Eval & Intervention for SCI

Question 1

SCI treatment for sensory loss

Answer 1

1. Implication for OT: increased risk of skin breakdown (pressure sores/decubitus ulcer
2. Treatment: Client/caregiver education (skin examination and techniques to provide pressure relief (weight-shift/AE)

Question 2

SCI treatment for decreased VC

Answer 2

1. Implication for OT: difficulty breathing
2. Treatment: OT supports breathing goals during treatment which can also be addressed by other healthcare teammembers (Dr., PT, respiratory therapist)

Question 3

SCI treatment for HTN

Answer 3

1. BP drops rapidly d/t standing up too quickly from sitting
2. Position client in supine with feet elevated about heart, then check BP

Question 4

SCI treatment for Spasticity

Answer 4

1. limits ROM and leads to contractures
2. Bed/W/C positioning

Question 5

SCI treatment for Heterotropic ossification

Answer 5

1. proper positniong in bed/W/C
2. maintenance of joint ROM
3. monitoring ROM regularly to identify aras with heterotropic ossification

Question 6

SCI treatment for DVT

Answer 6

1. blood clot formation (often in LE/abdominal area/pelvic area
2. Visual skin checks (are LE asymetric?; check color, size, or temp)

Question 7

SCI treatment for B&B

Answer 7

1. injuries at or above the S2-S5 level
2. estabilish new routines/habits for elimintion to minimize infection and decrease autonomic reflexia
3. Nurses estabilish B&B routine with guidance from dr.
4. OT supports NEW SKILL and HABIT ACQUISTION for transfers, clothing managment, safety with task performance, management of catherization.

Question 8

SCI treatment for temperature regulation & pain/nociceptive pain

Answer 8

1. make client aware of skin exposure to sun/severe temp

Question 9

SCI treatment for fatigue

Answer 9

address physiological, psychological, and environemtnal factors; sleep disturbances, med. side effects, use optimal awake hours for therapy

Question 10

Evaluation for SCI

Answer 10

1. precautions
2. physical (UE, ROM, strength, MMT, sensation, trunk balance)
3. MMT used to determin MAX contractions of m./m. groups
4. observation of endurance, fatigue, pain
5. hand/wrist function for tetraplegia (standarized hand function tests); FM strength
6. Standard/non-standard assessments

Question 11

The Spinal Cord Independence Measure

Answer 11

Assessment completed by the health care team and includes:
1. ADL performances
2. sphincter control
3. respiration
4. mobility

Question 12

The Quadriplegia Index of Function

Answer 12

1. an assessment sepcific for clients with tetraplegia or non-ambuatory individuals with cervical SCI
2. observer/free/pencil pen/max score of 100
3. developed d/t Barthel Index was found to be insensitive to small functional gains made
4. transfers, ADL, feeding, B&B program, w/c, bed mobility, education personal care

Assessment for SCI

Question 13

FIM

Answer 13

a widely used measure to assess severity of disability and client function, but is not specific to SCI

Assessment for SCI

Question 14

COPM

Answer 14

an assessment that measures changes in clients’ SELF-PERCEPTION of their occupational performance over time but is not specific to SCI

Assessment for SCI

Question 15

An OTR® evaluates a client who has sustained a traumatic brain injury and uses the Glasgow Coma Scale (GCS) to record the client’s conscious state using the combined score. Which of the following three responses is recorded with the GCS?

A] Verbal, threat, autonomic
B] Appropriate, motor, autonomic
C] Eye opening, motor, verbal
D] Eye opening, verbal, autonomic

Answer 15

Solution: The correct answer is C.

The GCS is an evaluative and reassessment tool that uses eye opening, verbal, and motor responses to track the level of consciousness of clients with head injuries.

A, B, D: Autonomic and threat responses are more closely linked to the central nervous system. Appropriate responses would describe a broader scale, and the term is not associated with the Glasgow Coma Scale.

Tipton-Burton, M., McL

Question 16

An OTR® is working with a client who has had a cerebrovascular accident (CVA). One of the client’s goals is independence in baking activities. Which modality intervention is BEST used to decrease shoulder subluxation of the nonpainful hemiparetic arm during this task?

Ultrasound
Fluidotherapy
Neuromuscular electrical stimulation (NMES)
Conventional transcutaneous nerve stimulation (TENS)

Answer 16

Solution: The correct answer is C.

NMES can be used during an activity to decrease shoulder subluxation post CVA.

A, B: Ultrasound and fluidotherapy cannot be used during an activity and do not increase functional control of muscles.

D: TENS can be used during an activity but is typically used for pain and edema control.

Question 17

An OTR® is preparing a client with T1 spinal cord injury for discharge to home alone. What is the BEST recommendation for required home assistance?

Homemaking assistance for a few hours a day
Attendant care for 24 hours a day
Attendant care for 12 hours a day

Answer 17

Solution: The correct answer is A.

A client with low-level (T1) SCI should be independent in personal care and only require a few hours of homemaking assistance each day upon discharge.

B: Attendant care for 24 hours a day may be indicated for clients with higher level SCI injury (C1–C4).

C: Attendant care for 12 hours a day may be indicated for clients with C5–C6 SCI injury.

Question 18

An OTR® receives an order to evaluate and treat a client with a traumatic brain injury. What test is MOST APPROPRIATE to determine the client’s level of consciousness?

Canadian Occupational Performance Measure (COPM)
Mini-Mental State Examination (MMSE)
Minnesota Multiphasic Personality Inventory (MMPI)
Glasgow Coma Scale (GCS)

Answer 18

Solution: The correct answer is D.

The GCS is the traditional method used by health care professionals to assess levels of consciousness after traumatic brain injury.

A: The COPM is used to detect changes in a client’s self-perception of occupational performance over time.

B: The MMSE is a screening tool used to detect cognitive impairment.

C: The MMPI assesses personality traits and psychopathology.

Question 19

What would be considered the first line of treatment in the acute setting for the medical management of a cerebrovascular accident (CVA) in which a clot or plaque is blocking the vessel?

Anticoagulants
Thrombolytic agents
Antiplatelet treatments
Nonsteroidal anti-inflammatory drugs

Answer 19

Solution: The correct answer is B.

Thrombolytic agents are the first line of treatment in the acute management of CVA to dissolve the clot that is blocking the flow of blood through its vessel.

A: Anticoagulants are second in the line of treatment to prevent new clots from forming.

C: Antiplatelet treatments work in the same manner as anticoagulants to prevent clots from forming and are also considered a second line of defense.

D: Nonsteroidal anti-inflammatory drugs are often contraindicated for patients with CVA.

Question 20

An inpatient had a traumatic brain injury several days ago. The OTR® is completing an initial mobility screening with the patient. When assisting the patient to move from supine to sit, the patient’s body moves into an extensor thrust pattern. This interferes with the patient’s ability to move independently to upright sitting. Which primitive motor response is inhibiting this bed mobility skill?

Associated reaction
Asymmetrical tonic neck reflex
Optical righting reflex
Tonic labyrinthine reflex

Answer 20

Solution: The correct answer is D.

Tonic labyrinthine reflex is a response that results in extensor tone while in supine.

A: Associated reactions occur when a motion in one extremity is copied in the opposite extremity.

B: Asymmetrical tonic neck reflex occurs when the head is turned to one side and the arm on the skull side flexes while the arm on the face side extends.

C: Optical righting reflex occurs when the head is unable to align with a horizontal object from a starting position of lateral head flexion.

Question 21

Which assessment tool for motor and sensory function would BEST be used with the population with spinal cord injury in determining baseline performance?

American Spinal Injury Association (ASIA) Scale
Canadian Occupational Performance Measure (COPM)
Modified Ashworth Scale (MAS)
Manual muscle testing

Answer 21

Solution: The correct answer is A.

The ASIA Scale is used to determine baseline sensory and motor control performance for clients with spinal cord injury.

B: The COPM provides information about the client’s perceived satisfaction with performance of daily occupations.

C: The MAS assesses muscle tone and would not provide information about sensory function.

D: Manual muscle testing is used to grade muscle strength and would not provide information about sensory function.

Question 22

A client who recently experienced a CVA is consulting with an OTR® for a work readiness program. During the initial interview, the client states, “Why should I go back to work?” Which assessment is appropriate for further assessing the client’s concerns?

Worker Role Interview
Work Environment Impact Scale
Functional capacity evaluation
Work Values Inventory

Answer 22

Solution: The correct answer is D.

The Work Values Inventory can help both the client and the OTR® understand the value the client places on work, which is important in identifying the client’s motivation to participate in the rehabilitation process.

A: The Worker Role Interview provides information to facilitate the client’s return to the workplace.

B, C: These physical capacity assessments do not address the client’s concerns.

Question 23

For a client with an L2 spinal cord injury, which statement BEST describes the muscle segments below the injury level 1 to 2 months postinjury?

Senses are elevated.
Muscles are spastic.
Sympathetic functions are hypoactive.
Muscles are flaccid.

Answer 23

Solution: The correct answer is B.

Because the monosynaptic reflex arc is intact but separated from higher inhibitory influences, muscles below the level of injury generally develop spasticity.

A: Sensory loss below the level of injury is common.

C: Sympathetic functions below the level of injury are hyperactive.

D: Although muscles may be initially flaccid for a short period of spinal shock, spasticity regularly develops below the injury.

Question 24

An OTR® receives evaluation orders for a client who has recently experienced a traumatic brain injury. The client only opens the eyes when the OTR applies a mild pinch to the client’s arm. What score should the OTR give the client on the Glasgow Coma Scale (eye-opening response category)?

7
3
2
4

Answer 24

Solution: The correct answer is C.

The OTR would give the client a 2 for the eye-opening response category.

A: The Glasgow Coma Scale has no score of 7 in the eye-opening response category or in any of the GCS’s other tests.

B: If the client opened the eyes in response to a verbal command or speech, the score would be 3.

D: If the client opened the eyes on their own, the score would be 4.

Question 25

Inpatient Rehabilitation Facility–Patient Assessment Instrument (IRF–PAI)

Answer 25

The IRF–PAI is used to assess ADLs and incorporates Medicare Section GG items for functional abilities and goals.