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Skills Final > ADLs/ IADLs + Neglect + Low Vision > Flashcards

ADLs/ IADLs + Neglect + Low Vision Flashcards

1
Q

Posterior Hip Precautions

A

BIC

  • No Bending > 90 deg, hip flexion
  • – teach LBD with reacher
  • – also don’t bring leg up or squat
  • No Internal Rotation: no turning toes in
  • – no kicking shoe off with other foot
  • No Crossing Legs: at either hips or ankles, no crossing midline/hip adduction
  • – may place pillow between legs to sleep
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2
Q

Spinal Precautions

A

BLT

  • No Bending at spine
  • – teach bringing feet to lap for LBD
  • No Lifting anything heavier than 5 lbs (a gallon of milk)
  • No Twisting at spine
  • – cannot twist trunk to wipe
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3
Q

AM PAC: Activity Measure for Post-Acute Care

A
  • outcome tool that measures activity limitations in areas of mobility, daily activities, and cognition.
  • scored on the amount of hands-on assist required to complete each item
  • completed by client, family member, or clinician
  • after the fact report, not observation
  • short form and computer based formats available
  • – 8 different short forms
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4
Q

AM PAC Scoring

A
  1. total or unable (total/dependent assist)
  2. a lot (max/mod assist)
  3. a little (min/CGA/supervision) 4. none (modified independent/ independent)
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5
Q

AM PAC Modifiers

A
  • CH: 0% impaired
  • CI: 1-20% impaired
  • CJ: 20-40% impaired
  • CK: 40-60% impaired
  • CL: 60-80% impaired
  • CM: 80-100% impaired
  • CN: 100% impaired
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6
Q

Intervention Strategies For

  1. use of 1 hand only
  2. Weakness
  3. Low-endurance
A
  1. one handed techniques, equipment to stabilize, make bilateral tasks unilateral
  2. let gravity assist, lightweight objects, devices to increase leverage
  3. energy conservation/work simplification
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7
Q

Intervention Strategies For

  1. Decreased ROM
  2. Decreased coordination
  3. Decreased memory
A
  1. long handled tools, built up tools, positioning of items
  2. stabilize object or body part, decrease need for coordination, adaptive devices
  3. decrease need for memory, develop habits, best fit for success
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8
Q

Intervention Strategies For

  1. Decreased vision
  2. Decreased sensation
  3. Low back pain
A
  1. lighting, contrast, use other senses
  2. use other senses, increase tactile input
  3. positioning, long-handled equipment
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9
Q

Intervention Strategies for Orthopedic and Neurological Diagnoses

A
  • Dress: affected then unaffected side
  • Undress: unaffected then affected side
  • Hemiparesis: do not add equipment unless needed, it is hard to learn and don’t want to be reliant if not necessary
  • Be mindful of leaning/slumping to one side
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10
Q

Unilateral Neglect

A
  • failure to report, respond, or orient to novel/meaningful stimuli presented to the side opposite a brain lesion
  • – when this failure cannot be attributed to motor or sensory deficits
  • almost always L neglect (seen with R brain damage)
  • an attention based impairment (lateralized attention deficit)
  • Safety issue: may not demonstrate caution because they don’t realize things are there/can’t compensate well for neglect
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11
Q

Unilateral Neglect

A
  • failure to report, respond, or orient to novel/meaningful stimuli presented to the side opposite a brain lesion
  • – when this failure cannot be attributed to motor or sensory deficits
  • almost always L neglect (seen with R brain damage)
  • an attention based impairment (lateralized attention deficit)
  • personal and spatial neglect can occur together or separately
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12
Q

Neglect Safety Issues

A
  • Safety issue: may not demonstrate caution because they don’t realize things are there
  • or can’t compensate well for neglect
  • discharge with 24/7 supervision even if walking and talking
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13
Q

Spatial Neglect

A
  • locating objects, reading, watching tv, locating voices
  • inattention to visual stimuli in the environment
  • Near Spatial or Far Spatial
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14
Q

Body Neglect

A
  • shaving, combing hair, bathing
  • does not integrate/use L side of body, does not attend to hair on left side of head/face
  • personal neglect
  • inattention to one side of the body
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15
Q

Coexisting Cognitive Impairments

A
  • these may or may not occur with neglect
  • unilateral sensory/motor loss
  • generalized attention deficits
  • visual field deficits (hemianopsia)
  • loss of postural control
  • physical features disorientation
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16
Q

Behaviors Seen with Neglect

A
  • Extinction: unable to feel sensations on one side of the body when both are stimulated (that arm test)
  • may only bathe, shave, comb one side of the body
  • eat from only one side of the plate, read only one side of a book
  • hard time locating voices on left side
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17
Q

Paper and Pen Assessments for Neglect

A
  • Cancellation: in a field with a variety of objects cross out only these ones
  • Line Bisection: cross out all of the lines on this page
  • Design copying: copy a simple picture
  • Drawing a clock, house, flower - see whether they draw both sides
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18
Q

Formal Assessments for Neglect

A
  • helps to generate levels of assistance that people may need, safety implications, provides a “why” to clinical observations/judgements
  • A-ONE
  • AMPS
  • Catherine Bergego Scale
  • Behavioral Inattention Scale
  • Baking Tray Test
  • Comb & Razor/Compact Test
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19
Q

A-ONE: Arnadottir OT-ADL Neurobehavioral Evaluation

A
  • uses standardized and structured observation during daily tasks of feeding, bathing, dressing, hygiene, mobility, communication
  • evaluates apraxia, neglect, spatial relations, perseveration, topographical disorientation, agnosias
  • requires 5 day training
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20
Q

AMPS: Assessment of Motor and Processing Skills

A
  • Measures how well a client performs familiar activities of daily living in terms of physical effort, efficiency, safety, and independence
  • Can be used to determine appropriate occupation-based interventions and goals
  • Requires 5-day training
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21
Q

Catherine Bergego Scale

A
  • standardized checklist to detect presence and degree of unilateral neglect during observation of everyday life situations
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22
Q

Behavioral Inattention Scale

A
  • Short screening of battery tests to determine the presence and extent of visual neglect on a sample of everyday life problems faced by those with visual inattention
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23
Q
  1. Baking Tray Test

2. Comb & Razor/Compact Test

A
  1. tests for spatial neglect

2. screens for spatial neglect in client’s personal space by assessing performance in functional activities

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24
Q

Intervention Strategies for Addressing Neglect

A
  • Awareness Training
  • Scanning Training
  • Limb Activation
  • Mental Imagery
  • Partial Visual Occlusion
  • Prisms
  • Computerized Training
  • Sustained Attention Training
  • Environmental Adaptations
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25
Q

Neglect Strategies from Glen Gillen Ch (were there more?)

A
  • Awareness Training
  • Scanning Training
  • Lighthouse Strategy
  • Limb Activation
  • Mental Imagery
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26
Q

Awareness Training

A
  • includes video feedback
  • using meaningful activities
  • discuss task performance: anticipated difficulties, strategies, evaluate performance
  • give feedback: verbal, visual, physical guidance
  • discuss compensatory strategies
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27
Q

Scanning Training

A
  • trunk, head, and neck rotation
  • scanning while static standing (“look left”)
  • Lighthouse Strategy
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28
Q

Lighthouse Strategy

A
  • combines scanning training with visual imagery
  • uses a picture of a lighthouse on the wall as a reminder
  • Be like a lighthouse: look left and right
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29
Q

Limb Activation

A
  • movement of contralesional side may approve awareness

- find then encourage affected side movements

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30
Q

Mental Imagery

A
  • good for people without active movement

- first practice twice on the R side then imagined 4 times on the L side

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31
Q

The problem with computerized training

A
  • how well do they transfer to functional tasks in the real world?
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32
Q

Environmental Adaptations (Neglect)

A
  • for clients who do not respond to remediation/restorative approaches/self-generated strategies
  • Ex: putting grooming items on right side of bathroom counter
  • Ex: putting bright tape on the left side to cue the patient to pay attention to that side
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33
Q

Macular Degeneration

A
  • gray spot in the middle due to a central scotoma
  • central scotoma: lesion between optic nerve head and chiasm
  • obscured central vision, but area around the spot is pretty clear
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34
Q

Glaucoma

A
  • dark around the sides, clear in the middle

- pressure causes compression of optic nerves

35
Q

Retinopathy

A
  • black spots
  • caused by damaged blood vessels in the retina
  • usually the result of diabetes
36
Q

Cataracts

A
  • Blurry

- the lens of the eye becomes cloudy

37
Q

Normal Age Related Visual Changes

A
  • decreased visual acuity
  • presbyopia (farsightedness caused by loss of elasticity of the lens of the eye)
  • Floaters
  • dry eyes
  • increased need for light
  • difficulty with glare
  • difficulty adapting to light and dark
  • reduced contrast sensitivity
  • reduced color perception
  • reduced depth perception
38
Q

A. Vision: 20/# (ex: 20/40)

B. VF stands for

A

A. you can see from 20 ft what someone should see from # ft
- so 20/40 means you need to get 2x closer to see it
B. Visual field - should be pretty wide, over 180 deg with peripheral vision

39
Q
  1. Moderate Vision Loss
  2. Severe Vision Loss
  3. Profound Vision Loss
  4. Near Total Vision Loss
A
  1. 20/70 - 20/100 or VF 21-61 deg
  2. 20/200 - 20/400 or VF 11-20 deg
  3. 20/500 - 20/1000 or VF 6-10 deg
  4. 20/2000 (no light perception) or VF < 5 deg
40
Q

Legal Blindness

A

20/200 or VF < 20 deg

41
Q

MA Driving Requirements for Vision

A
  • Unrestricted: 20/40 best corrected eye
  • Day-Time Restricted: 20/70 best corrected eye
  • Bioptic telescopes are allowed
  • Visual field > 120 deg required
42
Q

Low Vision Team

A
  • opthalmologist
  • optometrist
  • rehab teacher
  • orientation and mobility specialist
  • low vision therapist
  • OT, PT
43
Q

Distance Acuity

A
  • macula
  • Test: Distance Visual Acuity Chart
  • client reads letters from eye chart 20 ft away, test one eye at a time
  • Near: hold card about 13-16”
  • if client is 20/40 or worse, refer to specialist
44
Q

Testing Scanning

A
  • ability to search visually for objects
  • Scanboard Test
  • – should read in an organized way: clockwise, counterclockwise, rectlinear
  • – most start L hand corner and read L to R top to bottom
  • does client miss words or one side only or throughout?
45
Q

Accommodation (Vision)

and testing it

A
  • ability of eye to adjust focus at different distances
  • the process by which the vertebrate eye changes optical power to maintain a clear image or focus on an object as its distance varies
  • Test: listening to client concerns
46
Q

Testing Range of (Eyeball) Motion

A
  • move a pen in a large H, 12” in front of client

- can the client follow the pen to the far edges of the H (far field of eye movement)

47
Q

Pursuits/Tracking

A
  • movements that keep an image steady on the retina, track a moving object when stationary
  • jerkiness is abnormal
  • Test: client follows target moving only eyes, not head
  • – horizontal, vertical, diagonal, circular
  • may be palsy of the muscle
  • eye may stop right at midline
48
Q

Saccades

A
  • sequenced rapid eye movements that change the line of sight, used extensively in reading.
  • Test: client quickly looks back and forth b/w 2 points held about 6” apart. Can the client find the 2 points easily or do they continue searching for the target
  • Think of a tennis match (can they look back and forth?)
49
Q

Testing Convergence

A
  • client follows target as it approaches bridge of his/her nose and back out again to the start point.
  • Can the client follow target or does he/she lose eye contact and/or complain of blurry vision.
  • When does the target become one object? Break point should occur about 6”in front of nose.
50
Q

Ocular Alignment

A
  • crucial to coordinated function of both eyes and visual processing in general. If eyes are not aligned, client may experience diplopia, vertigo, confusion.
  • Are the eyes straight out?
51
Q

Nystagmus

and testing it

A
  • involuntary movement of the eyes (usually back and forth)
  • Test: Client looks straight ahead, shine pen into his/her eye, observe the reflection of the light in the cornea of the eye. Is the reflection of the light in the same position in both eyes?
52
Q

Estropia

A
  • one eye deviated inward

- reflection of a penlight will occur on lateral aspect of pupil in that eye

53
Q

Extropia

A
  • one eye deviated outward

- reflection of a penlight will occur on medial aspect of the pupil

54
Q

Normal Monocular Visual Field

A
  • 60 deg up
  • 70-75 deg down
  • 60 deg inward
  • 100-110 outward
55
Q

Testing Visual Field

A
  • Confrontation testing. — Can be done w/ or w/o an eye patch.
  • Client looks straight ahead at therapist’s nose and indicates when he/she detects stimulus in R/L and superior/inferior visual fields.
  • – Looking for the “visual cut” in which client doesn’t see stimulus until it’s near midline or as it gets closer to another visual field.
  • Ansler Grid: cover one eye, look at dark dot in center of grid, are any lines broken, blurry or missing?
56
Q

Reading involves

A
  • letter recognition
  • contrast sensitivity (normal 2.8%)
  • convergence/divergence
  • accommodation
  • saccadic eye movement/tracking
  • cognitive processing
57
Q

Intervention Strategies for People with Vision Loss

A
  • use remaining vision
  • lighting: most important
  • minimize glare
  • increase contrast
  • magnification
  • eccentric viewing
  • use other senses
58
Q

Increasing Lighting

A
  • most important!
  • Improves function for tasks that involve detail such as choosing clothes
  • Lighting more important for those with worse vision
  • Increased quality of life from task light
  • The closer light is to task, the brighter the light will be (task specific lighting, such as for reading or writing)
59
Q

Assessing Lighting

A
  • spaces with bright lights then dark - pupils will have hard time transitioning - even illumination would be better
  • Indirect vs direct lighting
  • Type of fixture and covering (want bulbs to be completely covered)
  • Fit of bulb to fixture (too big? Too small?)
  • Working light bulbs
  • Transition of lighting
  • Positioning of light
  • Access to light
60
Q

Minimizing Glare

A
  • Ex: big screen TV faces window
  • use shades on bulbs
  • position edge of lampshade below eye level
  • sheer curtains to cut down on glare but still allow light to enter (light diffuses)
  • use low gloss polish
  • cover shiny surfaces (table cloth)
  • matte instead of glossy paper
  • baseball cap
  • filters, polarized sunglasses
61
Q

Increasing Contrast

A
  • Delineate boundaries on tub, stairs, etc.

- use bright pillows, rugs, colored tape (a red pillow shows where a white couch is vs the white carpet)

62
Q

Magnification

A
  • Relative distance magnification
  • Relative size magnification
  • Large print books, telephones with large number buttons, watch face with large numbers…
  • Angular magnification (optics)
  • Electronic magnification
    = How do you know which kind of magnification they need?
63
Q

Magnification Power

A
  • x2 to x14 (2 times to 14 times)
  • So for example +5D/4 = 1.25x in order to read
  • Decreased contrast will need much more magnification
64
Q

Stronger magnifier = ____ field of view

A
  • Smaller

- So you want the lowest magnifier that will make it functional in order to maximize field of view

65
Q

Buying Magnifiers

A
  • Cost as a barrier
  • Magnifications not usually covered by 3rd party payers
  • Stand magnifier vs hand magnifier – consider if the client has a tremor, fatigue, activity endurance think about how they have to hold it at a good focal distance
66
Q

Eccentric Viewing

A
  • For people with macular degeneration
  • Using peripheral vision to compensate for loss of central vision
  • – but visual acuity is not as good in periphery than central (macula is central)
  • Try this: make a fist and put it on the bridge of your nose. What do you see? How do you compensate? (turn your head)
  • – Slight upright (2 o’clock) or left (10 o’clock) most commonly used for eccentric viewing
67
Q

Interventions for Vision Loss: Using Other Senses

A
  • Hearing: high pitches are lost first so use male voice for assistive devices
  • Tactile: raised dots, knots, rubber bands, paper clips, braille
  • – Most older adults cannot read braille because 2- and 3-point discrimination decreases over time
68
Q

Interventions for Vision Loss: Organization

A
  • Working with home helpers, don’t change the strategies that the client has already established (may be easier for helper, but not for client) - advocate so the home helper keeps them intact
69
Q

Assertiveness Training

for vision loss

A
  • Ex: asking customer service for help

- Recommend AT - OTs need to keep up with technology trends to make best recommendations

70
Q

Problem Solving Training

for vision loss

A
  • most effective strategy; active problem solving with best outcomes
  • Establish realistic goals
  • Brainstorm solutions, try out solutions, choose best solution, implement solution, evaluate the outcome
  • Looks very similar to OT process (Goal, Plan, Do, Check)
71
Q

Low Vision vs Neurological Impairments:
(A) Rates, (B) Functional Implications
1. Visual Field Impairment
2. Visual Inattention (Neglect)

A
  1. A. 25%L, 36%R
    B. Reading deficits, visual motor deficits, balance/mobility deficits
  2. A. 65%L, 82%R
    B. Reading deficits, visual motor deficits, balance/mobility deficits
    ** Visual Field Impairment looks a lot like Neglect!
72
Q

Low Vision vs Neurological Impairments:
(A) Rates, (B) Functional Implications
1. Convergence Insufficiency
2. Accommodative Deficits

A
  1. A. 40-56%
    B. Reading deficits, diplopia, blurred vision
  2. trouble looking at something near then something far or vice versa
    A. 21-56%
    B. Reading deficits, diplopia, blurred vision
73
Q

Low Vision vs Neurological Impairments:
(A) Rates, (B) Functional Implications
1. Pursuits and Saccades Deficits
2. Fixation Instability

A
  1. advanced tracking, important for reading
    A. 25-59%
    B. reading deficits, visual motor deficits, balance/vestibular deficits, blurred vision
  2. A. 5-13%
    B. reading deficits, visual motor deficits, blurred vision
    ** Balance separates these two
74
Q

Low Vision vs Neurological Impairments:
(A) Rates, (B) Functional Implications
1. Strabismus
2. Diplopia

A
  1. cross-eyed
    A. 11-32%
    B. binocular vision deficits, depth perception deficits, potential visual deficits, eye movement deficits, double vision, balance deficits
  2. seeing double
    A. 19%
    B. blurred vision, balance/vestibular deficits, nausea, reading deficits, visual motor deficits
75
Q

Visual Perception

A

hopefully there is a later/different deck notecard that talks about this in depth

76
Q

Methods of Field Enhancement

A
  • Scanning
  • Field Displacement
  • Field Enhancement
  • Minification: reverse magnification
77
Q

Minification

A
  • reverse magnification
  • for someone with bilateral peripheral field restriction
  • must have good visual acuity (minification worsens acuity)
  • makes objects smaller and farther away thereby widening the field
  • use least power possible to maintain clarity
  • do not use for someone who is confused –> increased risk of falling if walking while minifying
78
Q

Evaluate Mobility Awareness

A
  • Increase efficiency of information gathering; enhance visual scanning skills;
  • orientation and mobility instructor (referral)
  • use of adaptive devices, including quad cane
79
Q

Visual Field Deficit Interventions

A
  1. Scanning
  2. Adaptive Strategies
    a. Prism
    b. Scrolling text
    c. Reorientation of material
    d. Anchoring
    e. Patching
80
Q
  1. Scanning (Visual Field Deficits)
A
  • most used and most effective strategy
  • Systematic scanning methods. Small range of movements in all directions
  • – Left to right, then top to bottom
  • Training with a certified orientation and mobility instructor
  • Yellow acetate e.g. apply on the left side of the glasses
  • – This is to train them to scan (“now make everything yellow”) – make sure they are scanning into the area of the impaired visual field
81
Q

2a. Prism

A
  • effective for hemianopsia and neglect
  • Sector Prism, Peli Prism, Gottlieb Prism
  • Prism reflects the image
  • Prism puts a “ghost” of an image in the patient’s non-seeing area in the functional retinal area
  • Base of prism placed in direction of field loss
  • Allows person to see object with a smaller eye or head movement; no effect until person shifts gaze into prism
  • Ghost image or purposeful double vision to cue person to look to the side of impairment
    •Limited evidence to support use of prisms – improvements in QOL, improved VF awareness and improved community mobility using 40 diopter prism
82
Q

2b. Scrolling Text

A
  • Limited evidence to support use of scrolling text to improve reading performance in individuals with VF deficits
    – right to left scrolling text improved reading saccades and reading speeds after 4 weeks of daily sessions
83
Q

2c. Reorientation of material

2d. Anchoring

A

• Limited to no evidence to support use of anchoring, cueing, and reorientation techniques to improve reading performance

84
Q

2e. Patching

A
  • Limited evidence to support the use of patching to improve scanning and ADL performance
  • E.g. you need to keep the patch on in order for it to be effective. Effect goes away when the patch is removed

Skills Final (2 decks)

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