8. SOP, OT Roles, Mobility & Accessibility > Home Accessibility & Mobility > Flashcards
Home Accessibility & Mobility Flashcards
Americans With
Disability Act (ADA)
Established accessibility guidelines for buildings and facilities
Accessible route
Minimum clear width of an accessible route is 36”, except at doors
Max slope of Ramp
Max slope of ramp is
1:12
- Ramp slopes between 1:16 and 1:20 are preferred
- Most ambulatory people and most people who use a w/c cannot manage a slop of 1:30 for 30 feet.
Maximum rise for run
Maximum rise for any run is
30”
Minimum clearance width of a ramp
Minimum clearance width of a ramp is
36”
A ramp run that has a rise of more than ____ inches or a horizontal projection of more than ______ inches should have handrails on both sides.
Rise of more than 6”
Horizontal projection of more than 72”
For stairs, all steps should have uniform riser heights and uniform tread widths of no less than —–______ inches.
riser heights and tread widths of no less than 11”
Clearance between handrail and the wall
1-1.5” between handrail and the wall
Handrail height recommended for adults and children
Adults: 34-38”
Children: max height of 28”
Minimum doorway clearance
32 inches
Minimum width of a standard adult sized w/c and walker
for w/c: 26 inches
for walker: 18 inches
For exterior sliding doors, Thresholds at doorway should not exceed
Threshold should not exceed 3 / 4 inches for exterior sliding doors;
1 / 2” for other types of doors
Raised thresholds and floor-level changes at accessible doorways should be beveled with a slope of ______ .
slope of no greater than 1:2
Door hardwar for accessible door passages should be mounted no higher than -___— inches
no higher than 48 inches above the finished floor
Minimum diameter or T-shaped space for pivoting 180d with W/C
diameter of 60 inches
60” T-shaped space to avoid repeated tries to do a 180d with a w/c
An OTR® and a Level II Fieldwork student at a long-term care facility observe a new resident moving his wheelchair forward by gripping the front of the pushrim and giving it multiple tiny pushes. The OTR® asks the student, “Why do you think he is pushing his wheelchair that way?” The student observes a bit longer and responds:
The seat back is too low.
The wheelchair is too wide.
The seat back is too high.
The armrests are too low.
Solution: The correct answer is C.
When the seat back height is above the lower angle of the scapula, it can prevent adequate shoulder extension, which is necessary for contacting the pushrim.
A, B: If the seat back of the chair was too low, the client would able to extend his shoulders and get a proper grip on the pushrim; if the chair was too wide, the client would only reach the top of the pushrim.
D: If the armrests were too low, the client would have a greater ability to reach the top of the pushrim.
A client reports having difficulty with lower-extremity mobility in relation to getting into and out of bed. What piece of adaptive equipment is MOST appropriate to recommend to this client?
Leg lifter
Bed ladder
Bed rail
Trapeze bar
Solution: The correct answer is A.
A leg lifter is a device for moving one leg at a time. It can be used to allow the client to manually move the legs over the side of the bed or manually lift the legs into bed.
B: A bed ladder is a device on which a person pulls with one or both upper extremities, using each rung in progression until his or her trunk is at the desired position. It does not assist with moving the legs.
C: A bed rail can assist with rolling or moving in bed, but does not help move the legs.
D: An overhead trapeze bar assists with rolling over, lifting the hips up, scooting the body in bed, or obtaining a long-leg seated position in bed. However, it does not help move the legs.
A client presents at the occupational therapy clinic with a windswept deformity and needs to be assessed for a new wheelchair and a positioning device. In the documentation required for Medicare, the OTR® uses the term “windswept deformity” and also describes the impairment in body structure as follows:
Pelvis rotates posteriorly, increasing trunk flexion
Pelvis rotates anteriorly, increasing curvature of the lumbar spine
One side of the pelvis is lower than the other
One hip is abducted and externally rotated, and the other hip is adducted and internally rotated.
Solution: The correct answer is D.
Windswept deformity is the abduction and external rotation of one hip while the opposite hip is in adduction and internal rotation. One leg in external rotation and abduction at the hip, with the other leg internally rotated and adducted toward midline, is a classic sign of windswept deformity.
A: This describes kyphosis.
B: This describes lordosis.
C: This describes pelvic obliquity.
Although fitted with an ultra lightweight wheelchair (K0005), a client with bilateral above-the-knee amputations is prone to losing sitting balance and falling forward when propelling the chair. The position of the axle is in front of the pelvis. The OTR® needs to find a balance between stability and the effectiveness of arm propulsion. Because the chair is a K0005, which solution will the OTR® MOST likely suggest?
Move the axle forward so that the client’s center of gravity is behind the axle
Move the axle back so the client’s center of gravity is over the axle and add antitippers
Exchange the client’s pushrims for ones that have knobs for easier pushing
Make no changes to the axle but add antitippers to prevent falls
Solution: The correct answer is B.
By moving the axle backward, compromised stability will be offset by the antitippers, but movement efficiency will be increased during propulsion and the client’s center of gravity will no longer be at the front of the wheelchair, thus reducing the risk of falling forward.
A: Moving the axle forward will place the client’s center of gravity further back in the chair, increasing the risk of a backward fall.
C: Knobs are not needed on the pushrims because the client has good grasp.
D: Antitippers are used alone to prevent backward falls, and the client has been falling forward.
When measuring a client for a wheelchair, what are the four basic measurements the OTR® MUST take?
Seat width, seat depth, seat height, seat-back height
Seat width, seat depth, seat height, footrest length
Seat width, seat depth, seat-back height, footrest length
Seat width, seat depth, footrest length, seat-to-back angle
Solution: The correct answer is A.
These measurements must be provided when ordering a wheelchair. Other measurements are helpful for comfort (e.g., armrest height).
B, C: Footrests are adjustable and are not part of the basic required measurements.
D: Seat-to-back angle is an adjustment made to an adjustable wheelchair, not a required measurement.
A client has been using a wheeled walker for many years but has begun to complain that arthritis in the right hand is making it difficult to grasp the walker for any extended period of time, making functional ambulation difficult. Which recommendation would BEST help maintain this client’s mobility?
Use a wheelchair for the majority of functional activities.
Add bilateral forearm troughs to the current walker.
Add a padded grip to the right side of the walker.
Use a cane on the left side during all activities.
Solution: The correct answer is C.
A padded grip can be used on a walker to increase grip for someone with marked hand limitations. It allows the client to have the least restrictive device but still remain safe.
A: Compared with a walker, a wheelchair is too restrictive a form of mobility for a person who has not complained about falling or fatigue.
B: Because the client complains of arthritis only in the right hand, putting bilateral forearm troughs on the walker would be more restrictive than necessary.
D: A cane is not as stable as a walker. If the client has needed the stability of a walker for many years, a cane is not likely to be appropriate now.
An OTR® is working on sitting balance at the edge of the bed with a client who has had a stroke and has residual left-sided hemiplegia. The client requires minimal assistance to maintain static sitting because of lateral leaning. How can the OTR BEST adapt or modify this activity to improve sitting balance?
Prop a wedge and pillows behind the client.
Allow the client to bear weight on the left forearm on a small stool.
Position the client’s hips in more of an anterior pelvic tilt.
Instruct the caregiver on proper hand placement to support the client.
Solution: The correct answer is B.
Weight bearing on the affected side will provide lateral support and can help reduce tone. This positioning technique changes the physical demands of static sitting to improve participation in the task.
A: A wedge and pillows provide additional back support, thereby decreasing the sitting demands and not addressing the lateral loss of balance.
C: An anterior pelvic tilt may be a better position if the client is experiencing posterior loss of balance.
D: Caregiver training is not the best answer at this time because the OTR is working to improve sitting balance, not to maintain this level of assistance.
A client with multiple sclerosis has recently become more dependent on a manual wheelchair for functional mobility. The client lives alone and wants to remain independent. The house has two entrances: The front entrance has four steps with a total height of 28 inches. The entrance from the backyard has a 5-inch-high threshold and another separate 5-inch-high step 10 feet away from the threshold. What would be the MOST appropriate ramp modification for this client?
A 14-foot-long ramp at the front entrance
A 28-foot-long ramp at the front entrance
A 20-foot-long ramp at the back entrance, covering the step
Two 5-foot-long ramps for the back entrance and the step
Solution: The correct answer is D.
According to the Americans With Disabilities Act of 1990 (Pub. L. 101336) accessibility guideline, the maximum slope of a ramp is 1:12. Using two ramps at the back entrance has the advantage of shorter ramps, which are easier for a wheelchair user.
A: A 14-foot ramp will make the slope too steep for wheelchair use.
B: The front entrance, with a total height of 28 inches, will require a 28-foot-long ramp. Propelling a wheelchair safely up and down a ramp of this length is very taxing for a wheelchair user.
C: Propelling a wheelchair safely up and down a continuous, 20-foot-long ramp will be very tiring for a wheelchair user, especially a client with multiple sclerosis.
An OTR® is working with a student with a learning disability to improve independence getting to and from community college. Which action represents a scaffolding approach to this intervention?
The OTR® helps the student study the bus map to identify the appropriate route and then encourages to the student to look at the schedule to determine the times.
The OTR® accompanies the student to and from the school on the bus and points out landmarks to serve as visual reminders of the route.
The OTR® outlines what will be expected of the student regarding bus times, schedule, cost, and appropriate behavior on public transportation.
The OTR® encourages the student to take the bus with a friend to ensure the student does not get lost.
An OTR® is working with a student with a learning disability to improve independence getting to and from community college. Which action represents a scaffolding approach to this intervention?
The OTR® helps the student study the bus map to identify the appropriate route and then encourages to the student to look at the schedule to determine the times.
The OTR® accompanies the student to and from the school on the bus and points out landmarks to serve as visual reminders of the route.
The OTR® outlines what will be expected of the student regarding bus times, schedule, cost, and appropriate behavior on public transportation.
The OTR® encourages the student to take the bus with a friend to ensure the student does not get lost.
An OTR® is performing a physical examination as part of a positioning and seating assessment. For which conditions would the OTR® apply manual pressure to the pelvis to determine whether a deformity is flexible or inflexible?
Scoliosis, lordosis, sarcoidosis
Lordosis, exocytosis, windswept deformity
Kurtosis, kyphosis, lordosis
Scoliosis, windswept deformity, kyphosis
Solution: The correct answer is D.
With scoliosis, windswept deformity, and kyphosis, as well as with lordosis, the pelvis can be flexible or fixed (i.e., inflexible). For a client with any of these conditions, it is important to determine pelvic mobility in assessing seating and positioning.
A, B, C: Sarcoidosis is a disease, exocytosis refers to inflammatory cells in the epidermis, and kurtosis refers to a frequency curve; hence, none of these words applies to spinal deformity.
An OTR® is working with a client who recently sustained a right-sided cerebrovascular accident with left-sided paresis. The OTR is assisting the client with a wheelchair-to-bed transfer. What instructions would the OTR give the client BEFORE initiating the transfer?
Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels away from the bed.
Shift weight into an anterior pelvic tilt, place the right hand on the OTR’s back, and point the heels toward the bed.
Shift weight into an anterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed.
Shift weight into a posterior pelvic tilt, place the right hand on the wheelchair armrest, and point the heels toward the bed.
An anterior pelvic tilt moves the center of mass over the center of the client’s body. Heels should point toward the surface to which the client is transferring for easier pivot. Pushing up from the wheelchair armrest assists in the transfer.
A: Weight shift and hand placement are correct, but having the heels pointing away from the surface to which the client is transferring would make the pivot more difficult.
B: Weight shift and heel placement are correct, but placing the client’s hand on the OTR’s back may throw both the client and the therapist off balance and create the risk of injury.
D: Hand and heel placement are correct, but weight shifting into posterior pelvic tilt moves the center of mass back toward the buttocks.
An OTR® is addressing meal preparation with a client who recently sustained a fracture of the left humerus and is currently in a splint and sling. The client uses a straight cane for functional mobility. How should the OTR instruct the client to remove items from the oven during meal preparation?
Stand directly in front of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven.
Stand to the left of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven.
Stand to the right of the oven, open the door, reach in with the right arm, pull out the food, and place it on top of the oven.
Stand directly in front of the oven, open the door, reach in with a reacher using the right arm, pull out the food, and place it on top of the oven.
Solution: The correct answer is B.
Standing to the left of the oven allows the client to open the door easily with the right hand and remain as close as possible to the food item being retrieved when pulling it out of the oven.
A: Standing directly in front of the oven creates a bigger space between the client and the food item being retrieved, which means the client would have to bend farther forward, creating a bigger risk of falling.
C: Standing to the right of the oven would require the client to rotate to get the right arm in a position in which lifting the food item would be possible.
D: Reachers are not typically used to retrieve hot items from an oven, because they are generally made of materials that could melt in extreme heat and rarely can hold the weight of an item coming out of an oven.
An OTR® is considering a wheeled mobility device with an older adult client who has left hemiparesis as a result of a stroke. The client lives alone, and Medicare reimbursement is a consideration. The OTR proposes a scooter. What is the primary reason for proposing a scooter versus a manual wheelchair?
The client has mobility limitations that interfere with mobility-related activities of daily living.
The client’s home can easily accommodate a wheeled mobility device for moving from room to room in the home.
The client has a weakened left upper extremity.
The client lives alone.
Solution: The correct answer is D.
If a Medicare beneficiary is unable to self-propel a manual wheelchair and a caregiver is available, willing, and able to provide assistance, a manual wheelchair may be appropriate. In this case, however, the client lives alone.
A, B: These statements reflect Medicare criteria that must be met for all mobility assistive equipment.
C: The weakened upper extremity is one of many considerations; it is not the deciding factor.
A client has difficulty with ankle flexion that is causing an issue with tripping over items. In particular, the client is especially concerned with tripping in the bathroom. Which is the MOST appropriate environmental adaptation that could be recommended for this issue?
Removal of water spillage
Installation of grab bars
Removal of loose bath mat
Installation of a shower chair
Solution: The correct answer is C.
If a client is unable to lift the toes properly and is trying to manuver in a bathroom, a loose bathmat could catch the toe or foot and create a tripping hazard.
A: Water spilled on the floor might cause a client to slip, but not to trip.
B: Grab bars are an important safety item and may be used by a client to keep from falling, but they will not prevent a client from tripping.
D: A shower chair is important for clients who cannot bear weight or who have decreased endurance, but it cannot prevent a client from tripping.
