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87 Cards in this Set
- Front
- Back
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Types of environmental contexts |
-Physical/non human environment -Sensory = visual, auditory, tactile, olfactory, gustatory -Social-cultural/human = social roles, networks, -Personal = age, gender, SES, education level -Temporal = stages of life, time of year, time of day, history -Virtual= communication occurs by means of airways/comptuers; email, Facetime, social media. |
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Omnibus Budget Reconciliation Act (OBRA) |
mandates that restraints cannot be used without proper justification, agreement, and documentation
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Individuals with Disabilities Education Act (IDEA)
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mandates that kids with disabilities receive education in the least restrictive and most natural environment
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RESNA and NRRTS
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-professional organizations help to develop standards and measuring tools to ensure proper design, fabrication, prescription and delivery of technology
-RESNA offers certification for Assistive Technology Professionals and Seating Mobility Specialists |
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Role of OT in mastery of environment |
-Can advocate for and design environments that use principles of universal design to meet the physical, sensory, sociocultural and psychological needs of the individual.
-Can help to ID settings and approaches to implement ADA, OBRFA, & IDEA.
-They can also advocate for compliance to enable individuals to function as independently as possible in their environment
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Potential professional team members
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physician, OT, PT, SLP, Rehabilitation engineer (design equipment, modifications), computer expert, Assistive Technology Professional, Seating and Mobility Specialist, Rehabilitation counselor (assess and advise on vocational issues), social worker, psychologist, nurse, teacher, driver trainer, vendor, 3rd party payor
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Principles of Universal Design
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Principle 1-equitable use
Principle 2- Flexibility in use Principle 3- Simple and Intuitive Use Principle 4- Perceptible information Principle 5- Tolerance for error Principle 6- Low physical efford Principle 7- Size and space for approach and use |
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Equitable Use
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design is useful and marketable to people with diverse abilities
-provide same means of use for all users; identical whenever possible -avoid segregating or stigmatizing any users -provisions for privacy, security, and safety equally available to all users -make the design appealing to all users |
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Flexibility in Use
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design accommodates a wide range of individual preferences and abilities
-provide choice in methods of use -accommodate right or left handed use -facilitate user's accuracy and precision -provide adaptability to user's pace |
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Simple and Intuitive Use
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easy to understand , regardless of user's experience
-eliminate unnecessary complexity -consistent with user expectations and intuition -accommodate wide range of literacy and language skills -arrange information consistent with its importance -provide effective prompting and feedback during and after task completion |
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Perceptible Information
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design communicates necessary info effectively to the user, regardless of ambient conditions or user's sensory abilities
-use different modes (picture, verbal, tactile) for redundant info -provide adequate contrast between essential info and its surroundings -maximize legibility of essential info -make it easy to give instructions -provide compatibility with a variety of techniques or devices used by people with sensory limitations |
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Tolerance for error
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design minimizes hazards and the adverse consequences of accidental or unintended actions
-arrange elements to minimize errors -provide warnings of hazards and errors -provide fail-safe features -discourage unconscious actions in tasks that require vigilance |
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Low physical effort
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design can be used efficiently and comfortably and with a minimum of fatigue
-allow user to maintain neutral body position -use reasonable operating forces -minimize repetitive actions -minimize sustained physical effort |
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Size and space for approach and use
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appropriate size and space provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility
-provide clear line of sight to important elements for any seated or standing user -make reach to all components comfortable for any seated or standing user -accommodate variations in hand and grip size -provide adequate space for use of assistive devices or personal assistance |
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Evaluation of Performance skills and client factors |
Essentail to assess when conducting an environmental assessment. 1. Sensory skills 2. Visual perceptual processing skills 3. Musculoskeletal skills 4. neuromuscular skills 5. cognitive skills 6. psychosocial skills |
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Contextual evaluations |
Physical considerations Sociocultural considerations |
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Minnesota Rate of Manipulation Test
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standardized test to assess visual motor perception to assess for potential difficulty with computer use
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mounting location for indoor and outdoor railings
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indoor= 1 1/2' from wall
outdoor= waist high (34-48") and 1 1/2-2' in diameter with non-skid surfaces |
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minimum door width for walkers and wheelchairs
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walkers=18", wheelchairs=26"
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Evaluations for Risk Falls: INTRINSIC Factors |
1. vision 2. vestibular issues 3. neuromuscular issues 4. medication side effects 5. pathological conditions 6. delirium and/or dementia 7. anxiety and/or depression 8. prior history of falls 9. fear of falling |
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Evaluation for Risk Falls: EXTRINSIC Factors |
General house issues: floors, low lying furniture, poor threshold, poor lighting or glare, extension cords, clutter on floor. 2. Bathroom issues: no grab bars, toilet seat to low, wet floor 3. Kitchen: low cabinet doors open, step stool w/out handles 4. Bedroom: bed to high or low; reaching into closets 5. Living rooms: chairs to high or low, clutter |
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Presbyopia
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decreased visual acuity
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Interventions to improve functional mobility
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-active or resistive mm strengthening exercises and general conditioning exercises to improve or maintain flexibility, strength, endurance, and coordination
-PROM stretching to increase joint ROM -specific coordination training -neuromuscular reeducation training -balance training (sit and stand, static and dynamic, turning and stairs) -transfer training -bed mob -wheelchair safety -referral to PT for ambulation |
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Interventions to Prevent Falls |
1.Eliminate or minimize all fall risk factors; stabilize disease state, manage medication. 2. Provide sensory compensation strategies 3. Mod ADL for safety 4. Teach energy conservation techniques 5. Communicate w/ family and caregivers 6. Mod environment. - adequate lighting, use contrast colors, reduce clutter, handrails, light switches at top/bottom of stairs, non skid secure surfaces. - grab bars, non skid mats, night lights -correct bed heights -remove clutter -rearrange furniture 7. prescription of ATD and training on use |
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Average wheelchair width
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24-46" rim to rim
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minimal wc clearance for doorways and halls
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32", ideal is 36"
-additional 26" needed beside the door to allow for door swing -removing doorstops can add 3/4" -replacing with offset hinges adds 1 1/2-2" |
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Ideal hallway width
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36"
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Average wheelchair length
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42-43"
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turning space for 360 deg wheelchair turn
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60" x 60"
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maximal height an individual can reach forward from sitting in wc
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48" and at least 15" needed from floor to prevent tipping (p.335 fig 16-4)
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maximal height for countertops (wc)
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31"
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parking spaces for wc compliance
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adjacent 4' aisle to allow wheelchairs to maneuver
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width for pathways and walkways
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48"
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Ramps
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1:1
-minimum of 36" wide -railings 32" high depending on pt height -curbs at least 4" high -platforms 4' x 4' -90 deg turn needs 4x4' landing, 180 deg turn needs 4x8' 5' x5' platform for ramps leading to doors |
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Maximal height for side reach
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48" max and need 15" from ground
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space saver arm rests
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wraparound arm rests
-reduce overall width of chair by 1" |
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heel loops vs ankle straps
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heel loops prevent feet from slipping off footrest in a posterior direction
Ankle straps prevent slipping off footrest |
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types of tires
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1. pneumatic- air-filled, requires maintenance, more cushioned ride, shock absorbent
2. semi-pneumatic: airless foam inserts, less maintenance, good cushioning 3. solid-core rubber: minimal maintenance, tires mounted on spoked or molded wheels |
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Casters
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-smaller ones facilitate maneuverability
-pneumatic or semi-pneumatic available, but solid core are best for indoors and smooth services -caster locks can be added for increased stability during transfers |
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Hillholder devices
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allow wc to move forward but automatically brake when going backward
-useful for pt's unable to ascend ramps or hills without rest |
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wc seat width
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measure widest distance across hips/thighs and add 2"
-bariatric clients with pear shape have more gluteal femoral weight distribution. Consider widest portion of seated distribution, room for weightshifting, and for lift devices |
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WC Seat depth
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-post buttocks to popliteal fossa and subtract 2 inches
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Seat back height
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1-2" below scalpula, mid-scapula or axilla, or top of shoulder
-added height may prevent pt from locking onto push handle or fitting chair into car |
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Seat height
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-knees and ankles at 90 deg; measure distal thigh to heel
-footrest 2" clearance from floor, cushion selected will affect this -standard height 19.5" -hemi-height 17.5" -super low 14.5" |
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Armrest height
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-shoulders neutral, arms hanging to sides, elbows 90 deg
-measure under each elbow to cushioned seating surface -armrests too low cause leaning fwd, too high cause shoulder elevation |
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Bariatric considerations for wheelchair prescription
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-bariatric clients have center of body mass several inches fwd compared to normal
-rear axle displaced fwd compared to standard chair to allow for more efficient arm push -hard tires for increased durability -adjustable backrest to accommodate posterior bulk -reclining to accommodate excessive anterior bulk or orthostatic hypotension -power attached to heavy duty chair for fatigue |
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reclining back
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indicated for those unable to independently maintain upright seated position
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tilt-in-space
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indicated for pressure relief or for severe extensor spasms that may throw them out of the chair
-maintains normal seat to back angle |
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Recreational chair
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designed with large thick inner tube type tires and large front casters for all terrain use
-sand, mud, snow, off road surfaces |
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Sports chair
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-designed for racing, cycling, basketball, and other competitive sports
-ultra lightweight |
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Wheelchair mobility training
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-assess cognition to determine ability
-sitting posture -pressure relief -cushions, lap board, etc -time schedule for weight shifts and use of devices -propulsion training (gloves, feet to assist) -safety issues: locks, transfers, safe falling -how to manipulate basic parts -how to maneuver through community, wheelies, -basic maintenance -developmental considerations (discourage strollers) - |
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Amputee frame
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axle can be moved posteriorly for increased stability and accommodate for change in gravity center
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Indications for Attendant propelled chair
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-brief or chronic disability
-transport in the community -used for extended periods -powered mobility cannot be used -fit and comfort considered for all involved |
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Indications for Manual wheelchair
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-may independently propel
-may use quick release wheels (easier for cars) limit: standard weight is heavy with added seating |
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lightweight vs standard chair weight
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lightweight: 25-40 lbs
standard: 50 lbs without seating |
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Indications for powered chair
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-cannot use hands or feet
-energy expenditure limitations -arthritic upper extremities -prone to repetitive stress injuries -neuromuscular injury: prevent associated reactions -can change seat height or tilt |
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Assessment considerations for seating and positioning systems
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1. crucial to distinguish between flexible deformity and fixed deformity
2. evaluate pelvis FIRST, then LEs, trunk, UEs, head and neck, and feet |
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2 basic styles of seating
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1. Linear
- flat, non-contoured - custom or factory-ordered - firm, rigid seating - good for active pts who can perform ind xfers and/or who have minimal musculoskeletal involvement 2. Contoured and/or custom-contoured -ergonomically supports pt -excellent support -enhances postural alignment -pressure relief, dec abnormal posture -may be difficult for independent transfers -good for mod to severe CNS dysfunction or neurological disease |
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Seating system accessories and styles
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-solid wood insert- prevent hammock effect
-solid seat- stable BOS, easy to remove, can lower seat to floor height -lumbar back support-proper lumbar curve -foam cushions- sitting posture and comfort -contoured foam cushions- enhance pelvic and LE alignment -pressure relief cushions: A. fluid- facilitates alignment, pressure relief without changing support, good for those who need inc stability B. Air- minimal postural support offered, provides pressure relief, good trunk control needed -wedge cushions or antithrust seats prevent sliding out -pelvic guides keep hips stable -lateral supports extend up side of chair to just below armpits provide trunk support -triwall construction for infants and toddlers -abductor pads at hips to dec scissoring extension patterns |
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Advantages of prone and supine standers for pediatrics
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-prone- decrease effect of tonic labyrinthe reflex
-supine- more support posteriorly -sidelyers decrease effect of TLR and put hands in visual fields |
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Lofstrand crutches
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proximal arm has closure around it instead of support in axillary |
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Mobility/positioning status post total hip replacement (THR) |
-may not be permitted to roll on non-operated side (may cause internal rotation)
-pillows between knees in sidelying to maintain proper position, prevent adduction of operated hip |
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positioning status post CVA |
-may need education re proper positioning of UE to increase awareness, minimize pain, dec swelling, and promote normal tone |
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positioning status post LE amputations
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-may need training re use of pillows to prevent edema in LE
-may need training in how to provide passive stretching to residual limb while in bed to prevent shortening or contracture (which would make prosthetic difficult and painful) |
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Active aid commode
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commode w/ small wheels to allow xfer to bathroom and shower stall
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Chair lifts
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chair w/ power cord to allow elevation from surface (lift recliner)
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Assistive Technology devices
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any equipment or product used to increase, maintain, or improve functional capabilities of ind w/ disability |
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Electronic Aids to Daily Living (EADLs)
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formerly ECUs
-manipulate environment by accessing 1 or more devices via switch, voice, remote... -maximize indep and conserve energy -work lights, doors, phones, appliances, call help |
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Considerations in EADL device selection
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-input method
-output method -portability -safety -reliability -assembly and operation ease -maintenance schedule -current and future affordability |
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Types of EADL technology
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phones (special types), monitoring system, emergency response system, computers
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Computer adaptations
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1. eye gaze- severe mobility issues, ALS |
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Evaluation Assistive Technology Devices |
-Evaluation goals: -ID tasks wanted to be accomplished -Assess individual's ability and deficits including client factors & performance skills -Determine environment device will be used in and when it will be used. -ID assistive technological devices - consider the input method, processing method, output method, feedback method. |
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Intervention principles of assistive technology devices |
Select and use several devices on a trial basis to determine what services the individuals needs best.
Determine specific device after reviewing and incorporating all team members info.
Keep device as simple as possible
Provide multiple training sessions. |
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Considerations for augmentative alternative communications (no speech required)
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-speed at which message is conveyed
-portability: easy use in a variety of environments -accessibility- can they independently operate -dependability -vocabulary flexibility -time for repairs and maintenance |
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Documenting ATDs/ EADLs
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-document evaluation process
-document recommended ATDs selected and rationale for each item for reimbursement: 1. based on pt needs and goals 2. based on functional status and limitations 3. based on school/work/leisure needs 4. justify cost-effectiveness |
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Additional cocnsiderations for ATDs/EADLs
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-appliances and electrical cords used with ATD/EADL
-charging instructions must be followed -telephone answering machine may/may not permit ATD attachment -assess technology/computer abilities of pt -surge protectors -back-up systems -ensure carry over when OT not present -warranty info |
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Funding for ATDs/EADLs
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-state vocational and educational services for ind w disabilities, offices for vocational rehabilitation, divisions of vocational rehabilitation will pay if they enable a person to go to work or school
-private companies will fund to ensure ADA compliance -private insurance, medicare, medicaid, and workers comp may reimburse for certain devices |
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community mobility
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ability to access and use public and private transportation systems, including ability to walk, drive, ride a bike
-OT who provides driver training must be state licensed driving instructors -can become certified driving rehab specialists |
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Evaluation of driver ability
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1. visual-perceptual: color-blind is okay
2. cognitive-perceptual: alert, memory, rule knowledge... 3. motor: ROM, strength, response time... 4. psychosocial: delusions, hallucinations, anger... 5. side effect of medications 6. past driving experiences *above can be done with no special training |
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On-the-road driver ability eval
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1. operation- ability to brake, steer, and turn
2. tactical- respond to changes in conditions, traffic 3. ergonomics- airbag clearance of 12", positioning... 4. ability to manage emergencies, obtain assistance |
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Interventions for Driver Rehabilitation |
1. Adaptive driving equipment can be prescribed for individuals w/ specific limitations -hand controls replace accelerators & brakes -Steering knobs for one handed steering control - standard round spinning knob for a person w/ one intact upper extremity. - ring to accommodate a prosthesis - tri-pin or cuff to accommodate absent or weak grasp - Pedal extensions if feet do not reach - Zero effort or reduced effort steering to accommodate for decreasezd range, strength & endurance.
IF driving is unsafe alternative means to maintain mobility must be explored/implemented. |
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Funding for driver rehab
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state vocational and educational servcies, offices for vocational rehab, and division of vocational rehab if driving enables going to work or school
-insurance may pay for some (private, med, or workers comp) |
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General interventions for cognitive & sensory deficits |
1.Environment needs to be familiar, consistent, & predictable -visual reminders/tactile cues - structure to the environment -removal of clutter 2. Use contrasting colors to discriminate background from foreground 3. use retrain reduction techniques if a person is confused, agitated and/or a wanderer 4. Education of consumer, caregiver and family 5. make home modifications to ensure safety as needed. 7. provide a personal emergency system and train in its use. |
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Restraint reduction techniques
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1. assess behaviors that lead to agitation or wandering |
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Interventions to address agitation and/or wandering |
-approach from front at eye level |
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Purpose of wheelchair seating and positioning |
Promote comfort during upright ADL 2. Promote fxnal posture of appropriate back, trunk and/or leg support 3. promote physiological maintenance and tissue protection through prevention of shearing 4. Promote sensory readiness through provision of proper eye and head position. 5. decreasing progression of deformity through customized seating as needed. 6. Facilitate mobility with what means the person with a disability has available. |
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Specific assessments for wheelchair prescription |
Client factors & performance skill assessments - sensory, neuromuscular, musculoskeletal, cognition, psychosocial.
Personal assessment: age & developmental status, education & work history, leisure interests
Contextual assessments: physical environment, building characteristic of school, work, leisure
Wheelchair characteristics considered in assessment: transportability/portability, ride quality, wheelchair type.
Developmental considerations in assessments Transportability for, from, and in school. Allowance for adjustments w/ growth Allowance for use of other adaptive equipment Facilitation of social acceptance. |
