For neurodevelopmental(NDT) approach to reducing spasticity in a client's upper extremities. What technique would be used?
The Physician wants the occupational therapist to determine if the person is applying maximal effort or if he is magnifying his symptoms. What is the appropriate evaluation protocol for the therapist to use?
A one trial on the dynamometer on all five positions for each hand. A bell curve should be noted.
What does a pre-operative evaluation focus on?
It's focus is on the structure, contractures, ROM, & functional use.
What is performed at a level 2 gasgow coma scale with a TBI?
Sensory stimulation. A level 1 is completely non-responsive coma. A person at a level 2 has severe deficits. the person can open his/her eyes in response to pain & make incomprehensible sounds.
What can a person accomplish at a Allen's Cognitive level 5?
They can carry out three familiar steps and one new one.
What is a cubital tunnel syndrome?
This a a ulnar nerve compression at the elbow. It presenting symptoms are numbness & tigling along the ulnar aspect of the forearm & hand, pain at the elbow with extreme elbow flexion, weakness of power grip, & positive Tinel's sign at the elbow.
What are the result of a partial tendon tear?
What are the results of a complete tear?
What are the results of tendonitis?
- *Fair - Weakness and painful.
- *A complete tendon tear would have weakness but no pain.
- * Pain but no muscle loss.
What is Erb's palsy?
Results from injury to the fifth & sixth brachial plexus roots. It is that the arm hangs limp with the shoulder rotated inward due to atrophy & paralysis in the biceps, deltoid, brachialis, & brachioradialis muscles. This significantly limits functional movement.
What splint is used for Erb's Palsy? Define the splint.
Elbow locking splint stabilizes the elbow to enable the individual to position the hand closer to or away from his/her body for functional use.
What is the flail arm splint used for?
This splint is recommended for a brachial plexus injury of C5-T1 resulting in whole upper extremity involvement. It provides the needed stability at both the shoulder & elbow for functional positioning of the hand.
What is a capital expense?
It is an item that is above a fixed amount, typically $1000.00. A computer based driver rehabilitation program.
What are direct expenses?
Adaptive equipment & staff for they are related to service provision.
How is proprioceptive memory tested?
(in this case it was with a TBI pt)
(difficulties in a variety of perceptual skills)
It is tested by holding the limb in the desired position for 2-4 seconds, then returning it to starting position. the patient then attempts to replicate the position.
What is suprancuclear palsy?
Results in bradykinesia, rigidity, & axial dystonia which would make it difficult to regain skills in buttoning, snapping & zipping.
A child that rocks & figits show what kind of defit?
Vestibular input to help them attend & learning.
What does children with proprioceptive problems need?
Visual & verbal cues to know how to move their bodies & they often appear clumsy, bumping into objects in their environments.
What does children with low muscle tone frequently have difficulty?
Registering proprioceptive input & require more intense input into their muscles & joints. More intense tactile, proprioceptive, & vestibular input will help this child pay attention & stay with an activity for alonger period to provide caregivers with a written Sensory Diet(pushing/pulling heavy stuff, carrying books, pushing chairs, opening doors ect) to implement on a daily basis in the child's home & school environments for carryover.
What is Guillain-Barre' (GBS)?
- Is characterized by ascending motor weakness in the limbs, usually
- begining in the hands & feet. Paresthesias & pain are also a common occurrence. The best approach for this pt is to educate the pt
- about sensory deficits that are common to his condition & provide adaptive strategies for ADL is the pt is successful.
What would be the best splint for a child with cerebral palsy to improve functional use of the hands & arms. The child presents with mild spasticity throughout both hands & arms. The child has difficulty opposing the thumbs to each finger. Also has flat web spaces & can only perform forearm rotation of 35 degrees to hold items in each palm.
A Thumb-abduction supination splint. This splint would address all deficits. It is a useful splint for children with mild to moderate spasticity in the and & arm. It is also used to open the web space, position the thumb for opposition & supinate the forearm for improved hand placement & function.
What is the serpentine splint used for?
It is use to inhabit thumb adduction, position the wrist in neutral alignment, & facilitate forearm supination.
What is the standard neoprene thumb abduction splint use for?
Positions the thumb in a more abducted & extended position for improved opposition for prehension. It works well with children with mild spasticity of the thumb.
What is Brown-Se'quard's syndrome?
One side of the spinal cord is damaged. On the same side as the lesion there are paralysis and deficits in kinesthesia(the persons sense of position, weight, & movement in space) & proprioception (knowledge of the body & related objects in relation to the body) below the level of the lesion. Contrlateral to the lesion (on the other side) there is a loss of temperature & pain sensation below the lesion.
What is the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP)?
Test that measures gross & fine motor functioning in children ages 4.5 to 14.5.
What is Brunnstrom?
Occupational therapy treatment approach based on the use of limb synergies and other available movement patterns in ADL. Classified in 6 stages of recovery from hemiplegia.
What is the Canadian Occupational Performance Measure (COPM)?
A four step process assessment tool used to determine a person's perception of his or her ability to satisfactorily perform meaningful daily activities.
What is CV?
Cardiovascular - Pertaining to heart & blood vessels.
What is CARF?
Commission on Accreditation of Rehabilitation Facilities.
What is carpal tunnel syndrome?
Compression of the median nerve as it enters the palm of the hand through the space between the carpal bones in the wrist(carpal tunnel).
Symptoms are pain & numbness in the index & middle fingers & weakness of the abductor muscle of the thumb.
What is causalgia?
Painful, burning sensation often associated with reflex sympathetic dystrophy, also know as CRPS- chronic regional pain syndrome.
What is the glasgow coma scale?
What is it used for?
It is a diagnostic test, it initial evaluates & continues to assess to determine a person's legel of consciousness after a TBI.
- It consist of 3 test - eye, verbal & motor.
- highest being 15 - lowest being 3 vegie state.
- Best eye response- opening spontaneously 4
- opening to speech 3
- opening to pain 2
- No open 1
- Best verbal response oriented 5
- confused-some disorientate 4
- random talk 3
- moaning- no words 2
- non-verbal 1
- Best motor response - Obeys commands 6
- localizes to pain 5
- with draws from pain 4
- Extension to pain 3
- flexion to pain 2
- no motor response 1
Define Rancho Level of Cognitive functioning:
- Level I - No Response - Total Assist
- Level II - Generalized Resp - Total Assist
- Level III - Localized Resp -Total Assist
- Level IV - Confused -agitated - Max Assist
- Level V - Confused/inappropriate -Max Assist
- Level VI - Confused/appropriate -Mod Assist
- Level VII -Automatic/Appropriate -Min A for Daily Living Skills.
- Level VIII - Purposeful/Appropriate SBA
- Level IX - Purposeful/ Appropriate (SBAOR)
- Stand By Assistant on Request.
- Level X - Purposeful/Appropriate -Modified Independent.
What is Rancho level I?
Rancho Level II?
- Responds to repeated audo stimuli.
- Demonstrates generalized reflex responses to painful stimuli.
- Responses may be significantly delayed.
Rancho Level III?
- Responds to discomfort by pulling tubes or restraints.
- May respond to family or friends.
- Responds inconsistently to simple commands.
- Responds directly related to type of stimuli.
- Purposeful attempts to remove restraints/tubs go home.
- Absent short-term memory.
- Very brief non-purposeful movements .
- May exhibit aggressive or flight behavior.
- Unable to cooperate with treatment efforts.
- Verbalizations are frequently incoherent & or inappropriate to activity or environment.
Rancho Level V?
- May wander.
- Not oriented to person, place or time.
- Severely impaired recent memory, with confusion of past & present in reaction to ongoing activity.
- Absent goal directed, problem solving, self-monitoring behavior.
- Often demonstrates inappropriate use of objects without external direction.
- May be able to perform previously learned tasks when structured & cues provided.
- Unable to learn new information.
- External structure & cues are highly needed.
Rancho level VI?
- Inconsistently oriented to person, time & place.
- Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection.
- Remote memory more so than short term memory.
- *Emerging awareness of appropriate response to self, famkily & basic needs.
- *Mod A to prolem solve barriers to task completion.
- *Max A for new learning, lit or no carry over.
- *Consistently follows simple directions.
What are the duties of an OT practitioner consultant?
The role of the consultant is to help solve problems by, "Identifying & anilizing issues developing strategies to address problems. Identify resources. Ex for school would be to recommend class room activities that will develop performance skills areas of fine motor coordination.