FOR & Treatment Approaches

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.

1. Focus on normalize muscle tone; inhibit primitive reflexes; facilitate normal postural reactions; improve quality of movement; re-learn normal movement patterns
2. Uses of technique to facilitate desired movement during activity performance
3. Handing tech: Reflex inhibiting postures (RIPs); normal righting and equilibrium patters; WB, weight shift; use of positions that use both sides of body; avoidance of any sensory input that may adversely affect muscle tone

CNS patients have dysfunction in posture and movement; have potential to enhance function as brain reorganized through neuroplasticity

Question 5

Proprioceptive neuromuscular approach (PNF)

Answer 5

1. based on reflexes and hierarchic motor control. Emphasizes on MASS MOVEMENT and DIAGONAL patterns
2. Normal activity occurs in synergistic and functional movement pattern/in orderly sequence of total patterns of movement and posture
   goal-directed activities with techniques of facilitation

-Increase motor learning of the agonist through repetition of an activity (repeated contractions) and rhythmic initiation
-Reverse the motor patterns of the antagonist
-Learning to relax muscles helps to increase ROM and decrease spasticity
4. Stretching techniques include Hold Relax, Contract Relax, and Contract Relax Antagonist Contract
5. Used to manually facilitate a group of muscles that are weak in comparison to adjacent muscles
6. The development of movement patterns is facilitated using the shift between flexor and extensor muscles, using diagonal movement patterns to encourage this shift.

Question 6

Brunnstrom’s Movement Therapy

Answer 6

1. Focused on facilitating recovery through a specific sequence
2. Treatment focused on the promotion of movement from reflexive to volitional (7 stages of motor recovery following onset of hemiplegia-flaccid paralysis>spastic tone> flexor>extensor synergy>coord/movement near norm,>normal)
3. Early stage of recover include use of reflexes and associated reactions; pt. encouraged to think about movement and to gain control

In CVA patients (regressed to older pattern of movements)

Question 7

Margaret Rood’s Approach

Answer 7

1. Sensorimotor control is developmentally based; begins at person’s current level and progresses sequentially (PROXIMAL TO DISTAL)
2. Motivation enhances purposeful movement and meaningful activties will encourage practice of desired movements
3. Repetition is necessary for re-education of muscular responses

Facilitation of movements/inhibitation spasticity techniques:

-Light stroking, brushing, ice, heavy joint compression, resistance, vestibular stim, tapping / light compresion, neutral warmth, pressure on tendon insertion, slow rhytmical movement, slow stroke, rockingprolonged stretch

1. reciprocal inhibition/innervation
2. Co-contraction (HOLD)
3. Heavy work (proximal m contract and MOVE and distal segments are FIXED)
4. Skill- high level of control combined with stability and mobility (STABILIZED proximal seg while distal seg MOVE in space.

Question 8

Model of Human Occupations (MOHO)

Answer 8

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)

1. Personal occupation choices shapes the individual.
2. In order to UNDERSTAND occupations, we must understand the physical/social environments in which it takes place.
3. Occupation is DYNAMIC and CONTEXT-DEPENDENT
4. The environment impacts through opportunities, demands, resources, and constraints it provides

Group designed around specific roles/occupations (parenting group)-individuals can change as a result of interaction with environment (adapt and process feedback as they change)

Question 9

Ecological

Answer 9

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

Question 10

Ecology of Human Performance Model

Answer 10

• 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 11

Occupational Adaptation Model

Answer 11

3 elements:
-person,
-occupational environment, and
-interaction between the two.

-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.

Question 12

Person-Environment-Occupation

Answer 12

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 13

Family System Model

Answer 13

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

Question 14

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

Answer 14

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 15

Sensory Integration Approach

Answer 15

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

Question 16

Recovery Model

Answer 16

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 17

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 17

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 18

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 18

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 19

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 19

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 20

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 20

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 21

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 21

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 22

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 22

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.