Chapter 16 NBCOT Mastery of Environment Eval and Intervention Flashcards
(42 cards)
1
Q
Know the following environments
- Physical
- Sensory
- Social
A
- Physical - Everything non human (buildings, objects, tools, devices, animals, trees)
- Sensory
- Visual: lighting, colors, clutter
- Auditory: loudness of radios, loudspeakers, classroom noise
- Tactile: room temp, seating textures
- Olfactory: pleasant or offensive odors.
- Gustatory: pleasant or offensive tastes
- Social-cultural
- social roles: (student, parent. worker)
- Social network: social relationships
- Cultural aspects: structures, values, shared by a people
- Psychological aspect: environmental characteristics that can effect mood and stress.
5.
2
Q
ADA
A
Civil right s law aimed at allowing full participation in society fo rpeople with disabilities.
- accessible environments
- policies for employment, public accommodations and public service
3
Q
IDEA
A
- Mandates that children with disabilities recieve education in the least restrictive and most natural enviroment.
4
Q
Universal design principle 1
- The design is useful and marketable to people with diverse abiliteis
A
- provide means of use for all users. avoid segregating or stigmatizing, privacy security, and safty for all users. design appealing to all users
5
Q
Universal design principle 2
- accommodates a wide range of individual preferences adn abilitities
A
- provide choice in method of use, accommodate ri or left handed access, facilitate user accuracy , provde adaptability to the user’s pace
6
Q
Universal design principles 3
design is easy to understand, regardless of experience
A
eliminat unnecessary complexity, consistent with user expectation and intuition
7
Q
universal design principle 4
design communicates necessary info
A
uses different modes, pictorial, verbal, tactile, make essential info clear
8
Q
if an individual with a disability is to be discharged hom, a home eval should be done….
A
before the discharge date
9
Q
types of performance skills to assess when conducting an environmental eval
A
- sensory skill - tactile, sensation
- visual -perceptual processing skills - to assess difficulties interacting with environment
- Musculoskeletal skills - coordination, tone, to assess mobility in environment and object manipulation
- Cognitive skills - to assess if person is away of limitations and able to problems solve
- Psychocsocial skills - social support, able to ask for assistance
10
Q
Physical considerations
A
arrangement of furniture, accessibility of items, ease of use, workplace/houseing design, neighborhood accessibility
11
Q
Characteristics of the home environment
A
- type of dwelling (2 story etc),
- driveway,
- level where person lives
- dwelling entrance (ramp, stairs, railing)
- number of steps
- width of elevator doorway, hallway, entrance (esp for wheelchair)
- presence of smoke detectors, space heaters, emergency
12
Q
bedroom characteristics
A
- bed - size height, position
- side patient uses
- room for bedside commode
13
Q
bathroom considerations
A
- number of bathrooms
- location
- width of doorway
- type of bathing the individual performs
- type of shower (tub shower combo, stall shower
- grabbars
- rental home?
- nonskid mats, in and around the tub
- throw rugs
- antiscald valves
- handheld shower
14
Q
Kitchen Considerations
A
- location of meal prep devices
- accessible food, pots,
- countertop space
- direction of fridge opening, cabinetry
- fire extinguishers
- antiscald
15
Q
fall statistics
A
- 30-50% of persons over 65 years old fall
- falls result in - fractures, increased caution and fear of falling, loss of confidence to function, increased risk of recurrent falls
16
Q
Intrinsic Risk factors for falls
A
- vision - presbyopia, impaired depth perception, reduced night fvision and low light situations
- vestibula - vertigo
- neuromuscular systerm age related changes - decreased muscle fibers decreased stregth and endurance, difficulties in rising from a chair.
- disease - CHF, arrhythmias, hypotension, parkinsons’s disease, medication side effects, delirium, anxiety/depression, prior history of falls, fear of falling can lead to progressing deconditioning
17
Q
Interventions to prevent falls
A
- eliminate/minimize fall risk factors (stabilize disease
- Improve functional mobility (stregthening exercises, conditioning exercises, PROM stretching, spedcividc coordination training. neuro muscular reeducaiton balance training, sit and statnd positions, stantic and dynamic, surning, walking stairs, transfer training, bed mobility training, wheelchair safety, rfer to PT for gait training)
- sensory compensations strategies
- modify activities
- teach energy conservation techniques
- modify environment to reduce fall s and instability (lighting, contrasting colors, declutter, railings on stairs, grab bars in bathroom. non skid mats
- placing frequently used items near
- outline safety guidelines to follow
- check for dizziness that may have precedes the fall
18
Q
Wheel chair dimensions and accessibility needs
wheelchairs are 24”-26”
- minimim doorway clearance
- allowance for door swing
- min hallway clearance
- turning clearance
- max height for reaching sideways
- max height for countertops
- parking spaces
- ramps min width
- slope standards for ramp
A
- minimim doorway clearance- 32”
- allowance for door swing - 26” needed beside the door to allow for swing
- min hallway clearance - 36”
- turning clearance - 60”x 60”
- max height for reaching sideways - 48”
- max height for countertops - 31”
- parking space - must have adjacent 4’aisle
- ramps min width - 36” wide
- slope standards for ramp - 1in rise:1foot long
19
Q
Assessments for wheelchair Client factors
- sensory
- neuromuscular
- musculoskeletal
- cognition
- psychosocial
A
- sensory - sensory loss places the persona t risk for the development of decubiti, need for a seat cushion
- Neuromuscular - sitting posture, need for a seating application/positioning. Poor trunk control requires postural supports
- Musculoskeletal - physical limitations, compromised respiratory status may impede mobility, requiring a powered wheel chair.
- cognition - deficits in cognitive fun impede ability to operate powerred devices
- psychosocial - availability of social supports to assist with transportation and transferring to the wheelchair.
20
Q
Assessment for Wheelchair contextual assessments
- physcial environment
- building characteristics of school, work, leisure, and/or worship.
A
- Physical environment - areas of travel and sheelchair use, surfaces and terrains that will be traveled on, indoors/outdoors
- Building characteristics - doorways, hallways, restrooms, workspace design, parking,
21
Q
Assessments for wheelchair characteristics (wheelchair types)
- control mechanism
- feature
- propulsion method
A
- control mechanism - types of brakes, anti tippers
- features - lap tray, cushion, backpack, means for holding personal items, racing model for athletic individuals.
- propulsion method - onearm drive, use of hand rim projections, motorized, use of lower extremities to propel.
22
Q
Wheelchair assessments and developmental considerations
A
- Transportability to, from, and to school
- Allowance for adjustment when growth changes are experienced
- allowance for use of ther adaptive equpment (computer, augmentative communications)
- Facilitation of social acceptance
23
Q
Standard dimensions for wheelchairs
- adult
- narrow adult
- slim adult
- hemi/low seat
- junior
- child
- tiny tot
A
seat width seat depth seat height
- adult - 18” 16” 20”
- Narrow adult - 16” 16” 20”
- slim adult - 14” 16” 20”
- hemi/low seat - 17.5”
- junior - 16” 16” 18.5”
- child - 14” 11.5” 18.75”
- tiny tot - 12” 11.5” 19.5”
24
Q
Bariatric wheelchair considerations
A
- bariatric client center of body mass if positioned several inches forward. the rear axle is displaced forward in comparison with the standard wheelchair
- adjustable backrest to accommodate excessive poterior bulk
- reclining wheelchair to accommodate excessive posterior bulk.
25
Manual wheelchair indications, benefits and limitations
* indications/benefits - Able to independently propel, can use quick release wheels for easier car use.
* limitations - standard weight is heavy
26
Powered mobility indications/benefits, limitations
* Indications/benefits - cannot use hands or feet, energy expenditure limitations, arthritic upper extremities, prone to repetitive stress injury, neuromuscular injury: to prevent associated reactions. can change seat height or tilt.
* Limitations - large and heavy to transport, may need to use lifts
27
Wheelchair seating and positioning considerations
1. flexible deformity
2. fixed abnormal postures and deformities
3. areas to evaluate
1. flexible deformity - occupational therapist can mannually correct the position
2. Fixed abnormal postures and deformities - where changes cannot occur.
3. eval in this order: pelvis, LE, trunk, UE, head and neck and feet as stability is required prior to mobility and proximal control allows for better distal function.
28
Styles of seating
1. linear
2. contoured, cutom-contoured
1. Linear - flat, firm, rigid seating, good for active individuals, those who perform independent transfers and/or those with minimal musculoskeletal involvement
2. Custom-/Contoured - ergonomically support the individual, provides excellent support, enhances postural alignment, decreases abnormal posturing, provides pressure relief, may be difficult for independent transfers if decreased UE muscle strength. Good for individuals with moderate to sever central nervous system dysfuntion or neurological disease.
29
Major styles and accessories of seating systems
1. sollid insert
2. lumbar back support
3. foam cushions
4. contoured foam cushion
5. fluid pressure relief cushions
6. air pressure relief cushions
7. wedge cushions
8. pelvic guides
9. lateral supports
1. solid insert - prevents hammod effect provides soild base of support, stable base of support, easy to remove
2. Lumbar back support - give proper lumbar curve
3. Foam cushions - can enhance sitting posture and comfort
4. contoured foam cushions - enhance pelvic and LE alignment
5. fluid pressure relief cushions - facilitiates pelvic and LE alignment, provides pressure relief without changing support, good for indivituals who need increased stability
6. air pressure relief cushions - Minimal ostural support offered, provides pressure felief, good trun control is needed
7. wedge cushions or antithrust seats - have frunt higher in front than back to prevent the individual from sliding out of their seat
8. Pelvid guides - keep hips stable
9. Lateral supports - povide trunk suppor by extending up the sides of the chair, below person's armpits
30
Purpose of Standers for pediatric positioning systems
* prone standers
* supine standers
* standers provided weight bearing experience which maintains hips, knees, ankels and trunk in optimal position, facilitate formation of acetabulum and long bone development, and aid in bowel and bladder function
* prone standers decrease effect of tonic labryinthine reflex
* supine standers provide more support posteriorly
31
Ambulation aids for funcitonal mobility
1. Orthodic devices/ braces
2. canes
3. walkers
4. crutches
5. slings
1. orthodic devices braces - used to prevent contractures and provide stability to involved joints. AFO(ankle-foot orthosis), KAFO(knee-ankle-foot orthosis, HKAFO (Hip-knee-ankle-foot orthosis)
2. canes - single point cane, wide based quad cane(WBQC) is used to increase stability when a person is not able to balance on a straight can, Narrow based quad cane (NBQC) same as WBQC but narrow for client who may not need as much support.
3. walkers - standard (need fair balance and ability to lift device with UE), hemi walker (for those who do not have the ability to use 2 hands), side stepper ( a walker situated on a non-affected side of a person), rolling walker (for those who cannot lift a standard walker due to UE weakness of impaired balanced).
4. Crutches - standard (placed in person's axillary region to allow ambulation), platform(forearms are neutral and are supported and hands are in neutral position), Lofstrand (proximal arm has closure around it instead of support in axillary region
5. Slings - provide support to UE to upper extremity which may have fractured, and prevent poor handling of flaccid UE.
32
bed mobility s/p total hip replacement
* not permitted to roll on the non-operated side whichcan result in internal rotation of the operated hip, causing dislocation
* abductor pillow between lower extremities to prevent adduction of the operated hip
33
Bed mobility s/p CVA
* education of proper positioning of upper extremity to increase awareness, minimize pain, decrease swelling, and promote normalization of tone.
* maybe pillow between knees in sidelying to increase comfort and promote proper positioning.
34
Bed mobility s/p amputation of LE
* education in training for use of pillows and positioning to prevent edema in LE
* May also need training on how to provide passive stretching to residual limb while in bed to prevent shortening or contracture
35
types of transfers
1. Stand-pivot
2. popover or seated sitting
3. sliding board
4. dependent
5. mechanical lift
6. chair lift
1. stand-pivot - individual stands and turns to transfer surface
2. popover or seated sitting - full stand position is not required and is used for those with decreased endurance or weight bearing precautions
3. sliding board - for those who are not able to stand to transfer
4. dependent - care giver is required to fullly perform the transfer
5. mechanical lift chair - use of celining lift, hoyer lift or track lift
6. chair lift - chairs with power control to allow elevation from surface for individuals who may otherwisenot be able to transfer independently
36
1. bed transfer aids
2. bath transfer aids
1. bed transfer aids - trapeze, bedrail
2. bath trasfer aids - active-aid commode, a commode with small wheels to allow transfer to bathroom and shower stall when otherwise not possible, bedside 3:1 commode, ambulatory devices, wheelchairs
37
Considerations for electronic
* input mehtod, output method, portability, safety, reliability, durability, assembly ease, operation ease, mantenance schedule, current and future affordability
38
Evaluation goals for Electronic aids to daily living
1. how to determine device control site
1. the anatomic site at which the person demonstrates purposeful controlled movement must be determined inorder to determin devices control site
39
Interventions for driver rehab
1. adaptive driving equepment
2. alternitives to maintain community mob if person is determined to be unsafe or unable to drive,
1. adaptive drivign equipment - hand controlls, steering knobs forbedal extensions, zero effort/reduced effort steering, possition adjustments to steering tools
2. alternatives for community mobility must be explored and implemented, support must be provided to individual to deal with loss and its ramification on person's daily life.
40
Environmodification fo cognitive and sensory deficits
1. environment
2. visual
3. educaiton
4. home modifications
1. environment - needs to be familar consistend and predictable, provide structure, remove clutter, visual reminders and tactile cues to decrease confusion, increase awareness and facilitate independence, keep things in same place
2. visual - contrasting colors to discrimnate background from foreground or figures from background
3. education - train family, carrry over of intervetntion techs in modified environment, increase awareness of potential resources, increae awareness to rights to access resources
4. home mod - remove potential hazards, modification for fall prevention, modifications for sensory loss
41
Restraint Reduction
intervention to address contributing factors/correct underlying problems
* address contributing factors/correct underlying problems
* refer to physician for medical evalution
* safe nourishment (unbreakable water bottles)
* client directed toileting routine
* active listening
* include familiar and favorite objects in person's living space to personalize it.
42
restraint reduction
Interventions to address agitiation and/or wandering
* approach from person's front at eye level
* communicate calmly with use of simple statements
* distract with an activity or topic of interest
* redirect back to desired location
* engaged in activity of interest
* camouflage exits with no crossing signs, full length mirrors, vertical blinds
* put tape on floors to mark end of hall
* door alarms, monitoring devices
* make contained areas safe and interesting
