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726: Phys Dys > week 2 > Flashcards

week 2 Flashcards

1
Q

documentation purpose

A
  • record of session
  • legal document
  • reimbursement
  • reflects practitioner’s clinical reason and judgement
  • chronological record of client’s status
  • justifies need of skilled services
  • observation + interpretation= documentation
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2
Q

fundamentals of documentation

A
  • confidential requirements
  • client’s full name, date of birth, gender and case number
  • type of documentation
  • date services
  • acceptable terminology, acronyms, and abbreviation are used
  • clear rationale for purpose, value and necessity of skilled services
  • professional signature (first name or initial, last name) and credential
  • all errors are initialed and dated
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3
Q

ethical consideration

A
  • administrator directs an OT document patient as receiving 60 min of therapy; though patient was fatigued tolerating only 45 min
  • OT is asked to co-sign notes of an OTA not supervised by them
  • OT asked to use treatment code higher than services
  • documenting services not provided, using wrong billing codes, or co-signing notes without proper supervision are infractions possibly resulting in legal and professional sanctions
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4
Q

documentation flow and type

A
  • screening
  • evaluation
  • intervention a.k.a treatment plans
  • progress note
  • discharge note
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5
Q

medicare guidelines

A

4 criteria fro reimbursement of services

  • medically necessary
  • skilled services- safe and effective
  • consistent with diagnosis and symptoms
  • performed at safe, appropriate and effective level
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6
Q

medicare guidelines: medically necessary

A

patient’s condition requires skilled, knowledge and judgement of therapist to safely and effectively carry out POC

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7
Q

medicare guidelines: skilled services

A
  • intervention requires skills and competencies
  • specific to medical condition
  • treatment results in functional improvement
  • reduction in safety risks
  • prevention of secondary complications
  • teaching and training of caregivers
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8
Q

prognostic statement

A
  • best clinical judgement
  • establish goals
  • establish level of assist
  • establishes d/c plan
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9
Q

problem list

A
  • positive prognostic signs

- negative prognostic signs

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10
Q

problem list: positive prognostic signs

A
  • arousal
  • orientation
  • ability to follow directions
  • attention span
  • self-expression
  • ability to solve problems
  • medical stability
  • motivation
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11
Q

problem list: negative prognostic signs

A
  • pain
  • poor orientation
  • inability to attend under maximum structure
  • extreme uncooperativeness
  • medical instability
  • lack of ability
  • absent arousal
  • lack of intitation
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12
Q

problem statements

A
  1. develop problem list
  2. identify contributing factors
  3. prioritize outcomes
    client requires (assist level) in (occupation) due to (contributing factor)
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13
Q

metacognition

A
  • awareness of their own level of cognition

- conscious awareness of one’s thinking processes and ability to relate to processes in some way

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14
Q

assessing patient’s readiness for behavioral and lifestyle change

A

transtheoretical model of change

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15
Q

precontemplation

A

patient not intending to take action

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16
Q

contemplation

A

patient intending to take action in 6 months (ambivalent)

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17
Q

preparation

A

patient intending to take action in immediate future

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18
Q

action

A

patient makes specific behavior changes within last 6 months

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19
Q

enhancing occupational participation through

A

skill development and strategy generation

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20
Q

teaching-learning process involves

A
  • problem identification
  • problem solving
  • outcome assessment
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21
Q

stages of learning

A
  • aquisition
  • retention
  • transfer
  • generalization
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22
Q

learning is not merely a cognitive act; nor is it simply physical act of doing

A

also includes patient’s value and meaning placed upon activities in which they participate

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23
Q

acquistion

A

new skills and develop strategies for learning with application apply in natural contexts

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24
Q

dreyfus model

A
  • novice
  • advanced beginner
  • competent
  • profiecient
  • expert
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25
Q

dreyfus model: novice

A

concrete steps

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26
Q

dreyfus model: advanced beginner

A

requires greater attention and intention due to lack of experience

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27
Q

dreyfus model: competent

A

automatic

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28
Q

acquisiton OT facilitate strategic plans to

A

problem solve and develop new methods to perform task

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29
Q

learning

A

retention> transfer> generalization

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30
Q

cerebrovascular accident

A

CVA or stroke

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31
Q

CVA impacts

A

brain functioning

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32
Q

CVA last more

A

than 24 hours or leads to death within 24 hrs

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33
Q

stroke in one hemisphere of the brain often leads to

A

upper motor neuron dysfunction

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34
Q

hemiparesis

A

weakness

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35
Q

hemiplegia

A

paralysis

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36
Q

contralateral side

A

opposite side of body

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37
Q

CVA & other impairments

A
  • sensory impairment
  • cognitive and perceptual impairment
  • visual disturbances
  • behavioral changes
  • difficulty swallowing
  • speech and language function impairment
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38
Q

all impairments can significantly impact an individual’s ability to engage in chosen occupations

A

limiting participation and quality of life

39
Q

stroke epidemiology

A
  • # 1 cause of long-term disability in U.S
  • 795,000 cases on new or recurrent stroke each year
  • estimate 20.5% increase from 2011-2030
  • incidence higher in men (1.24%) although women have higher lifetime risk
  • > 50% acute neuro hospitalizations
40
Q

long term effects of stroke

A
  • 50% hemiparesis
  • 30% unable to walk without assistance
  • 26% dependent in ADLs
  • 19% aphasic
  • 35% clinically depressed
  • 26% during homes
  • QOL decreased
41
Q

CVA etiology 2 vascular syndromes causing stroke

A
  • ischemic

- hemorrhagic

42
Q

ischemic (approximately 87% of all strokes)

A
  • thrombus
  • embolism
  • also caused by systemic blood flow reduction
43
Q

thrombus

A

blood clot formed inside cerebral vessel

44
Q

embolism

A

blood clot originating in heart or arteries outside brain

45
Q

hemorrhagic

A
  • intracerebral (10% of strokes)

- subarachnoid

46
Q

subarachnoid most common causes of weakened vessels

A
  • aneurysms

- arteriovenous malformation

47
Q

transient ischemic attack

A

(TIA)

48
Q

F.A.S.T

A

Face
Arms
Speech
Time

49
Q

CVA modifiable risk factors

A
  • hypertension
  • diabetes mellitus
  • disorders of heart rhythm such as arterial fibrillation
  • high blood cholesterol and other lipids
  • cigarette smoking
  • obesity
  • lifestyle factors: physical inactivity, poor diet and nutrition
50
Q

CVA non-modifiable risk factors

A
  • age
  • gender
  • race
  • ethnicity
  • genetics
51
Q

medical management: acute care CVA

A
  • determining cause and site of stroke
  • preventing progression of lesion
  • reducing cerebral edema
  • preventing secondary medical complications
  • treating acute neurological symptoms
52
Q

medical management: acute care CVA: preventing progression of lession

A
  • restoration of blood flow and limitation of neuronal damage for ischemic stroke
  • control of intracranial pressure, prevention of rebleeding, maintenance of cerebral perfusion, and control of vasospasm for hemorrhagic stroke
53
Q

medical management: hospital CVA

A
  • dysphagia screening before oral intake
  • nutritional support
  • maintenance of appropriate blood pressure, body temperature, and blood glucose levels
  • cardiac evaluation and monitoring as needed
  • treatment of any acute complications that may arise (edema, pneumonia)
  • positioning & appropriate mobility
  • depression screening
54
Q

postacute care CVA

A
  • majority (2/3) of stroke survivors recieve rehabilitation
  • multidisciplinary team (physicians; nurses; occupational, physical and speech language therapist, psychology, social work, counselors
  • intensity varies by setting
55
Q

postacute care: intensity by setting

A
  • inpatient rehabilitation
  • subacute nursing homes
  • community home health
  • outpatient clinics
56
Q

recovery from stroke

A
  • varies with nature and severity of initial injury
  • spontaneous recovery
  • neuroplasticity
  • neurological and functional recovery
57
Q

stroke impact on daily occupation

A
  • kinds and mix of impairments vary with stroke but all impact performance and participation
  • trunk & postural control limitations impact functional mobility
  • upper extremity (UE) impairments affect use & control during daily activities
58
Q

trunk & postural control limitations impact functional mobility

A

walking, wheelchair use, body stability during reaching, placing

59
Q

upper extremity (UE) impairments affect use & control during daily activities

A

secondary complications of edema, muscle imbalances, shoulder pain & soft tissue injuries

60
Q

stroke impact on daily occupation: functional communications & QOL

A
  • converse, use email, items or people, understand what is said
  • different aphasias impact differently (broca, wernicke, anomic, global)
61
Q

stroke impact on daily occupation: visual impairments affect mobility, communications and object use

A

driving, functional mobility (falls), money management, use electronic communications, locating objects in environment

62
Q

stroke impact on daily occupation: psychosocial impairments

A

depression & anxiety frequently observed

63
Q

stroke impact on daily occupation

A
  • decreased or inability to participate
  • functional recovery
  • decreased social participation
  • interference with social relationships
  • altered sex drive
  • altered appetite
64
Q

assessment for transfer

A
  • cognitive function
  • visual acuity and perception
  • motor function
  • sensory function
65
Q

environmental attributes also influence person’s abilities during transfer and should be assessed

A
  • to and from bed
  • toilet
  • bathing equipment
  • car
66
Q

documentation of transfers

A
  • visual acuity and perception
  • cognition
  • motor function
67
Q

documentation for transfers includes

A
  • type of transfer accomplised
  • locations: starting and ending surfaces
  • amount and type of assistance required
  • amount and type of cuing/direction required
  • ambulation and or wheeled mobility devices used
68
Q

transfer goals

A
  • perform stand pivot transfer from to wheelchair and bed with distant supervision and occasional safety cues within 2 weeks
  • client will demonstrate good safety techniques during controlled fall from wheelchair and when regaining seated position
  • client will direct sliding board transfer with wheelchair set up, sliding board placement and removal, demonstrating safe transfer by 1 week
69
Q

intervention for improving transfer

A
  • remediation

- adaptation

70
Q

intervention for transfers

A
  • address underlying impairments and direct transfer training
  • impairment can be addressed alone or in combination
  • addressed in several activities while practicing actual transfers
  • environmental attributes also varied during training-differing heights of transfer surfaces
71
Q

transfer principles equipment set appropriate

A
  • optimal setup put feet in a position where they can just pivot without having to take any steps
  • wheelchair setup at about 45 deg angle from other transfer surface
72
Q

transfer principles weight shifts and body mechanics

A
  • transfer movements eased when person shifts weight forward bringing center of gravity over feet
  • maintain best position attainable
  • assure low back muscles are not overstretched and tenodesis hand grip is preserved
73
Q

transfer principles prepare for transfer

A
  • ensure wheel locks are engaged

- position oneself (such as feet off footrests and in position)

74
Q

transfer principles use momentum

A

compensate for weakness during transfers

-use assistance when in doubt

75
Q

optimal techniques

A
  • stand pivot transfer

- modified stand pivot transfer

76
Q

stand pivot transfer

A
  • person pushes up from seat surface-rise to standing and regains balance
  • pivots feet to stand with back to transfer surface
  • person reaches back and slowly sits
77
Q

modified stand pivot transfer

A
  • person stays in a crouch position

- reach for or hold on to transfer surface

78
Q

ambulation aids

A
  • canes, crutches and walkers-used to help people move from one place to another-often useful during transfers
  • standard walker (four legs) gives bilateral support
  • ambulation aid is included in documentation
79
Q

activities of daily living (ADLs)

A
  • basic activities of daily living (BADLs)

- basic skills-self-care, mobility

80
Q

instrumental activities of daily living (IADLs)

A
  • more advanced problem-solving skills
  • meal preparation
  • home management - $
  • emergency aid
81
Q

both ADL and IADL assessments

A
  • canadian occupational performance measure (COPM)

- kohlman evaluation of living skills (KELS)

82
Q

ADL assessments

A
  • barthel index

- functional independence measure (FIM)

83
Q

IADL assessments

A
  • assessment of motor and process skills (AMPS)

- kitchen task assessment (KTA)

84
Q

methods of teaching ADLs

A
  • physical cueing
  • manual guidance
  • repetition
  • backward chaining
85
Q

backward chaining

A
  • therapist assists client until last step is reached, and client performs last step independently
  • repeat as above, but client performs last two steps independently, etc
86
Q

functional independence measures (FIM)

A 
7-complete independence
6-modified independence
5-standby assistance/supervision
4-minimal assistance/contact guard
3-moderate assistance
2-maximal assistance
1-total assistance/dependent
87
Q

FIM 7

A

complete independence

no setup, cues or touching

88
Q

FIM 6

A

modified independence

adaptive equipment, longer time needed, safety considerations

89
Q

FIM 5

A

standby assistance/supervision

set-up, cues, coaxing, within one arm’s reach of patient

90
Q

FIM 4

A

minimal assistance/contact guard

75% or more, any touching

91
Q

FIM 3

A

moderate assistance

50-74% of work, more help than touching, any lifting

92
Q

FIM 2

A

maximal assistance

25-49% of work

93
Q

FIM 1

A

total assistance/dependent

<25% of work, automatically a total assist with 2 people assisting

726: Phys Dys (7 decks)

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