Exam 1 Flashcards

Question

Theory

Answer 1

Process of understanding a phenomena Define relationships between concepts Predict behavior Suggest ways a phenomena can change

Answer 2

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

Answer 3

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?

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

Focus on kinesiology Body as a machine Fix the body, fix the function All diagnosis Increase AROM and strength = return to work

Answer 9

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

Answer 10

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)

Answer 11

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

Answer 12

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)

Answer 13

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

Answer 14

Any kind of movement is good movement, even abnormal Sensorimotor based

Answer 15

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)

Answer 16

"muscle memory" Rehabilitation, sensorimotor

Answer 17

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

Answer 18

Teaching/learning Rehabilitative Motor learning

Answer 19

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

Answer 20

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

Answer 21

OTR COTA PT PTA SLE Activity therapist Recreational therapist Various physicians: MD, DO, DDS, DPM, OD, DC Social workers Pastors Nurse PA Medical supply DME Vocational counselors Orthotists/ prosthetists Rehabilitation councilors Teachers

Answer 22

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.

Answer 23

Supervision is required in every state AOTA says: "Supervision is collaborative... and ensures that clients receive the best possible care and services" Supervision should be determined by using factors such as supervisee's experience, practice setting, number of clients, complexity of client needs, and state requirements

Answer 24

Referral Screen Evaluation/Assessment Care plan/ treatment plan/ intervention plan/ goals/ IEP Daily notes/ treatment notes/ contact notes/ visit notes/ intervention notes Re-evaluations Discharge note Home program Other: - dr notes - discipline or team report - referral for other services - justification for programs or equipment

Answer 25

Evaluation is a process, assessment is a tool Aspects to assess: - past roles and performance (profile) - wants and needs (client centered) - setting - your abilities as a therapist We assess impairment to explain difficulty in performance We only assess areas we can impact

Answer 26

Also called treatment plan/ goal/ IEP From eval, identify problems that are appropriate for you to address - rank them with patient input - within our scope - important to the client - fit within your setting, experience, and time you will have

Answer 27

Collaborate Contribute Implementation

Answer 28

Everything you do must have been addressed on the eval and care plan

Answer 29

Administration

Answer 30

When you first see the patient

Answer 31

If care plan is done well If pt is noncompliant It pt transfers to another facility If pt needs another service or specialty Therapy becomes contraindicated Lack of progress Pt dies

Answer 32

Government regulations - state and federal Reimbursement rules Workplace pressure of critical pathways and clinical protocols - dependent on environment (hand surgeon in area = lots of hand pts) Customary and reasonable services offered Traditions and customs of staff and facility Physical aspect of the building or facility Staff experience and training

Answer 33

Acute care hospital Acute rehab Subacute rehab Skilled nursing Home care Assisted living Community based Outpatient Da y treatment Worksite Telemedicine

Answer 34

1-2 days out Acute injuries, exacerbation of conditions Typically seen daily Pt typically seen - amputees - heart attack - TBI, spinal cord - orthopedics (hip replacement or fx) Special conditions - weird exacerbations (sickle cell, diabetes, Ms., cancer) - PPE - team - vital status - IV, catheter, intubation - bedside therapy Goals will probably be basic. May only have long term goals.

Answer 35

Inpatient 1-3 weeks out Neurological, orthopedic, cardiac, general deconditioning, other disorders Typically seen daily for 3-4 hours What would you do? - ADLs - transfers - endurance for ambulation, eating, laundry, etc. - feeding - driving retraining - cooking/food prep - wheelchair skills Special considerations - preparing them for home, not hospital - induviduality Goal is not to get them independent in rehab, but independent in the home setting

Answer 36

Also called Step Down or Transition Unit Inpatient - often in the same building as a nursing home or hospital Neuro, ortho, cardiac, general medicine Weeks to months from onset Typically seen daily Basically the same as acute, but at a much slower rate with shorter therapy sessions Some come from the nursing home Typically not expected to be independent. Usually go home with a family member or spouse.

Answer 37

Inpatient Typically months to years - may go here before acute rehab Neuro, orthopedic, cardiac, general medical Typically seen daily, weekly, monthly, or consult They have to have something medically going on which would require a skilled nursing service. Must have a physical separation between Medicare A and B. Long term, assisted living, and independent living are not medical.

Answer 38

Hospital care Skilled nursing facility care Short-term nursing home care Home health Hospice

Answer 39

"Welcome to Medicare" exam prevention visit Annual wellness visits every 12 months Lab tests Medical equipment Orthotics and prosthetics Mental healthcare Ambulance services

Answer 40

Old rule: must be home bound New rule: unable to leave the home on a frequent basis without difficulty Patient is considered homebound if trips: - are infrequent - are short in duration - require a taxing effort Patient requires intermittent: - skilled nursing, includes psych - PT - SLP - OT Neuro, cardio, orthopedic, deconditioning Typically seen 1-7x a week for 60 days Typically must come out of hospital Working on ADLs, IADLs, transfers, mobility, etc. Can be done any place.

Answer 41

Just like the patient home - out of picket - insurance may pay Typically, consultation or as needed after new diagnosis or exacerbation Places have different standards; this establish the goals - they must be able to get themselves to the diner without assistance - they must be appropriate and not need extensive medical care Cost and care vary greatly

Answer 42

Clients may be days to months from injury or exacerbation They come to you Typically more specializations - pediatrics - hand - industrial rehab - lymphedema Can't trap client More involvement from client Typically seen 1-5x per week May have contracts Referral source becomes a bigger issue

Answer 43

Relatively new Typically larger companies Able to stay in the "work mode" and on site Requires the opportunity to work with the employer to ease a client back in Focus on restoring abilities or may have a wellness aspect

Answer 44

Client may be seen months to years Generally neurological, behavioral, autism, down syndrome Drug, alcohol Eating disorders Restore and develop skills

Answer 45

Remedial – teaching/learning something new Goal might be adaptive but teaching it will use remedial techniques.

Answer 46

Have the client complete an interest inventory

Answer 47

Screen the client to see if they are a candidate for OT

Answer 48

Obtaining information and interpreting data needed for intervention Not a one time thing Goes throughout the entire treatment process Before - referral, discussion with physician, medical records After - follow up, patient survey

Answer 49

Refers to a specific tool - MMT, ROM May be standardized Used during evaluation process

Answer 50

Assessments Collaboration Make suggestions depending on competence of COTA CANNOT make treatment plan or interpret information from patient

Answer 51

Effectiveness of therapist Scientific foundation for treatment - everything has to circle back to evaluation and care plan - if it isn't in the evaluation, you can't treat it Communication between medical professionals Improve OT profession

Answer 52

Medical records - orders - restrictions - referral source Patient/ family interview - structured or semistructured (COPM) Observation - aware or formal - unaware or informal - both are valid and documental Assessments - standardized - nonstandardized * reliable * valid * adheres to industry norms * there are deviates from the protocols which is why they are not standardized

Answer 53

Reliability - consistency or the test, retest Validity - tests what it intends to test

Answer 54

1. Evaluation is an ongoing process from referral to discharge and beyond - role of COTA 2. The views and priorities of the client should always be the center 3. Evaluation should (and in some cases legally must) be ecologically and culturally valid 4. Outcomes of the evaluation should yield an in-depth understanding of the client's participation in occupation

Answer 55

"has uniform procedures for administration and scoring" - published Good clean numbers but we should also use - skilled observation, gets better with experience - interviews - chart reviews Types - normed referenced: compared to like peers * have to figure age - criterion reference: measure actual performance on a task * performance based * self report based * pass or fail Most standard assessments have been assessed on normal populations.

Answer 56

Uniform procedure Test manual Technical information Information on administration, scoring, and interpretation Fixed number of items Fixed protocols for administration

Answer 57

Assist with medical and education diagnosis Document developmental of functional status - baseline Planning of intervention Research Eligibility for programs

Answer 58

Take the place of observation or clinical reasoning skills Be the sole independent measure of anything

Answer 59

Therapists must understand the stats of the assessment in order to: - choose the correct one - interpret the results - explain to parents/caregivers

Answer 60

Norm referenced - descriptive statistics - based on bell curve Measure of central tendency - middle point of a distribution - mean: average - median: middle score of distribution - mode: number that occurs the most

Answer 61

the squared deviations of the scores from the mean - will always be positive

Answer 62

Squared root of the variance (+ or -) Important in figuring many standard scores Shows what is an acceptable degree of variance from the average score

Answer 63

68% within 1 SD 95% within 2 SD 99.7% within 3 SD

Answer 64

used to compare to the standard, several ways to do this Z score T score Intelligence quotients Developmental index scores Percentile score Age equivalency score

Answer 65

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

Answer 66

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

Answer 67

Developed from many tests (developmental index scores are the same) The mean is 100 with a standard deviation of 15 or 16 (depending on the test) Always positive 2 SD is the standard for: Below 68-70 IQ= intellectual disability Above 130-132-gifted

Answer 68

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

Answer 69

The score is the age at which the raw score is at the 50%. So, if the scores ranged 1-10 and 50% of the class of 1st graders got 7, then 7 would be the age equivalent for a 1st grader.

Answer 70

Tells you the strength of the relationship Range from -1.00 to 1.00 0.0=no relationship Negative relationship: opposition - Coefficient -0.75 for the relationship between aspirin and headaches - This tells you people who had a headache and took aspirin felt better. - The more you do it, the less you get the response Positive relationship: same - The more you do it, the more you get the response

Answer 71

Test-retest-not too close and not too far as to allow for development Interrater – I give it to them, then Madi gives it to them, and we get about the same score Intrarater – one person performing the same test

Answer 72

How the assessment measures a theoretical construct, looks for differences in groups - Groups method-test kids with Downs’ and “normal” kids, what is the difference in their scores - Factor analysis-statistics to determine a relationship between items - Repeated Administration- repeat the test before and after an appropriate intervention to see if it goes up

Answer 73

Do the items on the test represent what is being assessed? Expert agreement Pilot – getting feedback from small group on things such as questionnaire (did you understand what I was asking, why did you select your answer) - A small-scale test of the methods and procedures to be used on a larger scale

Answer 74

Based on correlation coefficient - Usually run from .4-.8, above .7 indicates predictability Concurrent-two tests or assessments - At home pregnancy test and doctor performing pregnancy test - ACT and SAT – tend to score in same percentile Predictive –the test now and a performance measure in the future - Lung capacity – if you score in 70th percentile, you can predict they won’t be able to walk 50 feet without sitting down

Answer 75

Choose an appropriate test (role of COTA) - Condition - Setting - Age - Performance area affected Check the stats Learn the test - Study the test - Observe others and discuss - Practice - Check interrater with an experienced tester - Prepare-cue sheets etc. - Prepare testing site - Compare and discuss results with experienced tester - Recheck periodically against and experienced tester Select good environment Administer the test (role of COTA) Figure the results and USE them - What if the result are contradictory or not enough - The results should link to your goals! Is the test clinically useful - To assess or not to assess, that is the question

Answer 76

Are you competent? Client privacy - Just because physician ordered it, doesn’t mean they get the results Communication of results - Not a secret - Not the time to impress Cultural bias Many tests require certification to perform the test

Answer 77

Does this lead to a recommendation that relates to occupational performance Is this relevant to everyday life - How do the goals relate to the real world

Answer 78

Happening in natural environment ADL assessment in someone’s home

Answer 79

Ask questions, get a check mark Do not replace observation of occupational performance and should not be used alone

Answer 80

Psych settings, some peds and nursing home Often used with abuse

Answer 81

Pretty numbers Speak the same language Understanding of statistics Easy to pass on to another professional Great way to monitor development-controlled Good way to monitor the success of a program

Answer 82

Expensive Rigid – don’t allow deletions and add ons Can NOT stand alone Brief “snapshot” - Bad day, cold, scared Bias

Answer 83

Used in a lot of developmental assessments 1 or 9 – outside of 2 SD 2-8 within 2 SD

Answer 84

The start of OT Says occupation provides meaning; organization; physical, mental, and psychosocial health; building relationships