based activity
- Use highly structured, simple, concrete activities that hold the individuals attention
- When the person appears to be focusing in on a hallucinatory experience, attempt to redirect him/her to reality-based thinking and actions

Managing the effects of Alzheimer's
- Make eye contact and show you are interested in the person - value and validate what is said
- Maintain a positive and friendly facial expression and tone of voice during all communications - do not give orders, use short simple words/sentences, do not argue/criticize
- Use non-verbal communication
- Create a routine that uses familiar and enjoyable activities
- Activities that demonstrate and promote personal interests and independence
- Analyze and grade carefully
- Do not rush - process is important
- Note effects of time of day and attend to safety issues

Intervention for suicide risk
- ID the motivation behind the suicidal intention and ID of alternatives
- Development of problem solving skills and stress management techniques to increase the individuals ability to manage life stressors
- ID of positive goals and interests to increase motivation for recovery
- ID of positive personal attributes and support systems to increase hopefullness
- Activities that produce successful outcomes especially with an end-product promote positive thinking
- Activities designed for the expressing and validation of feelings
- Moderate physical activity elevates mood
- Development of skills that increase functional performance

Factors to consider when recommended adaptive strategies
- What is important to the individual about the task
- Is strategy compatible with particular social context
- Does strategy enhance the individuals sense of personal control
- Does strategy minimize effort
- Does strategy interfere with social opportunities/diminish presentation of self
- Is the recommended strategy temporarily realistic given the context
- Does strategy provide for safety

Top down
Considering a person's areas of occupations first
Bottom up
Focuses initially and/or solely on performance skills and client factors
Katz Index of ADL - A
Independent in all 6 activities
Katz Index of ADL - B
Independent in any 5 activities
Katz Index of ADL - C
Independent in all but bathing and one other activity
Katz Index of ADL - D
Independent in all but bathing, dressing, and one other activity
Katz Index of ADL - E
Independent in all but bathing, dressing, toileting, and one other activity
Katz Index of ADL - F
Independent in all but bathing, dressing, toileting, transfers, and one other activity
Katz Index of ADL - G
Dependent in all activities
FIM Score of 1
Person could not be evaluated performing the task of he/she required total assistance in task performance
FIM Score of 2-5
Increasing levels of assistance required from a helper for the individual to do the task
FIM Score of 6-7
Person is independent in task performance and does not require a helper
AE for self-care activity performance
- Grab bars and toilet safety frame
- Bedside (3-1) commode or raised toilet seat
- Bowel training and bladder control device
- Skin inspection mirror
- Toilet paper holder

AE for grooming/oral hygiene
- U-cuff to hold toothbrush, razor, comb, brush
- Built-up, angled, or long-handled brushes/razors
- Blow-dryer, nail clippers, nail polish holders
- Faucet turners
- Electric toothbrush, floss holders, water pik

AE for bathing/showering
- Grab bars, non skid mat
- Tub and shower bench
- Shower commode
- Handheld shower
- Anti-scald valves/faucets
- Built up, angled, long-handled bath sponge or bath matt
- Soap on a rope, soap dish
- Storage units

AE for dressing
- Reachers, dressing sticks, pants dressing poles
- Built-up, angled, or long-handled shoe horn
- Pull-on clothing, Velcro type closures, front opening closures for clothing
- Elastic shoelaces, slip on shoes
- Button hook, zipper pull, zipper loop
- Sock/stocking aid

AE for feeding/eating
- Adapted nipples/bottles for infants
- Scoop dish or plate guards
- Non-slip placemat or dycem
- Built up, angled, weighted, long handled, swivel utensils
- Rocker knife, spork
- Adapted cups or long/angled straws

AE for med management
- Easy open, non-child-proof bottles
- Pill organizers, medication minders
AE for cleaning
- Suction bottom bottle and glass brushes
- Reacher
- Aerosol can holders
- Built up, angled, long-handled sponges, dusters, brooms, mops, dustpans
- Front-loading washer/dryer
- Electronic dishwasher, self-cleaning oven, automatic defrosting fridge

AE for cooking
- Faucet and knob turners
- Anti-scale faucets/valves
- Jar openers, bowl holders, saucepan stabilizers
- Nonskip pad, placemat, dycem
- Cutting board with stabilizing nail, built up edges
- Built up angled utensils, rocker knives
- Adapted timers
- Electric can opener
- Lightweight pots, pans, dishware
- Auto hot water dispenser/hot pots
- Strap loops to open doors
- Reacher, step stools
- Utility cart
- High kitchen stool

Boutonniere deformities
Lengthening or rupture of the extensor digitorum communis tendons and is expressed by DIP hyperextension and PIP flexion
Swan-neck deformity
Results from rupture of the lateral slips of the extensor digitorum communis or flexor digitorum superficialis tendon and results in DIP flexion and PIP hyperextension
Trigger finger deformity
Results from thickening of the flexor digitorum superficialis tendon at the flexor tunnel (tendon sheath), affected joint tends to say open upon attempt to close or fist the hand
Synovitis of the MP joints
Can cause damage to the MP ligaments with palmar disclocation in conjunction with, or indpendent of, ulnar drift
Risk management
Process that identifies, evaluates, and takes corrective action against risk
Charcot-Marie-Tooth disease
Neuropathic muscular atrophy characterized by progressive weakness of the distal muscles of the arms and feet
Froment's sign
Assesses the motor function of the adductor pollicis with is innervated by the ulnar nerve

Attempt to pinch an object firmly with the thumb which results in flexion of the distal joint of the thumb

Direct therapy involves techniques that utilize a bolus
Modification of consistency, amount, and pacing of solids and liquids
Utilizing postural interventions to increase swallowing efficiency during meals
- Chin tuck
- Head tilt
- Head turn

Specific swallowing adaptations
- Supraglottic swallow technique to voluntarily close/protect airway during food intake
- Mendlesohn's maneuver (voluntarily prolonging the rise of the larynx by prolonging tongue contractions)
Indirect therapy involves procedures that do not include use of a bolus
- Thermal (cold) stimulation provides sensory input to the inferior faucial arches via the chilled dental exam mirror to elicit swallow reflex
- Reflex facilitation
- Strengthening, facilitation, and coordination of oral movements
- Airway adduction procedures
- Positioning to maintain the trunk/head/neck in correct postures

Overhead suspension splint
Best suited for individuals presenting with proximal weakness with muscle grades in the 1/5 to 3/5 range
Radial nerve laceration
Weakness or paralysis of the extensors of wrist, MCPs, and thumb with characteristic wrist drop
Median nerve palsy
Presents of flattening of the thenar eminence and "Ape hand"
Ulnar nerve palsy
Claw hand
Radial nerve palsy
Saturday night palsy resulting from a position that compresses the radial nerve
Splint for low level radial nerve injury
Dynamic extension splint that provides wrist, MP, thumb extension to prevent over stretching of the extensor tendons during healing phase
Blocked practice
Picking up items that are of the same shape, size, and weight involving repeated performance of the same motor skill
Random practice
Involves the performance of several motor tasks in random order to encourage the re-formulation of the solution to the presented motor problem (ie. different grasp patterns)
Max height for countertops
31 inches
Minimum doorway widths for wheelchair accessibility

Ideal is 36"

Max and min height for reaching forward in wheelchair
48" and 15" to prevent tipping
Hemi-height wheelchair
Dynamic interactional approach
Utilizes awareness questioning to help the individual detect errors, estimate task difficulty, and predict outcomes

Level of auditory processing skills must be considered to determine if adaptations/modifications are needed with implementing approach

Over or undershooting of target
Neurofunctional approach
Emphasizes functional activity performance in the actual environment
Separating items into two groups and placing them into a category
Planning, organization, implementation of the steps of a task in an appropriate order
Problem solving
Recognition and definition of a problem and the selection and implementation of a plan
Registration, integration, recall, and retrieval of information
Rood patterns in sequence
1. Supine withdrawl
2. Rollover
3. Prone extension
4. Neck co-contraction
5. Prone on elbows
6. Quadruped
7. Standing
8. Walking

Peripheral neuropathy
Syndrome of sensory, motor, reflex, and vasomotor symptoms, with symptoms exhibited according to the distribution of the affected nerve; slow and progressive onset and course

Etiology diabetes, Lyme disease, MS, alcoholism, metabolic, infectious diseases

Utilization review
Analysis of the use of the resources within a facility; examines medical necessity and cost efficiency of these resources
Sequence of self feeding with a spoon
- 6.5-7 self-feeding with a cracker
- 9 holding and banging a spoon
- 9.5 stirring with a spoon
- 12-14 bringing a filled spoon to mouth

Secondary prevention
Early detection of problems in a population that have diagnoses that place them at risk for development of complicating or 2ndary conditions
Direct service
Implementation of intervention with clients and therapist
Primary prevention
Targets individuals with no pre-existing condition
Needs assessment
Done to determine programming needs
**Contraindication for Cardiac Rehab**
Isometric exercises
Visual imagery
Process of making a mental picture of information so that it can be remembered
Visual cognition
Ability to mentally manipulate visual information and integrate it with other sensory information
Visual memory
Retrieval and recall of info that has been stored and encoded
Release of toys
- 3-4 bang on table but not voluntarily release
- 7-8 able to give up objects with an assisted release
- 9-10 months more efficient release
- 12 months voluntary release

Cubital tunnel syndrome
Ulnar nerve compression at the elbow - numbness, tingling along ulnar aspect of forearm/hand, pain at elbow with extreme flexion, weakness of power grip, and positive Tinel's sign at elbow
Erb's palsy
Injury to the 5th and 6th brachial plexus roots - arm hangs limp with shoulder rotated inward due to atrophy and paralysis in the biceps, deltoid, brachialis, and brachioradialis
person relates, often unconsciously, to another person as if that person were someone else, usually someone significant
Someone believes a person or an event to be perfect
Blaming someone else for one's difficulties
Person unconsciously falls into the role to which the other person has transferred him
Wheelchair seat belts
Extend across the hips and into the lap at a 45 degree angle
Anti-psychotic medications
Side effects - dry mouth, blurry vision, photosensitivity, constipation, orthostatic hypotension, Parkinsonism, dystonias, akathisias, tardive dyskinesia, and cardiovascular disorders

Complications - Neuroleptic Malignant Syndrome - increased BP, tachycardia, sweating, convulsions, coma

Mood stabilizing medications
Side effects - excessive thirst, tremors, excessive urination, weight gain, nausea, diarrhea, cognitive impairment

Precautions - high levels cause nerve damage/death, toxicity symptoms include motoric disturbance

Anti-convulsants medications
Side effects - dizziness, drowsiness, ataxia, weight gain, sedation
SSRI medications
Side effects - nausea, headache, sexual dysfunction, insomnia
Side effects - dry mouth, blurred vision, sedation, postural hypotension
MAOI medications
Side effects - weight gain, hypotension, insomnia, liver damage

Headache is first side of increased tyramine

Anxiolytic medication
Side effects - drowsiness, ataxia, headache, nausea, depression, dependence
Anti-obsessional medications
Side effects - nausea, headache, sexual dysfunction, insomnia
Brunstromm's Stage 1
flaccidity, no voluntary or reflexive activity
Brunstromm's Stage 2
Minimal voluntary movement, components of the synergies are elicited as reflex reactions, spasticity develops
Brunstromm's Stage 3
Marked spasticity, synergies are performed voluntarily
Brunstromm's Stage 4
Movements that begin to deviate from synergy can be accomplished on a volitional basis
Brunstromm's Stage 5
Movements which differ greatly from the basic synergies are utilized
Brunstromm's Stage 6
Spasticity is essentially absent; isolated muscle actions are freely performed
Brunstromm's Stage 7
Normal motor function
Functional splinting position
20-30 wrist extension
45 MCP flexion
20-30 IP flexion
thumb abducted

Safe splinting position
0-20 wrist extension
70-90 MCP flexion
IP extension
thumb abducted and extended

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