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514 > Beckys 618 Final! > Flashcards

Beckys 618 Final! Flashcards

1
Q

Dysphagia: What are the 4 phases of the normal swallow?

A
  1. oral preparatory stage
  2. Oral Stage
  3. Pharyngeal stage
  4. Esophageal stage
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2
Q

What is the role of OT with a client with swallowing dysfunction?

A
  1. Posture: upright feet on floor, affected side supported.
  2. communication and cognition
  3. visual scanning
  4. increase use of AE
  5. increase fine motor skills
  6. improve head and neck control
  7. assist with self feeding and improve swallowing.
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3
Q

Dysphagia: Know the difference between types of diets i.e. NPO, mechanical soft, etc

A

Diets:
1. puree
2. ground diet: pts can manipulate something . Often these diets are dry so add gravy to help swallow easier.
3.mechanical soft diet: ground meat and ground veges
4. soft diet: meat falls off bone- no crunchy ie nuts, popcorn
5. regular diet
Fluids:
1. thin: normal
2. nectar thick liquid
3. honey thick liquid

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4
Q

What are the signs of dysphagia?

A
  1. coughing during or after drink
  2. wet or gurgly sounding voice during/after eating or drinking
  3. Extra effort or time needed to chew or swallow
  4. Food or liquid leaking from the mouth or getting stuck in the mouth
  5. Recurring pneumonia or chest congestion after eating. Right lower lobe pneumonia due to aspiration.
  6. raised respiratory rate during/after eating
  7. discomfort or pain during swallowing.
  8. WEIGHT LOSS OR DEHYDRATIONFROM NOT BEING ABLE TO EAT ENOUGH!
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5
Q

Pharyngeal stage

A

involves elevation and retraction of the soft palate, laryngeal closure and suspension of respiration, relaxation and opening of the sphincter at the top of the esophagus, bolus is propelled into the esophagus.

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6
Q

Esophageal stage

A

Involuntary process whereby food finally passes through the esophagus into the stomach.

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7
Q

what is dysphagia?

A

difficulty swallowing

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8
Q

Oral prep stage

A

This stage is voluntary and involves the preparation of the bolus with the aid of saliva, good lip seal, jaw movement and chewing.

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9
Q

Oral stage

A

During the oral stage, also a voluntary process, the tongue elevates and rolls back, sequentially contacting the hard and soft palate, moving the bolus backwards.

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10
Q

aspiration

A

material falls below the vocal folds. ie liquids, food, reflux, vomit: cough or choke is sign

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11
Q

silent aspiration

A

pt lacks sensation does not cough in response to aspiration.

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12
Q

Aphasia

A

a language disorder that can impair a persons ability to comprehend /understand or speak. This disorder usually affects some or all language abilities, such as speaking, understanding, gesturing, reading, writing. “ Brain holds word hostage”

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13
Q

Apraxia

A

is a motor speech disorder that can impair a person s ability to speak. Apraxia is characterized by difficulty in articulating speech sounds/ words, formation of gestures or pantomime( pretend w/o using words). Formation of letters when writing. Frequently , this pt is able to produce “automatic” phrases such as greetings, counting, singing, cursing, more easily than “ novel” utterances.

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14
Q

Dysarthia

A

is a motor speech disorder than can be caused by paralysis, weakness or incoordination of the muscles of speech as a result of brain damage from stroke, surgery, disease process, traumatic brain injury or tumor. This pt is unable to speak with normal muscular speed, strength, precision and timing. Speech may be slurred or otherwise difficult to understand. ( mouth full of marbles).

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15
Q

communication strategies for DYSARTHIA

A
  1. Allow extra time for pt to respond
  2. speak face to face
  3. reduce background noise
  4. have pt speak louder or softer
  5. offer pen and paper to help with communication
  6. remind pt to take deep breath before speaking to help with speech
  7. encourage good posture
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16
Q

Back Pain: What are the various conditions that may contribute?

A
  1. overuse injury
  2. strain
  3. injury
  4. Degenerative disc disease
  5. spinal stenosis
  6. osteoporosis
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17
Q

Back Pain: What tests are routinely done to DX?

A

Babinski, upper quarter screen, Rhomberg, whole lower quarter screen ( ROM, MMT). Look for foot drop, tripping over things( when this occurs surgery is option).

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18
Q

Back pain: What are some basic strategies to help patients perform daily occupations safer?

A

Maintain fitness adults 150 min each week. Strengthen core, back and leg muscles, stand and stretch every 20 minutes if sitting long periods of time.
Proper body mechanics: cognizant of lifting,
backpack ergonomics, shoveling, gardening( half kneel- knee pads), office ergonomics (wrist straight and even with keyboard and elbows), traveling use a lumbar roll to support lumbar area and stretch frequently. Laundry: pick up one leg while leaning to get laundry out of machine. Vacuum: bend knees. dishwasher: stool or kitchen chair. Bathroom: mirror that springs off wall to protect cervical area. Car transfer: grab bar, hooks on door. TX ideas: set obstacle course: lifting milk crates, pushing grocery cart, open close fridge, mop, vacuum, bath child. demonstrate first! recommend ergonomic vacuum.

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19
Q

Back pain: Define acute vs chronic back pain

A

acute: sudden lasts less than 3 months
Chronic: lasts greater than 3 months

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20
Q

Stenosis

A

narrowing of spinal canal, nerve root compression, sensory/motor symptoms.
Strengthen and cardio vascular , strengthen and stretch arm muscles.

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21
Q

Disc Disease

A

Osteoarthritis
disc bulges or ruptures
common in lumbar spine

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22
Q

Cervical pain

A

Due to trauma or arthritis
Hyper ext. or flexion
Hyper lordosis
nerve entrapment, facet impingement, foraminal closure

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23
Q

Kyphosis

A

prolonged stooped posture, may follow boney damage

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24
Q

Lordosis

A

From forwarding tilting of pelvis, poor posture, obesity, pregnancy.

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25
Q

Ankylosing Spondylitis

A

Ossification of spinal ligaments

stiff joints. Flexibility and stretching is important.

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26
Q

Laminectomy

A

Procedure done first before Discectomy then Fusion.
post sx no Bending, lifting or twisting. Often the first option for surgery. removal of lamina to relieve nerve root compression. Post laminectomy can log roll in bed, use reachers, long handled bath sponge, tub bench. OT X2 sessions max.

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27
Q

Discectomy

A

permanent portion of the disc to relieve pressure on a nerve.

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28
Q

Fusion

A

permanent fusion of 2 or greater vertebrae to correct, or relieve pain. Bone is grafted from the hip. Attached with wire, cage , screw, plates, etc. to increase stability. Will lose ROM. 70% of people get this procedure for back pain.

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29
Q

Oncology: What are some Evaluation & treatment areas from a phys dis perspective?

A

energy conservation, increase limited ROM and exercise program post surgery (mastectomy). Prescribe equipment DME, raised toilet seat, shower seat, grab bars, work on ADLs.
Eval: falls risk, balance, ROM, pain scale, fatigue scale.
Post surgery: restore active ROM, PRE- biomechanical approach ( anything to do with movement.), sleep positions.

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30
Q

Oncology: What does metastasis mean?

A

goes from original site to the new site.

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31
Q

Oncology: Differentiate between benign & cancerous.

A

Benign: slow growing, encapsulated, non- metastasizing, can be serious and deadly as they compress healthy brain tissue and surrounding structures: cysts, adenoma, fibromata, lipomata
Malignant (Cancerous): fast growing, abnormal to host area, metastasize.

32
Q

Oncology: What are the different types of cancers an OT may commonly treat & what deficits would likely result?

A

metastatic brain tumors: grade I or II= low grade glioma, grade III = high grade astrocytoma, grade IV= Glioblastoma or malignant astrocytic glioma 65% of brain tumors.( note astrocytes cells and glial
cells in the brain)
TX: Cam or Lotka to assess cognition and disinhibition ( lose filter b/w brain and mouth).
Meningioma: originates in meninges, slow growing, benign grade I, but can be grade II-IV.
Oligodendroglioma: Tumor arises from fatty cells that cover and protect. Usually in cerebrum and in middle aged adults. Can be grade II or III.

33
Q

Oncology: What are the different types of cancers an OT may commonly treat & what deficits would likely result?

A

Metastatic spinal cord involvement: SCI signs result from compression due to metastasis and CA infiltration of vertebral body. Symptoms include: radicular pain (shooting pain from foot to leg issues falling, motor weakness, sensory disturbances, bowel and bladder dysfunction).

34
Q

Oncology: What are the different types of cancers an OT may commonly treat & what deficits would likely result?

A

Metastatic bone CA: greater than 50% with breast lung or prostate CA, eventually develop bone mets. Extreme pain is impairing function. Falls risk. DME= raised toilet seat, shower seat, grab bars.
Abdominal or chest cancers: can cause bloating or swelling, pain. TX can lead to secondary problems. Energy conservation, prescribe DME and work on ADLs.

35
Q

Oncology: What are the different types of cancers an OT may commonly treat & what deficits would likely result?

A

Modified Radical Mastectomy: breast, lining of chest wall muscles and axillary lymph nodes removed.
pecs are intact
issues of weakness and deformity decreased
used to treat early, advanced or inflammatory breast cancer ie skin
IF PECS HAVE TO BE REMOVED LOOSE LOTS OF FUNCTION.

36
Q

Breast cancer

A

affects 1-10 women.
Affects males. Mastectomy most common procedure. Types of surgery: breast, pecs muscle, lymph nodes.
Lymphedema, disfigurement, UE weakness results.

37
Q

Oncology: What are the different types of cancers an OT may commonly treat & what deficits would likely result?

A

Simple Mastectomy: Removal of entire breast
Lymph and pecs and other muscle tissue preserved.
Most common
Usually d/c from hospital the next day.
Post mastectomy clinical problems: UE weakness, chest wall adhesions,
cervical and sh pain
lymphedema.

38
Q

Assessment and intervention Oncology

A

Intervention: relaxation tapes, melatonin for sleep ask Dr. , mobility, strength, balance, posture, coordination, dexterity, manipulation, pain, endurance ( Brief fatigue inventory, dyspnea scales), ROM, sensation, vision/perception, cognition, ADLs, DME/AE, sleep positioning, prevocation skills, coping, psychosocial, leisure. ROM, cane excercises, finger ladders, HEP, decrease stairs to 1X a day, stats say 5 min exercise help combat fatigue, encourage naps. Over all immune system health, diet. Apple picking.
Assessments ideas: nine hole peg test,
CUE, Tinetti, TUG, Berg, Jebsen ( may have to change hand dominance). upper quarter screen, mmt, check vitals and respiration. check if compensating w/resistance.

39
Q

Precautions oncology:

A

read chart, no thermal or electrical modalities over malignancies, be mindful of infection control, aggressive exercise is often contraindicated.

40
Q

Approaches: compensatory/remedial approach oncology

A

compensatory: DME/AE, energy conservation, positioning, splinting, activity modification
Remedial: Biomechanical approach when recovery is occurring, HEP, cardiovascular conditioning as tolerated. p 415 acute care book.

41
Q

Vision Therapy : What areas are assessed in the clinical vision assessment?

A

structural, refractive ( what creates the rainbow in crystal means bent light), functional.
Functional vision problems: Convergence, accommodation (focusing cranks up), Oculo-motor, strabismus- muscle palsy, Amblyopia, visual field loss, visual perception.,
Refractive conditions: Myopia, Hyperopia, Astigmatism, Presbyopia: Presbyopia is a condition associated with aging in which the eye exhibits a progressively diminished ability to focus on near objects..

42
Q

Vision Therapy: Refractive conditions (myopia, astigmatism, hyperopia, amblyopia)

A

Myopia: near sided
Hyperopia: far sided
Astigmatism:a defect in the eye or in a lens caused by a deviation from spherical curvature, which results in distorted images, as light rays are prevented from meeting at a common focus.
Amblyopia: also called lazy eye, is a disorder of sight. It involves decreased vision in an eye that otherwise appears normal, or out of proportion to associated structural problems of the eye. In amblyopia visual stimulation either fails to be or is poorly transmitted through the optic nerve to the brain for a continuous period of time. It also can occur when the brain “turns off” the visual processing of one eye to prevent double-vision, for example in strabismus (crossed eyes). It often occurs during early childhood and results in poor or blurry vision.

43
Q

Vision Therapy:

A

Goals: reduction/ elimination of visual symptoms, improve balance, comfort, cognition. Methods: selective occlusion, applications of lenses, prisms, filters, active vision therapy.
prisms: compensatory: horizontal or vertical muscle palsy, loss of convergence, visual field loss.
Behavioral Prism application: visual midline shift, poor localization, poor balance. can do vestibular system exercises ( look turn ur head).
Optometric vision therapy: use to improve convergence, fusion, accommodation, eye movements, peripheral awareness, perceptual/ processing skills.

44
Q

Vision Therapy: What do the Hart Chart, flashlight games, etc. work on?

A

Hart chart: improve the ability to organize and track visually. Use eye patch on eye and read hart chart with other eye. ( saccadic fixations)
Flash light games: to organize eye, hand and body movements, in visually directed and monitored spatial operations.

45
Q

smile

A

” Everytime you smile at someone, it is an action of love, a gift to that person, a beautiful thing.” Mother Theresa

46
Q

Vision: near point stress model

A

eyes are designed for distant vision, convergence stress response activates adrenals the adrenaline affects the whole body including divergence in eyes and dilation of the pupils when trying to read up close uses.
3 ways that people adjust to near point stress: 1.sacrifice far vision in order to see far away. 2. reduced performance in reading (headaches decreased, comprehension, behaviors decreased.) 3. quitting= avoidance of all tasks requiring reading.
peace fingers b/w eyes helps with motion sickness.

47
Q

Vision: Near Triad

A

convergence, constriction of pupils and accommodation ( focusing of lens) this is required to read up close and it requires parasympathetic

48
Q

myopia

A

near sided

49
Q

hyperopia

A

far sided

50
Q

Fragile Binocular ( near point stress)

A

car sick feeling, dorsal and ventral pathways disorganized. Fix with peace fingers in-between nose and eyes, look at periphery and breath deep.

51
Q

pursuit

A

smooth following

52
Q

saccaided

A

reading- movements/jumping

53
Q

Focual pathway

A

central vision: this tells you what things are.

54
Q

Ambient

A

periphery, balance

55
Q

Accommodation ( focusing)

A

symptoms: 10% of TBI cases, blurred vision, headaches, squinting, double vision, reading problems, eye pain

56
Q

Oculo- Motor tracking

A

40% of ABI pts, two systems: pursuits and saccades

symptoms: can’t follow objects, loses place when reading reversals, nystagmus which is either congenital or acquired.

57
Q

Strabismus ( eye turn)

A

10-25% of ABI( acquired brain injury) population symptoms: closing of an eye, double vision, head turn or tilt, poor depth perception.

58
Q

Visual field

A

32% population ABI, hemianopia, quadrantanopsia, perceptual: visual neglect, antons syndrome:Anton–Babinski syndrome, also known as visual anosognosia, is a rare symptom of brain damage occurring in the occipital lobe. Those who suffer from it are “cortically blind”, but affirm, often quite adamantly and in the face of clear evidence of their blindness, that they are capable of seeing
Visual midline shift phenomena

59
Q

visual field defect

A

bumping into objects, poor night vision, tunnel vision, drifts to one side when ambulating, holds onto walls, people etc.

60
Q

Post trauma vision syndrome

A

characteristics: exophoria, exotropia, accommodative problems, poor convergence, low blink rate, spatial disorientation, balance/ postural difficulties.
Symptoms: Diplopia( single object appears double), objects appear to move, visual memory problems staring behavior, poor tracking ability, astenopia (a fatigue or tiring of the eyes).

61
Q

convergence problems ( pointing system)

A

closing one eye, double vision, muscle palsy, headaches, pain, reading problems, print is blurry, ocular discomfort

62
Q

accommodation problems ( focusing system)

A

focusing problems headaches, pain, double vision, squinting, closing one eye, reading problems, ocular discomfort.

63
Q

motilities ( tracking system)

A

inability to follow objects smoothly, reading problems, skipping words, re-reading words, reversals, nystagmus- regular, rapid, involuntary eye movements.

64
Q

Strabismus ( eye turn)

A

closing one eye, double vision, head tip/ turn, sudden onset of eye turn, muscle palsy, poor depth perception.

65
Q

visual perceptual ( processing)

A

problem judging size, poor distance judgment, coordination issues, left-right confusion.

66
Q

field defects ( peripheral vision)

A

bumping into chairs, objects etc…, poor night vision, tunnel vision, leans on walls, people, midline shift.

67
Q

developmental disability

A

significant limitations in intellectual function and adaptive behavior as expressed through perceptual, social and practical adaptive skills.

68
Q

developmental disability: frames of reference

A

PEO and Moho

69
Q

Remedial

A

means to try and fix the problem if can. ie could use adaptive automatic light switch for bathroom. Remedial strategies help get back to baseline..ie raised toilet seat, shower seat.

70
Q

developmental disability: behavior strategies

A

Cognitive: Allen’s cognitive disability modeI involve matching activities to client cog level ( 6 levels).
Cognitive behavioral approaches: change behavior through skill building and edu. home program, resources. Barter w/ behavioral strategies to be able to get through TX. Lots repetition ie 6 sessions and reinforce and praise good.
Biomechanical and physical: reduces physical deficits in accompanying DX.
builds the physical components for function from ground up.
Strengthening, ROM, coordination, endurance.

71
Q

developmental disability: behavior approaches

A

Behavioral: used to train in a particular skill or target a behavior. 1. instruction 2. modeling 3. reinforcement. a. token environments. b. positive reinforcement. c. chaining ( focus on familiar tasks like shampooing hair steps).
sensory integrative: decreasing sensory defensiveness .
reduce negative behaviors ( self injurious)
improve underlying sensory processing and sensory integration ( textures, temps, colors…increase or decrease )
Facilitate adaptive responses to daily living such as brushing program, weighted vest.

72
Q

developmental disability: approaches

A

remedial: improve underlying deficits. ie teach how to write checks and reconcile check book. Teach how to use soap, shampoo, deodorant, how to rinse thoroughly, safe getting in/out of shower.
adaptive: change to environment or activity to compensate for deficit. ie social worker deposits checks and manages finances and provides client with spending money. tear free shampoo, soap on a rope, wash mitt, shower seat, grab bars, non skid mat.

73
Q

developmental disability: assessment

A

Observation plays a major role.
observe for :
Motor: position, stability, mobility
Process: attention, initiative, organization
communications: eye contact, method of expression.

74
Q

developmental disability: assessment tools

A

Vineland adaptive behavior scale second ed. measures adaptive behavior birth to 90. communication, ADLs, socialization, motor skills, maladaptive behavior.
Sensory integration inventory: provides info on the pt. sensory processing behavior, self stimulating behaviors, and self injurious behaviors.
Scales of indep. behavior: ages infant to 80. administered with structured interview or check list. ADLs and IADLs assess level in key behaviors needed for functioning in these areas.

75
Q

developmental disability: intervention

A 
requires repeated drills and practice to achieve internalization of learning with performance in appropriate contexts for generalization of learning. ( falls risk, safety)
changing needs
occupational preferences
occupational desires
examples: getting up on time
toileting schedule on  phone alarm
get work on time
get on routine schedules

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