NBCOT AOTA RATIONALE- Work,Drivers Rehab, AE Flashcards
Which recommendation should the OTR® provide nursing staff to maximize this patient’s independence with BADLs for a pt functioning in Level VI in Rancho and observed to put toothpaste on a washcloth when preparing to brush teeth and attempted to brush hair with a toothbrush.
Provide task setup and simple instructions. To support use of appropriate tools and guided support in instructions.
A client WITH MS expresses interest in developing an exercise program but states that weakness and fatigue are barriers. What program should the OTR® FIRST recommend?
AQUATIC THERAPY to reduce effects of weakness while promoting exercise
What are advantages of a scooter over a power wheelchair?
They are lighter and easier to transfer in the car
According to CARF, what is the most commonly accepted client-to-staff ratio?
5:1 Ratio
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. It is a device for moving one leg at a time manually.
What is necessary for wheelchair safety for a client with bilateral lower-extremity amputations?
Rear antitippers. Because patients with BLE now have uneven weight distribution, the wheelchair is more likely to tip backward with less weight in the front. Thus, anti tippers prevent this.
A client is able to say only “yes,” “no,” or “hello.” This client is also incontinent of bladder and bowel and is unable to walk. In which stage of Alzheimer’s disease (AD) is this client?
Late stage of AD
A client in the late stage of Parkinson’s disease presents for an occupational therapy evaluation. Which of the following symptoms can the OTR® expect to see?
Resting tremor, rigidity, and oral motor deficits. Swallong becomes difficult in later stages. Resting tremor and rigidity begins in the early stage and persists throughout the later stages.
The OTR wants to elicit a postural response at the trunk when completing an intervention activity. Where should the OTR place task objects FIRST to elicit a trunk response?
Beyond arms reach to facilitate weight shift and postural changes.
Which assessment would be MOST effective for assessing this client’s upper-extremity ability who has ALS reporting limited fx abilities?
Purdue Pegboard. timed test of upper-extremity function and is useful in determining a client’s functional limitations.
Which assessment should the OTR® administer to assess a client’s ability to visually identify forms or objects from incomplete presentations?
MVPT
Which behavioral symptom might a client with early-stage dementia have?
a. Pacing
b.Difficulty choosing appropriate clothing
C. Vulgar or rude language
D. Suspicion
Suspicion
What is an effective strategy to facilitate maximal independence in self-feeding with a client who has middle- to late-stage dementia?
Provide hand-over-hand guidance for food retrieval and utensil-to-mouth motions.
What does vocational evaluation assesses?
Vocational evaluation assesses a client’s readiness and ability to engage in a particular occupation.
The movements of a client diagnosed with a TBI are exaggerated and oscillating. What term BEST describes the client’s movements?
Ataxia
The owner of a construction company asks an OTR® completing work tolerance screenings to notify applicants whether they have been hired on the basis of their screening results. What should the OTR® do?
Inform the owner that the OTR® will review the results of the completed work tolerance screenings with the owner so the owner can summarize the results with applicants and notify them of the hiring decision.
An OTR® is observing a client’s driving performance in a contained environment; the client is performing tasks and responding to demands involving car controls and car handling or maneuvers. Which testing approach is the OTR® using?
Closed Route
An employer of a meat-packing plant contacts an OTR® to provide consultation because of a recent increase in the prevalence of work-related musculoskeletal injuries. What would the OTR®’s FIRST course of action be?
Job site analysis. to obtain physical demands of the work
An OTR®; is educating a client with C7 spinal cord injury to use tenodesis grasp. What is an appropriate explanation to the client of how to engage tenodesis?
Bring the wrist back, and the fingers will grasp to hold on to an item
The client is employed as a plumber. Essential job functions include reaching, bending, crawling, lifting, pushing and pulling, using tools, and lifting materials weighing 25–50 lb. Which accommodation is MOST appropriate for the OTR® to recommend?
Flexible work schedule and use of leave of time as needed
What assistive technology would be appropriate to recommend to a client who has middle-stage dementia or the client’s caregivers?
Door alarms
A pt with B 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, what should the OT suggest?
Move the axle backward to move the COG of the pt from the front of the wheel towards more the back and add antitippers to reduce fall risk.
he OTR wants the client to be able to complete transfers when the client discharges to home. What strategy should the OTR use to enhance the client’s ability to transfer at home?
Address transfers in multiple areas and surfaces
(client’s room, tx room, hospital lounge). Generalization involves the ability to use skills and complete tasks in different contexts. Tasks should be practiced in varied contexts.
Who is the client in work injury cases?
Work injury cases involve many parties; the worker with the injury remains the client.
Seating biomechanics take into account the client’s stability, postural support, and mobility needs. When determining seating requirements, what would the OTR® FIRST assess?
PELVIS
While performing PROM for a client with stroke, the OTR®; notes that the client’s shoulder is resistant to flexion beyond 90°, although the client reports being pain free. What does this finding suggest?
The scapula is not gliding to produce full flexion. Muscles most likely shortened from disuse and limit full flexion.
An OTR®; is teaching a client with stroke compensatory strategies to don a pullover shirt. The client has hemiparesis that limits upper-extremity movement in the affected side. What is the FIRST step the client should be taught?
Dress affected arm first. WEAK SIDE FIRST in UB dressing
A client with multiple sclerosis (MS) experiences ataxic movements when performing fine motor self-care tasks. During treatment addressing oral hygiene, what might the OTR® FIRST do?
Position the client’s trunk and upper extremities to provide proximal support for the shoulders and elbows
What are the use of cross out assessments
Cross-out assessments are used in visual scanning and can be beneficial in detecting spatial neglect or visual field impairments.
An OTR® is working with a client with a T2 spinal cord injury. While performing ADLs, the client reports a pounding headache and is sweating profusely. What action is MOST APPROPRIATE for the OTR® to take to help the client?
Client must be experiencing autonomic dysreflexia in which BP is high. Place the client upright, remove restrictive devices, and check the client’s catheter, alerting the client’s nurse and physician as soon as possible
Which setting is MOST effective for job coaching with an adult client with mental illness?
Workplace with assigned job duties
An assembly-line worker is returning to work after being treated for cubital tunnel compression at the left elbow from prolonged pressure on surfaces. What is the MOST appropriate height for this client’s workstation?
Just below elbow height. Ideally tho for precision assembly–> above the elbow height is recommended but in this case, in order to reduce adding pressure to the elbow, placing it below would be best in addition to recommending a magnifier.
What should the OTR® tell the aides about the expected level of dressing performance for these residents who have Stage 3 AD?
Verbal cueing and physical assistance are needed throughout the dressing task
An OTR® is performing a physical examination to determine the client’s seating and positioning needs before ordering a new wheelchair. What rule of thumb would the OTR® use for the client’s ability to sit upright?
Minimal hip flexion of 90 degrees.
In a job demand analysis, what factors are included to accurately assess the overall level of work?
Strength demands, physical demands, and frequency of work tasks
A client with early-stage amyotrophic lateral sclerosis (ALS) wants to remain physically active and continue to go to the local gym. Which action would the OTR® take?
Recommend modified workouts consisting of endurance and light strengthening exercises
What strategy might an OTR® appropriately recommend to caregivers of a client with Alzheimer’s disease to assist with fall prevention?
Engaging client in daily structured activities
Why should fall prevention strategies be implemented with clients with middle-stage dementia?
Declines in judgment of distance, direction, and ground surfaces may increase risk of falls.
what does the Glasgow coma scale measure?
Eye opening, motor, verbal
An OTR® is working with a client in the active phase of C8 spinal cord injury. What is the BEST method of preventing heterotopic ossification in the client?
Maintain joint of ROM. Heterotopic ossification refers to the growth of bone in abnormal anatomic locations and is best prevented with joint ROM and medication routine
Ocular motor skills may impair a client’s ability to scan a busy intersection or to effectively maneuver a vehicle in an unfamiliar area. What are the performance implications for driving?
Increased time to identify objects in and along the road along with eye fatigue.
During the interview, the OTR® discovers that the client is required to lift construction equipment weighing 20 lb on a frequent basis. At what level of work must the OTR® create work simulation tasks?
Medium
=exerting 20-50 lb of force occasionally, 10-25 lb of force frequently
what constitutes light work?
20 lb occasionally and 10 lb frequently
what constitutes heavy work?
exerting <100 lb of force occasionally, <50 lb of force frequently
what constitutes very heavy work?
more than 100 lb of force occasionally, in excess of 50 lb of force frequently
The OTR® suspects the client is exhibiting less than maximum effort during assessment. How would the OTR® BEST assess grip strength to determine whether client is exhibiting maximal effort?
Have the client complete one trial on each of the five handle settings of the Jamar dynamometer.
The five-level grip test is used to determine maximum and consistent effort by clients. The OTR® should expect the strongest grip on the second and third handle settings
The client reports no crash record and no violations or citations but avoids night driving, highway driving, and driving in rush-hour traffic or heavy rain. What are the MOST APPROPRIATE areas of intervention for addressing remediation of the client’s driving skills?
Processing speed, visual scanning, and divided attention skills
The OTR® suggests that the client return to work on a light duty schedule. Which consequence is MOST likely to result when a client returns to work on light duty?
The client’s confidence in his or her abilities to complete job tasks increases.
An OTR® who is not a certified driving specialist has a client who needs an assessment to determine whether safe driving is possible. When is it necessary to refer this client to a specialist in driving?
When a formal driving evaluation has been determined to be necessary
A new client is unable to sit up on the edge of the bed or stand without assistance. The OTR® has decided to address bridging in bed. Why is this a functional activity for an OTR to address?
Bridging is used to assist with lower body dressing in bed.
Which assessment would an OTR® administer to assess a client’s ability to visually scan information using central and peripheral vision and to process that information in a timely fashion?
Useful Field of View
The OTR® observes that the wheelchair has a backrest cushion that positions the client’s pelvis beyond the rear wheel axle. Which wheelchair modification should the OTR® recommend to reduce the client’s shoulder pain?
Remove the backrest cushion
The client has CRPS Type 1 and the client’s pain increases to 6 or higher on a 0–10 scale while using the hand. The skin presents with mild discoloration of the dorsal surface of the wrist. What should the OTR® FIRST include when establishing the client’s work conditioning program?
Stress-loading tasks
During the ergonomic assessment, the OTR® observes that the client uses the mouse 80% of the time. What will the OTR® MOST likely recommend?
Performing full upper body stretches after every 20 minutes of mouse use
The client has repeatedly made comments to the therapist about experiencing pain during all activities and being unable to return to work because of constant severe pain. Which type of symptom magnification is the client MOST LIKELY exhibiting?
The gameplayer
(gamer player or malingerer) manipulate sxs for positive gain
The DOT defines _______an activity or condition that occurs one-third to two-thirds of the day.
frequently
The DOT defines ________ an activity or condition that occurs as much as two-thirds to a full day
constantly
The DOT defines ________ an activity or condition that occurs as much as one-third of the day.
occasionally
What is included when using a top-down approach to reduce risks in jobs?
Involving managers for work simplification
As systemic changes are expected for top-down approach
What should be the FIRST priority for the OTR® when addressing the issue of functional ambulation?
SAFETY
A client receiving special education instructional support arrives at the occupational therapy clinic for an evaluation as part of the student’s transition planning needs. As part of the evaluation process, what must the OTR® FIRST determine?
performance skills
A worker participating in back–neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10-lb discs onto a dowel. Which design element should be considered for the client’s workstation?
workstation height should allow some elbow extension
Clients who leave a workplace because of impairments can receive assistance from _______ to return to that or another workplace
vocational rehab
An OTR® is completing a functional ambulation task with a client when the client’s legs begin to buckle. What is the MOST appropriate way for the OTR to manage this issue?
Lower the client down on OT’s flexed leg slowly to the floor
When an OTR® evaluates a client’s visual range of view without eye or head movements, what is the OTR® examining?
Visual Field
Where should the front edge of the wheelchair seat be in relation to the client’s hamstrings?
1–2 inches proximal to the posterior side of the bent knee
A client is a hands-dependent sitter. What goals would the OTR® have for such clients when providing a positioning and seating system?
Support the pelvis and trunk to free the hands for activities
An OTR® is fitting a client with a pelvic deformity and minimal dynamic sitting balance impairments to a new wheelchair. What type of cushion would be MOST appropriate for a client with this issue?
Custom-countoured
