FINAL EXAM Study Guide Flashcards
occupation vs. activity vs. task
Occupation = activity that gives meaning and identity; ie: mother
Activity = thing done as part of an occupation; ie: cooking (as a mother)
Task = basic unit of an action/activity; ie: mixing batter (part of cooking)
contrived activities
Made-up activities that my include some of the same skills required for an occupation. Simulates actual activity, helps get client ready. Ex: using doll to practice before tying own shoes.
preparatory activities
activities which help the client ready for the purposeful activity; ROM, exercise, strengthening/stretching, etc.
purposeful activity
activity meaningful to client and used during intervention that is goal-directed and typically involves an end product (ie: making a sandwich as part of making lunch).
occupational performance
ability to carry out ADLs and one’s occupations that result from interaction among client, context, and activity.
function
action for which a person is fit; the ability to perform.
Laddering (what and when?)
Laddering= Advancing career based on experience rather than returning to classroom.
1971-AOTA adopted resolution for COTAs to advance (to OTR) this way (Career Mobility Program).
1973-First group endorsed to take exam in 1974.
1982-Laddering stopped.
Important events of OTA history:
- *1958: First 3-month educ prog. (for OTAs in mental health)
1958: Mildred Schwagmeyer joins AOTA; most knowledgeable on OTA
1967: AOTA holds first COTA meeting at conference - *1977: First COTA certification exam
1991: COTAs participate on AOTA exec board
Women behind the field of OTA
- Ruth A. Robinson - president of AOTA 1955-89; on Committee on OTA from inception; developed training curriculum for OTAs
- Marion W. Crampton - Chair of Mass. OTA education program
- Mildred Schwagmeyer - Asst. Director of Educ at AOTA; then dir. of technical ed.; Most knowledgable on subject of OTAs
- Ruth Brunyate Wiemer - Pres of AOTA, guided thru reorg period (OTRs feared unknown and new OTAs)
Benjamin Rush
US Quaker, first physician to institute moral treatment practices after Tuke and Pinel’s work.
Herbert Hall
Considered a founder of OT as profession. “WORK CURE”
Harvard Med School physician who adapted arts and crafts movement for medical purposes/treatment. Worked with invalid patients providing supervised crafts to improve health/financial independence. Occupation as therapy for people with nervous/mental disorders called “WORK CURE.” Early president of Natl. Society for Promotion of OT (1920-23).
Thomas Kidner
TB treatment and vocational rehab.
Friend of George Barton; fellow architect/teacher. Established presence of OT in vocational rehab and TB treatment. Developed system of vocational rehab for disabled Canadian vets of WWI. Constructed institutions for disabled. Designed hospitals in CA and US for treatment of TB.
Gary Kielhofner
Developed Model of Human Occupation (MOHO) as grad student at USC. Published 19 textbooks and 150 journal articles; developed model that would allow OTs at all levels to better address important client issues. Provided profession with evidence to support occupation-based practice and tools to evaluate clients. Remained visionary and scholar; promoted field of OT.
List the Founders of the Profession of OT:
- Herbert Hall
- George Edward Barton
- Dr. William Rush Dunton Jr.
- Eleanor Clarke Slagle
- Susan Tracy
- Susan Cox Johnson
- Thomas Kidner
Eleanor Clarke Slagle
MOTHER OF OT. “HABIT TRAINING”
Student of social work; studied curative occupations; 1912, asked by Adolf Meyer to direct OT dept at Henry Phipps Psychiatric Clinic in MD. There, developed “HABIT TRAINING.” Later in Chicago, started workshop for chronically unemployed and first professional school for OTs, Henry B. Favill School of Occupations. Her home was first hq of NSPOT. Served each office there, and AOTA now has an award named after her.
John Ruskin and William Morris
Led Arts and Crafts Movement; opposed machine production; using hands leads to health; high standard of craftsmanship
George Edward Barton
Architect under Morris. Boston Society of Arts and Crafts. Disabled himself. Consolation House.
Architect in London who studied under William Morris (arts and crafts movement). Went to Boston and founded Boston Society of Arts and Crafts. After personal experience with disabling conditions, he wanted to improve plight of convalescents. Opened Consolation House in 1914, using occupation (arts/crafts) for treatment.
Adolf Meyer
POV became philosophical base of OT.
Swiss physician, came to US in 1892; became prof of psychiatry at Johns Hopkins Univ. Point of view became the philosophical base of OT. (Holistic, psycho-biological approach, meaningful activity promoting health)
Susan Cox Johnson
Designer and arts/crafts teacher from Berkeley. Became director of occupations at Montefiore Home in NY; there showed occupations as uplifting, improving mental/physical health. Later taught at Columbia.
Susan Tracy
First book on OT.
Nursing instructor involved with arts/crafts mvmt and use of occupations. Hired in 1905 at Adams Nervine Asylum in Mass., where she developed occupations program. Wrote first book on OT: “Studies in Invalid Occupations.”
William Rush Dunton Jr.
Father of OT.
Psychiatrist. In 1891, became physician at Sheppard Asylum in MD; incorporated arts/crafts treatment in early 1910s. Known for his writings on OT and was president of NSPOT for 21 years.
Philippe Pinel and William Tuke
Credited for Moral Treatment movement;
All ppl entitled to compassion; using purposeful activity.
Pinel=french physician
Tuke=english Quaker/merchant
metaphysics
Concerned with nature of humankind and addresses how humans engage, organize their lives, and find meaning and interact with others. OT practitioners are committed to holistic and humanistic practice.
epistemology
Related to the nature, origin, and limits of human knowledge and investigates such questions as “How do we know things?” and “How do we know that we know?” Provides base for understanding motivation, change and learning.
axiology
Concerned with the study of values. This area explores questions of desirability and questions of ethics, such as “What are the standards and rules of right conduct?” For OTs, this includes client-centered care, quality of life, and ethics.
reductionistic approach
US healthcare system generally operates this way; humankind reduced to separately functioning body parts. Professionals specialize and treat specific areas independently.
holistic approach
Perspective traced to Adolf Meyer’s philosophy of OT. Emphasizes organic and functional relationship between parts and the whole being. Interaction of biological, psychological, sociocultural, and spiritual elements. If one element is disrupted, it reflects throughout the whole.
Humanism
The belief that the client should be treated as a person, not an object. Basis of OT. Goes further into concepts of altruism, equality, freedom, justice, dignity, truth and prudence (core values of OT).
Core values and attitudes of OT:
Altruism, equality, freedom, justice, dignity, truth, and prudence.
Emerging areas of practice
- Aging in place
- Driver assessments/training programs
- Community health and wellness
- Needs of children and youth
- Ergonomics consulting
- Tech and assistive-device developing and consulting
- Health and wellness
- Vision
CarFit Volunteer Positions
Technician: Assess drivers’ fit and educate on options. OTAs apply online and attend half-day training to be one.
Instructor: Teach techs and event coordinators at training events. Ensure consistency of program.To be one, attend min of 3 events, have management and teaching skills, and knowledge of Carfit policies/procedures.
Event Coordinator: Was previously technician; brings events to community. Host, secure and manage events, train techs, communicate with AAA, AARP, AOTA about events. Must attend a training to be one.
NBCOT
National Board for Certification in Occupational Therapy. 15 member board of directors composed of 8 OT practitioners and 7 public members. Functions independently in all aspects of initial certification. Provides exam to become certified after completion of accredited OT/OTA education program.
Accreditation Council for Occupational Therapy Education
ACOTE; part of AOTA that regulates entry-level education for OT and OTA programs in US; Reviewed/revised every 5 years; Educ. programs must show compliance to be accredited.
Supervision as per CBOT (CA Board of OT)
“Supervision of an OTA” means that the OT shall at all times be responsible for all OT services provided to the client. The OT formulates/documents each client’s record, with his or her signature, the goals and plan for that client, and shall make sure that the OTA assigned to that client functions under appropriate supervision. OT conducts at least weekly review/inspection of OT services by the OTA.
• The supervising OT must follow progress of each client, provide direct care to the client, and to assure that the OTA does not function autonomously.
• An OT shall not supervise more OTAs, at any one time, than can be appropriately supervised in the opinion of the board. Three OTAs shall be the maximum supervised by an OT at any one time, but the board may permit a greater number. In no case shall OTAs exceed twice the number of OTs employed by a facility at any one time.
Levels of Supervision
- Direct/Continuous = in immediate area at all times; for student, limited permit holder or aides
- Close = daily, direct contact at work site
- Routine = face-to-face at least every 2 weeks at work site; interim supervision thru telecommunication
- General = initial direct contact at least once/month; interim supervision as needed by tele-communication
Non-Entry Level Roles of OTA
- Educator to consumers
- Educator to peers
- Fieldwork educator
- Supervisor
- Administrator
- Consultant
- Dept. Manager
- Academic fieldwork coordinator
- OTA program director
Board certification
AOTA offers this to OTs in gerontology, mental health, pediatrics and physical rehab.
Specialty Certification
AOTA provides certification to OTs and OTAs for:
• community mobility
• environmental modification
• feeding, eating and swallowing
• low vision.
(Practitioners document # of hours in 3 years; submits application and portfolio)
Entry-level vs Intermediate-level vs Advanced-Level Practitioner
Entry-level= developing skills, socialization into profession, acceptance of expected responsibilities/role
Intermed-level= increased independence, mastery of basic functions, more abilities based on experiences, educating other personnel, initiation of specialization/collaboration
Advanced-level= refinement of specialized skills, understanding complex issues affecting role functions, contributing to knowledge base and profession growth, considered expert
Frequency supervising OT must review/inspect services provided by OTA:
At least weekly, according to CBOT.
Number of OTAs that may be supervised by one OT
According to CBOT, maximum of 3, but board could approve more. Never twice as many OTAs as OTs.
CFOT
California Foundation for Occupational Therapy; enhances public view of OT, supports students/practitioners/researchers advance knowledge and skills.
OTAC
Occupational Therapy Association of California; collective voice for OTs/OTAs in CA, advocates for members
WFOT
World Federation of Occupational Therapists; world-wide voice of OT that sets standards of practice internationally; promotes research/educ.; demonstrating OTs relevance to society.
AOTF
American Occupational Therapy Foundation. 501 (c)(3) that supports OT research through grants/scholarships and publications.
CBOT code for supervising aides
Section 2570.2 (a): OT or OTA must provide direct in-sight supervision of aides, and to document client’s record of tasks performed by aide.
2 Sections of the Framework
- Domain: Outlines profession’s purview and areas in which members have established body of knowledge and expertise.
- Process: Dynamic occupation and client-centered process used in the delivery of OT services.
Aspects under Domain:
1) Occupations
2) Client Factors
3) Performance Skills
4) Performance Patterns
5) Contexts and Environments
Principles included in OT Code of Ethics
6 total:
1) Beneficence
2) Nonmaleficence
3) Autonomy
4) Justice
5) Veracity
6) Fidelity
Beneficence (define):
Well-being of client. Using proper judgment and competency.
Concern for the well-being and safety of the recipients of services. Taking action by helping others; promoting good by preventing and removing harm.
Nonmalificence (define):
Do no harm. Uncompromised care.
To abstain from causing harm to others. To not impose risks of harm even if potential risk is without malicious or harmful intent. Goals pursued justify the risks that must be imposed to achieve those goals (ie: treatment that has pain will over time benefit the client).
Autonomy (define):
Client’s choice. Transparency.
Respect the right of client to self-determination, privacy, and consent. Allowing client to decide goals for intervention; involve authorized agent when needed. Protect confidential information.
Justice (define):
Fair and lawful. Access and advocacy.
OTP shall promote fairness and objectivity in provision of services. Respect and consistently follow applicable laws. Generate unbiased decisions.
Veracity (define):
Honesty and accuracy.
Provide comprehensive, accurate and objective information when representing the profession. Use truthfulness, candor and honesty in transmission of info and foster understanding. Requires thoughtful analysis of how full disclosure of info may affect outcomes.
Fidelity (define):
Respect and discretion. Selflessness.
Treat clients, colleagues and other professionals with respect, fairness, discretion and integrity. Keep commitments. Maintain respectful collegial and organizational relationships.
Define Lifespan (Developmental) Stages
- Infancy: birth to 1 year
- Childhood: Early (1-6 years); Later (6-12 years)
- Adolescence: 12-20 years
- Young and Middle Adulthood: 20-65 years
- Later Adulthood: Over 65 years
Pediatrics – Define and Common Issues
Pediatrics = Birth to end of high school. (Sometimes work with pregnant mothers.)
Common issues:
• Sensory processing disorders
• Low muscle tone, decreased muscle strength
• Fear of movement
• Decreased attention span, hyperactivity
• Difficulty with motor planning, balance, gross motor delays, fine motor delays
• Immature play skills, overreacting
• Improper pencil grip/poor handwriting
• Impaired bilateral or hand-eye coordination
• Difficulty with self care, ADLs
Landmarks of Infancy:
- Rapid growth in motor, social, cognitive skills
- Gross/fine motor develop via reach, grasp, roll, sit, crawl and walk
- Primitive reflexes
- Social-expressing emotions
- ADLs – recognition of food sources, bathtime, al-lowing dressing
- Cognitive – awareness of objects, faces, voices
Landmarks of Childhood:
- Growth and refining skills
- Play is main occupation
- Play goes from solitary to parallel, moves toward end goal, rules start, cooperative play
- Imaginative play from 3-5 years
- Move into occupation of education – rules, routines, reading, writing, socializing, cog. Skills
Landmarks of Adolescence:
- Striving toward independence, peer group pressure
- Games with rules, group standards instead of adult standards, leisure and social activities
- Focus moves outside of family
- Confusion in relationship with adults
- Sexual identity developing
- Growth changes, postural changes, awkward motor movement
Landmarks of Young/Middle Adult-hood:
- Time of achievement
- Employment decisions
- Group affiliations
- Guiding next generation; child rearing
- Completing education
- Relationships
- Home management
Landmarks of Late Adulthood:
- Reflection/evaluation of one’s life
- Physical changes – sensory/health issues
- Adjustment to/acceptance of impending death
- What I’m leaving behind
- Decreased workload – increased time on hands
- Loss of peers
Intervention for Infancy:
- Muscle tone
- Coordination
- Symmetrical movements
- Posture
- Play (motor skill development), sensory regulation, splinting, positioning, cardiac rehab., feeding, behavior reg., parent training
- Family centered
Intervention for Childhood:
- Play development (Motor, cognitive, social, psychological, language skills)
- Least restrictive environment – closest to a regular classroom, yet encouraging success
Intervention for Adolescence:
- Firm yet fair limits
- Emotional expression
- Learn to trust
- Give control where possible
- Group interaction
- Self care
- Work preparation activities
- Leisure exploration
Intervention for Young/Mid Adults:
- Help re-engage in meaningful occupation
- Help be successful in roles and consider context
- Ergonomics
- Rehab from illness/injury
Intervention for Later Adults:
- Safety
- Home evaluation
- Driving
- Rehab for illness/injury
- Depression
- Learned helplessness – person relinquished control to others due to level of help offered; no longer making decisions
CBOT Minimum Standards for Infection Control
Regulation 4175: OTs must comply with all applicable Standard Precautions. Avoiding spreading infectious agents. Includes: Hand hygiene, use of PPE, respiratory hygiene (cough etiquette), client care equipment handling/cleaning.
CBOT 4175 Regulation on handwashing:
- When hands are visibly soiled, hands shall be washed with soap and water for a 20-second scrub and 10- second rinse or an antimicrobial hand wash.
- If hands are not visibly soiled, an acceptable alter-native is with an alcohol-based hand rub.
HIPAA
Health Insurance Portability and Accountability Act.
Set rules for access to protected health information (PHI). Manages and safeguards information, encourages patient rights. PHI access based on “need to know” and “minimum necessary” principles.
WHO’s 5 Moments of Hand Hygiene
1) Before touching patient
2) Before clean/aseptic procedure
3) After body fluid exposure risk
4) After touching a patient
5) After touching patient surroundings
Standard Precautions Practices (Types)
Infection preventing practices: • Hand hygiene • Personal Protective Equipment (PPE) • Safe Injection Practices • Respiratory Hygiene/Cough Etiquette
Precaution Types (for inpatient care)
1) Airborne Precautions: TB, Chickenpox; Use Airborne Isolation Room (AIIR), door shut; Wear N95
2) Droplet Precautions: Flu, Bact Meningitis, Pertussis; Private room, door shut; Wear standard mask w/wout shield
3) Contact Precautions: MRSA, VRE, C diff.; Private room, door open; Wear gloves and gown
% of Time Spent Sleeping
1/3 of life
Sleep position for least back pressure
On your back (2nd least is side)
Weight limit for backpacks
10% of body weight; or never more than 25 lbs.
How far below waist to wear back-pack?
Never more than 4 inches below waist
Ways to solve monitor glare
- Use glare screen
- Place monitor perpendicular to light source
- Aim lights at wall or desk to diffuse them
- Reduce contrast betw screen and border around it
Best monitor for color choices
8-bit LCD panel monitor
20/20/20 Rule
For every 20 mins on a screen, look at something 20 feet away, for 20 seconds
Distance from face to place monitor
Arm’s length
How to set screen brightness
Should be same as a white sheet of paper held next to it in that lighting/time of day.
Applications of Telehealth in OT
- Early Intervention for Children
- School Based
- Pediatric Private Practice
- Pediatric Hospitals
- VA Healthcare System
- Burn Unit Consultations
- Adult Private Practice (Rehab and Wellness)
- Mental Health (education, independence, emotional health, employment, ADLs)
- Productive Aging
- Ergonomics
- Coaching patients with TBI
Considerations for incorporating tele-health:
- Client access to technologies
- Services that are amenable to telehealth
- Position of employer on using it
- Knowledge of telehealth resources
- Licensure in my state
- Will I be reimbursed?
- Are technologies HIPAA compliant?
- Do I have/can I acquire competency to deliver services this way
- Can OTAs be supervised
CBOT 4172 Standards of Practice for Telehealth
• OT or OTA must have valid license
• OT must inform patient and get their consent
• OT shall determine if in-person eval is necessary based on details of the intervention
• OT/OTA delivering telehealth must:
a) Use same standard of care;
b) Comply with all other provisions/regulations of OT Practice Act
Certified Driver Rehabilitation Specialists
(CDRS). Gold standard in driver rehab service through ADED. With backgrounds in healthcare and/or driver education, driver rehabilitation specialists are professionals who have completed additional training and education in the field of driver rehabilitation.
*DRS (Driver Rehab Specialists) are allied health professionals who have not obtained ADED certification.
ADED
Association for Driver Rehabilitation Specialists – nonprofit org dedicated to promoting safe, independent mobility for aging and disabled. Provides educ and support for professionals in field of driver rehab. Certifies Certified Driver Rehabilitation Specialists (CDRS).
Four common conditions in which driving concerns are addressed
1) Dementia
2) Parkinson’s Disease
3) COPD
4) Physical Disabilities
Body Language
Read others’ body language, but also be aware of your own! Consider what you are projecting before you react to a negative response. Posture, stance, gestures, eye contact, personal space, facial expression and energy level send messages you may not intend.
Vocal Cues
How you speak often gives a perception:
Monotone=boredom Slow speed/pitch=depression High voice/emphatic pitch=enthusiasm Ascending tone=astonishment Abrupt speech=defensiveness Terse/loud=anger High pitch/drawn out=disbelief
Tips to Improve Listening:
1) Do not fake understanding. Ask to repeat if needed.
2) Do not tell speaker you “know how they feel”. Reflect you understand but not that “you are with them”
3) Vary your responses.
4) Focus on the feelings (when reflecting back, use accurate feeling word)
Questions to ask yourself about the effectiveness of your people skills:
1) Are you truly listening and hearing what is being said?
2) How can you slow down your rx and respond successfully to behavior you do not like or expect?
