AHHHHH Flashcards
What was the philosophy of the Moral Treatment movement?
All people, even the most challenged, are entitled to consideration and human compassion
What movement was based on the belief that using one’s hands to make items connected people to their work, physically and mentally, and helped with restoring health?
Arts and Crafts Movement
List the founders of NSPOT
Susan Cox Johnson
George Edward Barton
Eleanor Clark Slagle
William Rush Dunton
Isabelle Newton
Thomas Kidner
Who were the first practitioners of the OT profession who worked during WWI?
Reconstructive Aides
What do client factors include?
- values, beliefs and spirituality
- body functions
- body structures
all influence the client’s performance in occupations
Why be concerned with a model or approach?
It guides your thinking
keeps therapists on the same page
gives us a reference point
Characteristics of an OT Model
-derived from theory or techniques
-guides OT practice
-helps to identify problems and solutions
Characteristics of an OT Frame of Reference
-based on theory
-gives us a direction to look at the patient
-helps us determine where to start
-allows us to focus on a select area of the patient’s problems
-helps to select evaluation and treatment techniques
Which OT model approaches treatment according to the patient’s Habituation, Volition, and Performance ?
MOHO Model
Which frame of reference considers the human body as a living machine and uses principles of physics for treatment methods?
Biomechanical
What are the goals of the biomechanical approach?
-evaluate limitations in ROM, strength, and endurance
-restore functions
-prevent or reduce deformity
What is the Sensorimotor approach most appropriate for?
CNS dysfunction
- muscles not receiving normal directions from CNS
-the problem is in the brain and not the muscles
Which Frame of Reference approach uses neurophysiological mechanisms to normalize muscle tone and elicit more normal movement?
all Sensorimotor approaches
What does rehabilitation mean?
restoration to a former state
What does the rehabilitation approach focus on?
focus is on abilities rather than disabilities; learning to compensate
What is the goal of the rehabilitation approach?
goal is to live as independently as possible despite disability
Which Frame of Reference approach considers the latest scientific advances in methods and equipment/assistive technology?
Rehabilitation approach
What are some limitations of the Biomechanical, Sensorimotor, and Rehabilitation Approaches?
They do not address cognitive or psychological components explicitly; not holistic
List the stages of treatment continuum in Phys Dys Practice
- Adjunctive methods
- Enabling Activities
- Purposeful Activity
- Occupational Performance and Occupational Roles
What does the Adjunctive Methods stage consist of?
PAMS, PROM, exercise, braces, splints, sensory stimulation
-focuses on body functions
-preparation for purposeful activities
What does the Enabling Activities stage consist of?
simulating purposeful activities
-ie: sanding boards, skateboards, stacking cones/blocks/ ADL boards, peg boards
-may not be meaningful to Pt, but necessary for training skills for occupations
What does the Purposeful Activities stage consist of?
activities that have an inherent or autonomous goal and is meaningful to the patient
ie: feeding, toileting, dressing, mobility, arts, crafts, work, educational activities
What does the Occupational Performance and Occupational Roles stage consist of?
patient resumes roles in their living environment and community
-focus on assisting Pt with transition back
List the stages of the 5-Stage model for adults with developmental disabilities
- orientation and welcome
- movement and energizing
- perceptual tasks and sensorimotor
- cognition for expressing feelings
- closure and preparing to take control
what does the abbreviation “WS” mean?
Work Simplification
what does the abbreviation “EC” mean?
Energy Conservation
What is the focus of non-purposeful activities?
focus is on the process or movements and increasing strength
-no inherent goal other than motor function
Activities are analyzed according to what 3 perspectives?
-mental and physical limitations of the person
-physical environment
-social environment
List 9 characteristics of appropriate activities for treatment
1 goal directed
2 meaningful
3 matched to patient’s needs
4 elicits mental/physical engagement
5 prevents or remediates dysfunction
6 related to patient’s interests
7 adaptable, gradable, age appropriate
8 selected through OTA’s judgement
9 collaborated with patient
List of contraindications for therapeutic exercise
-poor general health
-recent surgery
-inflamed joints
-need voluntary control of muscles
-tone abnormalities
-abnormal heart rate
-elevated blood pressure
-vertigo
4 types of exercise used to increase strength
-active-assisted
-active
-resistive isotonic
-isometric
-slowed performance
-increase in respiration and perspiration
-decreased ROM
-inability to complete reps
these are all signs of what?
signs of fatigue
Definition of Therapeutic Exercise
any body movement or muscle contraction to prevent or correct a physical impairment, improve musculoskeletal function, and maintain a state of well-being
How do you increase strength?
high weight, low reps
how do you increase endurance?
low weight, high reps
Definition of Endurance
Ability to do work for prolonged time and resist fatigue
What is the purpose of AROM and PROM?
to maintain motion
What is active exercise?
exercise performed by the patient without assistance
What is passive exercise?
exercise provided by an outside force such as the therapist or a machine
isotonic muscle contraction
muscle movement with equal resistance
concentric muscle contraction
motion occurs, muscle shortens
isometric muscle contraction
static contraction; no joint motion, muscle length unchanged
eccentric muscle contraction
muscle lengthens
Which exercise type is used for Fair+ (3/5) to Normal (5/5) where resistance is moved through ROM; w/ resistance produced via added weight
Isotonic resistive exercise
Which exercise type is used for Poor (2/5) to Fair (3/5) where no resistance is moved through ROM; w/ resistance produced via friction
Isotonic active exercise
Which exercise type is used for Poor (2/5) to Fair (3/5) where Pt moves through part of ROM and practitioner or device completes the rest of the ROM
Active-assisted exercise
Which exercise type requires no muscle contraction and is used when active motion is contraindicated
Passive Exercise
What is Passive Stretch?
therapist moves the joint through the available ROM, holds momentarily, applies gentle but firm stretch at end of ROM
What is Active Stretch?
patient uses force of agonist to increase length of antagonist muscles (independent)
What is the purpose of Isometric Exercise w/o resistance? Who is it used for?
maintain strength when AROM is not possible or contraindicated
-patient’s in casts, after surgery, arthritis, burns
What is the purpose of Isometric Exercise w/ resistance?
increase strength of Fair to Normal
What is the goal of coordination training?
to develop the ability to perform multi-muscular motor patterns faster and more precise
__________ of an uncoordinated patterns ___________ faulty patterns
Repetition ; reinforces
PAMS: what is heat used for?
increase motion, decrease joint stiffness, relieve muscle spasms, increase blood flow, decrease pain
Contraindications of using heat
acute conditions, sensory loss, impaired vascular structures, malignancies, fresh wounds
PAMS: What is conduction? What is an example?
-transfer of heat from one object to another through direct contact
-Paraffin
-moist heat packs
PAMS: What is Convection? What is an example?
Supplies heat by fluid motion around the tissues
-whirlpool
-fluidotherapy
PAMS: What is Conversion? What is an example?
-heat is generated internally by friction
-Ultrasound: sound waves penetrate the tissue and vibrate the molecules
PAMS: What is Cryotherapy? What is it used for?
Cold therapy; vasoconstriction that decreases blood flow to the tissue
used to decrease edema, pain, and inflammation
Definition of Iontophoresis (electrical modalities)
induction of topically applied ions into the tissue to treat inflammatory conditions or scar formation
Name 2 types of electrical modalities and their purpose.
TENS- pain control
NMES(FES)- to elicit muscle contraction
What are the 8 steps in the OT Process?
1 referral for OT services
2 screening
3 evaluation
4 observation of performance skills/ client factors
5 treatment planning
6 treatment implementation/ intervention
7 re-eval/reassess
8 Discharge
Definition of Evaluation
process of obtaining and interpreting data necessary for intervention
Definition of Assessment
specific tools or instruments used during the evaluation process
How do we gather information during the evaluation process?
-Medical records review
-interview
-observation (structured/unstructured)
-testing (formal/informal)
-interdepartmental notes/ discussions/ team conferences
Who is responsible for establishing treatment goals and plan of care for the clients?
OTR
True or false? the OTA is responsible for selecting the FOR.
FALSE; the OTR is responsible
What does a treatment plan include?
-Pt goals
-Pt strengths and weaknesses
-estimate rehab potential
-STG & LTG
-collab w/ Pt, family, caregiver, community resources
-select media, methods, environment, personnel to meet goals
-frequency & duration
-plan for re-eval
-plan for d/c
What is the role of the COTA during the OT process?
- may administer tests or assessments under guidance of OTR
- COTA must have good observation skills/ build rapport early
- can contribute to treatment plan, especially after reassessment
- documentation and education of Pt and family
- can contribute to d/c planning
- legally responsible for following treatment plan and implementation
Why is Clinical Documentation important?
- critical for patient care
- serves as legal document
- quality reviews
- validates patient care provided
- reduce re-work of claims processing
- compliance with insurance/ payor’s guidelines
- impacts coding, billing, and reimbursement
list of requirements for treatment notes
- factual and accurate
- patient centered
- legible and organized
- clearly support diagnosis and care plan
- outlines and supports charges for billing
- doc. Pt subjective observations
- doc. progression and regression of Pt
- clearly states professional assessment of patient
- supports need for prescribed duration of care and frequency
3 things to take caution of when documenting
- chart promptly
- never chart ahead of time
- be detailed and specific enough to recall events 2-3 years after; protects you if called to testify in court
List of what Modality Documentation must include:
- rationale for use of modality
- parameters of the modality, time, etc.
- response of patient to the modality
- response of pt and caregiver to education
- area of body treated
- objective edema measurements
- subjective finding to include pain rating, pain location, description of pain, and effect on function before and after each application
What are the two OT/PT code categories
Service-based codes
Time-based codes
What are Service-Based Codes?
-physical medicine services that do not use time-based unit for billing
- same CPT code applies, only bill for one single session
What are Time-Based Codes?
-billing based on 15-minute increments for the multiple units of time that are spent in direct contact with the outpatient
Quality outcome of documentation for the patient
Quality and continuity of care
quality outcome of documentation for the therapist
prevent reduced or denied payment
Quality outcome of documentation for the facility
proficiency in the process of coding, billing, and reimbursement
List of Payer Sources
private pay
private insurance plans (employer or other funded)
Medicare (federally funded)
Medicaid (state funded)
Tri-care (dept. of defense funded)
Worker’s Compensation (employer funded)
Vocational Rehabilitation (state funded)
Goal writing: what does RUMBA stand for?
Relevant
Understandable
Measurable
Behavioral
Achievable
What are the stages of the 5- Stage Model for Developmental Disabilities?
1 orientation and welcome
2 movement and energizing
3 perceptual tasks and sensorimotor
4 cognition for expressing feelings
5 closure and preparing to take control
What did living arrangements for individuals with disabilities look like in the past?
- most were placed in institutions
- “learned helplessness”
- indv. lived in large, overcrowded conditions; spent days in large rooms waiting for showers and meals
- staff poorly trained; ratios as low as 4:300
Definition of Developmental Disabilities
Refers to sever, chronic disability that is
-attributable to mental or physical impairment or both
-manifests before age of 22
-results in significant limitations in self-care, language skills, mobility, self-direction, capacity for ind. living, economic self-sufficiency
Body functions to be aware of when working with indv. with dev. disabilities
- more susceptible to cardiac, pulmonary, blood, digestive, metabolic, urinary, reproductive, and skin conditions
- vision, hearing, and speech limitations
- may exhibit food allergies
- may exhibit side effects from medicines
Motor functions to be aware of when working with indv. with dev. disabilities
- may exhibit low, high or mixed muscle tone
- may exhibit poor oral motor control
- may exhibit a wide range of motor problems and difficulty learning complex motor tasks
Mental functions to be aware of when working with idv. with dev. disabilities
- often lack global mental functioning
- may have attention deficits
- may have emotional instability
- may have difficulty w/ impulse control
- difficulty choosing activities, low motivation
What does intervention for motor functions include for indv. with Dev. Disabilities
intervention includes repetition, practice, simple directions, and modifications or adaptations
Examples of Specific Mental functions one may come across while working with indv. w/ dev. disabilities
short attention span
memory deficits
poor perception slower ability to process information
difficulty recognizing people or objects
poor problem solving or critical thinking
speech/language deficits
difficulty adding/subtracting
poor motor planning
emotional liability, poor regulation
poor body image and self-awareness
Strategies for treatment with indv. w/ dev. disabilities
determine etiology of the client’s actions-unmet needs
behavior modification techniques
environmental modification
sensory strategies
“chaining”
Why is OT one of the best suited professions to help people get back into their jobs?
strong professional preparation in the nature of occupation, analysis of activities, and the physical and mental factors that support engagement in occupation.
List of Industrial Therapy Services
OT
PT
Physicians
occupational health nurses
vocational counselors
safety or risk engineers
insurance case managers
What does a Job analysis include?
-questionnaires/ review of job description
-interview with employee and employer
-observation of shifts and safety procedures
-formal measurement of heights, distances, work cycles
What is Work Conditioning?
-part of the acute phase
-focuses on physical components; covers strength, aerobic fitness, flexibility, coordination, and endurance
What is Work Hardening?
-comprehensive
-combines work simulation, strengthening, and endurance with behavioral components
What are the goals of Work Hardening?
-achieve maximum physical tolerance
-develop positive worker behaviors
-increase confidence
-identify problems that may necessitate alternative job
What is a Functional Capacity Eval (FCE)
battery of tests to give baseline measure of current level of functioning
includes:
-medical history
-worker interview
-job analysis
-pain assessment
-physical assessment
-standardized assessment
-work task simulation
-summary
-ID of problems that interfere with work performance
-Bennet Hand Tool Test
-Minn. Rate of Manipulation Test
-Purdue Pegboard
-Nine-hole Peg Test
-Valpar Work Samples
-BTE Box
These are all examples of what?
Standardized Assessments
How long does it typically take to complete an Functional Capaciy Eval?
4-6 hours, sometimes on 2 consecutive days
What are the most important aspects of a CFE?
Reliability and validity of testing protocol
Definition of Individual Work Hardening Plan
Structured, goal-oriented, individualized treatment program designed to maximize an individual’s ability to work
What does a Functional Capacity Evaluation (FCE) include?
includes:
-medical history
-worker interview
-job analysis
-pain assessment
-physical assessment
-standardized assessment
-work task simulation
-summary
-ID of problems that interfere with work performance
What is the #1 Worker’s Comp claim?
Lower Back Pain
Definition of Individual Work Hardening Plan
structured, goal oriented, individualized treatment program designed to maximize an individual’s ability to work
What are the goals of an indv. work hardening plan?
-increase duration of daily participation
-increase physical tolerances
-improve body mechanics and posture
-develop pain management strategies
-facilitate appropriate worker behaviors
What are the benefits of having ergonomic services at the work site?
-immediate access to rehab services
-facilitates early return to work
-convenient scheduling of therapy
-manages cost and quality of care
-eliminate job simulation; real work
-positive morale; concern for worker
ulnar deviation is common sign of what?
Rheumatoid Arthritis
synovitis is a primary clinical feature of what?
RA
What are some deformities that can occur with RA?
-swan neck
-boutonniere
-trigger finger
-thumb deformities
-ulnar deviation
is there a cure for RA?
no
What is the medical treatment for RA?
-tx to reduce inflammation, pain, joint damage
-medication
-exercise
-heat and cold
-joint protection
-weight control
-surgery
-coping strategies
common side effects of steroid use for RA
bone erosion, diabetes, weigh gain, hypertension
Why would someone with RA receive surgery?
- to repair or remove damaged soft tissue or replace destroyed joints
- to relieve symptoms and slow the process of jt. destruction
