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Question 1

Sensorimotor Approach

Answer 1

• Encourages change through the use of physical activity and the effect physical activity has on muscle tone, muscle strength, and range of motion
• Change in the motor learning system occurs through the use of repetition, promoting feedback to allow for habituation
• Intervention provides gross motor movement, including exercise, parachute games, and sensory exploration

Question 2

Motor-Learning Approach

Answer 2

• Occupation based approach that helps the child achieve motor goals using problem solving, practice with reinforcement, whole task activities, and refinement of a skill during everyday activities
• Interventions provide guided and supported repeated practice of daily activities to promote learning and independence

Question 3

Biomechanical Approach

Answer 3

• Improves range of motion, strength, or endurance
• Focus on postural alignment, joint stability and relationships, and
  musculoskeletal problems
• Interventions focus on postural alignment, postural stability, level of motor skill performance, effects of gravity, effects of the supporting surface, and most efficient postures for functional performance

Question 4

Neurodevelopmental Approach

Answer 4

• Uses biomechanical principles in addition to a range of handling and positioning techniques that promote motor function
• Intervention relies on sensory input to facilitate postural tone and supporting movements
   (vs. proprioceptive neuromuscular approach=crossing midline using diagonal movements.
• Aimed at the restoration of function through identifying and correcting underlying impairments that interfere with movement and particiation; emphasis is on regaining normal movement and postural control following proximal to distance patterns

Question 5

Model of Human Occupations (MOHO)

Answer 5

-Seeks to explain how occupation is motivated, patterned, and performed.
* Addresses/emphasizes on the “3 dimensions of doing” at the participation, performance, and skills level
o Volition (motivation)
o Habituation (roles/ routines)
o Performance capacity (physical/mental abilities)

• In order to UNDERSTAND occupations, we must understand the physical/social environments in which it takes place.
• emphasizes “occupational adaptation” through “motivation”, “routines and patterns”, “nature of skills and performance” and the “influence of context on occupations”.

Question 6

Ecological

Answer 6

• Emphasizes the importance of the environment on occupational engagement
• Addresses:
  o Person
  o Environment (physical or social)
  o Occupation or task

Question 7

Ecology of Human Performance Model

Answer 7

• places emphasis on the interaction of the person, the activity demands, and the context. Intervention not only focuses on the skills of the person but also places emphasis on the context and the task. The model describes five strategies to address these factors:
  o Establish
  o Alter
  o Adapt
  o Prevent
  o Create

Question 8

Occupational Adaptation Model

Answer 8

Understanding the interaction between the client’s perceived level of task mastery and the demands of the environment. **3 elements: **
-person,
-occupational environment, and
-interaction between the two.

The model of Occupational Adaptation states that success in occupational performance is a result of the person’s ability to adapt with sufficient mastery to satisfy the self and others.

MASTERY

The desire for mastery is inherent, and USING MEANING OCCUPATIONS to provide a sense of mastery and competence will elicit adaptive responses.

ODD

Question 9

Person-Environment-Occupation

Answer 9

Person, environment, occupation, occupational performance

P-E-O fit!
Family centered approach

The Person-Environment-Occupation Model places equal emphasis on the environment and the occupation during the intervention.

Access potential strengths/weakness

Question 10

Recovery Model

Answer 10

1. provide individuals with choice
2. support them in achieving self-identified goals
3. address all aspects of life
4. empower them to make decisions and do for themselves.

Question 11

Family System Model

Answer 11

Internal (family dynamics, values, beliefs) and external (insurance, employment, access to health care) factors influence family functions

Question 12

Cognitive Orientation to daily Occupational Performance (CO-OP) approach

Answer 12

performance-based treatment approach for children and adults who experience difficulties performing the skills they want to, need to or are expected to perform

“ask, don’t tell” principle of guided discovery using CO-OP. The OTR asks rather than tells the child the sources of breakdown during performance in occupations.

Question 13

Sensory Integration Approach

Answer 13

-Emphasizes the use of naturalistic environments for intervention.
-Adaptive response occur in optimal arousal states
-Multi system
-Just right challenge

Question 14

Behavioral

Answer 14

1. Uses repetition to shape a client’s behaviors in a safe environment in order to reduce negative thoughts and emotions.

Question 15

Psychodynamic

Answer 15

1. Suggest that unresolved childhodd event are caused of dysfuntion
2. Uses projective media for expression: clay magazine collages, painting, and poetry
3. Mostly discussion-based and indvidualized
4. Emphasis on social environment; conscious and unconscious forces motivates behavoirs
5. Goals: self-awareness and understanding of influences of past on present behavior

Question 16

Psychoanalytic

Answer 16

1. Allows client to gain access to unconscious and developm insight and awareness

unconscious forces influences behaviors

Question 17

Developmental

Answer 17

1. Examines the client’s age and expecations of the enviromnment and uses activities that faciliate successful completion

Question 18

An OTR® who is working for a school district intends to apply the Ecology of Human Performance (EHP) Model as a guiding theory for practice. Which program BEST demonstrates the create intervention strategy of the EHP Model?

A] Developing a social skills program embedded in all students’ recess time
B] Planning an educational program to address potential bullying of students with behavioral challenges
C] Discussing with teachers how to promote a classroom environment to support a child with learning challenges
D] Suggesting the use of therapy balls as chairs in the classroom to address the needs of children with sensory processing issues

Answer 18

Solution: The correct answer is A.

The create intervention strategy of the EHP Model is meant to be used at the population level rather than at the client level. Strategies and programming are applied in a larger contexts, not with individual clients.

B: This approach is an example of a prevent intervention strategy.

C: This approach is an example of an alter intervention strategy.

D: This approach is an example of an adapt–modify intervention strategy.

AOTA

Question 19

According to the Model of Human Occupation (MOHO), occupational therapy intervention will best benefit adult clients with mental illness through which of the following approaches?

A] Understanding the interaction between the client’s perceived level of task mastery and the demands of the environment
B] Understanding the client’s dimensions of occupational participation and performance
C] Understanding how the environment can be adapted, modified, and restored to enable effective performance
D] Understanding how the client uses sensory information in the environment

Answer 19

Solution: The correct answer is B.

The “dimensions of doing” is part of MOHO.

A: This approach is based on occupational adaptation theory.

C: This approach is based on the Ecology of Human Performance model.

D: This approach is based on the sensory integration model.

AOTA

Question 20

Which model of practice emphasizes cultural safety, decentralizes the self, and emphasizes restoration of the harmony of the person within his or her surrounding contexts?

A] Culture-emergent model
B] Kawa model
C] Counseling psychology model
D] Person–Environment–Occupation model

Answer 20

Solution: The correct answer is B.

The Kawa model, developed in Japan, was designed to create a feeling of safety within the Japanese culture. It emphasizes harmony between the person and her or his surroundings.

A: The culture-emergent model stresses development of skills for cross-cultural interactions

C: Counseling psychology is a specialty in the field of psychology.

D: The PEO model is a model of occupational performance that focuses on the interaction between the person, the person’s environment, and the person’s desired occupations.

Question 21

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR asks the client about the client’s successes and failures as a child and begins to discuss how these early experiences might be the reason the client is experiencing anxiety at work. The OTR and the client discuss ways to manage these feelings. What frame of reference does this intervention suggest?

A] Cognitive–behavioral
B]Psychodynamic
C] Cognitive disability
D] Behavioral

Answer 21

Solution: The correct answer is B.

The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based.

A: The cognitive–behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate.

C: The cognitive disability frame of reference uses the client’s strengths to allow for function. An example of a cognitive disabilities intervention is training caregivers to provide appropriate environmental supports for the client.

D: The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Using breathing and relaxation techniques during a stressful event can facilitate a change in response.

Question 22

An OTR® believes that changing clients’ negative beliefs ultimately reduces negative emotional statements and leads to a change in behavior. What is this OTR’s main theoretical perspective?

A] Cognitive disability
B] Developmental
C] Cognitive–behavioral
D] Sensorimotor

Answer 22

Solution: The correct answer is C.

The cognitive–behavioral perspective deals with clients’ emotional responses to experiences and assists them in reframing their behavioral responses.

A: A cognitive disability perspective focuses on clients’ current abilities and does not aim to change clients’ emotional response or behaviors, only the environment.

B: The developmental perspective focuses on current life expectations and how clients approach situations in the context of those expectations.

D: The sensorimotor perspective focuses on controlling or modifying external sensory stimuli to improve clients’ ability to function. It regulates responses through physiological, not cognitive, processes.

Question 23

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR suggests that the client use breathing techniques and relaxation breaks during the work day to minimize the client’s response to stressful events at work. What frame of reference does this intervention suggest?

A] Cognitive–behavioral
B] Psychodynamic
C] Cognitive disability
D] Behavioral

Answer 23

Solution: The correct answer is A.

The cognitive–behavioral frame of reference works on thoughts and reactions related to triggers in the environment. Deep breathing can help generate a calmer physical response to anxiety triggers. Another example of an intervention using this approach is journaling to help identify triggers for one’s anxiety.

B: The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based.

C: The cognitive disability frame of reference uses the client’s strengths to allow for function. An example of a cognitive disabilities intervention is training caregivers to provide appropriate environmental supports for the client.

D:The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Behavioral interventions generally involve types of reinforcement for desired behaviors. Applications include token economies and social skills training.

Question 24

An OTR® is working with a client in an inpatient psychiatric facility and decides to use the Allen Cognitive Level Screen to assess cognitive functioning. Which goals would be appropriate on the basis of the Cognitive Disabilities Model?

A] The client will demonstrate appropriate coping skills in identified stressful situations with 100% success.
BT he client will independently apply relaxation techniques and report relief from stress at 0/10 after using the technique.
C] The client will apply grounding techniques with 100% accuracy as a preventative measure to reduce over-stimulation.
D] The client will be discharged home from the inpatient psychiatric unit with daily checks from caregiver to address novel safety needs in the home environment.

[Grounding is a practice that can help you pull away from flashbacks, unwanted memories, and negative or challenging emotions.]

Answer 24

Solution: The correct answer is D.

The Cognitive Disabilities Model assesses the client’s current cognitive functioning to maximize supports in the environment that will facilitate maximal occupational performance. This goal suggests that after discharge, the client will be placed in an environment that will successfully manage the client’s current cognitive ability through appropriate environmental supports.

A: This goal is based on a cognitive–behavioral approach, not the Cognitive Disabilities Model.

B: This goal is based on the behavioral approach, not the Cognitive Disabilities Model.

C: This goal is based on a sensorimotor approach, not the Cognitive Disabilities Model.

Question 25

An OTR®’s guiding framework about improving the lives of clients with mental illness is that changing clients’ negative beliefs about experiences and situations ultimately reduces negative emotional states and behaviors. What is the OTR®’s main theoretical perspective?

Psychoanalytic
Developmental
Cognitivebehavioral
Occupational

Answer 25

Solution: The correct answer is C.

Cognitivebehavioral therapy focuses on changing how one thinks about behavior to change the behavior itself.

A: Psychoanalytic theory focuses on deep-seated, early life relationships.

B: Developmental theory uses stages of development to explain behavior.

D: An occupational perspective would incorporate the use of activity as a means of influencing behavior.

Bruce, M. A. G., & Borg,

Question 26

n OTR® working in a neurology unit was referred a client with low back pain and weakness in one leg, causing difficulty walking. During the interview, the client mentions that the low back pain started after several stressful life events, but the client does not recall a specific injury. Malingering and fear of illness do not seem to be a part of this scenario, because the client is eager to resume exercise and other activities. What is the client’s likely diagnosis?

Low back pain
Factitious disorder
Histrionic personality disorder
Functional neurologic disorder

Answer 26

Solution: The correct answer is D.

All symptoms point to functional neurologic disorder (formerly known as conversion disorder).

A: Organic low back pain is caused by traumatic or repetitive musculoskeletal injuries.

B, C: The case as described includes no signs of factitious disorder or histrionic personality disorder.

Question 27

conversion disorder

Answer 27

Conversion disorder (also known as functional neurological system disorder) is a condition in which a person experiences physical and sensory problems, such as paralysis, numbness, blindness, deafness or seizures, with no underlying neurologic pathology. These problems are serious enough to negatively impact important life functions, such as academic performance, social relationships and family life.

s&s:
Weakness or paralysis.
Loss of balance or difficulty walking.
Tremors or seizures.
Vision problems, such as double vision or blindness.
Hearing problems or deafness.
Difficulty speaking or inability to speak.
Difficulty swallowing.

Question 28

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR (with the client’s permission) works with the employer to identify work tasks in which the client can be successful. What frame of reference does this intervention suggest?

Cognitive–behavioral
Psychodynamic
Cognitive disability
Behavioral

Answer 28

Solution: The correct answer is C.

The cognitive disability frame of reference uses the client’s strengths to allow for function. An example of a cognitive disability intervention is training caregivers to provide appropriate environmental supports for the client.

A: The cognitive–behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate.

B: The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention is usually discussion based.

D: The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Using breathing and relaxation techniques during a stressful event can facilitate a change in response.

Question 29

Which group activity would be the MOST appropriate to engage clients in an expressive activity using the psychodynamic approach?

Baking chocolate chip cookies
Constructing a magazine collage
Hiking in the woods
Attending a dance performance

Answer 29

Solution: The correct answer is B.

The psychodynamic approach makes use of projective media such as clay, magazine collages, painting, and poetry.

A: Making chocolate chip cookies using a recipe is a structured activity that does not allow for expression of the individual’s personality.

C: Hiking is not an expressive activity.

D: Attending a dance performance as a passive spectator does not allow for self-expression.

Question 30

Which of the following elements is an important component of the Recovery Model?

Peer support and teaching
Social–emotional learning
Cognitive–behavioral therapy
Sensory–motor interventions

Answer 30

Solution: The correct answer is A.

The Recovery Model suggests a broad context for intervention, not specific intervention strategies provided by mental health providers. The Recovery Model is a client-centered approach to recovery that encourages the supports necessary for a person to recover within a context that is comfortable for that person. It may include peer support and teaching.

B: Social–emotional learning is an approach used primarily in children, not in adults; it is not part of the Recovery Model.

C: Cognitive–behavioral therapy is a specific intervention strategy that might be helpful to someone with certain types of mental illness, but it is not part of the Recovery Model.

D: Sensory–motor interventions might be used to address specific symptoms of mental illness, but they are not a primary focus of the Recovery Model. The Recovery Model is a broad philosophy that suggests that individuals should choose their approach to recovery from among community supports, peers, and mental health services. It does not advocate specific strategies.

Question 31

An OTR® is providing intervention to a client with an anxiety disorder who has panic attacks when faced with difficult work tasks. The OTR begins to work with the client on physiological responses and the thought processes leading up to the panic attacks and suggests that the client begin to keep a log or journal of when the panic attacks occur and the thoughts immediately preceding them. What frame of reference does this intervention suggest?

Cognitive–behavioral
Psychodynamic
Cognitive disability
Behavioral

Answer 31

Solution: The correct answer is A.

The cognitive–behavioral frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate.

B: The psychodynamic frame of reference suggests that unresolved childhood events are the reason for dysfunction. A psychodynamic intervention usually includes creative and expressive media and journaling for reflection.

C: The cognitive disability frame of reference uses the client’s strengths to allow for function. An example of a cognitive disability intervention is training caregivers to provide appropriate environmental supports for the client.

D: The behavioral frame of reference relies on the idea that behavior is learned and that it can be unlearned. Techniques like behavior modification, reinforcement, desensitization, and shaping are used to reduce the incidence of undesired or maladaptive behaviors.

Question 32

A client who has an enduring mental illness arrives late for an initial occupational therapy evaluation at a community mental health facility. The client’s appearance is unkempt and dirty. The client lives with family members, spends the majority of leisure time drinking with friends, and has been terminated from multiple jobs. One of the client’s goals is to “get a job.” What should be the PRIMARY focus of this client’s intervention when using the Model of Human Occupation?

A] Helping the client gain mastery over living conditions and work environment based on the client’s preferences
B] Exploring the client’s thoughts and underlying conflicts related to engagement in occupation
C] Teaching the client self-care and vocational exploration skills in areas of occupational interest
D] Supporting the client’s participation in daily routines and work tasks based on current skills and abilities

Answer 32

Solution: The correct answer is D.

The focus on Model of Human Occupation in intervention is for the client to engage in occupational performance through doing, thinking, and feeling within the therapeutic environment.

A: Mastery of a task is not essential within the Model of Human Occupation in intervention, because the emphasis is on occupational engagement.

B: The Model of Human Occupation considers a client’s thoughts and feelings about the abilities for doing everyday activities, but not the client’s thoughts and underlying conflicts related to engagement in occupation.

C: Therapeutic strategies within the Model of Human Occupation include giving feedback, coaching, structuring, and encouraging client to encourage occupational participation; these strategies do not include teaching the client to do something. Rather, the environment is set up so that the client is able to engage and learn about the occupation through the guiding of the practitioner.

Question 33

An OTR® is working with children with autism in an early childhood intervention program. Which practice BEST reflects an integrated developmental model of assessment for these children?

Use of the most appropriate standardized assessments
Observation of the children’s function in various contexts
Observation of the children without their parents to see their natural behaviors
Use of an unfamiliar examiner to provide more objective results

Answer 33

Solution: The correct answer is B.

Integrated developmental assessment incorporates multicontextual sources of information.

A, C, D: These practices are not consistent with the principles of the integrated developmental model of assessment.

Question 34

An OTR® plans to use a top-down approach to assess a 15-year-old child with attention deficit hyperactivity disorder and oppositional defiant disorder. Which top-down frame of reference emphasizes the three “dimensions of doing” at the participation, performance, and skills level?

PersonEnvironmentOccupation Model
Occupational Adaptation Model
Model of Human Occupation
Ecology of Human Performance Model

Answer 34

Solution: The correct answer is C.

The Model of Human Occupation articulates the three dimensions of doing.

A, B, D: The other frames of reference do not use the term dimensions of doing of participation, performance, and skills.

Question 35

An OTR® at a private outpatient clinic is working with a child with a severe anxiety disorder. The OTR decides to use an alter approach to intervention following the Ecology of Human Performance (EHP) Model. Which approach BEST exemplifies the alter intervention strategy?

Teaching the child strategies to monitor arousal and anxiety levels in different situations
Corresponding with the school personnel to discuss ways to support the child at school
Discussing advantages and disadvantages of home schooling with the child’s parents
Developing an educational training program for parents to inform them about children’s anxieties

Answer 35

Solution: The correct answer is B.

According to the EHP Model, the alter intervention approach focuses on the client’s context. Interventions are geared toward providing appropriate contexts to support the client’s needs.

A: This approach is an example of the establish–restore intervention approach.

C: This approach is an example of the adapt–modify intervention approach.

D: This approach is an example of the create intervention approach.

Question 36

An OTR® plans to use ecological assessments to evaluate the strengths and weaknesses of a 4-year-old child with autism. Which assessment is a good example of an occupational therapy ecological assessment?

Knox Preschool Play Scale
Bruininks–Oseretsky Test of Motor Proficiency
School Function Assessment
Beery–Buktenica Development Test of Visual–Motor Integration

Answer 36

Solution: The correct answer is A.

The Knox Preschool Play Scale is an assessment of play skills that can be used in various performance contexts.

B, D: The Bruininks–Oseretsky Test of Motor Proficiency and the Beery–Buktenica Development Test of Visual–Motor Integration are not ecological assessments.

C: The School Function Assessment is an ecological assessment for children aged 5–12 years (kindergarten through 6th grade).

Question 37

An OTR® is using an Ecology of Human Performance Model to help a child with attention deficit hyperactivity disorder improve handwriting efficiency. Which intervention strategy is MOST consistent with this approach?

Use movement-based activities to help the child improve focus and attention during structured tasks
Use highlighted ruled paper to enable the child to stay within boundaries when writing
Facilitate the child’s development of strategies to develop mastery of handwriting tasks
Strengthen the child’s hand muscles to improve pencil grasp

Answer 37

Solution: The correct answer is B.

Modifying or adapting task tools is an intervention strategy of the Ecology of Human Performance Model.

A: Movement-based activities are a sensory integration strategy.

C: Strategies to develop mastery are part of the Occupational Adaptation Model.

D: Strengthening hand muscles is part of a biomechanical approach.

Question 38

An OTR® is evaluating a child who is depressed and suicidal after experiencing severe bullying in school. On interviewing the child, the OTR identifies that the child’s sense of self-efficacy and personal capacity have been severely affected, and the child does not want to go to school anymore. Using a Model of Human Occupation theoretical framework, which component of the child’s volition should the OTR work on as a primary concern?

Personal causation
Values
Interests
Habituation

Answer 38

Solution: The correct answer is A.

**Personal causation is defined as one’s sense of self-competence and effectiveness **while engaged in occupations. Because the child’s self-efficacy and personal capacity have been severely affected, it is best to address the child’s personal causation as a primary concern.

B: Values are defined as what is important and meaningful to the client as shaped by culture and context. Values are part of the volition system, but perceptions of self-efficacy and personal capacity are not defined as values.

C: Interests are part of the volition system and are defined as what is pleasurable and satisfying to the client, but perceptions of self-efficacy and personal capacity are not defined as interests.

D: Habituation is another component of the person system, but it is not part of volition.

Question 39

An OTR® is working with a child with a learning disability. A classroom teacher reports that the child consistently needs multiple bathroom breaks during the reading hour. The OTR uses pragmatic clinical reasoning to investigate what is causing the need for multiple breaks and provide supports to the classroom teacher. Which actions BEST describe pragmatic clinical reasoning?

The OTR observes and monitors whether the child also asks to be excused for bathroom breaks during fun occupational therapy activities and documents these observations.
The OTR sits down during therapy and invites the child to talk about the reasons for the frequent bathroom breaks in a nonthreatening and safe context.
The OTR explores further with the classroom teacher what activities happen during the reading time and gathers additional information from the child’s parents.
The OTR asks the child to create a story sharing the child’s experiences and possible struggles during reading time in the classroom.

Answer 39

Solution: The correct answer is C.

Pragmatic clinical reasoning enables the OTR to incorporate knowledge about the client’s contexts. By knowing features of the child’s classroom context, the OTR may be able to identify reasons for the frequent bathroom breaks.

A: This approach is an example of scientific reasoning, in which the OTR gathers information and uses trial and error to identify the reasons for the frequent bathroom break.

B, D: These approaches are examples of narrative reasoning, in which the OTR gathers knowledge about the child’s experiences and uses stories to understand the reasons for the bathroom breaks.