Mastery of the Environment: Eval and Intervention

Question 1

Universal design

Question 2

low vision assessment

Answer 2

• occupational profile
• evaluation of visual factors
• eval of environmental factors
• eval of occupational performance

Question 3

eval of visual factors

Answer 3

visual acuity assessment
- Minnesota low vision reading test
- LEA numbers test

peripheral field test
- Have client focus on a target straight ahead, while seated or standing, with the client’s back to the OT. The client keeps eyes and head facing forward. The OT stands next to the client’s shoulder and proceeds to walk forward, parallel to the client’s line of sight. The client indicates the point at which any part of the occupational therapist is visible
- for glaucoma
- Amsler Grid

Question 4

evaluation of environmental factors

Answer 4

• Available sources of light and glare
• Possible positions for task lights, reading stands, and tables
• Organization systems
• Access to low-vision devices
• Ergonomics of task performance
• Emergency response procedures

Question 5

eval of occupational performance

Answer 5

-ADLs, IADLs, education, rest, work, play, leisure, and social participation

• Canadian Occupational Performance Measure (COPM), the Barthel Index, and the Performance Assessment of Self-care
  Skills (PASS).

Question 6

visual acuity adaptive approaches

Answer 6

• Increase illumination
  - Fluorescent lighting is the least tolerated light source. Halogen and LED is generally tolerated well.
• Utilize enlarged print or objects. Use optical devices
• Visors and side shields can reduce glare
• Near tasks, light should be placed opposite the working hand or on the side of the good eye. Adjustable lighting for clients with light sensitivity
• Decrease clutter and organize the environment.
• Utilize intact sensory systems to compensate
• Gooseneck lamps and floor lamps can be positioned near the reading surface to improve the client’s ability to read

Question 7

contrast sensitivity adaptive approaches

Answer 7

• Use different colors to increase contrast (black mug with white milk, light walls with dark furniture)
• Provide light modifications that eliminate glare

-Use solid colors because patterns can blend with the background

• Decrease clutter in the environment

-Bright tape on stairs, bright paint on door and cabinets, and bright labels

-Vertical blinds, window dressings and shades can help control the amount of light in the room.

Question 8

diplopia

Answer 8

• double vision
• can cause difficulty with spatial judgement, disorientation, mobility, eye-hand coordination, postural control, and reading
• refer to ophthalmologist or optometrist
• OT role is to communicate how the deficit is affecting functional performance
• vision specialist may prescribe prisms, partial or full
  occlusion, visual training or surgery
• ## the OT SHOULD NOT APPLY OCCLUSION WITHOUT THE PHYSICIAN OVERSIGHT

Question 9

visual field deficits

Answer 9

• includes homonymous hemianopias and scotomas (blind area)
• deficits may be seen in clients with or without visual neglect
• Impaired visual field will impact ambulation,
  awareness, driving, and occupational performance.

Question 10

visual field restorative approach

Answer 10

• effective search patterns TOWARDS AFFECTED SIDE
• Use games such as checkers, worksheets (mazes, letter cancelling), and computerized games.
• Place items on the side of poor vision to force looking to that side.
• Provide verbal, tactile, and auditory cuing to the affected side to encourage looking.
• Incorporate movement with scanning tasks
• Verbally and visually imagining routes can assist in looking to the affected side.

Question 11

visual field adaptive approach

Answer 11

• In order to adapt/compensate, your client NEEDS TO BE AWARE OF THE PROBLEM. We can assist in
  developing awareness through prompting or cueing during tasks
• Place all needed items within the client’s visual field for functional independence
• Carryout tasks in a variety of contexts
• To improve reading utilize anchoring techniques by placing a ruler, tape, a line, or numbers on the side of the deficit and encourage your client to find the anchor each time they read a line. The anchor informs them that they have covered the
  entire visual field
• Have client follow the tip of a pen and maintain fixation as they write across the page
• Add color and contrast to door frames and furniture.

Question 12

visual inattention restorative approach

Answer 12

• Should only be utilized if the client is able to be made aware of the deficits and how it’s affecting occupational performance. They also must have the capacity to learn new strategies for attention and visual search
• activities that encourage awareness to the NEGLECTED SIDE

Question 13

visual inattention adaptive approach

Answer 13

• For the client who is unable to be made aware of deficits and cannot be taught new scanning strategies
• Place all needed items within the client’s visual field for functional independence
• Have clients identify and recall own compensatory strategies and engage in tasks utilizing strategies

Question 14

wheelchair standard measurements

Answer 14

• Standard W/C measurements are 16 (depth) x 18 (width) x 20 (height)
• Narrow W/C measurements are 16 (depth) x 16 (width) x 20 (height)

-Slim W/C measurements are 16 (depth) x 14 (width) x 20 (height)

• Bariatric W/C width is up to 24 inches. *The center of mass should be more forward to ensure stability
• Door width minimum is 32 inches. Preferred is 36 inches
• Turning radius of 360 degrees requires 5x5 feet (60x60 inches)
• Ramp: for every 1 inch of vertical rise, 12 inches of ramp is needed
• At the top of ramps, there needs to be a landing for rest of 5x5 feet (60x60 inches).

Question 15

wheelchair components: armrests

Answer 15

• Styles can be full length (difficult to get close to a table/desk) or arm length (good for getting under
  surfaces)
• Can be height adjustable, fixed, or removable, with pull-out or swing-away options
• Wider, contoured armrest pads for more arm support (good for joystick user)

-Tubular style swing-up armrests (for self-propelling)

Question 16

wheelchair components: footrests

Answer 16

• Support the user’s feet and may act as a step for transfer in and out

-Single plate or double plate, fixed, pull-up, swing-in or swing-out, and manual and powered elevating leg
rests

• Typical angle of footrests is 70 or 90 degrees
  90-degree footrest hangers to accommodate tight hamstring muscles
• If footplates are too far in front the pelvis will be pulled into a sacral sit position (rounded trunk)

-Footrest hangers that are angled less than 90 degrees decreasing maneuverability in tight places

-Shoe cups, ankle straps, or toe straps to secure the feet onto the foot rest for added stability

Question 17

types of leg rests

Answer 17

fixed
- minimal benefit

swing-away
- allows feet to be placed on floor to prepare for transfers and for a front approach on w/c

detachable
- allows safe path of transfers

elevating
- for edema control and reduction

limb board
- supports residual limb after LE amputation

Question 18

wheelchair components: tires

Answer 18

Solid
- less maintenance but less versatile, use on smooth floors, not good on carpet or uneven terrain

Pneumatic
- useful over varied terrain but can be punctured and requires maintenance

Question 19

wheelchair components: casters

Answer 19

• Large casters handle uneven terrain
• Small casters provide the client with a lower front seat-to-floor height and improved maneuverability in small areas
• Narrow-width casters handle smooth surfaces well but can become stuck easily in uneven terrain

Question 20

wheelchair components: frames

Answer 20

• Rigid Frames allow for greater maneuverability in tight spaces and a stiffer ride
• Folding frames may add weight but maybe
  easier to load and stow for some people when the wheelchair is not in use
• Adjustable seat-to-floor height so can be rolled
  under tables and client’s can propel with their feet. Client’s can remove and stow the wheels, fold down the wheelchair’s backrest compactly, and place the individual pieces of the wheelchair into the vehicle.

Question 21

wheelchair components: additional attachments

Answer 21

pelvic belts
- attach at hip level 45 degrees

pelvic lap belts
- for excessive hip extension
- at hip level 90 degrees

harness
- for person lacking sufficient trunk control

arm trough/lapboards
- support hypotonic UE and prevent edema

mobile arm supports
- for UE with proximal weakness to engage on feeding and other ADLs

brake extensions
- for person w/ limited ROM

hand-rim projections
- person w/ weak hand grip

one-arm drive
- For individuals with only one functional upper extremity
- Requires strength and coordination to move straight.

Question 22

wheelchair measurements

Answer 22

width
- add 2 in

depth
- subtract 2 in

seat to floor
- Measure from the top of the resident’s seat to the floor (top of cushion if applicable)

back height
- Measure from set to the top of the shoulder flor clients who have poor trunk control who is
dependent in propulsion. Measure from the seat to the inferior angle of the scapula for a self propeller with good trunk strength

armrest height
- Seat individual with shoulder in neutral and elbow bent at his or her side to 90 degrees. Measure
from top of seat to under forearm/elbow

Question 23

wheelchair features

Answer 23

power chairs
- Recommended for individuals who do not have the strength, endurance, or coordination to negotiate a
wheelchair manually
- Clients need to have a basic level of visual-perceptual and cognitive functioning.
-Scooters provide individuals who have good balance and upper extremity control with a means of power mobility for open areas and general outdoor community mobility

tilt in space
- Seat orientation can be changed while the seat-to-back angle remains the same
- The whole seating system (cushion and back support) tilts backward.
- Can be manual or powered (independent operation by the user)
- Tilt ranges are 45 to 65 degrees
- Accommodate users with insufficient head and trunk control, hip pain, pressure relief under the pelvis,
may encourage trunk and neck extension for a more work-ready position
- may restrict the child’s field of vision (visual field is directed upward toward the ceiling requiring child to
flex the head forward to see), limit the development of head control

recline
- The back support can be shifted backward or forward for varying levels of support and upright posture
- Seat-to-back angle opens from the seated angle to about 170 degrees
- Gastrointestinal issues may need to recline after a meal
- Can be manual or powered

Question 24

type of wheelchairs

Answer 24

Economy Standard Wheelchairs
- are for short-term use because they are heavy and require significant energy to propel. They can be folded with limited adjustment features

Lightweight Wheelchairs
- weigh less (between 26 and 36 lb) than standard chair offers more flexibility and adjustments for
reduced effort and easier transportation

Ultra Lightweight Wheelchair
- (weighs <26 lb) are designed for active clients who may or may not participate in adapted
sports and recreation, such as competitive racing or wheelchair basketball

Heavy-duty Specialty Manual Wheelchair
- (accommodates seat widths >22 inches, and supports up to 400 lb) designed for
bariatric clients who require wheelchairs that can support >250 lb
- The center of mass should be positioned several inches forward and the rear axle is displaced forward to ensure stability

Specialty Manual Wheelchairs include manual tilt and manual recline wheelchairs
- Tilt Wheelchairs change the orientation in space and is better when there are devices mounted on the chair. Shear (friction which can tear skin) is not a concern. Can increase seat-to-floor height which can be dangerous if a client tries to get out of the chair. They cannot be rolled under a desk and tray items will fall off
- Recline Wheelchairs change the seat-to-back angle greater than 90 degrees. Offers rest without the need to transfer. Maintains hip precautions. Alleviate orthostatic hypotension. Less obtrusive and can roll under a desk. Not useful for clients with limited hip extension ROM. Cannot be used with contoured seating system due to causing shear (friction
which can tear skin)
- Both tilt and recline change the position for improved pressure relief, greater comfort, and postural control.

Question 25

type of seating

Answer 25

Planar
- flat surface for those who require minimal support. Planar cushion is a block of foam that can be adapted

Contoured (match the shape of the body)
-for those with moderate positioning needs who are at low risk for ulcers

Adjustable back can assist with the control of the pelvis.

Question 26

types of cushions

Answer 26

Foam
-inexpensive, lightweight, good envelopment (degree to which a person sinks) BUT can bottom out, prone to deterioration with moisture, and can trap heat

Air-filled
-long-term and short-term resilience, good pressure distribution, can be inflated to different degrees BUT userswith poor sensation may not detect air leak, high maintenance, and prone to tears

Gel
- good envelopment, thermal properties, pressure redistribution, and postural support BUT can weigh more

Honeycomb
- has good pressure distribution, airflow for ventilation, good resiliency BUT less envelopment.

Question 27

Postural control for wheelchairs

Answer 27

• The most important positioning principle is proximal stabilization which facilitates movement of the head/extremities. Positionof the pelvis is the first area addressed because it effects the posture of the entire body. Typically, the hip angle (seat-to-back
  angle) is maintained between 90 to 100 degrees
• Slight anterior tilt or a neutral pelvis is desirable. It should be leveled and in midline
• Hips at 90 degrees in recommended for most to inhibit extensor tone and reduce posterior tilt. Increase the amount of hip flexion, reducing the angle to less than 90 (80-90) to further inhibit extensor tone
• 90 degrees of hip flexion is difficult to achieve in those with tight hamstrings or deformity. Opening the hip angle slightly (5-10 degrees) reduces posterior pelvic tilt caused by the pull of the hamstrings
• Pelvic obliquity is when one side of the pelvis is higher. It identifies the side that is lower. Left pelvic obliquity means the left hip is lower and should be positioned higher.

Question 28

Positioning the W/C for a transfer

Answer 28

• Place the wheelchair at approximately a 0- to 30-degree angle to the transfer surface.
• Lock the brakes on the wheelchair and the bed
• Place both of the client’s feet firmly on the floor.
• Remove the wheelchair armrest closest to the bed.
• Remove the wheelchair pelvic seat belt.
• Remove the wheelchair chest belt and trunk or lateral supports if present.

Question 29

types of canes

Answer 29

straight or single access
- for one leg

wide-based quad cane
- to increase stability when person can balance on straight cane

narrow-based quad cane
- to increase stability when person can balance on straight cane
- for person who may not require much support

Question 30

types of walkers

Answer 30

standard walker
- for person w/ fair balance and ability to lift device with UE to advance

rolling walker
- for person who can’t lift standard walker due to UE weakness or impaired balance

hemi-walker
- for those who do not have the ability to use 2 hands

side-stepper
- walker that is put on the nonaffected side of a person

rollator (three-wheeled walker)
- for those who need increased stability and/or fatigue easily

walker bags, trays, and baskets
- to assist in transporting personal items

Question 31

types of crutches

Answer 31

standard crutches
- use under axilla for ambulation

platform crutches
- forearms are neutral and supported and hand are in neutral position

Lofstrand crutches
- proximal arm has closure around it instead of support in the axillary region

Question 32

bed mobility aids

Answer 32

hospital beds
- to assist with rolling, positioning for sleep and assuming a short-sit position

overhead trapeze
- to assist with rolling over and assuming a long sit position

rope ladders
- assist in pulling to a seated position

hoyer lift
- to transfer individuals who are dependent

bedpans and urinals
- to decrease need to leave bed

Question 33

transfer types

Answer 33

stand pivot
- person stands and turns to transfer to surface

pop-over or seated sitting
- for person with decreased endurance and/or weight bearing precautions

sliding board transfer
- for those who are not able to stand to transfer (SCI, amputations)

dependent
- caregiver fully performs transfer

mechanical lift
- ceiling lift, track lift, Hoyer lift