Intervention Basics
What are the steps to an activity analysis?
1.Type of activity (occupation or activity based)
2.Determining relevance & importance to the client
3.Identifying the steps required
4.Determining the objects and properties
5.Determining the space demands
6.Determining the social demands
7.Determining the required body functions
8.Determining the required body structures
9.Determining the required performance skills
10.Analyzing for therapeutic interventions
Neurological approaches focus on what two types of motor components?
Motor control & motor learning
What does a biomechanical approach involves?
What is the Moro reflex and how can it inhibit development if not integrated?
can interfere with head control, sitting equilibrium, and protective reactions
List 3 AE to use with dressing
dressing stick, shoe horn, sock aid, button hook
What is functional cognition?
•ability to integrate thinking and performance skills to accomplish complex everyday activities
What information is pertinent to include in an intervention plan?
Patient name, age, diagnoses, initial evaluation date, frequency of tx, goals
Documentation is what type of record?
Medical record
What does the principle use it or lose it mean?
Failure to drive brain functions can lead to functional degradation (failure to use affected limb may reduce brain connection to limb)
What type of activity would be considered adjunctive for a biomechanical approach to tx?
exercise, PAM, orthoses
What 3 activities can you do to work on STNR integration?
List the levels of independence
•Independence
•Modified Independence (use of AE, takes more than a reasonable time, or safety considerations exist)
•Supervision (standby assistance)
•Contact guard assistance (therapist has one or two hands on client)
•Minimal assistance (25%)
•Moderate assistance (50%)
•Maximal assistance (75%)
•Dependent
In order to engage a client in cognitive strategy training, clients must be aware of what?
Own limitations
What is an adjunctive strategy?
What should be included in tx documentation?
S - subjective
O - objective
A - assessment
P - plan
What is CIMT?
1.Forced use of the impaired UE by restraining the less impaired UE in a sling or hand mitt for appr. 90% of waking hours
2.Massed practice (6-8 hours a day) of the impaired UE through shaping
What are the three concerns for reserving functional ROM?
1.Prevention of deformity
2.Restoration or improvement in the capacity for motion
3.Compensation for limited motion (which is using permanent)
What are pre-handwriting tasks to include with a 3 year old?
scribbling, imitating lines, circular scribbles, beginning on circle shape.
Beginning with the lowest downgrade to the highest upgrade, discuss grades to bed mobility
•Bridging in bed
•Rolling in bed
•Scooting in bed
•Side-lying to sitting at EOB
•Sitting at the edge of the bed to supine
What are 3 phases of cognitive strategy training?
Acquisition, mastery and generalization, maintenance
Give an example of an Enabling intervention strategy?
UE exercises, dressing board, practice operation of AE
What does having a radar mean?
Observations and analysis of the 'big' picture: environment, social, personal, temporal, physical
What are 4 sensory stimuli for muscle tone?
Icing, vibration, tactile, proprioceptive
What are the common intervention approaches to the rehabilitative FOR?
•Assistive technology
•Compensatory techniques
•Environmental modifications
•Orthotics & prosthetics
What is upbeat nystagmus?
Vertical nystagmus
What is OT's role in hospice?
oEnabling occupations that help clients tie up loose ends
oContinuing routine occupations that maintain client sense of well-being
oEnabling occupations that deepen spiritual experience
What is an example of an external memory strategy?
Checklists
Timetables and memory books
Day planners/organizers
Cognitive assistive technology (CATs)
A long term goal address UB dressing, what skills should the STG include?
UB ROM, sequencing, FM, gross motor coordination, orientation
What 4 executive functioning skills does the OT need to have when creating an intervention plan?
Clinical reasoning, decision making, judgement, problem solving
What is central to functional movement? Allows individual to adapt to changes within and between systems
Variability
What is any of a class of external orthopedic appliances, braces, or splints applied to the body to stabilize, control, limit, or immobilize a body part, prevent deformity, protect against injury, or assist with function?
Orthosis
What 'tools' can we use to promote chewing in children?
Chew tube, gloved finger, stick foods, mesh bag
List 4 common problems in retirement
oLoss of the worker role
oLack of time structure
oChanges in social interactions and relationships
oLoss of purpose or daily meaning
oFinancial factors, loss of income
oIncreased stress
oDecline in social status
Self-awareness and monitoring of a person's own cognitive process is what type of strategy?
Metacognitive strategy
Why is it important to be specific with performance skills you are wanting to address in the STG?
Tx OT/OTA understands goals, third party payers understand goals, family/doctors see progression of skills asked
Plateau over extended amount of time, poor attendance, met all goals, client/family able to complete tasks at home safely.
What is difference between PNF and NDT?
PNF is based on normal movement patterns and motor development, mass movements are spiral and diagonal in nature
NDT encourages the use of both sides, discourages use of compensatory techniques. Goal is to normalize tone and inhibit primitive patterns of movement
What are the contraindications for thermotherapy?
•Cancerous lesions
•Open wounds
•Infectious diseases with fever
•Severe circulatory obstruction disorders
What ADL skills are appropriate for a 2nd grader to complete?
dressing, hygiene (some help with hair PRN), shoe tying, simple chores, simple meals (sandwich, some microwave)
List the 3 types of work intervention with the corresponding definition
Work readiness: program allows clients to explore other options if they cannot return to a previous occupation (can be referred to their state’s department of rehabilitation)
Work conditioning: follows acute care and precedes work hardening; focuses on remediation of physical and cognitive deficits to improve work function. *program may be an hour long then progress to an 8 hour day as client improves
Work hardening: multidisciplinary structured treatment designed to maximize client’s ability to return to work. Psychosocial, communication, cognitive, and physical components are addressed
List the 5 skills within the cognitive hierarchy? Listing foundational skills to top skills.
•Arousal and orientation
•Attention and processing
•Memory
•Executive functioning
•Self-awareness
Which letter cannot always be done in therapy? A, E, P, O
Occupation based - limited resources, cannot 'leave' the building for therapy