Midterm B Unit 5

Question 1

Subtest areas

Answer 1

like fine motor precision and fine motor integration provide scaled scores. Scaled scores help us to be able to compare one person’s score to another but are different than a standard score in that they don’t necessarily follow a bell curve. That is that we can’t say that a percentage of the population would typically fall above or below the median scaled score like we can in a standard score. It does allow us to compare the score to others who have performed the assessment though.

Question 2

Composite score

Answer 2

example fine motor control is made up of fine motor precision and fine motor integration together. With these composite scores, you do get a standard score which allows you to compare the score to peers and see how the client is performing based on a normal bell curve.

Question 3

types of scores that you get one

Answer 3

First, you get a total points score. These total points score really don’t mean a lot to you unless you’re extremely familiar with the test. That doesn’t tell you anything about the relationship between the child’s performance and typically performing peers.

Question 4

types of scores that you get two

Answer 4

The confidence interval is telling us that within 90% confidence we can say what a child scored. It’s pretty much like saying we’re pretty sure we’re right within a certain range like within 3 for motor precision. We have a scale score of 17, and we’re 90% that we are confident we got the right score plus or minus 3, meaning given a retest they may score between 14 and 20, which is plus or minus 3 from 17. This information helps us to narrow how close they are to being within the norm or outside of the norm

Question 5

Some of these Subtests

Answer 5

have a much broader band in which we can assert confidence. This may mean that if the norm for manual coordination is 21, they could be a lot closer to the norm than we’re suspecting and a standard score of 27 because the confidence interval is plus or minus 6.

Question 6

Percentile rank

Answer 6

information that was given in many instances, especially with pediatric assessments. Percentile rank, age equivalent, and descriptive categories are nice information to have, but when we are reporting scores on documentation, we want to use the actual standard and scale scores to describe the client. The percentile ranks, age, and descriptive categories are better for when we’re talking to parents.

Question 7

bell curve about standard deviation e.g.

Answer 7

Well we have a composite score, and we’re looking for a 90% confidence interval that a
the standard score falls within one standard deviation away from the norm. What this means is that most children, 68%, will fall within one standard deviation below or above the average. Once you get outside of that one to two standard deviations, we start to be a little bit concerned about the child’s performance. Only 27% of children perform 1-2 standard deviations above or below the norm. Then when we moved to well below the average, we’re saying that a very small percentage of children perform at that level. For more than 2 SD below the norm, less than 2.5% of the population performs at that level. If we look at this child’s scores, we can see the standard score along with the confidence intervals.

Question 8

Reviewing the standard scores helps us to

Answer 8

understand that the child is typically performing fine manual control but is below average to well below average on several other subtests with their lowest score most in manual coordination. Additionally, we can do the same with subtest scaled scores where we look at how the child is performing compared to averages which in this case is 15. We can see that the child is performing well in fine motor precision and fine motor integration as well as balance with some below-average performance in bilateral coordination, strength, and upper limb coordination, and well-below-average performance in the area of manual dexterity and running speed and agility.

Question 9

What is missing from this problem statement “Hand over hand assistance is needed due to difficulty with manipulation”?

Answer 9

occupation

Question 10

What is missing from this problem statement “Max A for w/c to bed transfer”

Answer 10

contributing factor

Question 11

What is missing from this problem statement “Cues are needed for cooking due to deficits in task initiation and termination”?

Answer 11

assist level

Question 12

What is a problem statement?

Answer 12

identifies the areas of occupation and the contributing factors that are causing those occupations to be a problem for a client. They are developed as part of a problem list that you come up with during the initial assessment. So you can think about if you’re looking at a client and you are trying to create a picture of what are they having problems with and what is contributing to those problems?

Creating problem statements allows for prioritization so you can create five, or six, however, many problem statements are appropriate for the client.

Question 13

Problem statements are similar to…

Answer 13

when you created a domain where you listed what occupation was the problem from a broad category like ADL, I ADL what was the subcategory that was a struggle for the client to engage in, like bathing, dressing, driving. And then why is that occupational performance a problem.

to connect it back to those other areas of the domain, like performance patterns, performance skills, context and environment, and client factors.

Question 14

In terms of prioritization…

Answer 14

think about what skills are needed to build on future skills. So if the person is unable to sit edge of bed due to sitting balance issues, they are probably not going … you could create a problem list statement that includes their inability to drive or their inability to stand in the shower, their inability to participate in a leisure activity or a work task. But those aren’t necessarily a priority at this point. If they can’t even sit edge of the bed, we’re probably not going to be working on them getting back to participating in something like water aerobics if that’s their leisure activity or get back to driving if they’re not able to sit on edge of the bed.

Question 15

Now is it important that they have functional mobility?

Answer 15

Absolutely.
But you would talk about it in terms of functional mobility, not the length that they can
walk. That’s more of a PT-related problem statement

Question 16

What do you think is causing the problem?

Answer 16

If you think it’s a client factor, then you’re going to go to the specific components under client factors and decide what the contributing factor is. For example, it could be a body function, a mental-body function like memory. It could be a global mental function like energy and drive. You could think of a performance scale and maybe it’s a process scale-like navigate. It depends on what is going on with your specific client. Remember though that these need to be appropriate for what you are going to be able to do as the occupational therapist. So
when you’re selecting an occupation, it should be appropriate for the setting that you’re
in and for the type of client that you’re working with.

Question 17

after you’ve selected your occupation and your specific component

Answer 17

then select a potential contributing factor. that occupational participation or that rationale
section. Why is this a problem? And go to your performance skills, client factors,
performance patterns, and context and environments, and select one of those areas.

Question 18

Writing appropriate problem statements

Answer 18

We want to address the recipient of the service. So you can use things like the client, patient, student, child, infant, consumer, resident, individual veteran, or Mr. Or Mrs. As well as addressing the person by their first and last name if it’s appropriate.

When in doubt, always go with more formal than less formal.

Question 19

When you’re writing a problem statement

Answer 19

the diagnosis is not the problem. The contributing factor that’s a result of the diagnosis is the problem that’s contributing to an occupational performance deficit. What we can change as an OT, what we are treating is the factors that result from that.

So you would not write a problem statement that said that the person was unable to
drive due to a right CVA or right-sided stroke, because the right-side stroke is the
diagnosis. That’s not why they’re not able to drive. It’s the resulting factors that
developed because of the right-sided stroke that cause them to not be able to drive.
And this is very important when you’re documenting because you can’t fix a right-sided
stroke, a right-sided CVA.

Question 20

treatment codes versus diagnosis codes

Answer 20

The ICD-10 codes for treatments and medical diagnoses are different. The medical
diagnosis, in this case, would be a right-sided CVA, which has its own set of numbers that
identifies that as the problem. And the treatment diagnosis may be the generalized
weakness or the hemiplegia or the increased tone or the decreased ability to participate
in ADLs. Whatever is going on as a result of the CVA.

Question 21

the basics of writing a problem statement

Answer 21

problem statements follow the development of the occupational profile and the analysis of occupational performance, which makes up the evaluation. So you write, you go through the evaluation. You might do an interview, you might do some assessments with them, and then you come up with your problem list.

whenever possible you want to specify the extent that which there is an interference with
occupational performance. So we don’t want to just say that they’re having a problem
with bathing. How many problems with bathing are they having? The more measurable
we can make the problem statements, the easier it’ll be to write your goals, but also the
easier it will be for you to show progress.

Question 22

What you want to do first is

Answer 22

identify the area of occupation with a measurement of the limitation if possible. So something like unable to prepare a meal independently, they’re not able to prepare a meal independently. A better way to write that might be that they require mod assist to prepare a meal.

what that means is that they require 50% assistance to prepare a meal. That’s a
measured component of the limitation. We also want to identify the contributing factor
with measurement if possible and include the diagnosis as what the contributing
factor is secondary to. So the causing factor may be decreased balance. That’s the
contributing factor secondary to a right CVA. That’s the diagnosis. What would be even
better is if I had a measure of the decreased balance like fare plus, which is a way we
grade balance.

Question 23

Example of what NOT to do

Answer 23

The client is unable to prepare a meal independently due to decreased balance secondary to a right CVA. As mentioned before, there was a problem with this because we were unable to document progress, unable to perform versus assist level required for the occupation are two very different things. And when possible you should be including the assist level required. We also didn’t indicate the amount of limitation in the contributing factors, so if at all possible we should include a measure of the limitation.

Question 24

A good example of what to write

Answer 24

client requires max assist to prepare meals independently,
due to decreased balance with a grade of fare plus secondary to a right CVA.

you should be able to say that this is the assist level, max assist. I’ve identified the individual client. This is the occupation, preparing a meal, which thinks about what occupation is that? You should’ve thought IADL. Contributing factor is the balance. The measurement of balance is fair plus and the diagnosis is the right CVA.

a short sentence that tells you that the client is unable to prepare a meal without max assistance because they have fare plus balance after a right CVA.

Question 25

another good example of writing

Answer 25

Ms. P requires mod assist for lower body dressing due to decreased stability to bend secondary to 7 out of 10 low back pain.

Included is the diagnosis, which is the low back pain. I’ve only included decreased stability to bend, which doesn’t have a measurement. You could do some kind of functional measurement to put in there about how far they’re unable to bend or what the limitation is.

Question 26

exceptions to think about

Answer 26

They either can or can’t participate in work.
It’s very hard for them to participate in work with 50% assistance or 75% assistance.
There are some other variables. Perhaps they need cues. Perhaps they need
modifications. But sometimes it’s just a can or cannot. In that case, you would write it
without the assist level where you say the client is unable to engage in what occupation due to what contributing factor. Such as Ms. P is unable to drive herself due to diplopia. I have a hard time saying that word, which is double vision, secondary to a TBI. What would double vision fall under? What contributing factor? You should have thought client factor and sensory function. Drive falls under what occupation? You should have thought I ADL.

Question 27

OTR role in Evaluation

Answer 27

OTR directs the evaluation process and all aspects of the initial contact. Initiates and directs the evaluation interprets data, and develops the intervention plan. Delegates assessment task to the COTA as indicated. Interprets information from the COTA and integrates the data into the process.

Question 28

COTA role in Evaluation

Answer 28

COTA implements delegated assessments; must demonstrate service competency in order to do so. Provides verbal and written reports of observations, assessments, and client capacities to the OTR.

Question 29

OTR’s role in intervention planning

Answer 29

OTR takes the overall responsibility for the development of the intervention plan. Collaborates with the COTA and client to develop the intervention plan.

Question 30

COTA’s role in intervention planning

Answer 30

COTA collaborates with the OTR and client to develop the intervention plan. Must be knowledgeable about evaluation results. Can provide input into the intervention plan based on client needs and priorities.

Question 31

OTR’s role in intervention implementation

Answer 31

OTR takes the overall responsibility for intervention implementation. Delegates aspects of the plan to the COTA and provides appropriate supervision for this. Collaborates with the COTA to select, implement, and make modifications to OT interventions.

Question 32

COTA’s role in intervention implementation

Answer 32

COTA must be knowledgeable about the client’s OT goals. Collaborates with the OTR to select, implement, and make modifications to OT interventions. Participates in the supervisory process to ensure competency and meet the requirements of the setting and law.

Question 33

OTR’s role in intervention review

Answer 33

OTR responsible for determining the need for continuing, modifying, or discontinuing OT services. Elicits information from the COTA and reviews documentation by the COTA about the client’s responses to intervention.

Question 34

COTA’s role in intervention review

Answer 34

COTA exchanges information with the OTR and provides written documentation about the client’s responses to and communications during the intervention.

Question 35

OTR’s role in targeting and evaluating outcomes

Answer 35

OTR is responsible for selecting, measuring, and interpreting outcomes related to the client’s occupational performance. Delegates outcome measurements and identification of discharge-related resources to the COTA as appropriate.

Question 36

COTA’s role in targeting and evaluating outcomes

Answer 36

COTA must be knowledgeable about the client’s targeted OT outcomes. Provides information and documentation related to outcome achievement. May implement outcome measurements and provide needed client discharge resources as delegated by the OTR.