Visual/Perceptual Deficits
A client consistently bumps into objects located on the left side and reports being unable to see them.
Which visual deficit is MOST likely?
A. Left homonymous hemianopsia
B. Unilateral neglect
C. Agnosia
D. Figure-ground deficit
Correct Answer
✅ A. Left homonymous hemianopsia
Rationale
Homonymous hemianopsia results in loss of half of the visual field in both eyes. Unlike neglect, the client is aware that the information is missing.
NBCOT Tip
👀 Can't see it = Visual field cut
🧠 Doesn't attend to it = Neglect
A client is unable to demonstrate how to use a toothbrush when asked, but successfully brushes their teeth when given the toothbrush and instructed to begin.
This deficit is MOST consistent with:
A. Ideomotor apraxia
B. Ideational apraxia
C. Agnosia
D. Unilateral neglect
Correct Answer
✅ A. Ideomotor apraxia
Rationale
Clients with ideomotor apraxia have difficulty performing a motor action on command but may complete the same task automatically during a functional activity.
NBCOT Tip
Can do it automatically but not on command = Ideomotor Apraxia
A client opens their eyes only when spoken to.
What is the client's Eye Opening score on the Glasgow Coma Scale (GCS)?
A. 1
B. 2
C. 3
D. 4
Correct Answer
✅ C. 3
Rationale
GCS Eye Opening:
NBCOT Tip
👀 Spontaneous = 4
🗣️ Speech = 3
😖 Pain = 2
❌ None = 1
A client with a TBI repeatedly attempts to stand without assistance despite requiring moderate assistance for transfers.
This behavior is MOST indicative of:
A. Agnosia
B. Impulsivity
C. Ideomotor apraxia
D. Figure-ground deficit
Correct Answer
✅ B. Impulsivity
Rationale
Impulsivity is common following TBI and increases fall risk because the client acts before considering safety consequences.
NBCOT Tip
🚨 Acts before thinking = Impulsivity
A college student with a TBI frequently forgets appointments, assignment due dates, and daily tasks.
Which intervention is MOST appropriate?
A. Memory notebook
B. Smartphone reminder system
C. Daily verbal reminders from family
D. Written checklist posted in the bedroom
Correct Answer
✅ B. Smartphone reminder system
Rationale
A college student with a TBI who is struggling with appointments, assignment due dates, and daily responsibilities would benefit from a smartphone reminder system because it provides immediate, portable, and customizable support for memory and organization.
Smartphone features may include:
These tools support independence and are highly relevant to the cognitive demands of a college environment.
Question
A client is unable to identify a toothbrush when looking directly at it but can correctly describe its shape and use it appropriately once it is placed in the hand.
This deficit is BEST described as:
A. Constructional deficit
B. Agnosia
C. Figure-ground deficit
D. Spatial relations defici
Correct Answer
✅ B. Agnosia
Rationale
Agnosia is the inability to recognize or identify an object despite intact sensation, vision, and cognition.
NBCOT Tip
Agnosia = "I can see it, but I don't know what it is."
A client attempts to brush their teeth using a comb and then attempts to comb their hair using toothpaste.
This behavior is MOST indicative of:
A. Ideomotor apraxia
B. Constructional deficit
C. Ideational apraxia
D. Figure-ground deficit
Correct Answer
✅ C. Ideational apraxia
Rationale
Ideational apraxia involves difficulty understanding the purpose of objects and completing a task in the correct sequence.
NBCOT Tip
Wrong object or wrong sequence = Ideational Apraxia
A client scores 4.4 on the Allen Cognitive Level Screen (ACLS).
Which intervention is MOST appropriate?
A. Independent medication management using a weekly pill organizer
B. Establishing a familiar daily routine with visual cues
C. Independent community navigation using public transportation
D. Managing finances independently
Correct Answer
✅ B. Establishing a familiar daily routine with visual cues
Rationale
Clients at ACLS Level 4 can complete familiar routines but often have difficulty with problem solving, safety awareness, and adapting to new situations. Visual cues and consistent routines support successful participation.
NBCOT Tip
ACLS 4 = Goal-directed actions
Think:
📋 Routines
👀 Visual cues
🏠 Familiar tasks
A client insists they are capable of driving independently despite significant cognitive deficits and recent safety incidents.
This behavior is BEST described as:
A. Anosognosia
B. Constructional deficit
C. Aphasia
D. Ideational apraxia
Correct Answer
✅ A. Anosognosia
Rationale
Anosognosia is a lack of awareness or denial of deficits and commonly affects safety and rehabilitation outcomes.
NBCOT Tip
🧠 Doesn't recognize the deficit exists = Anosognosia
A client with left unilateral neglect following a right CVA frequently misses obstacles on the left side during wheelchair mobility.
Which intervention is MOST appropriate?
A. Anchoring techniques using a visual marker on the left side of the wheelchair
B. Visual scanning training during wheelchair mobility
C. Contrasting colored tape along the left edge of the environment
D. Lighthouse strategy practice during tabletop activities
Correct Answer
✅ B. Visual scanning training during wheelchair mobility
Rationale
All four interventions may be appropriate for treating unilateral neglect. However, visual scanning training during wheelchair mobility directly addresses the client's identified occupational performance problem and promotes carryover into functional mobility tasks.
NBCOT Tip
When several interventions are appropriate, choose the one that:
🎯 Directly addresses the identified deficit
🏠 Occurs during the functional task
🔄 Promotes the greatest carryover
A client has difficulty locating a hairbrush on a cluttered bathroom counter but can easily find it when all other items are removed.
Which visual-perceptual deficit is MOST likely?
A. Figure-ground deficit
B. Agnosia
C. Unilateral neglect
D. Depth perception deficit
Correct Answer
✅ A. Figure-ground deficit
Rationale
Figure-ground deficits impair the ability to distinguish an object from surrounding visual information.
NBCOT Tip
🔍 "Can't find it in clutter" = Figure-ground problem
A client with apraxia is learning a morning grooming routine.
Which intervention is MOST appropriate?
A. Verbal cueing only
B. Step-by-step visual cues and task breakdown
C. Increase task complexity
D. Complete the task for the client
Correct Answer
✅ B. Step-by-step visual cues and task breakdown
Rationale
Breaking tasks into smaller steps and providing visual cues helps compensate for motor planning deficits and improves task performance.
NBCOT Tip
For apraxia:
📋 Simplify
🪜 Break down steps
👀 Use visual cues
A client demonstrates severe agitation, poor attention, and attempts to remove medical lines and tubes. The client is unable to cooperate with treatment and displays non-purposeful behavior.
Which Rancho Level is MOST likely?
A. Level III: Localized Response
B. Level IV: Confused-Agitated
C. Level VI: Confused-Appropriate
D. Level VIII: Purposeful-Appropriate
Correct Answer
✅ B. Level IV: Confused-Agitated
Rationale
Level IV clients are highly agitated, have poor attention, and often demonstrate non-purposeful behavior.
NBCOT Tip
😡 Agitated = Rancho IV
A client with TBI has poor safety awareness and frequently forgets to lock wheelchair brakes before transfers.
Which intervention is MOST appropriate?
A. Eliminate all transfer practice
B. Establish a transfer checklist with visual cues
C. Focus only on strengthening exercises
D. Allow the client to learn through repeated falls
Correct Answer
✅ B. Establish a transfer checklist with visual cues
Rationale
External cues and structured routines improve safety and support successful task completion.
NBCOT Tip
Poor awareness → External supports
A client with a CVA demonstrates learned nonuse of the affected upper extremity despite having active movement available.
Which intervention is MOST appropriate?
A. Mirror therapy
B. Bilateral upper extremity training
C. Constraint-Induced Movement Therapy (CIMT)
D. Task-oriented repetitive reaching activities
Correct Answer
✅ C. Constraint-Induced Movement Therapy (CIMT)
Constraint-Induced Movement Therapy (CIMT) is specifically designed to address learned nonuse by restricting use of the unaffected upper extremity and encouraging repetitive use of the affected arm during functional activities.
NBCOT Tip
When you see:
✋ Active movement present
✋ Client avoids using affected arm
✋ Learned nonuse
Think:
🎯 CIMT
A client consistently places a drinking glass too far from the edge of the table when attempting to grasp it.
Which visual-perceptual deficit is MOST likely?
A. Agnosia
B. Figure-ground deficit
C. Spatial relations deficit
D. Visual memory deficit
Correct Answer
✅ C. Spatial relations deficit
Rationale
Spatial relations deficits impair the ability to judge the position of objects relative to oneself and other objects.
NBCOT Tip
📍 Misjudging where things are = Spatial relations
A client with a left CVA speaks in short, effortful phrases and becomes frustrated when attempting to communicate. The client follows directions accurately and appears to understand most conversations.
Which type of aphasia is MOST likely?
A. Receptive (Wernicke's) aphasia
B. Global aphasia
C. Expressive (Broca's) aphasia
D. Ideational apraxia
Correct Answer
✅ C. Expressive (Broca's) aphasia
Rationale
Clients with Broca's aphasia typically:
NBCOT Tip
🗣️ Broca's = Broken speech
A client at Rancho Level VI (Confused-Appropriate) is participating in an ADL session.
Which intervention is MOST appropriate?
A. Provide a highly structured environment with one-step directions only
B. Encourage problem solving during familiar tasks with moderate assistance
C. Initiate independent community outings without supervision
D. Focus treatment on sensory stimulation and arousal activities
Rationale
Clients at Rancho Level VI demonstrate emerging goal-directed behavior and can participate in familiar activities. They are beginning to problem solve but still require assistance for planning, sequencing, and safety.
NBCOT Tip
Rancho VI = Emerging Problem Solver
Think:
🧩 Familiar tasks
🤔 Guided problem solving
👨⚕️ Moderate assistance
📋 Structured support
A client with TBI wants to begin cooking independently but demonstrates impaired judgment and difficulty recognizing hazardous situations.
Which intervention is MOST appropriate?
A. Independent meal preparation
B. Simulated cooking with supervision and safety cueing
C. Discontinue kitchen activities
D. Focus only on upper extremity strengthening
Correct Answer
✅ B. Simulated cooking with supervision and safety cueing
Rationale
Supervised practice allows the client to develop awareness and safety skills while minimizing risk.
NBCOT Tip
NBCOT loves:
🚨 Real task
👀 Supervision
📋 Cueing
before full independence.
A college student with a TBI reports difficulty organizing assignments, managing deadlines, and prioritizing responsibilities across multiple classes.
Which intervention is MOST appropriate?
A. Use planners, calendars, and task-management systems
B. Implement a smartphone reminder system only
C. Recommend a memory notebook for all assignments
D. Provide weekly verbal reminders from professors
Correct Answer
✅ A. Use planners, calendars, and task-management systems
Rationale
The student's primary challenge is executive dysfunction, including organization, planning, prioritization, and time management. A comprehensive organizational system addresses multiple executive functioning deficits and promotes independence across academic tasks.
NBCOT Tip
🧠 Memory problem = Remembering information
📅 Executive function problem = Planning, organizing, prioritizing, and managing time
A client is unable to copy a simple clock drawing and demonstrates difficulty arranging objects appropriately in space during ADL tasks.
Which deficit is MOST likely?
A. Figure-ground deficit
B. Constructional deficit
C. Agnosia
D. Visual memory deficit
Correct Answer
✅ B. Constructional deficit
Rationale
Constructional deficits affect the ability to organize and assemble visual information into a meaningful whole. Difficulties may be seen with drawing, copying designs, and arranging objects in space.
NBCOT Tip
🕐 Clock drawing problems are classic for constructional deficits.
A client with a left CVA speaks fluently and produces long sentences; however, the speech contains incorrect words and the client is unable to follow simple verbal directions.
Which intervention is MOST appropriate during OT treatment?
A. Provide lengthy verbal explanations for all tasks
B. Use short, simple directions paired with visual demonstration
C. Ask open-ended questions to assess understanding
D. Rely exclusively on verbal cueing throughout treatment
Correct Answer
✅ B. Use short, simple directions paired with visual demonstration
Rationale
The client demonstrates characteristics of receptive (Wernicke's) aphasia, including impaired comprehension and fluent but often nonsensical speech.
Effective interventions include:
NBCOT Tip
🧠 Can't understand language = Receptive Aphasia
Treatment focus:
👀 Show it
👉 Gesture it
🗣️ Simplify it
rather than talking more.
A client demonstrates:
What is the client's GCS score and injury severity?
A. 8, Severe TBI
B. 8, Moderate TBI
C. 10, Moderate TBI
D. 10, Severe TBI
Correct Answer
✅ A. 8, Severe TBI
Rationale
GCS = Eye + Verbal + Motor
Total GCS = 8
Severity classifications:
Because the score is 8, the injury is classified as severe TBI.
A client with a right CVA is preparing for discharge home. During therapy sessions, the client repeatedly attempts transfers without assistance despite requiring moderate assistance and having experienced multiple recent falls.
What is the MOST appropriate OT recommendation?
A. Allow independent transfers to improve confidence
B. Focus treatment exclusively on strengthening activities
C. Recommend close supervision and environmental safety modifications during functional mobility
D. Delay all transfer training until discharge
Correct Answer
✅ C. Recommend close supervision and environmental safety modifications during functional mobility
Rationale
Clients with right CVAs may demonstrate impaired safety awareness, poor judgment, impulsivity, or anosognosia. Close supervision and environmental modifications reduce fall risk while still allowing participation in functional activities.
NBCOT Tip
For CVA clients with poor awareness:
🚨 Safety first
👀 Supervision
🏠 Environmental modifications
♿ Functional practice
before independence is considered.
A client with a TBI is preparing to return to work as an administrative assistant. The client independently completes ADLs and demonstrates adequate memory for routine tasks. However, the client becomes overwhelmed when managing multiple responsibilities simultaneously and has difficulty prioritizing tasks when unexpected interruptions occur.
Which intervention is MOST appropriate?
A. Use a smartphone reminder system to improve recall of work tasks
B. Implement simulated work tasks requiring prioritization, scheduling, and management of competing demands
C. Use a daily planner to organize appointments and deadlines
D. Establish a structured daily routine with written checklists
Correct Answer
✅ B. Implement simulated work tasks requiring prioritization, scheduling, and management of competing demands
Rationale
All four interventions could be beneficial for a client with TBI.
However, the client's primary limitation is executive functioning under complex, real-world conditions, specifically:
NBCOT Tip
Ask yourself:
What is the actual deficit?
📱 Forgetting → Memory aid
📅 Organization → Planner
📋 Routine completion → Checklist
🧠 Multitasking + prioritization + adapting to interruptions → Executive function training