Exam 1 Flashcards
Learn vs. relearn
Children learn, adults relearn
What are the steps to the OT process?
Evaluation
Intervention
Reevaluation
Outcome
Evaluation
- Coincides with referral (prescription, order, recommendation); you may accept or deny a referral based on your work setting and area of expertise
- OT Profile: contains client’s interests, roles, goals, support system, habits, environment, client factors
- Analysis of occupational performance
- bottom up: performance skills first, occupation last
- top down: occupation first, performance skills last
- Identify targeting outcomes: based on what the pt did and wants, evaluation results (gives starting point), EBP (from experience, facility, and research)
Intervention
Planning: based on what was found in eval; if it’s not in the eval, you can’t treat it
- made up of long term (objectives) and short term (benchmarks) goals
1. LTG (end goal, can stand alone)
a. STG (can never stand alone)
* Activity
Implementation: activities that help reach long term goals
Reevaluation
Constant
Formal or informal
Potential outcomes:
- continue OT as planned
- review current intervention
- review current targeting outcomes
- discontinue OT services
* referral
Activity/occupational analysis
It is the cornerstone of all we do.
Identify the properties of the given occupation or activity.
- specific to task, client, and client’s environment
Break it down into small steps
- we can get goals or benchmarks from this
Determine what materials, equipment, adaptations, time, and space are needed.
How is the activity/occupation therapeutic?
Can it be graded or adapted?
Helps us document and find “just the right fit”
Analysis process: Vacuum
Object used: kirby vacuum with 25 ft cord, stored on the 1st floor
Environmental demands: shag carpet, 20ft hall, carpeted 2nd flood
Social demands: done alone, important role for client
Contextual demands: client takes pride in a clean home, loves her current vacuum
Sequencing and timing: can be done in 1 therapy session, not many other options to vacuuming, no time requirement
Required actions:
- retrieve vacuum
- unwind cord
- plug in
- turn on
- push back and forth
Grading tasks
Strength:
- resistance
- gravity
- weights
- orthotics
Range of motion
- positioning of an item
- PROM
- orthotics
- adapting the item
Endurance/tolerance:
- standing vs. siting
- time
- repitition
Coordination:
- big to small
- slow to fast
Perceptual/cognitive/social:
- one step, two step
- set up vs. full retrieval
- prompts
Preparatory tasks
Theraband or weight lifting to increase strength
Often called:
- therapeutic exercise
- therapeutic activity
Preparatory methods
PROM to wam a patient up
Hot pack
Something you do to a patient
Occupation as the means
The occupation is the change agent, intervention, and therapy
Occupation as the ends
use theraputty to increase strength so they can open jars
Purpose of therapeutic exercise and activity in OT
Develop or restore normal movement patterns and improve voluntary or automatic responses
Develop or restore strength and endurance to allow for functional tasks
Develop, improve, or restore coordination
Increase muscle power
Remediate ROM deficits
Increase work or task tolerance
Prevent or eliminate contracture or deformity
Therapeutic use of self
Planned use of one’s personality, insights, perceptions, and judgements as part of the therapeutic process
- your knowledge (evidence based)
- your experiences (be professional)
- your physical body
- your support
Evidence based intervention
Interventions based on clinical expertise, patient values, and the best, most recent research.
EBP ensures that treatments are effective.
OT toolbox
Occupation and activities
- occupation as the ends or means
- basis of what we do
- activity analysis
Preparatory methods and tasks
- things that make function more likely
- modalities, orthotics, equipment, modifications to environment
- prepares you for intervention that will have a functional outcome
Education and training
- training: telling them exactly what to do; education: telling them how to implement it into their daily life
- teach, reteach
- new skills, new ways
Advocacy
- defending why they need services
- establishment of new programs
- pt getting equipment
Group intervention
Clinical reasoning
How we informally decide what the client needs, interventions, and services will be
It grows with experience, EBP, and education
5 types of critical reasoning that can lead to good clinical reasoning
Procedural
Interactive
Conditional
Narrative
Pragmatic
Procedural reasoning
Based on what needs to happen next
Rules, policy, protocol
Closely related to client factors and body functions
- diagnosis, prognosis
What typically happens
- gives birth to critical pathways, clinical tracts, protocols
Interactive reasoning
Forus is on what makes the patient tick
Therapeutic use of self is big
Not everyone tracts the same
- what motivates this client?
- how do you communicate with them?
Conditional reasoning
The “what if” game
Constant reassessment of function
Context is huge
“Ok, you can bathe in the rehab bathtub, but what if you go to Disney or home?”
Narrative reasoning
Storytelling
Lets the patient tell their story
Therapist uses therapeutic use of self to connect and look for themes
Used more in psych, with noncompliant patients, and children with autism
Pragmatic reasoning
Realistic/sensible
Considering community supports, environment, and therapist skill level
Client centered practice
First person language/preferred name
Choices
- this includes understanding the evidence
* “ultrasound goes deeper but moist heat feels better”
Interventions that are flexible and accessible to the client
- variety and ease
Intervention that is contextually relevant to the client
- rehab bathrooms and kitchens
- opportunity for grading but no substituting
Respect
Theory
Process of understanding a phenomena
Define relationships between concepts
Predict behavior
Suggest ways a phenomena can change
Model of practice
The first step is putting the theory to practice
They are slow to develop and change
May involve specific assessments or types of assessments
Common MOPs
- MOHO
- Ecology of human performance
- PEO
-OA
MOHO Model
Volitional subsystem - client’s values, interests, and feelings
- “I want to… I need to…”
Habituation subsystem: client’s habits and roles
- How they see themselves
- “I am a…”
Performance capacity
- what did they do in the past?
- what are their expectations?
- what is their capacity to perform?
Ecology of Human Performance Model
Not OT specific
When the environment or context matches a person’s ability they can engage in tasks
Looks at human performance based on past experiences, skills, health, culture, and context
Create the equality between ability and environment/context by:
- Establish/restore
* rehab
* learn/relearn
- Alter environment
* wheelchair ramp
- Adapt or modify a task
* wheelchair basketball for basketball player
- Prevent
* orthotics, education, activity
- Create new opportunities
* wheelchair basketball for a kid with CP who can walk
PEO Model
Equal emphasis placed on the
- person: client centered
- environment: attention to the physical, social, and cultural impact
- occupation: self-care, productive, leisure
* activities as part of occupations leading to occupations
* button board = activity of dressing
Occupational Adaptation Model
Focus on the occupation and the individuals ability to internally adapt to meet the occupational challenges within their environment
- focus is on self chosen activities
Used with autism
Frame of reference
Help us to apply clinical reasoning to develop an organized and appropriate intervention
Not a protocol, but they do provide structure
It is appropriate to blend several.
- biomehcanical and sensorimotor: yes
- biomechanical and rehabilitation: no
New ones pop up more commonly or new protocols under old FORs
Common FORs:
- biomehcanical
- rehabilitation
- sensorimotor
- behavioral
Biomechanical FOR
Focus on kinesiology
Body as a machine
Fix the body, fix the function
All diagnosis
Increase AROM and strength = return to work
Rehabilitation FOR
Focus on helping patient reach fullest potential
Adaptation, compensation
All diagnosis
Provide an accommodation to return to work
- build up a handle
- let pt sit
Sensorimotor FOR
Focus is improving the way the brain interprets incoming sensory information to produce an output (usually motor)
Upper/lower motor neuron damage
CNS issues only (CP, CVA, sensory processing)
Behavioral FOR
Psychological
Social
emphasizes the use of behavioral modification to shape behaviors, which supports to increase the tendency of adaptive behaviors or to decrease the probability of maladaptive learned behaviors
uses elements such as stimuli (unconditioned, conditioned), reinforcement, extinction, backward chaining, systematic desensitization, and token economy as forms of intervention to achieve target behaviors that improve performance
Task oriented approach
Combination of biomechanical and rehabilitative
practicing real-life tasks (such as walking or answering a telephone), with the intention of acquiring or reacquiring a skill (defined by consistency, flexibility. and efficiency)
Neurodevelopmental techniques (NDT)
Bobath
If input is abnormal, output will be abnormal
Sensorimotor based
DOES NOT work with rehabilitative
used to analyze and treat posture and movement impairments based on kinesiology and biomechanics
movement, alignment, range of motion, base of support, muscle strength, postural control, weight shifts, and mobility
Brunnstrom
Any kind of movement is good movement, even abnormal
Sensorimotor based
Rood or PNF FOR
Proprioceptive neurofacilitation techniques
Diagonal (D1, D2)
Sensorimotor
Facilitation and inhibition techniques
Facilitation: quick icing, quick tendon reflex (bouncing, tapping, vibration), quick and unpredictable vestibular input
Inhibition: heat, deep constant pressure, slow and consistent vestibular input (rocking)
Motor learning FOR
“muscle memory”
Rehabilitation, sensorimotor
Cognitive FOR
Used on kids over 5 with no significant cognitive decline
Uses cognition to compensate for physical/emotional issues
emphasizes five aspects of life experience: thoughts, behaviors, emotion/mood, physiological responses, and the environment
Remedial approaches FOR
Teaching/learning
Rehabilitative
Motor learning
Adaptive/compensatory approaches
Rehabilitative
MOHO and PEO
emphasizes the use of teaching-learning process and activity analysis to achieve the goal which is the acquisition of specific skills or appropriate behaviors required for optimal performance within an environment. It also emphasizes the context of the environment, functional behaviors, and learned skills
Development FOR
Milestones
Age appropriate
suggests that development is sequential, and behaviors are primarily influenced by the extent to which an individual has mastered and integrated the previous stages
OTR vs. COTA
COTAs follow OTR’s treatment plan.
COTAs carry out interventions in line with the OTR’s patient goals.
COTAs do not complete the evaluation/discharge paperwork.
COTAs write daily notes which entail what they worked on with the patient and everything that went on in the treatment session.
COTA should be part of every aspect of therapy, but OTR has the lead in each step.
Standard deviation in a normal distribution
68% within 1 SD
95% within 2 SD
99.7% within 3 SD
Z score
To find it, subtract the mean for the test from the clients score and divide by the SD
The Z score can run + or -
Negative means the score is below the mean, positive means it is above the mean
A Z score of less than -1.5 usually means a deficit
The Z score follows the standard deviation (+ or -)
Follows normal distribution
T score
T-score comes from the z-score-the mean is 50 (so it is always positive) and is in standard deviations of 10
A T score below 50 is below the mean, above 50 is above the mean
Think TEST scores
Percentile score
Score 0-100%
Percentage based on the sample whose score is at or below the particular score
75% means that 75% of the people in the study scored at or below the level of the individual
Not equal in size across the distribution
Much easier to increase from 2-5th percentile
Much harder to go from 90-92%
Fewer numbers on the end
Stanine
Used in a lot of developmental assessments
1 or 9 – outside of 2 SD
2-8 within 2 SD
