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cancer refers to

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abnormal cell growth Changes in a cell's DNA

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Current Statistics demonstrate that ______ men and __________ women will be diagnosed with cancer in their lifetimes.

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1 in 2 men 1 in 3 women

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with cancer, ____________ can disrupt a person's occupational function

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Both the disease and its treatment

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with cancer, both the disease and its treatment can disrupt a person's occupational function including

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Routine roles can be disrupted Roles and activities associated with those roles can be lost Impairments can lead to long-term disability

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It is estimated that in 2010, over ____________ new cases of cancer were reported It is estimated that almost __________ people died

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1.5 million 570,000

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Men are at greatest risk for

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prostate, lung, and colorectal cancers.

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Women are at greatest risk for

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breast, lung, and colorectal cancers.

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Two Primary Risk Factors:

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Environmental Genetic--Unknown cell reproduction

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Cancers can be graded in terms of

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degree of differentiation, which is the degree to which the cell resembles the source tissue.

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Cancers can also be staged in terms of

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the degree to which a cancer has progressed. Tumor Size Number of Lymph Nodes to Which the Cancer Has Locally Spread Presence of Metastasis

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GX

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Grade cannot be assessed (Undetermined grade)

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G1

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well-differentiated (Low grade)

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G2

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Moderately differentiated (Intermediate grade)

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G3

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Poorly differentiated (High grade)

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G4

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Undifferentiated (High grade)

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G= The bigger the number the

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grading of the cancer cell—how it looks in comparison to a healthy cell the worse it is

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X means G1— G2—

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very low and cant even assess it cancer cell looks a lot different than healthy cells harder to tell between healthy cells and non healthy cells

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stage 0

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Carcinoma in Situ (early cancer is present only in the layers of cells in which it began)

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stage 1, 2, 3 the higher numbers indicate...

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more extensive disease: greater tumor size, and/or spread of the cancer to nearby lymph nodes and/or organs adjacent to the primary tumor.

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stage 4

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The cancer has spread to another organ.

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TX

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primary tumor cannot be evaluated

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T0

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no evidence of primary tumor

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Tis

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primary tumor

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T1, T2, T3, T4

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Size and/or extent of the primary tumor

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Nx

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Regional lymph nodes cannot be evaluated

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N0

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No regional lymph node involvement (no cancer found in the lymph nodes)

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N1, N2, N3

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Involvement of regional lymph nodes (number and/or extent of spread)

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MX

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Distant metastasis cannot be evaluated

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M0

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No distant metastasis (cancer has not spread to other parts of the body)

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M1

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Distant metastasis (cancer has spread to distant parts of the body)

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Leukemia

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blood cells, bone marrow, and/or blood-forming tissue

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Myeloma

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Plasma cells in the bone marrow

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Lymphoma

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Glands or nodes of the lymphatic system

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Sarcomas

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Cancer of the bones, cartilage, fat, muscle, blood vessels, or other connective tissue

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carcinoma

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Skin or lining of the internal organs

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diagnosis most seen by OT

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Breast Cancer Lung Cancer Brain Cancer Head and Neck Cancer Sarcoma

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Breast cancer surgeries may include

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lumpectomy, partial mastectomy, full mastectomy, radical mastectomy, cryotherapy

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_______________ issues can arise when treating patients with breast cancer

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Emotional as well as physical

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OT issues with breast cancer

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Fatigue, pain, lymphedema, limited ROM, decreased strength, "Chemo Brain" and other cognitive deficits

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Radical mastectomy—

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also getting rid of muscle lymp nodes etc

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full mastectomy

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entire boob but not getting rid of muscles and lymph nodes

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brain cancer Cause many functional deficits:

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Impaired cognition Weakness Visual-perceptual deficits Sensory loss Bowel-bladder dysfunction Fatigue/Sleep issues

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head and neck cancer begin in....

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cells in the oral cavity, nasal cavity, thyroid gland, and pharynx

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head and neck cancer treatment may cause

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disfiguration, pain, weakness, communication issues, and swallowing Some guilt/anxiety regarding cause and implications

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soft tissue sarcomas develop from

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fat, muscle, nerve, fibrous tissues surrounding joints, blood vessels, and deep skin tissues

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Primary bone tumors develop from

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both bone and cartilage

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types of sarcomas

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soft tissue sarcomas primary bone tumors

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sarcomas usually found in

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extremities

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sarcoma OT issues

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peripheral neuropathy, fatigue, lymphedema, pain, limited ROM, perceptual issues, and inability to complete tasks

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primary treatment for sarcomas

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Surgery (Amputations often)

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Effects of Tx on Functional Capacities and Abilities, Course of treatment can involve multiple modalities:

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Surgery Chemotherapy Radiation Experimental therapies Problems that result may be physical, cognitive, and/or emotional.

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Chemotherapy can cause

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induced peripheral neuropathy or tremors

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Radiation may cause

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fibrosis

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Surgery or Radiation involving one or more lymph node may cause

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lymphedema

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Other reactions to cancer treatment may include

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musculoskeletal changes, fascial tightening, fatigue, pain, nausea, and cognitive dysfunction

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Psychosocial Adjustment Issues

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Loss of control Occupational deprivation and loss of valued routines and roles Change in one's sense of well-being May experience disruption of social or cultural contexts Depression Anxiety Sleep disturbance Pain

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cancer-related fatigue (CRF)

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An unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with functioning.

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The term "chemobrain" refers to

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survivors' complaints of mild cognitive impairment (MCI) during or following chemotherapy.

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Both fatigue and (mild cognitive impairments) MCI may be symptoms of

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many medical problems including anemia, cardiac or respiratory dysfunction, stress, depression, sleep disorders and so on.

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The risk of psychological distress in individuals with cancer relates

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much more strongly to their level of disability than it does to the cancer diagnosis itself." when a person physically cant do the things they want to do it causes more disruption than the diagnosis --disruption of roles

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The Role of OT in Oncology

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to facilitate and enable an individual patient to achieve maximum functional performance, both physically and psychologically, in everyday living skills regardless of his or her life expectancy

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Type of OT assessments and evaluation selected depends on

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client's medical and cognitive status.

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Clinician needs to understand the following:

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Medical history Previous response to and side effects of treatment Prognosis Current and potential impact of disease and treatment on performance areas

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Goals and Moderating Variables That Affect Realistic Goal Setting across the Continuum of Care

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Enable clients to optimize their quality of life.

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moderating variables

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-Rapid changes in medical and functional status -Severity of disease and individual's expectations regarding recovery may be incongruous. -Important to help the individual modify valued goals and roles accordingly -When possible, long-term goals should guide client back toward resuming activities such as work, driving, leisure, social interaction, play, and education.

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Rapid changes in medical and functional status

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good day/week bad day/week might bounce back might not

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Severity of disease and individual's expectations regarding recovery may be incongruous.

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some people still fight to the end some people have different expecations

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The most extensively studied treatment for CRF (cancer related fatigue) and has consistently demonstrated good results in cancer survivors is?

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physical activity

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According to the NCCN Clinical Practice Guidelines on CRF: "Exercise has a powerful effect on cancer-related fatigue, and fatigue levels were _________ lower in exercising participants, even in studies with small sample sizes. The evidence supporting exercise as an intervention for fatigue is category 1 based on the number of studies conducted, good quality of the designs, large effect size of exercise on cancer-related fatigue, and consistent outcomes across studies."

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40% to 50%

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T/F Treatment is not much different for those with cancer than for other medical conditions.

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true

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Interventions focus on the following:

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Promoting health in the face of disease Restoring performance skills and patterns Preventing disability Modifying contexts, activity demands, or performance patterns Providing supports that help maintain function

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OT intervention for Fatigue management and energy conservation

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sit down during any tasks (energy conservation) adjust environment so things most needed are close to them prioritize what they want to spend energy on

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OT intervention for Sensory reeducation and desensitization (hyper or hypo sensitivity)

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use a koozi for drinks or wear a glove on sensitive hand item find in the rice massaging (scar management)

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OT intervention for Scar management

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scar massage breaking up scar formation

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OT intervention for Conditioning (range of motion, strengthening, endurance)

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adaptive equipment modification of enviornment modalities such as ultrasound

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OT intervention for Fall prevention and other activities to promote home safety

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teach risk of falls

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OT intervention for Wheelchair seating and positioning

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recommend certain types of cushions educate on 90 90 angles

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OT intervention for Cognitive training/strategies

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reminders cues checklists turn down water heater

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OT intervention for Stress and anxiety management

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coping strategies breathing techniques set small achievable goals to boost confidence investigate triggers to anxiety and how to help with those

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OT Intervention

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Pain management Lymphedema Management Management of ADL's

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pain management

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modalities compression sleeves

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lymphedema management

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manual lymph drainage (need certification)

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Expected Course of Recovery (or Decline)

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Depends on when the cancer is detected, how the cancer is staged, and the individual's response to treatment. Earlier detection and treatment typically indicate better prognosis. Therapists need to promote both physical and psychosocial rehabilitation for cancer clients while providing a comprehensive, multidisciplinary approach to prevent and treat disability.

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OT and Hospice Care

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Helps clients find relief from pain and suffering and improve their quality of life by supporting their engagement in daily life occupations that clients find meaningful and purposeful. Considers environmental and contextual factors Considers personal factors

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Loss of independence and role can result in ___________. Occupational therapy can help a person to adopt new and appropriate functions and roles and to maintain self-esteem

answer

social death prior to biological death

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