Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
267 Cards in this Set
- Front
- Back
|
What is the Domain of OT?
|
The focus and factors addressed by the profession
|
|
|
What is the Process of OT?
|
Describes how OT does what it does; puts the concept of occupation into practice
|
|
|
What is step 1 in the evaluation process?
|
Collect information for the initial database
|
|
|
What is step 2 in the evaluation process?
|
Conduct an information-gathering clinical interview
|
|
|
What is step 3 in the evaluation process?
|
Gathering clinical (objective) data
|
|
|
What is step 4 in the evaluation process?
|
Documenting the assessments
|
|
|
Long-term goals include what?
|
The area of occupation
|
|
|
Short-term goals include what?
|
Performance skills and client factors
|
|
|
What do functional goals do?
|
Describe changes we hope to see in performance skills or patterns that will lead to improvements in areas of occupation - bottom up approach
|
|
|
What are the components of a functional goal?
|
A = actor (patient)
B = behavior (will improve/demonstrate) C = Conditions under which behaviors will occur D = degree (level of performance) or duration (time frame) |
|
|
Goals should be what?
|
R = relevant
U = understandable M = measurable B = behavioral A = achievable |
|
|
An initial evaluation should include what?
|
dx, disability status, PMH, assessment results, POC
|
|
|
Progress notes, including SOAP notes, should include what?
|
they should summarize the treatment program and patient's progress to date; should include: # of visits, problems, status towards goal achievement, treatments/interventions used, POC
|
|
|
Discharge notes should include what?
|
Provides a summary of outcomes of treatment; should include: # of visits, tx goals, summary of patient's progress, reason for D/C, remaining problems, recommendations
|
|
|
"SOAP" note stand for what?
|
S: Subjective - info told by patient
O: Objective - ADL assessments, all assessments A: Assessment - interpretation P: Plan |
|
|
Objective information includes what?
|
- How long did we see pt.?
- What did we focus on? - What activities did we do? |
|
|
Assessment information includes what?
|
- How well did they participate?
- make inferences |
|
|
The Plan includes what?
|
Goals, what they will continue to work on
|
|
|
What is validity?
|
How well does the test measure what it is supposed to measure?
|
|
|
What is reliability?
|
How consistently does the test measure? How dependable is the test?
|
|
|
What is the Rehabilitation FOR?
|
Teaches compensatory methods when remediation of underlying deficits is not possible
|
|
|
What is the main goal of OT:
|
for the patient to achieve maximal level of independence
|
|
|
Using a "holistic approach" means what?
|
Dealing with the psychosocial and psychological issues which impede independence and adaptive behaviors.
|
|
|
What is forward chaining?
|
teach steps in order and do in order
|
|
|
What is backward chaining?
|
teach last step first
|
|
|
What does a top-down approach to evaluation consist of?
|
therapist begins assessment process by learning about the client's occupational history and interests
|
|
|
What does a bottom-up approach to evaluation consist of?
|
therapist focuses on identifying problems in specific performance factors
|
|
|
What is Adaptive Equipment?
|
used to compensate for physical limitation, to promote safety, and to prevent injury
|
|
|
What is Electronic Aids to Daily Living?
|
provide a bridge between an individual with limited function and an electronic device
|
|
|
What are the effects of a left side CVA?
|
expressive and receptive language
|
|
|
What are the effects of a right side CVA?
|
sensorimotor, visual perceptual
|
|
|
What is the etiology of a CVA?
|
hypertension, blood vessels become inelastic (plaque build-up), high cholesterol, age, gender, genetics, heredity
|
|
|
What is the pathophysiology of a CVA?
|
lack of blood flow, plaque build-up
|
|
|
What does the anterior cerebral artery control?
|
emotion, executive functioning
|
|
|
What does the cerebellum control?
|
equilibrium, balance, and coordination
|
|
|
What does the middle cerebral artery control?
|
sensory
|
|
|
What does the posterior cerebral artery control?
|
sensorimotor and vision
|
|
|
What is an Ischemic CVA?
|
- coratid artery
- build up on arteries and lack of blood flow |
|
|
What is an embolism?
|
a blood clot or piece of plaque breaks off and travels to brain
|
|
|
What is thrombosis?
|
blockage in the arteries causes a lack of blood flow to brain
|
|
|
You will see the most amount of recovery in a CVA patient during what period of time?
|
The first 6 months
|
|
|
What is the COPM?
|
Canadian Occuaptional Performance Measure - standardized interview to gain information on what is important to the client
|
|
|
What are the effects of a CVA on trunk control?
|
- inability to perceive midline
- poor static sitting posture - trunk weakness in all planes - spinal contracture - inability to shift weight through pelvis |
|
|
What are the symptoms of impaired trunk control following a CVA?
|
- dysfunctional arm control
- increased falls - visual dysfunction - dysphagia - poor sitting alignment |
|
|
Define dysphagia
|
difficulty swallowing
|
|
|
Aphasia can affect what?
|
can affect auditory comprehension, reading comprehension, oral expression, written expression, ability to interpret gestures, and mathematical skills
|
|
|
Define Alexia
|
reading comprehension
|
|
|
Define Agraphia
|
Written expression
|
|
|
Define Global aphasia
|
loss of all language skills
|
|
|
What is Broca's aphasia?
|
speech apraxia and agrammatism
(language expression - "broken language") |
|
|
What is Wernicke's aphasia?
|
impaired auditory comprehension and feedback with words
|
|
|
What is Anomic aphasia?
|
difficulties with word retrieval only
|
|
|
Define Dysarthria
|
NOT expressive aphasia
Articulation disorder resulting from dysfunction of CNS mechanisms that control speech muscles |
|
|
Assessing level of arousal consists of what?
|
how awake and mentally active the patient is
|
|
|
Assessing orientation consists of what?
|
person, place, time, and situation
|
|
|
Assessing cognition consists of what?
|
familiarity and recognition of faces and objects
|
|
|
Assessing attention span consists of what?
|
the patient's ability to stay on task
|
|
|
What is the incidence of depression among clients who have sustained a CVA?
|
32-61%
|
|
|
Following a CVA, look for psychosocial adjustment such as:
|
anxiety, agoraphobia, substance abuse, sleep disorders, mania, aprosody (difficulty in expressing or recognizing emotion), behavioral problems, lability, and personality changes
|
|
|
What is Motor Control?
|
the ability to make dynamic postural adjustments and direct body and limb movement in purposeful activity
|
|
|
Motor control requires what?
|
- normal muscle tone
- normal postural tone and postural mechanisms - reflexes - selective movement - coordination |
|
|
Motor control is regulated by what?
|
cerebral cortex, basal ganglia, and cerebellum
|
|
|
The basal ganglia controls what?
|
Movement - like tremors in parkinson's disease
|
|
|
The cerebellum controls what?
|
coordination and balance
|
|
|
What is plasticity?
|
The ability for the brain to recovery after a brain injury or a lesion. Brain can take over for damaged areas
|
|
|
What is normal muscle tone?
|
A continuous state of mild contraction. High enough to resist gravity but low enough to allow movement.
|
|
|
What does normal function of muscle tone rely on?
|
cerebellum, basal ganglia, vestibular system, neuromuscular system, normally-functioning stretch reflex, motor cortex, midbrain, spinal cord functions
|
|
|
Normal muscle tone is characterized by what?
|
- Effective co-activation
- Movement against gravity and resistance - Ability to maintain limb position - Balanced b/w agonist and antagonist - Ability to shift b/w stability and mobility - Ability to use mms in groups or selectively with normal timing and coordination |
|
|
Flaccidity is characterized by what?
|
absence of tone and deep tendon reflexes
|
|
|
What is hypotonus?
|
Decrease in normal muscle tone (low tone) with diminished or absent deep tendon reflexes
|
|
|
What is hypertonus?
|
Increase in muscle tone; worsens in presence of noxious stimuli - often occurs in synergistic neuromuscular pattern (UE flex, LE ext)
|
|
|
What are the 3 characteristics of Spasticity?
|
- hyperactivity of the muscle spindle's phasic stretch reflex with hyperactive firing of IA afferent nerve
- velocity dependence - clasp-knife phenomenon |
|
|
How is spasticity different from hypertonia?
|
- Hypertonia is not velocity dependent
- During PROM, there is no catch felt with hypertonia |
|
|
What is Clonus?
|
- A specific type of spasticity often present in clients with moderate to severe spasticity
- Characterized by repetitive contractions in the antagonistic muscles in response to rapid stretch |
|
|
What is Rigidity?
|
An increase in muscle tone of agonist and antagonist muscles simultaneously.
|
|
|
What is Lead pipe rigidity?
|
resistance through entire movement
|
|
|
What is Cogwheel rigidity?
|
Goes in a pattern like:
mvt - stop - mvt - stop - etc. |
|
|
What is Decorticate rigidity?
|
increased tone in extensors - arms and fist clench
|
|
|
When should you rate spasticity and hypertonia?
|
In the same position and at the same time of day with specific clients
|
|
|
How should you assess spasticity?
|
move limb through PROM rapidly
|
|
|
How should you assess rigidity/hypertonia?
|
move limb through ROM slowly and note location of first tone
|
|
|
What is Heterotrophic Ossification?
|
If the person's body parts are not moved over a period of time (days to weeks), the body deposits boney (osteoblasts) material in the tendons. The area becomes inflammed and is painful
|
|
|
Tone and strength can be influenced by:
|
- position of head and body in space
- abnormal contractions - deficits in tactile and proprioceptive sensation - impaired reciprocal inhibition |
|
|
How do you evaluate strength and control in trunk flexors?
|
Sit client up and observe control with anterior and posterior trunk shifting by therapist
|
|
|
How do you evaluate strength and control in trunk extensors?
|
Observe for ability to attain and maintain erect spine and neutral pelvic tilt
|
|
|
How do you evaluate strength and control in trunk lateral flexors?
|
Observe for ability to laterally shift trunk L and R
|
|
|
How do you evaluate strength and control in trunk rotators?
|
Reaching, trunk extension with rotation, segmental rolling
|
|
|
Define Ataxia
|
delayed initiation of movement responses, errors in force and range of movement, errors in rate and regularity of movement
|
|
|
Define Adysdiadokinesia
|
inability to perform rapid alternative movements
|
|
|
Define Dysmetria
|
inability to estimate ROM necessary to reach target - hyper- or hypo- (may over or under estimate distance)
|
|
|
Define Dyssynergia
|
voluntary movements are broken up into components parts and appear jerky
|
|
|
What is Rebound phenomenon of Holmes?
|
lack of check reflex
|
|
|
What is a Nystagmus?
|
involuntary eyeball movement
|
|
|
What is Dysarthria?
|
explosive or slurred speach
not limited to cerebellum - tounge, esophagus, trachea |
|
|
What is Chorea?
|
irregular, puposeless, involuntary, coarse, quick, jerky, dysrhythmic movements
|
|
|
What are Atheoid movements?
|
continuous, slow, wormlike, arrhythmic movements that primarily affect distal extremities
|
|
|
What is Dystonia?
|
persistent posturing of the extremities with concurrent spine torsion and trunk twisting
|
|
|
What is Ballism?
|
limb flies out suddenly
|
|
|
What is a Tremor?
|
intention, resting, essential famillial (head bobbing)
Due to depletion of dopamine or damage to the cerebellum |
|
|
What are the physical effects of Poliomyelitis and Post-Polio Syndrome?
|
extreme fatigue, muscle atrophy, scoliosis, osteoporosis, fractures, contractures, depression
|
|
|
What are the functional effects of Poliomyelitis and Post-Polio Syndrome?
|
ambulation, stairs, driving, eating and swallowing, decreased health status, transfers, home management, dressing, bladder/bowel control
|
|
|
What should an assessment of Poliomyelitis and Post-Polio Syndrome consist of?
|
ROM, sensation testing, coordination, activity demands, COPM, psychosocial and emotional factors, MMT, swallowing assessment, respiratory function
|
|
|
What should you look for when assessing axillary nerve injuries?
|
weakness or paralysis of the deltoid muscle, leading to limitations in shoulder flexion, abduction, extension, and weakness in lateral rotation of the arm
|
|
|
What muscles are affect with Erb-Duchenne Syndrome?
|
- muscles of the shoulder and elbow are affected, hand movement is retained
- look for: paralysis and atrophy in the deltoid, brachialis, biceps, and brachioradialis muscles; Waiter's tip position |
|
|
What is the "waiter's tip position?"
|
elbow extended
forearm pronated wrist flexed |
|
|
What is Klumpke's syndrome?
|
- muscles that are used for wrist and finger flexion and abduction and adduction of the fingers are affected
- look for: paralysis to the distal musculature of the wrist flexors and the intrinsic muscles of the hand, intrinsic minus hand deformity, claw hand deformity |
|
|
Assessment of a long thoracic nerve injury should consist of what?
|
- muslces that are used to anchor the apex of the scapula to the posterior rib cage, and scapular abduction and upward rotation
- look for winging of the scapula |
|
|
What is Myasthenia Gravis?
|
- affects the neuromuscular junction
- symptoms include eyelid drooping, double vision, oropharyngeal muscle weakness, decreased intercostal muscle strength leading to difficulty coughing, decreased muscle strength and endurance throughout the day |
|
|
What is ptosis?
|
eyelid drooping
|
|
|
What is diplopia?
|
double vision
|
|
|
What are the three major types of Muscular Dystrophy?
|
- Duchenne
- Fascioscapulohumeral - Myotonic |
|
|
What does executive functions include?
|
volition, planning, purposive actions, effective performance
|
|
|
What is anosognosia?
|
the lack of awareness of one's deficit - this may affect a client's willingness to participate in rehabilitation
|
|
|
What is explicit memory?
|
the ability to recite information
|
|
|
What is procedural memory?
|
memory for a skill or sequence of actions
|
|
|
What are some common factors that can affect memory?
|
- medication side effects
- sleep disorders - stress - depression - poor management of chronic health conditions |
|
|
What should intervention focus on for client's with Amyotrophic Lateral Sclerosis (ALS)?
|
the client's participation in occupational performance because the client's functional status changes frequently and intervention focused on physical performance is limited; as status declines, environmental supports may also be needed (DME, Adaptive equipment, etc.)
|
|
|
What should intervention focus on for client's with Alzheimer's Disease?
|
supporting occupational performance for the individual by maintaining capabilities and adapting tasks ad environments or otherwise compensating for declining function while helping them to maintain control over their lives in the least restrictive environment
|
|
|
What should goals focus on with Alzheimer's Disease?
|
- maintaining, restoring, or improving functional capacity
- promoting participation in occupaitons that are satisfying and that optimize health and well-being - help ease the burdens of caregivers |
|
|
What is the role of OT in the early stages of Huntington's disease?
|
- Addressing cognitive components of memory and concentration
- Addressing motor disturbances with clothing modification and home modifications |
|
|
What is the role of OT in the middle stage of Huntington's Disease?
|
- Promote engagement in purposeful activities
- Assist family in arranging to take over finances - Teach family how to cue client to complete simple ADL tasks |
|
|
What is the role of OT in the final stage of Huntington's Disease?
|
Work with client's in the following areas:
- client's are usually totally dependent for all self-care - Dysarthria is present - Splinting and positioning for rigidity - Demential worsens - Behavioral outbursts |
|
|
What areas should be assessed with Multiple Sclerosis?
|
- Sleep patterns
- Visual abilities - Perceptual processing and cognitive status - ADLs - evaluate social context - Behavioral issues |
|
|
What should goals focus on with Multiple Sclerosis as the disease progresses?
|
adaption
|
|
|
What will interventions focus on with Multiple Sclerosis?
|
- problem-solving and compensatory strategies
- time management - role delegation - use of adaptive equipment |
|
|
What is the role of OT with Parkinson's Disease?
|
teaching compensatory strategies, client and family education, environmental/task modification, and community involvement
|
|
|
What should OT intervention focus on in early stages of Parkinson's Disease?
|
- equipment modification
- adaptive equipment in bathrooms, home safety - routine modification - worksite evaluation and modification - work simplification and energy conservation |
|
|
What should OT intervention focus on in the middle stage of Parkinson's Disease?
|
- education/intervention for dysphagia
- community mobility and access to community support programs |
|
|
What should OT intervention focus on in the final stage of Parkinson's Disease?
|
Additional home modifications for environmental access and control - should be operated by light switch because voice activation may not work if dysarthria is present
|
|
|
What are common physical effects of HIV and AIDS?
|
- fatigue
- CNS and PNS impairment - visual deficits - sensory deficits including neuropathies - cardiac problems - muscle atrophy |
|
|
What are common psychological effects of HIV and AIDS?
|
- altered ability to cope with and adapt to changes that create illness
- depression - anxiety - guilt - anger - preoccupation with illness versus wellness |
|
|
Define "perception
|
making sense out of sensory input
|
|
|
What is an adaptive approach?
|
provide training in daily living behaviors to facilitate adaption to the environment for maximal functioning of the patient - (compensatory)
|
|
|
What is a remedial approach?
|
provide training which seeks to cause some change in CNS function
|
|
|
What is the basis of the Sensory Integrative Approach?
|
Controlled sensory input can elicit specific motor responses. The sensory-integrative functions of the brain can be influenced by selected activities which provide the necessary input and evoke the desired motor response.
|
|
|
What is the basis of the Bobath (neurodevelopmental) Approach?
|
Perceptual retraining is inegral to the handling techniques and feedback about correct movement during a motor retraining program. The experience of the sensation of normal movement and feedback about correct performance enhances the retraining of perceptual and motor functions.
|
|
|
What is the Transfer of Training Approach?
|
the practice of a particular perceptual task carries over to the performance of similar tasks or practical activities requiring the same perceptual skills
|
|
|
What is Astereognosis?
|
- theoretically a tactile perceptual deficit
- may involve tactile and kinesthetic reeducation by discriminating objects that are dissimilar |
|
|
What is Body Scheme?
|
how one perceives the position of the body and the relationship of the body parts
|
|
|
What is a Neurodevelopmental approach to Body Scheme?
|
may involve bilateral weight bearing to faciliate total body awareness.
|
|
|
What is a Transfer of Training approach to Body Scheme?
|
may include assembling a human figure puzzle and quizzing them on body parts... which could transfer over to dressing
|
|
|
What is a Sensory-Integrative approach to Body Scheme?
|
providing sensory input to stimulate awareness
|
|
|
What is Body Image?
|
- How one feels about themselves (emotional)
- visual and mental memory of one's body - a mental representation of self relative to feelings, thoughts, and physical features |
|
|
What is Somatognosia?
|
lack of awareness of body structure and the failure to recognize one's parts and their relationships to each other. Difficulties in a person's reference point to the outside world is also noted. Will have trouble using contralateral limbs, may confuse sides of body, may not differentiate properly his/her own body parts and those of the examiner.
|
|
|
How can Somatognosia be evaluated?
|
point to body parts on command, draw a man, describe position of body parts
|
|
|
How can Somatognosia be treated?
|
rub body part with cream or clothe while working with it (SI approach)
|
|
|
What is Unilateral Neglect?
|
The inability to integrate and use perceptions from usually the left side of the body or left side of the environment.
|
|
|
What is Anosognosia?
|
The most severe form of neglect; fails to recognize severity of the condition.
|
|
|
How can Anosognosia be evaluated?
|
*Always assess at midline*
draw a man, copy flower/house, human figure puzzle, pegboard designs, crossing out letters |
|
|
How can Anosognosia be treated?
|
Tactle/kinesthetic input to the affect side (SI approach) and adaptive techniques
|
|
|
What is Right-Left Discrimination
|
An ability to understand and use concepts of the right and left. A person might not be able to name or point to his/her own right or left body parts on command, or may not be able to discriminate between the examiner's right and left sides.
|
|
|
What can Right-Left Discrimination be evaluated?
|
Ayers right/left discrimination test, point to body parts on command, orientation of right and left, ADL observation
|
|
|
How can Right-Left Discrimination be treated?
|
compensatory techniques, work separately (transfer of training) and then integrate into ADL through compensatory or SI approaches
|
|
|
What is Spatial Relations Syndrome?
|
Presents varied problems in perceiving spatial relationships and distances between objects or between self and two or more objects; perceiving your body relative to your environment
|
|
|
What is a Figure Ground deficit?
|
trouble differentiating the foreground from the background; patient may have trouble finding things in a cluttered drawer, trouble with depth and distance perception
|
|
|
How can a Figure Ground deficit be evaluated?
|
Ayres figure ground test, functional testing
|
|
|
How can a Figure Ground deficit be treated?
|
keep things in the same place, organize things, scan and pick things (signs, lights) out of the environment when driving, narrow the environment (use hand as a cue for visual tracking)
|
|
|
What is a Form Constancy deficit?
|
the inability to attend to subtle variations in form (may confuse a water pitcher for a urinal or a razor for a toothbrush since they have similar shapes)
|
|
|
What is a Position in Space deficit?
|
the inability to interpret and deal with concepts of spatial positioning of objects (up-down, from-behind, in-out)
|
|
|
What is a Spatial Relations deficit?
|
trouble perceiving the position of two or more objects in relation to self and in relation to each other
|
|
|
How can a Spatial Relations deficit be evaluated?
|
Ayres Space Visualization test, Bender Visual Motor Gestalt test, Frostig Spatial Relations, observation
|
|
|
How can a Spatial Relations deficit be treated?
|
furniture mazes, block designs, compensate - hand width from w/c to bed, cues
|
|
|
What is Topographical Disorientation?
|
Difficulties in understanding and remembering relationships of places to one another so that he/she may have difficulty finding his way in space (i.e. unable to find way back home in a familiar neighborhood, can't take plates from dishwasher to cupboard) - must be a situation client is familiar with
|
|
|
How can Topographical Disorientation be treated?
|
Through an adaptive approach - adapt environment with stickers, use rote memorization of maps, etc.
|
|
|
What are Depth and Distance Perceptual deficits?
|
Depths and distances are misjudged so that a person may have difficulty navigating stairs and architectual barriers. Problems with driving, pouring liquid from container to container, etc.
|
|
|
How can Depth and Distance Perceptual deficits be treated?
|
use foot to feel/judge distance of stair...
|
|
|
Praxis =
|
ability
|
|
|
What is Contructional Apraxia?
|
involves a parietal lobe lesion; impairment in producing designs in two or three dimensions by copying, drawing or constructing whether upon command or spontaneously. Inability to assemble or organize parts (making a sandwich). Results in problems with body scheme and dressing skills
|
|
|
How can Contructional Apraxia be evaluated?
|
dimensional design copying, block bridges, Benton 3-D, Contructional apraxia test, assemble block designs
|
|
|
What is Dressing Apraxia?
|
The inability to dress oneself due to a disorder in body scheme and/or spatial relations rather than motor performance. Patient may put clothes on backwards, upside down or inside out.
|
|
|
How can Dressing Apraxia be evaluated?
|
Functional - ask patient to take off/put on clothing
|
|
|
How can Dressing Apraxia be treated?
|
lots of structure, cognitive cues, verbal cues, labels/color coding
|
|
|
What is Motor Apraxia?
|
Difficulty with exectuion; unable to perform a purposeful motor task on command, although the patient understands the concept and purpose. May be able to carry out simple automatic motor tasks but cannot complete a complicated sequence
|
|
|
How can Motor Apraxia be evaluated?
|
perform a purposeful motor task on command, use jux-a-cisor wire maze, ex: "touch shoulder"
|
|
|
How can Motor Apraxia be treated?
|
the "on command" causes the blocking so the trick of the therapist is to not tell the patient what to do... they can perform automatically
|
|
|
What is Ideomotor Apraxia?
|
The inability to initiate gestures or perform purposeful motor tasks on command, even though the idea or concept of the task is understood. Unable to perform on command but can carry out many old habitual motor tasks automatically.
|
|
|
What is the difference between Motor Apraxia and Ideomotor Apraxia?
|
They are similar however the lesion sites are different.
|
|
|
What is Ideational Apraxia?
|
The inability to carry out activities automatically or on command because the patient no longer understands the concept of the act.
|
|
|
How can Ideational Apraxia be evaluated?
|
The Goodglass Test for Apraxia and Ayres imitation of postures
|
|
|
What is Verbal Apraxia?
|
Difficulty in forming and organizing intelligible words, although the musculature remains intact. This does differ from aphasia. This is difficulty with motor planning related to speech.
|
|
|
How can Apraxia be treated?
|
Need to break down each step when teaching ADLs, each step needs to be independent of the next because sequencing is very difficult.
|
|
|
What can OTs do in the rehabilitation process of Spinal Cord Injuries?
|
evaluation, retraining, provision of AE, training in adaptive techniques, and psychosocial intervention to maximize participation in life.
|
|
|
What is ASIA Impairment Scale Classification A?
|
Complete lesion with no motor or sensory function preserved.
|
|
|
What is ASIA Impairment Scale Classification B?
|
Incomplete lesion in which sensory but no motor function is preserved below the neurological level - must include sacral segments S4 through S5.
|
|
|
What is ASIA Impairment Scale Classification C?
|
Incomplete lesion - motor function is preserved below the neuro level and more than 50% of the key muscles below the level have a grade of <3 (fair)
|
|
|
What is ASIA Impairment Scale Classification D?
|
Incomplete lesion - motor function is preserved below the neuro level and more than 50% of the key muscles below the level have a grade of 3 or more.
|
|
|
What is ASIA Impairment Scale Classification E?
|
Motor and sensory functions are normal.
|
|
|
How long does Spinal Shock occur for?
|
24 hours to 6 weeks
|
|
|
What are the symptorms of Spinal Shock?
|
Areflexia below the level of the injury with decreased DTR and disturbed sympathetic function, decreased constriction of blood vessels, low BP, slow HR, no perspiration below level of injury
|
|
|
What should you watch for when assessing and treating patients with a Spinal Cord Injury?
|
skin breakdown, pressure sores, decubitus ulcers, decreased vital capacity, osteoporosis, orthostatic hypotension, autonomic dysreflexia, spasticity, heterotropic ossification
|
|
|
What does a driving evaluation consist of with a patient who has a Spinal Cord Injury?
|
clinical evaluation, on-the-road eval, vehicle modification recommendations, recommended driver training and education, final fitting, licensing assistance, w/c mobility, transfers and w/c management
|
|
|
What are some common adaptions for vehicles for patients with Spinal Cord Injuries?
|
- standard power steering and breakes with automatic transmission
- mechanical hand controls for gas and brake - steering device (knob or v-grip) - upper torso support strap - accessible switches for lights, horn, and wipers |
|
|
What are the key muscles that still work with a C1-C3 SCI?
|
- Sternocleidomastoid
- Upper trapezius - Levator scapulae |
|
|
What is the key movement still available with a C1-C3 SCI?
|
neck control
|
|
|
What is the ADL status of a C1-C3 SCI?
|
Total dependence (will not change)
|
|
|
What are the key muscles that still work with a C4 SCI?
|
- Diaphragm
- Trapezius |
|
|
What is the key movement still available with a C4 SCI?
|
shoulder shrug
|
|
|
What is the ADL status of a C4 SCI?
|
Total dependence with functioning external power systems.
|
|
|
What are the key muscles that still work with a C5 SCI?
|
- Deltoid
- Bicepts - Supinator - Rotator cuff muscles |
|
|
What is the key movement still available with a C5 SCI?
|
- Good shoulder control
- Elbow flexion (can extend a bit due to bicep muscle and gravity) - Supination |
|
|
What is the ADL status of a C5 SCI?
|
Feeding, brushing teeth, washing face, combing hair, dressing upper body, home-making activities (making a light meal such as breakfast)
|
|
|
What are the key muscles still available with a C6 SCI?
|
- Extensor carpi radialis longus and brevis
- Pronator teres - Pectoralis minor - clavicular head |
|
|
What key movements are available with a C6 SCI?
|
- Good wrist extension
- Pronation |
|
|
What is the ADL status of a C6 SCI?
|
Feeding, grooming, dressing with minimal assist for lower extremities, transfer independently to bed and mat table, drive care with hand controls
|
|
|
What are the key muscles still available with a C7 SCI?
|
Triceps, Latissiums dorsi, Flexor digitorum profundus and superficialis, Extensor digitorum, Flexor carpi radialis, Pectoralis major - sterno attachment
(everything but intrinsic hand muscles) |
|
|
What key movements are available with a C7 SCI?
|
- Elbow extension
- Finger flexion and extension - Wrist flexion (basically everything but fine motor control) |
|
|
What is the ADL status of a C7 SCI?
|
Total independence, drive car with hand controls
|
|
|
What are the key muscles still available with a C8-T1 SCI?
|
- Interossei
- Lumbricals - Thenar and hypothenar muscles |
|
|
What key movements are available with a C8-T1 SCI?
|
- MP flexion
- Finger abduction and adduction - Thumb movments - ALL HAND FUNCTION - NO LONGER A QUADRAPLEGIA |
|
|
What is the ADL status of a C8-T1 SCI?
|
Total self care independence, drive care with hand controls, transfer wheelchair into car
|
|
|
What muscles make up the hypothenar eminence?
|
flexor digiti minimi
opponens digiti minimi abductor digiti minimi |
|
|
What muscles make up the thenar eminence?
|
flexor pollicis brevis
abductor pollicis brevis adductor pollicis opponens pollicis |
|
|
The level of the SCI designates what?
|
The last FULLY FUNCTIONING neuro segment
(ex. C5 quad means C6 and below is lost) |
|
|
Complete lesions cause the absence of ___________ below level of injury.
|
motor and sensory function
|
|
|
What are the four leading causes of death after SCI?
|
- respiratory problems
- heart disease - subsequent trauma - septicemia (pressure ulcers, UTI, URI) |
|
|
How is a Complete SCI defined?
|
total paralysis and loss of sensation due to lesion of ascending and descending N tracts below level of lesion ASIA scale
|
|
|
What is Central Cord Syndrome?
|
more destruction in center of cord than periphery, greater paralysis and sensory loss in UE nerve tracts and more central than for LE
|
|
|
What is Brown-Sequard Syndrome?
|
lateral damage; one side of tthe cord is damaged (stab wound or gunshot); motor paralysis and loss of proprioception on ipsilateral side and loss of pain, temperature, and touch on contralateral side
|
|
|
What is Anterior Cord Syndrome?
|
injury damages anterior aspect of cord; paralysis and loss of pain, temperature, and touch sensation; proprioception is preserved
|
|
|
What is a Cauda Equina SCI?
|
Incomplete lesion that involves peripheral nerves
|
|
|
What is the first stage of skin breakdown (pressure sores)?
|
red area, blanches on pressure, disappears quickly if pressure is removed
|
|
|
What is the second stage of skin breakdown (pressure sores)?
|
reddened, discolored, blue/black area does not blanch, discoloration does not disappear, blisters develop, superficial skin loss, MUST keep pressure OFF
|
|
|
What is the third stage of skin breakdown (pressure sores)?
|
blister or skin break (ulceration) area may be infected, bony prominences may be uncovered and eventually destroyed, deeper layers of skin involved
|
|
|
What is the fourth stage of skin breakdown?
|
wound extends into tendon, muscle and bone with drainage
|
|
|
What are common complications associated with a SCI?
|
Osteoporosis, Orthostatic Hypostension, Autonomic Dysreflexia, Spasticity, Heterotopic ossification, Psychological reactions
|
|
|
What are the two types of a TBI?
|
focal injury
axonal injury |
|
|
If a patient with a TBI is in a coma, what should you evaluate?
|
1. State of Conscientiousness
2. Presence and quality of reflexes 3. Sensory Awareness 4. PROM 5. Muscle tone 6. Cognition 7. Prefeeding/oral motor skills |
|
|
If a patient with a TBI improves to conciousness, what should you evaluate?
|
daily living skills, visual perceptual motor skills, vision, cognition, UE sensibility, pain, endurance
|
|
|
What is a good intercranial pressure?
|
<20mmHg
|
|
|
What are some possible treatment ideas for a TBI?
|
sensory stimulation, improve patient's posture and positioning, increase and maintain PROM, increase patient's functional independence in ADLs, work on kitchen and IADLs, address interpersonal and behavioral skills, improve cognition
|
|
|
What is Work Hardening?
|
It provides a transition between acute care and return to work will addressing the issues of productivity, safety, physical tolerances, and worker behaviors; highly structured and goal oriented program designed to maximize the individual's ability to return to work
|
|
|
What insurance coveres Work Hardening?
|
Worker's compensation insurance
|
|
|
What conditions are often seen with Work Hardening?
|
back problems, carpal tunnel, knee/hip problems, hand problems
|
|
|
What are goals geared toward with Work Hardening patients
|
returning to work
|
|
|
How often are patients seen for Work Hardening?
|
5 days/week
4-8 hours/day |
|
|
What is Work Conditioning?
|
A graded down version of work hardening that meets the typical time frame of therapy to help increase endurance; still involves job simulation and replicates job demands; may or may not have been injured at work; looks at all areas of occupation, NOT just work
|
|
|
Who pays for Work Conditioning?
|
Covered by 3rd party payer or worker's compensation; can be covered by disability insurance, Michigan Rehabilitation Services, and Auto-No Fault
|
|
|
What are some reasons for Work Hardening and Conditioning programs?
|
Employment attitudes, Social Security Disability guidelines, Cost containment, Give workers confidence (body mechanics and ergonomics, increase physical capacities, etc.)
|
|
|
How should an OT evaluate a patient receiving Work Conditioning or Hardening services?
|
Complete a Work Demands Evaluation, look at written job description, talk to employer, do a job site analysis
|
|
|
What is a Job Site Analysis?
|
- identifies problem work areas
- identifies work areas to be modified - provides recommendations for ergonomically correct areas - provides opportunity to make better RTW recommendations |
|
|
What does a Functional Tolerance Profile consist of?
|
sitting, standing, walking, lifting, carrying, climbing, stoop/kneel/crouch, crawling, pushing/pulling, reaching, handling, fingering, feeling, driving, hearing/vision, balance, fatigue, heat/cold (environment), sleeping
|
|
|
When testing for gross sensation, what areas should be tested?
|
1. Dorsal side of hand
2. Palm of hand 3. Extensor/dorsal forearm 4. Flexor/volar forearm (anterior) 5. Lateral proximal upper extremity 6. Medial proximal upper extremity |
|
|
What is Stereognosis?
|
The ability to recognize common, everyday objects without sight (use sensation, perception, cognition)
|
|
|
What is Astereognosis?
|
The inability to recognize common, everyday objects without sight
|
|
|
What is Diplopia?
|
Seeing double
|
|
|
What are Positive Symtoms?
|
actions the patient does not want to perform but cannot prevent (hypertonicity/spasticity, tremors, athetosis, tics, fasciculation)
|
|
|
What are Negative Symptoms?
|
actions the patient wants to perform but cannot (akinesia, bradykinesia)
|
|
|
What is Akinesia?
|
hesitancy in starting movement
|
|
|
What is Bradykinesia?
|
slowness of which movement is executed (shuffling gait)
|
|
|
What is the role of OTs with wheelchairs?
|
- measure patient
- select a wheelchair - select a seat system - teach patient and family how to use the chair |
|
|
Are motor pathways ipsilateral or contralateral tracts?
|
Ipsilateral - same side of body
|
|
|
What is the Lateral-spinal thelamic tract (LST)?
|
- pathway on lateral aspect of the cord that communicates between the spine and brain
- responsible for pain and temperature - contralateral - crosses over to the other side of the body |
|
|
What is the Dorsal column medial lemiscus (DCML)?
|
- pathway on the dorsal aspect of the cord
- responsible for proprioception, 2-point discrimination, and light touch - ipsilateral - same side of body |
|
|
What are the functional capabilities of a patient with Central Cord Syndrome?
|
can walk but can't use arms
|
|
|
What is Arterial Sclerosis?
|
the wall of the blood vessel is getting built-up corrosion and blocking blood flow - tissue doesn't get the nutrients they need due to lack of blood flow
|
|
|
What is Artery Hardening?
|
arteries aren't as flexible
|
|
|
What is Ischemia?
|
tissues don't get the nutrients they need
|
|
|
What is Angina Pectoris?
|
chest pain, arm pain, jaw pain
|
|
|
What is a Miocardial Infarction?
|
heart attack
tissues do not get the nutrients they need so they become necrotic and die |
|
|
What is Heart Failure?
|
The heart grows large and becomes inefficient (does not pump well)
|
|
|
What is a MET?
|
the level of physical expenditure needed for an activity
|
|
|
What is an activity that requires 1 MET?
|
In chair, feet up (lazy boy position)
|
|
|
What is an activity that requires 2 METs?
|
Dressing
|
|
|
What are some activities that require 3 METs?
|
Ironing and washing dishes
|
|
|
What are some activities that require 4 METs?
|
bowling, swimming slowly, table tennis
|
|
|
What are some activities that require 5 METs?
|
walking briskly and golf
|
|
|
What are some activities that require 8 METs?
|
heavy gardening, cycling (13 mph), touch football, competitive badminton, jogging
|
