NBCOT – General Practice – Flashcards

Part of fulfilling the ethical responsibility to maintain a safe and secure group environment is to meet in a physical space that allows escape from a dangerous situation. Knowing where the exits are located ensures that participants and the leader can escape if necessary.

The suggested interrater reliability of a standardized test is 80%

Concepts and assumptions a. Person: personal characteristics of the client b. Environment: cultural, social, psychological, organizational, and physical components of the client's surroundings c. Occupation: self-directed, functional tasks and activities d. Occupational performance: outcome of the transactional relationships among child, environment, and occupation e. Person-environment-occupation fit: goal of interventions to promote change in the child, occupation, and environment to optimize occupational performance

1. Concepts and assumptions a. Volition: a person's desire to participate in certain occupations i. Personal causation: a person's sense of competence and effectiveness while engaged in occupations ii. Values: that which is important and meaningful to the person iii. Interests: activities that provide enjoyment and satisfaction to the person b. Habituation: internalized readiness to demonstrate consistent patterns of behavior c. Environment: surroundings that create opportunities for or barriers to participation in meaningful and culturally relevant occupations d. Performance capacity: physical and mental components enabling a person to participate in occupations e. Dimensions of doing: Occupational participation, occupational performance, occupational skill

1. Concepts and assumptions a. The three basic elements targeted in intervention are (1) the person, (2) the occupational environment, and (3) the interaction of person and occupational environment i. The person has an innate desire for mastery in occupation; in addition to the person's sensorimotor, cognitive, and psychosocial systems, intervention targets his or her experience of personal limitations and potential. ii. The environment is where occupation occurs and has social, physical, and cultural properties; the environment produces a demand for the mastery of occupation. iii. The interaction between person and occupational environment produces a press for mastery as evaluated by the person and elements of the environment. b. Occupational adaptation is a normative process that is prominent in periods of transition

1. Concepts and assumptions i. The person is composed of sensorimotor, cognitive, and psychosocial skills. ii. The demands of a task determine which specific behaviors the person will need to participate successfully. iii. The context includes the temporal, physical, social, and cultural aspects of the environment. iv. Performance range is the number and type of tasks available to the person.

- close: daily, direct contact - routineL direct contact at least every 2 wks - general: at least monthly direct contact with supervision available as needed by other methods - minimal: provided only as needed basis, and may be less than a month

is used to determine what activities to use to increase the client's level of func- tional independence in consideration of the disease or disability

is used during the face-to-face experience with the client to get the client's perspective on the illness, injury, or disability and to involve the client in the goal making for the intervention plan.

occurs when the bigger picture is evaluated; the practitioner reviews the client's functional status before the disability and at present.

1. Altruism: "The individual's ability to place the needs of others before their own" 2. Equality: "The desire to promote fairness in interactions with others" 3. Freedom: "The desires of the client must guide [occupational therapy practitioner's] interventions" 4. Justice: Relating "in a fair and impartial manner to individuals with whom they interact and respect and adhere to the applicable laws and standards regarding their area of practice" 5. Dignity: Treating each client respectfully and as an individual by enabling the client "to engage in occupations that are meaningful . . . regardless of level of disability 6. Truth: "In all situations, occupational therapists, occupational therapy assistants, and students must provide accurate information, both in oral and written form" 7. Prudence: Use of "clinical and ethical reasoning skills, sound judgment, and reflection to make decisions" within the occupational therapy practitioner's area of practice

1. Principle 1, Beneficence: "Occupational therapy personnel shall demonstrate a concern for the well- being and safety of the recipients of their services" a. Example: Maintaining current knowledge by attending evidence-based educational sessions pertinent to the performance of duties as an occupational therapy practitioner b. Example: Using current and updated assessment tools to obtain accurate client data for intervention

Principle 2, Nonmaleficence: "Occupational therapy personnel shall intentionally refrain from actions that cause harm" a. Example: Transferring clients from a wheelchair to the bed using due care to avoid harm by locking the wheelchair and bed brakes b. Example: Not practicing occupational therapy under the influence of drugs or alcohol

Principle 3, Autonomy/Confidentiality: "Occupational therapy personnel shall respect the right of the individual to self-determination" a. Example: Respecting the right of clients to refuse to participate in occupational therapy services b. Example: Safeguarding the privacy and confidentiality of clients by complying with HIPAA regulations

Principle 4, Social Justice: "Occupational therapy personnel shall provide services in a fair and equitable manner" a. Example: Assisting at a health fair to help promote the health of members in the facility or community b. Example: Treating clients fairly no matter what their gender, age, ethnicity, or marital status

Principle 5, Procedural Justice: "Occupational therapy personnel shall comply with institutional rules, local, state, federal, and international laws and AOTA documents applicable to the profession of occupational therapy" a. Example: Learning about laws and regulations that have an impact on the provision of occupational therapy services b. Example: Following reimbursement guidelines for different payer sources

Principle 6, Veracity: "Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession" a. Example: Ensuring documentation is accurate and truthful b. Example: Avoiding plagiarism of others' work

Principle 7, Fidelity: "Occupational therapy personnel shall treat colleagues and other professionals with respect, fairness, discretion, and integrity" a. Example: Treating coworkers, clients, and other health care workers respectfully, such as by not divulging personal information to others

a. "Ineligibility for certification" b. Reprimand: Formal but private letter of disapproval c. Censure: Public disapproval d. Probation: "Continued certification is subject to fulfillment of specific conditions" e. Suspension of certification for a specific time period f. Revocation: permanent loss of certification

cost related to OT services such as salaries and benefits.

any item about a fixed amount, such as a computer system

the evaluation and approval of proposed intervention plans by third party payers

the evaluation of ongoing intervention programs

is a system in which the quality of work by a group of health professionals is reviewed by their peers

is a plan to review the use of resources within a facility to determine necessity and cost efficiency

The goal of activity analysis is to achieve a thorough understanding of the therapeutic activity by breaking it down into its individual parts as well as the skills needed to successfully complete each task. This foundation of knowledge helps steer treatment approaches and inform clients. Ideally, the chosen therapeutic activities will provide clients with the just-right challenge

a. Scaffolding occurs when the occupational therapist assists the client with parts of the task that are too difficult, but the client finishes the task himself or herself. b. This technique may help motivate a client by proving to the client that he or she can complete an activity or task

a. Based on a client's performance, grading involves increasing ("upgrading") or decreasing ("downgrading") the demands of an activity step by step to promote occupational performance when tasks are too easy or too difficult to complete. b. Activities are graded to improve the deficits or skills; the occupational therapist carefully changes the demands of the activity to more appropriately match the client's ability

As a client's skills emerge or improve, the occupational therapist slowly lessens or eliminates his or her support. The result is improved independence in the task or activity

This approach includes communicating expectations and support in a way that helps the client perform and improve in tasks and skills

a. This approach is also known as activity synthesis: "the process of combining component parts of the human and nonhuman environment so as to design an activity suitable for evaluation or intervention relative to performance", and it involves modifying an activity to match the client's abilities b. Adaptation and modification aim for the client's successful involvement in preferred occupations; instead of working to improve or change a client's ability, this strategy focuses on changing the activity demands to match a person's current ability i. Decrease the demands. • Make the activity require less cognitive skill. • Reduce or change the necessary physical skills to complete the task. ii. Implement the use of adaptive equipment or assistive devices; for example, instruct a client with hip precautions to use a sock donner. iii. Alter the social or physical environment. • Empower clients to instruct their caregivers; for example, a patient with end-stage AIDS who mostly stays in bed can be encouraged to alert his or her caregiver to the time for repositioning, how to use wedges or pillows to properly protect skin, and how to examine skin for any signs of breakdown. • Instruct clients in adaptive positioning or organization of workspaces to ease occupational performance; for example, a client with carpal tunnel syndrome can modify home and work office to promote neutral wrist positioning during computer tasks.

are defined as "any item, piece of equipment or product system whether acquired commercially off the shelf, or customized, that is used to increase, maintain or improve functional capabilities of individuals with disabilities"

are defined as "any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device"

specialist in assistive technology application; typically has a professional background in engineering, occupational therapy, physical therapy, recreation therapy, special education, speech-language pathology, or vocational rehabilitation counseling"

A. No technology refers to, for example, hook-and-loop fasteners, grab bars, and built-up handles. B. Low technology includes inexpensive items that are readily available commercially (e.g., jar opener, sock aids, reacher). C. High technology includes devices, hardware, or software that may require specific training to use (e.g., augmentative communication devices, powered mobility). D. Electronic aids to daily living (EADLs), formerly known as environmental control units (ECUs), are devices that allow control of electrical or electronic appliances through the use of one or more switches

includes interactions and balance among four major elements: 1. Activity 2. Context 3. Human skills 4. Assistive technologies

1. Sensors; used to obtain data from the environment a. Visual function, visual acuity, visual field, tracking, scanning, and accommodations b. Auditory function and thresholds c. Somatosensory function d. Control of posture and position 2. Central processing a. Perception b. Cognition c. Psychosocial d. Neuromuscular control 3. Effectors: the neural, muscular, and skeletal elements of the human body that provide movement or motor output a. Resolution b. Range c. Strength d. Endurance e. Versatility

A. Identify task or activity that the client wants to accomplish. B. Identify the client's abilities and deficits in the areas of client factors and performance skills. 1. Client factor examples: muscle and postural tone, ROM, strength, endurance 2. Performance skills examples: postural stability and balance, information-processing ability, problem-solving ability, memory, visual-perceptual function C. Determine the environment and context in which the activity will occur. 1. Home 2. School 3. Work 4. Community 5. Social 6. Cultural 7. Virtual D. Identify assistive technology devices. 1. Determine the human-assistive technology interface: How will the device will be activated (e.g., switches, keyboard, joystick, mouth stick, voice activation, eye gaze)? 2. Consider the processing method (i.e., how the device will process the information after input). 3. Determine the output (e.g., turn on the lights, close the garage door, reply to e-mail). 4. Determine whether built-in feedback is needed to ensure proper use of the device (e.g., auditory feedback, tactile feedback). E. Identify funding source. 1. Private, state, and federal insurances 2. Workers' compensation 3. State vocational and educational services 4. Department of Vocational Rehabilitation 5. Private 6. Donation 7. Loaner 8. Grant

A. Gather information from various sources, including the client, supporting family or caregiver, and all team members. B. Consider proximal stability through proper positioning. C. If possible, obtain loaner or demonstration pieces for trials. D. Ensure proper positioning of the device to enable ease of access. E. Keep devices as simple as possible—more is not better. F. Ensure the chosen device is dependable (i.e., consistent performance in every use). G. Provide multiple training opportunities in different environments and contexts.

1. Use of alternative sensory pathway a. Tactile substitution (e.g., bump dot, braille) b. Auditory substitution (e.g., books on tape, text to speech, talking devices and appliances) 2. Reading aids a. Optical aids (e.g., handheld magnifier, field expanders, telescopes) b. Nonoptical aids (e.g., enlarged print; reverse reading, i.e., white print on a black background) c. Electronic aids (e.g., closed-circuit TV, electronic magnifier, tablet computers) 3. ADL aids a. Kitchen aids (e.g., boil alert, liquid level indicator, talking kitchen scale) b. Medication management (e.g., "talking" medication box, magnifying pill cutter, jumbo pill box) c. Miscellaneous (e.g., lighted magnifying makeup mirror; large universal remote control for television; talking watch or clock) 4. Mobility aids a. Cane with warning device (e.g., UltraCane with ultrasound beams and sensors [Sound Foresight Technology Ltd., Harrogate, England], laser cane) b. Wheelchair-mounted mobility device (e.g., clear-path indicator) c. Navigation aids

1. Use of an alternative sensory pathway a. Tactile substitution (e.g., Tadoma method—tactile lipreading by putting the thumb on the speaker's lip and the fingers along the speaker's jawline; vibration) b. Visual substitution (e.g., flashing lights, speech-to-text, captioning) 2. Hearing aids a. Air conduction b. Bone conduction c. Cochlear implants 3. Telephone access a. Teletype device b. Captioning service

A. Memory aids (e.g., personal digital assistants, smartphones, digital recorders, reminder applications) B. Time management: devices that remind the client of the preprogrammed task or event to occur (e.g., smartphone, tablet computer) C. Prompting, cueing, and coaching (e.g., medical paging system, global positioning system locator, smart house)

Wheelchair 1. Manual versus powered 2. Recliner, tilt-in-space 3. Stand-up wheelchair 4. iBOT Mobility System (Independence Technology LLC, Warren, NJ) a. Control interfaces for powered mobility system (e.g., joystick, head control, sip and puff)

A. Enhance the client's independence in operating appliances or devices in the environment B. Low technology (e.g., key holder, stove knob turner, doorknob extender) C. EADLs 1. Control functions: on-off light control, television, radio and appliances, open or close door or drapes 2. Transmission methods: remote control, X10 house wiring, ultrasound, infrared, radio frequency, Bluetooth 3. Trainable versus programmable controlle

A. For clients who have severe speech and language impairments across the life span B. Team approach 1. Client and family 2. Speech-language pathologist 3. Physical therapist 4. Teacher 5. Teacher's aide or job coach C. Evaluation and intervention processes 1. Evaluation a. Predictive assessment—understanding the client's current needs and predicting future needs b. Serial assessment—continuing evaluation to meet changing needs c. Curriculum-based assessment—to help coordinate and integrate use of AAC in classroom d. Assessing barriers to participation i. Cultural ii. Social iii. Physical iv. Performance skill e. Assessing representation—what types of symbols the client will use to communicate 2. Matching the human-technology interface with the client's physical and performance skill abilities a. Joystick b. Keyboard i. Expanded keyboard: large keys for clients with limited motor control and accuracy ii. Miniature keyboard: small keys for clients with limited ROM and control iii. Light touch activation system for clients with decreased strength iv. Delayed touch activation system for clients with poor motor control and accuracy v. Keyboard guard to prevent clients from making mistakes when they have poor motor control or ataxia c. Switches; can be positioned to be operated by different parts of the body and extremities (e.g., head control, between legs, elbow or shoulder control) d. Alternative pointing interfaces i. Eye gaze: for clients with very limited to no hand function but good stability control of the head ii. Mouth stick: for clients with very limited to no hand function, limited head control or movement; must have adequate respiratory support iii. Head pointer: for clients with very limited to no hand function, limited head control or movement, also compromised respiratory support iv. Voice control: for clients with very limited to no hand function or incoordination • Determine vocabulary retrieval techniques. • Determine the optimal visual display for the user. 3. Implementation a. Mounting and positioning of devices b. Vocabulary selection and expansion c. Physical skill development d. Developing three types of communication competency through systematic training i. Operational competence: competency in operating the AAC device ii. Linguistic competence: thorough understanding of the AAC device's symbol system and rules of organization iii. Social competence: knowledge of skills in sociolinguistic (e.g., turn taking, initiating a conversation) and sociorelational (i.e., understanding the interaction between people in conversation) areas e. Periodic follow-up 4. Special considerations a. Portability: easy to use in a variety of environments and contexts b. Accessibility: mounting and positioning for independent operation c. Dependability: durable, consistent performance d. Vocabulary flexibility e. No tech (e.g., gestures, facial expression), low tech (e.g., communication board, labeling), high tech (e.g., computerized, speech output)

The minimum clear width of an accessible route is 36 inches, except at doors. 1. Ramp a. The maximum slope of a ramp is 1:12. Ramp slopes between 1:16 and 1:20 are preferred. Most ambulatory people and most people who use a wheelchair cannot manage a slope of 1:12 for 30 feet. b. The maximum rise for any run is 30 inches. c. The minimum clear width of a ramp is 36 inches. d. A ramp run that has a rise of more than 6 inches or a horizontal projection of more than 72 inches should have handrails on both sides. 2. Stairs: All steps should have uniform riser heights and uniform tread widths of no less than 11 inches. 3. Handrails a. Clear space of 1-11⁄2 inches between the handrail and the wall b. A height of 34-38 inches, or waist height depending on the person's height, measured to the top of the gripping surface from the ramp surface or stair nosing, is recommended for adults. c. A maximum height of 28 inches is recommended for children. 4. Doorway a. The minimum clear opening is 32 inches. (Note: The minimum clearance width for a standard adult-size wheelchair is 26 inches; the minimum clearance width for a walker is 18 inches.) b. Thresholds at doorways should not exceed 3⁄4 inch in height for exterior sliding doors or 1⁄2 inch for other types of doors. c. Raised thresholds and floor-level changes at accessible doorways should be beveled with a slope no greater than 1:2. d. Door hardware for accessible door passages should be mounted no higher than 48 inches above the finished floor. 5. Wheelchairs: minimum of 60-inch diameter or a 60-inch by 60-inch T-shaped space for a pivoting 180° turn to avoid the need for repeated tries and bumping into surrounding objects

A. Definition: "The concept of design in all products and the built environment to be aesthetic and usable to the greatest extent possible by everyone, regardless of their age, ability, or status in life" B. Principles 1. Equitable use 2. Flexibility in use 3. Simple and intuitive use 4. Perceptible information 5. Tolerance for error 6. Low physical effort 7. Size and space for approach and use C. General considerations 1. Competence-environmental press a. All environments have expectations for behavior. b. The adaptive zone is an area in which individual competence is in balance with the environmental demands. c. Maladaptive behavior may occur when the environmental demands exceed or fall below the level of individual competence. d. The physical characteristics of the environment can be either a barrier or a facilitator of optimal occupational performance. 2. Before the home assessment, the occupational therapist should have knowledge of the client's current performance skills level, limitations in client factors, and previous and expected performance patterns in the home environment. 3. Recommendations after home assessment may include a. Physical modifications such as rearrangement of furniture, installation of handrails or grab bars, removal of throw rugs, installation of task lamps, decluttering of the environment, rearrangement of kitchen storage area b. Introduction of assistive devices such as three-in-one commode, bathtub bench, shower chair, raised toilet seat, reacher c. Behavior changes such as using a tote bag instead of a big laundry basket, strategically placing cordless telephones around the house, leaving commonly used pots and pans on the stovetop instead of storing in the cabinet d. Strategies for pacing and energy conservation, such as placing high barstool in kitchen for meal preparation, strategically placing chairs around the house as rest stations e. Strategies to ensure safety for clients with cognitive impairment, such as door alarm, bed alarm, wall or door poster to hide door handle and lock, placing side bolt high out of client's reach f. Strategies for safe mobility and activity demands modifications for clients with low vision or who are blind g. Introduction of electronic aids to daily living (formerly known as environmental control units) 4. Special considerations for age-related physical changes a. Stability b. Mobility c. Carrying items d. Climbing stairs e. Sitting f. Rising g. Bending h. Reaching i. Grasping j. Pinching

A. Goal: modification of the environment, context, and activity demands to support client's safe and independent occupational performance at home B. Three types of home assessment 1. By evaluating the environment (e.g., architectural barriers or fire hazards in the home, without consideration of the person living in the home) using a home safety checklist a. Self-assessment that can be done by the person or other family members b. Increases awareness of potential hazards at home c. Can receive general information with minimum professional input 2. By evaluating the person (e.g., using standardized or general assessment tools that do not specifically pertain to home safety) a. Assessment of performance skills, performance patterns, client factors, and client's areas of occupation b. Professional opinion for general home modifications based on the client's abilities and limitations c. Very little to no regard of the environment itself 3. By evaluating the interaction of the person with the environment for person-environment fit, using a home evaluation checklist a. Only done when an on-site home evaluation is feasible b. Important areas and environments to assess are those in which the client has activity engagement (e.g., bathroom, bedroom, kitchen, but not necessarily laundry room if the client does not need to do his or her own laundry) c. Important to assess how the client interacts with the environment during the activity (e.g., reaching for the light in the bedroom, using a chair to sit down for dressing, using a walker in the kitchen while cooking)

1. Assess client's safety when a. Getting in and out of the house or apartment b. Getting in and out of bed c. Getting on and off the toilet d. Getting in or out of the shower or bathtub e. Reaching and carrying with or without use of mobility aids f. Sitting and rising up from a chair g. Stepping over a threshold h. Mobility on changed floor surfaces (e.g., carpet to hardwood floor or hardwood floor to tile floor) 2. Ease of functional mobility a. Using a cane or quadcane: walking around obstacles and furniture and walking on different floor surfaces b. Using a walker: maneuvering around obstacles and furniture, handling walker on different floor surfaces c. Using a wheelchair: maneuvering on different floor surfaces or threshold, making turns from hallway to room and reverse, making turns within the tight space of a room, transferring on and off the wheelchair to other surfaces such as toilet or bed d. Stair management: ability to use handrails, ability to carry object going up and down the stairs, endurance when using stairs e. Chair, bed, and toilet: ease of sitting down or rising up from different heights f. Kitchen mobility: reaching; carrying; turning in tight spaces; opening and closing cabinets, drawers, and refrigerator; bending; multitasking; walking on tile or linoleum floor surface g. Bedroom mobility: reaching into closet, opening and reaching into drawers, bending, carrying, walking on carpet or hardwood floor h. Bathroom mobility: Opening and closing shower door or curtain; stepping over shower threshold or bathtub; availability of grab bars and position for toilet and shower transfer; walking on carpet, tile, or linoleum floor; adequate space for the wheelchair to get into the bathroom or proximity to the toilet or shower for transfer i. Entrances: All available entrances, stairs versus threshold 3. Ease of occupational performance in the home environment a. Dressing b. Toileting c. Bathing d. Hygiene and grooming e. Dining f. Meal preparation g. Laundry management h. Household management i. Gardening or horticulture j. Leisure activities such as watching TV and reading k. Social activities l. Work activities such as use of computer m. Taking care of pets n. Taking care of others o. Any other significant role for the client