Mastery of the environment: evaluation and intervention Flashcards
correct answers about planning d/c
with an older adult - consider multiple contexts in the home: physical (architectural barriers), sensory (lighting), social (available network), cultural (norms related to family caring), personal (demographics, age, SES, education), temporal (daily routine), and virtual (access to tech)
legislation related to the environment
- ADA: mandates full participation in society for people with disabilities
- Omnibus budget reconciliation act (OBRA): restraints cannot be used without proper justification/documentation
- IDEA: children with disabilities receive education in the lease restrictive and most neutral environment (IEPs, accommodations, inclusive models)
- Assistive technology act: improves access of AT by funding
- Fair housing amendments act: all multifamily housing with an elevator and ground floor units of buildings w/o an elevator meet 7 accessibility requirements
- Section 504 of rehabilitation act: all programs receiving fed air make reasonable accommodations for those with disabilities including alterations in physical spaces
principles of universal design
- Equitable use: design is useful and marketable to people with diverse disabilities
- Flexibility in use: accommodates a wide range of individual preferences
- Simple and intuitive use: easy to understand
- Perceptible information: communicates necessary info to the user regardless of abilities
- Tolerance for error: minimizes hazards
- Low physical effort: design can be used efficiently and comfortably w/o fatigue
- Size and space for approach and use
question about OT providing home based services to a person who is visually impaired
- providing AT and environmental modifications
- ADLs and IADLs
- functional mobility training in their home
- collaboration with social worker/case manager for funding for AR
- refer them to certified orientation and mobility (O&M) specialist for community training
assistive tech caution
do not show them top of th eline devices that is not covered by their insurance and if they do not have the financial resources to self pay for them
Evaluation of home safety - standardized assessments
- Safety assessment of function and the environment for rehabilitation (SAFER): response to safety concerns in the home
- Safety assessment scale (SAS) - people with neurocognitive disorders/safety in home
- Home environment assessment protocol (HEAP): neurocogntive disorder for 4 major dimensions - safety of common home hazards, support of daily function through adaptations, support of orientation with visual cues, support of comfort with meaningful items
- In-home occupational performance eval (I-HOPE): activities performed in the home that are required for aging in place, sort 44 activity cards and observe doing relevant ones
low vision evaluation
assesses the ability of people with low vision to maintain their safety and independence within their home and community
*administer in well-lit clinic or home environment with no glare
- medical history/dx, client factors, self-report and goals, assessments of vision (acuity, field, contrast)
standardized and non for low vision
- flower design card: determine dominate eye (process vision)
*important to not tell the person what is being tested until after bc it will skew results - Low vision LEA numbers chart (acuity)
*client cannot move their head closer to the target
more on page 467
helpful hints for administrating low vision assessments
- may wear glasses except visual field testing
- maintain the correct distance according to the test
- generally, test eyes individually then together except near visual acuity bc reading happens with both eyes
- well lit environment except for peripheral visual field testing
low vision intervention
- training and compensatory techniques in ADLs
- use of adaptive devices, magnification, prisms
- better person environment fit, home modifications
- PRL training: preferred retinal locus: use intact vision by looking around the Sotoma (dark spot) to focus on top, bottom, L/R of an object
- increasing contrast between rooms, tape on stairs
- removing clutter
- using other senses: tactile, counting steps
- keep commonly used items in the same places
fall efficacy scale (FES)
measures a person’s fear of falling during nonhazardous activities of daily living (dressing, meal prep, mobility)
not at all concerned to very concerned
interventions to prevent falls
- eliminate or minimize fall risk factors, stabilize disease states, manage medications
- improve functional mobility
- sensory compensation strategies (lighting, markings)
- modify ADL - sitting, adaptive devices
- energy conservation
- modify environment in all areas of the home and outside
- sturdy shoes no socks
if a fall occurs
- check for cuts, bruises, painful swelling
- serious injuries: head injury, SCI, hip fracture
- check for dizziness
- do not lift them alone, call for help
wheelchair cautions
- if back height of a chair is extended, may prevent them from locking onto the push handle for stabilization or weight shifting, may be more difficult to fit into a vehicle
- reclining back wheelchairs may elicit flexor or extensor spasms and should not be prescribed for someone with spasticity
- reclining back chairs should not be prescribed to someone with limited him or knee ROM because it may exceed their available range
bed mobility s/p THA
no rolling on operated side (bc internal rotation)
use abducter pillow to prevent adduction
