Domain 1 (Part 1) Flashcards
Play Occupations
meaningful, intrinsically motivating and purposeful performance activities
Exploratory (Sensorimotor)
Play occupation that uses sensory input to learn new experiences
Ex: infant touching mom’s face
Relational (Functional)
Play occupation that uses toys consistent with their intended purpose
Ex: pretending to self-feed with a spoon
Pretend (Imaginary)
Play occupation that involves making objects/toys perform intended actions
Ex: pretending to use a phone to talk
Social
Play occupation that includes:
• Interaction with and emotionally relating to others
Behavior and skills to develop and progress through childhood
Gross Motor
Pay occupation that involves full body, kinesthetic motor movements
Ex: climbing on a play structure
Constructive
Play occupation that involves using objects/toys to produce or build something
Ex: putting together a puzzle
Primitive Developmental Reflexes
Automatic movements performed by an infant without conscious effort in response to a stimulus, typically integrated by early childhood and are a precursor to functional movement (a persistent primitive reflex is usually indicative of a CNS dysfunction)
Righting Reaction
Postural reflex present from approximately 3 months – 6 months of age that functions to orient the body in response to visual and vestibular input
Ex: neck on body, body on body, body on head
Protective Extension
Postural response present at approximately 6 months of age and continues throughout life, characterized by reflexive straightening of the upper extremities in response to a loss of balance
Equilibrium Reaction
Postural reflex present at approximately 6 months of age and continues throughout the life span and is a reflexive response to help maintain or recover balance, includes shifting the body to reorient to midline
Grasp Pattern
Fine motor function of the hand, either precision or power, used to manipulate items- patterns include: cylindrical, power, tripod
Power Grasp
Grasp used when stability and strength are required and includes:
• Ulnar digits flexed and ulnar side of hand controlling object
Radial digits less flexed while manipulating the object
Hook Grasp (Prehension)
Type of prehension grasp used to carry an item with a handle without using the thumb and palm
Ex: lunchbox
Cylindrical Grasp
Grasp used for holding a tube-shaped item
Ex: drinking glasses, baseball bat
Lateral Pinch (Prehension)
Prehensile pattern used to grasp a small item with the thumb opposed to the radial side of the index finger
Ex: placing a key in a lock
Pincer Grasp (Prehension)
Prehensile grasp used to manipulate small objects with the thumb opposed to the index finger and middle finger
Ex: picking up a pencil
Tripod Grasp (Precision)
Precision grasp used to manipulate small objects with the thumb opposed to the index and middle finger tips, providing more stability than a pincer grasp
Ex: writing utensil
Tip Pinch
Pinch used to pick up and hold small objects with the thumb opposed to the end of the index finger forming an oval shape
Ex: picking up a pin
Spherical Grasp
Grasp used to pick up and hold round items
Ex: apple, baseball
Emotional Regulation Development Phases
- Neurophysiologic Modulation
- Sensorimotor Modulation
- Control
- Self-Control
- Self-Regulation
Neurophysiologic Modulation
Phase occurring between birth and 2-3 months of age, characterized by ability to:
• Regulate arousal (self-soothe, respond to parental soothing)
• Activate organized patterns of behavior (routine sleep-wake cycles)
Sensorimotor Modulation
Phase occurring between 3-9 months of age, characterized by:
• Enjoyment of sensorimotor play
• Sensory Exploration
• Possible sensory modulation challenges
Control
Phase occurring between 12-18 months of age, characterized by:
• Emerging awareness of social demands
• Varying levels of inhibition/compliance
Self-initiated monitoring related to an understanding of consequences
Self-Control
Phase occurring between 24-48 months of age, characterized by:
• Emerging sense of identity
• Demonstrated knowledge of social norms
Minimal flexibility and adaptation to change
Self-Regulation
Phase occurring between 36 months of age and older, characterized by emerging:
• Flexibility to adapt to unexpected changes
• Self-awareness
Capacity to evaluate own behavior
Motor Learning Strategies
Exploratory, Perceptual, Skill Achievement
Exploratory Motor Learning
Occurs between 1-3 months of age where the infant learns about the self and environment using primitive movement patterns to:
• Swipe at objects
• Initiate reach
Complete low level skills
Perceptual Motor Learning
Occurs between 3-6 months of age where the infant uses perceptual skills developed through exploration, characterized by:
• More accurate and direct reach
• Consistency of movement patterns
Engagement in trial and error learning
Skill Achievement Motor Learning
Occurs between 6-9 months of age, characterized by:
• High adaptability
• Both perceptual learning and increased self-organization
Using action patterns that are orderly and efficient
CVA Modifiable Risk Factors
• Smoking • Hypertension • Diabetes Mellitus • Obesity • Sedentary Lifestyle • Stress High Cholesterol
CVA Non-Modifiable Risk Factors
• Family History • Age (late adulthood) • Gender • Post-Menopausal History of Heart Disease
Neurological Deficits Associated with Left Hemisphere Dysfunction
• Right hemiparesis or hemiplegia
• Sensory impairment on right side of body
• Language impairment (expressive and/or receptive aphasia)
• Bilateral motor apraxia
Frustration
Neurological Deficits Associated with Right Hemisphere Dysfunction
• Left hemiparesis or hemiplegia • Sensory Impairment on left side of body • Unilateral body and spatial neglect • Visual field cut on left side Decreased insight into deficits
Neurodegenerative Conditions
Progressive neurological disease of the CNS, may be structural or neurochemical, and advances according to characteristic stages
Parkinson’s Disease (PD)
Associated with deterioration in the substantia nigra, characterized by: • Rigidity • Bradykinesia • Resting Tremor Festinating Gait
Multiple Sclerosis (MS
Associated with white matter lesions in the CNS and demyelination process, characterized by fluctuant changes in: • Energy level • Sensation • Weakness • Cognition • Vision Mobility
Amyotrophic Lateral Sclerosis (ALS)
Associated with progressive death of upper and lower motor neurons, characterized by:
• Muscle weakness in one or more extremities
Difficulty with speech, swallowing, and/or breathing
Guillain-Barré Syndrome
Acute demyelinating condition characterized by:
• Symmetrical and progressive paralysis
• Ascending weakness starting in feet
• Possible involvement of cranial nerves and muscles of aspiration
Typical course:
• Acute Phase (2-4 weeks)- progressive increase in symptoms
• Plateau Phase (a few days- weeks)- no change
Progressive Recovery Phase (up to 2 years)- gradual improvement
Huntington’s Disease
Genetically-inherited degenerative neurological disease typically beginning between 30-50 years of age, characterized by
• Choreiform movements
• Decline in thinking and reasoning skills
• Alterations in mood
Interventions focus on supporting engagement in occupation (ECWS, AE, environmental modifications, communication devices, dysphagia management, cognitive strategies, seating/mobility)
Duchenne’s Muscular Dystrophy
Inherited genetic disorder resulting in muscular weakness and atrophy in the proximal musculature of the pelvis and shoulder girdle with symptoms being more common in males and detected around 3 years
• Results in gradual loss of independent ambulation and progressive deterioration of musculature of the trunk, neck, distal extremities
Cognition typically remains unaffected
Systemic Lupus Erythematosus
Autoimmune inflammatory disease affecting joints, skin, blood cells, and vital organs, characterized by a distinct butterfly-shaped facial rash that crosses both cheeks
Symptoms may be acute, chronic, or episodic and include: joint pain or swelling, skin lesions, fatigue, Raynaud’s phenomenon, dyspnea, alterations in cognition
Alzheimer’s Disease (AD)
Most common form of dementia characterized by a decline in memory, thinking, and performance skills, with
Mild Stage of Alzheimer’s Disease
Associated with difficulty remembering new information, getting lost, challenges with money management, increased time to complete ADL/routines, mood and personality changes
Moderate Stage of Alzheimer’s Disease
Associated with increased memory loss and confusion, impulsive behavior, difficulty in completing daily activities, poor problem solving and judgment, and possibility to experience hallucinations/delusions/paranoia
Severe Stage of Alzheimer’s Disease
Associated with inability to communicate, dependence in ADLs, incontinence, and dysphagia/increased risk of aspiration
Myasthenia Gravis
Autoimmune motor unit disorder, characterized by:
• Ptosis and double vision
• Possible difficulty with chewing, swallowing, speech
• Weakness and fatigue that increases throughout the day
Interventions include: ECWS, sleep hygiene strategies, AE, activity modification
Chronic Obstructive Pulmonary Disease (COPD)
Pulmonary condition associated with limited airflow from the lungs, characterized by:
• Difficulty breathing
• Shortness of breath during activity
• Dyspnea and fatigue, influencing performance
• Persistent cough
Includes emphysema and chronic bronchitis
Dyspnea
Shortness of breath due to impaired breathing in response to activity or at rest, may require: • Medical attention • Activity modification • Instruction in breathing techniques Dyspnea control postures
Orthopnea
Shortness of breath due to impaired breathing when lying in a supine position- recommendations may include for client to sleep in an upright position
Myocardial Infarction
Emergency medical condition characterized by blocked flow of blood to the heart muscle, resulting in damage to the heart
Angina
Chest pain or pressure in response to exertion or at rest radiating to: arms, neck, jaw, back
Cerebral Palsy (CP)
Neurological condition caused by a brain injury or brain malformation that occurs while the brain is developing before, during, or immediately following birth, characterized by impaired:
• Body movements and gross motor skills
• Muscle control and tone
• Muscle coordination and fine motor skills
• Reflexes, posture and balance
Oral motor functioning
Down Syndrome
Genetic disorder associated with chromosome 21; characterized by mild to moderate intellectual disability, physical developmental delay, low muscle tone, and characteristic facial features
Autism Spectrum Disorder (ASD)
Neurodevelopmental disorder characterized by a range of symptoms such as: • Social dysfunction • Stereotypical behavior patterns • Perseverative thoughts or interests • Sensory processing deficits Executive dysfunction
Developmental Dyspraxia
Neurodevelopmental disorder characterized by: • Clumsiness and poor coordination • Motor planning deficits • Learning difficulties Perceptual deficits (visual and motor)
Attention Deficit Hyperactivity Disorder (ADHD)
Neurobehavioral disorder characterized by one or more of the following:
Inattention, Restlessness, Impulsivity, Emotional Dysregulation, Sensory Processing, Social Immaturity
Fetal Alcohol Spectrum Disorder
Congenital birth defect secondary to gestational exposure to alcohol resulting in mild to severe impairment in one or more of the following areas of development: physical, cognitive, social, behavior
Torticollis
Dystonic disorder that is either congenital or acquired; defined by abnormal, asymmetrical head or neck position
Interventions may include: ROM exercises, positioning, environmental adaptations
Major Depressive Disorder (MDD)
Mood disorder that may be characterized by:
• Persistent low mood
• Anhedonia (inability to feel pleasure)
• Changes in sleeping and appetite
• Decreased energy
Feelings of hopelessness
Bipolar Disorders
Mood condition that manifests as manic, depressive or mixed episodes
• Type I- primarily manic
Type II- primarily depressive
Cyclothymic Disorder
A less severe form of bipolar disorder where the duration of symptoms does not meet the criteria of major maniac or depressive disorder
Schizophrenia
Psychotic thought disorder with altered sense of reality, symptoms may include:
• Hallucinations and delusions
• Disturbance in thinking and behavior
Emotional blunting, social isolation, cognitive changes
Anxiety Disorders
Emotional condition characterized by an abnormal reaction, overwhelming fear, and uncontrollable thoughts resulting in a physiological response impacting daily functionv
Personality Disorders
Psychological condition that may be characterized by:
• Disturbance of personality traits
• Behaviors inconsistent with societal norms and expectations
Problems with interpersonal relationships
Addiction
Condition impacting personal, social, and occupational functioning with physical or uncontrollable dependence on a substance (drugs, alcohol) or behavior (gambling)
Substance Use Disorder
Condition in which an individual is reliant on the use of substances for non-medical purposes, may lead to physical and psychological addiction
Interventions may include: CBT, 12-step programs, recovery programs, pharmacotherapy
Eating Disorders
Serious emotional and physical disorders including extreme preoccupation with food, body image, and weight; Intervention approaches may include: CBT, group therapy, family therapy
Anorexia Nervosa
Fear of gaining weight, inability to maintain adequate nutritional intake due to distorted perception of body weight and body image
Bulimia Nervosa
Fear of gaining weight, binge eating followed by purging secondary to excessive concern about body weight
Binge Eating Disorder
Excessive intake and weight gain, maladaptive coping mechanism to deal with stress, anxiety, or depression
Depersonalization
DSM classification of dissociative disorders characterized by:
• Retreating into a dreamy world with unrealistic feelings
• Impaired self-awareness
Disconnecting from the physical being
Dysphagia
Difficulty in swallowing associated with:
• Neurological, developmental, or oral motor condition
Sensory, motor, or behavioral dysfunction
Cleft Lip & Palate
Structural deformity in which the upper lip and/or palate has a congenital separation requiring surgery
Intervention may include safe feeding strategies pre and postoperatively
Oral Motor Dysfunction
Functional impairment of the musculature of lips, jaw, tongue, and cheeks, typically associated with neuromuscular or developmental conditions, resulting in difficulties with:
• Eating
• Blowing/sucking
Speaking
Neurobehavior
Processing of sensory stimuli that results in a behavioral response
Sensory Processing
Ability of the CNS to interpret and regulate responses to sensory input
Sensory Integration
Ability to process, interpret, and integrate sensory information to produce a behavioral or motor response
Sensory Modulation Problem
Inability of the CNS to regulate responses to sensory input from common daily stimuli, resulting in:
• Hyper-responsiveness
• Hypo-responsiveness
• Sensory-seeking
Hypo-responsiveness
A form of sensory modulation in which the CNS is slow to register or process sensory input
Behavioral characteristics include a lack of response to: socially-relevant signals, painful stimuli, alarms and flashing lights
Hyper-responsiveness
A form of sensory modulation in which the CNS registers or processes sensory input at a heightened state; behavioral characteristics include an overwhelming response to or an avoidance of: social situations, noises, textures
Tactile Defensiveness
Inability of the CNS to regulate tactile input resulting in overreaction to ordinary touch sensations on the skin or in the mouth, behavioral manifestations may include • Extreme discomfort • Emotional outbursts • Aggression • Anxiety
Gravitational Insecurity
Inability of the CNS to regulate vestibular input resulting in overreaction to changes in head position and movement during ordinary activities, behavioral manifestations may include intense fear/avoidance of:
• Riding on toys
• Heights
• Gross motor activities
SCI Level C1-C3 Functional Outcomes
• Ventilator dependent
• Total physical assistance for BADL and IADL
Ability to direct care needs
SCI Level C4 Functional Outcomes
• Initially vent dependent, progress to breathing independently w/ reduced vital capacity
• Total physical assistance for BADL and IADL
• Ability to direct care needs
• Power WC w/ adapt. for independent mobility
Total assistance for bed mobility/transfers
SCI Level C5 Functional Outcomes
- Independent respiratory function w/ reduced vital capacity (may need assistance for a productive cough)
- Total assistance for bowel and bladder management
- Independent self-feeding w/ AE
- Assistance for grooming w/ AE
- Total assistance for bathing
SCI Level C6 Functional Outcomes
• Independent respiratory function with reduced vital capacity (may need assistance for a productive cough)
• Minimal to total assistance for bowel and bladder management w/ AE
• May need some assistance for basic ADL, transfers, bed mobility w/ AE, and outdoor WC propulsion in manual WC
Total assistance for standing
SCI Levels C7-T1 Functional Outcomes
• Independent respiratory function • Assistance for bowel management • Mod I for BADL • Some assistance for standing • Mod I for bed mobility/transfer Independent driving with modifications
SCI Levels T2-T12 Functional Outcomes
• • Independent to modified independence for BADL
• Mod I for bowel/bladder management
• Mod I for bed mobility, transfer, standing
Independent WC mobility
SCI Levels L1-L5
• Independent in ADL and bed mobility
• Ambulate with assistive devices
• May use WC for distance, independent w/ loading/unloading from vehicle
Independent driving with hand controls
Pressure Ulcers Stage 1
• No open wound or tears in the skin • Skin reddens, but does not blanch • Warm to the touch • Surrounding area may feel either firmer or softer Client may report pain
Pressure Ulcers Stage 2
• Partial-thickness skin loss • Exposed dermis • Open wound that looks like a scrape, blister, or tear • Client reports pain and tenderness • Warm to the touch Localized edema
Pressure Ulcers Stage 3
• Full-thickness skin loss
• Open wound that looks like a crater
Wound extends into the fat layer but not the tendon, muscle, or bone
Pressure Ulcers Stage 4
• Full-thickness tissue and skin loss
• Open wound with visible muscle, tendon, or bone
Tunneling or undermining may both be present
Unstageable Pressure Ulcers
• Full-thickness skin and tissue loss
Wound is completely covered by eschar or slough
Changes Associated With Aging in the Musculoskeletal System
• Decrease in bone density
• Sarcopenia (loss of muscle mass/strength)
• Decline in skeletal flexibility/mobility
Joint degeneration
Changes Associated With Aging in the Nervous System
• Brain atrophy
• Decrease in nerve conduction velocity
• Reduced ability to maintain homeostasis
Decline in cognitive processing: memory, reaction time, processing speed, problem-solving
Changes Associated With Aging in the Cardiopulmonary System
• Thickening of the inner lining of the heart
• Decreased cardiac output
• Changes in the elastin of the arterial walls
Reduced lung volume
Changes Associated With Aging in the Integumentary System
• Reduced collagen and elastin
• Decreased melanin production
• Reduced tactile sensitivity
Changes to hair growth, color, and thickness
Changes Associated With Aging in the Genitourinary System
• Smaller bladder capacity • Bladder muscle weakness • Reduced sensation to void • Decline in urethral closure Changes in sexual organ functioning
Hypertrophic Scar
Type of scar formation caused by an overproduction of collagen and increased vascularity, characterized by:
• Initially appearing as raised, thick, erythematous, possibly in a circular or spiral pattern
Progressively becomes flatter and more pliable as the wound matures and collagen fibers relax
Superficial Burn (First-Degree)
Typically associated with: mild sunburn or short exposure to a heat source, chemical, or hot liquid
• Damage only to epidermis
• Dry, superficial redness, blister free
• Reports of mild to moderate discomfort
No risk of scar formation or contracture
Superficial Partial Thickness Burn
Typically associated with a severe sunburn or lengthy exposure to a heat source
• Damage to upper dermis and epidermis
• Blistering and redness
• Reports of significant discomfort
• Low risk of hypertrophic scar formation
Deep Partial Thickness Burn
Typically associated with direct contact or lengthy exposure to a heat source
• Complete destruction of epidermis and most of the dermis
• Redness and large blisters
High risk of hypertrophic scar or contractures
Full Thickness Burn
Typically associated with damage to nerve endings, dermis, and epidermis
• Pale in appearance
• Decreased tactile sensation
High risk of hypertrophic scar or contractures (may require surgery to promote wound healing)
Web Space Contracture
Loss of tissue elasticity between fingers or toes impacting function, commonly associated with soft tissue trauma such as a burn
Hallucination
Perceived sensory experiences (visual, auditory, tactile, gustatory, and somatic) without an actual stimulus, may be associated with psychosis, schizophrenia, or brain injury
Delusion
False and unfounded belief contrary to the reality of the situation or environment (may be a symptom of schizophrenia)
Perseveration
Thinking or talking about the same thing repeatedly without ability to independently redirect (may occur following brain injury or cognitive dysfunction)
Obsession
Persistent, unwanted, and intrusive thoughts that create feelings of urgency and anxiety (psychological state commonly seen in OCD)
Compulsion
Repetitive behaviors performed in response to obsessive thoughts used to minimize anxiety (psychological state commonly seen in OCD)
Splitting
Strain between therapist-client relationship and/or interprofessional team members where the staff response to manipulative behaviors of a client include: blurring professional boundaries or creating team division
Affective Instability
Emotional state commonly seen in borderline personality disorder, characterized by rapid mood swings usually between negative emotions such as anger, anxiety, depression
Self-mutilation
Maladaptive coping mechanism to express feelings, includes intentional act of self-injurious behavior of: burning, cutting, pricking, scratching
Restlessness
A neurobehavioral impairment that results in a decreased ability to remain still or relax
Irritability
A neurobehavioral impairment that results in feelings of agitation or annoyance
Emotional Lability
A neurobehavioral impairment characterized by a rapid change in mood that is often disproportionate to the circumstance or the expected emotion
Frustration
An emotional response that results in resistance to participate in an activity and provokes the desire to stop engagement in an activity
Confabulation
A memory impairment that causes an individual to share false details of situations, memories of past events, or personal information without the intention to deceive
Apathy
Lack of interest in purposeful activities or events in the environment (associated with impairment in prefrontal cortex)
Cognitive Flexibility
A component of executive functioning that involves the ability to think about various ideas simultaneously and switch between different ideas
Spasticity
Abnormal motor movement resulting from impairment in the CNS, characterized by hypertonia
Pitting Edema
Type of interstitial swelling in the extremities in which an indent appears after pressure is applied, typically graded from absent (0) to severe (3+)
Subluxation of the Shoulder
Musculoskeletal condition characterized by partial dislocation of the glenohumeral joint, typically caused by trauma or decreased muscle strength in the rotator cuff
Clonus
Reflexive abnormal motor movements in response to a tendon stretch, indicative of a cortical lesion, characterized by a series of involuntary rhythmic contraction and relaxation of the muscle
Rigidity
abnormal neurogenic movements resulting in reflexive posturing, inflexibility, muscular stiffness or jerky, irregular movements
Neuropraxia (1st degree)
Seddon’s classification of a nerve compression where there is a disruption of the myelin and spontaneous recovery is expected
Intervention may include: pain relief, orthotic positioning, A/AA/PROM exercises, activity modification, patient education
Axonotmesis (2nd degree)
Seddon’s classification of a nerve compression that recovers spontaneously, but is more severe compared to a neuropraxia, characteristics include:
• Axon and myelin sheath disruption
• Endoneurium remains intact
• Valerian regeneration occurs during healing
Intervention may include: pain relief, orthotic positioning, A/AA/PROM exercises, activity modification, patient education
Neurotmesis (3rd degree)
Seddon’s classification of a completely severed nerve where recovery will not occur without surgery
Intervention may include: pain relief, orthotic positioning, A/AA/PROM exercises, activity modification, patient education
Rigidity
Abnormal neurogenic movements resulting in reflexive posturing, inflexibility, muscular stiffness or jerky, irregular movements
Decorticate Rigidity
Characteristic abnormal reflexive posturing secondary to a severe brain injury, typically in patients with a score of three on the motor section of the Glasgow Coma scale, includes:
• Flexion of the elbows across the chest
• Adduction and flexion of the wrists
• Flexion of the fingers
• Extension and internal rotation of the legs
Plantar flexion of the feet
Decerebrate
Rigidity
Characteristic abnormal reflexive posturing secondary to a severe brain injury, typically in patients with a score of two on the motor section of the Glasgow coma scale, includes:
• Adduction and extension of the arms next to the body
• Pronation of the forearms
• Flexion of the wrists and fingers
• Extension and internal rotation of the legs
Plantar flexion of the feet
Cog-Wheel Rigidity
Motor dysfunction secondary to a lesion of the basal ganglia in which the muscles respond in a jerky motion when force is applied during flexion of a joint (common symptom of PD)
Clasp-Knife Rigidity
Reflexive abnormal motor response due to a cortical lesion in which a spastic muscle suddenly releases tension and gives way in response to passive stretch
Lead Pipe Rigidity
Motor dysfunction secondary to a lesion of the basal ganglia where during slow PROM, constant resistance is felt throughout (common symptom of PD)
