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Flashcards in Exam one Deck (72):
1

Goal of AT

Increase function, related to universal design, individualized

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Low tech

Easy to use, no electric power, no training,

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Medium tech

Easy to use but more complicated than low tech, batteries or may have electric component, limited learning time, more expressive than low tech

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High tech

Use is complex and programmable, requires specific training, can be user friendly (user needs cognitive problem solving and memory skills)

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Control interface

The hardware a person uses to operate or control device, access

Requires motor, sensory, and cognitive

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Selection set

Items available used to make choices

The size, type, and location of use is based on user's need and ability

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Selection methods

Way in which user makes their selections using the control interface

Direct, Indirect, Scanning

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Direct selection method

Uses the interface to make the selection, requires refined movements

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Indirect selection method

Steps to make a selection, example- scanning

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Scanning requires

Good visual tracking skills, good attention, ability to sequence, little motor control

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Directed scanning

Interface activated
Device scans through selection set vertically
Horizontally
User makes the selection by pausing on the choice or activating another control interface

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Dwell

Pausing on the choice

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Coded access

Morse code, takes higher cognitive skills

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Methods of activation

Movement, respiration, phonation

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Spatial

Size of interface

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Sensory

Feedback given,
the richer the sensory feedback the greater the performance typically

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Control interface for indirect selection

Selection techniques for scanning
Automatic: items presented continuously, user makes selection when choice is presented, high degree of motor skill
Step: Switch activated for each item, move through items, then second input when choice is made
Inverse: : individual activates and holds switch closed, when switch is held down, items are scanned, when they want to make choice, they let up on switch

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Augmentative communication

Systems that either supplement or replace communication for a user, low tech --> high tech,

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Rate enhancement

Reducing number of selections and increasing output
Motor learning
Numeric codes
Abbreviated expansion
Semantic encoding
Predictive selection

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Motor learning

Learning location of items

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Numeric codes

Numbers replace words, phases or sentences

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Abbreviated expansion

Part of word/ phase stands for more
Two types-
Truncation: shortened form
Contraction: Eliminate vowels

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Speech output

Synthesized: generated electronically, takes less memory,
Digitized: human speech recored and stored on device,
Concatenative speech synthesis

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Reimbursement for telehealth

Medicare presently doesn't reimburse for telehealth provided by OT

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Virtual means to promote health

Wearables, texting, access to records electronically, apps

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Vitualy reality

Mental health concerns: depression, anxiety
Simulation for home environments, stoke, (OT)

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What is a swtich

Switches open and close a circut

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What to consider with switches

Potential control sites, functional range of motion at control sites, unique sensory needs, mounting issues, can the client..
activate switch, wait for the selection, activate at given time, hold the switch for activation, release on command, carry out steps for selection

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Types of switches

Mechanical, electrical, single switch, arrays

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Switches activated by body movement detect movement in four different ways

1. Mechanical most common
2. Electromagnetic
3. Electrical
4. Proximity

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Modes of operation, switches

Momentary, latched, timed, switch-latch timers

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Momentary

Maintain pressure on switch to keep the item working

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Latched

Activation turns it on, reactivation turns it off

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Timed

Activation turns on and runs for specified time

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Positioning related to AT selection

Position of consumer will affect the position of the equipment

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Look at...

Voluntary movement (controlled and consistent), movement patterns, ability to initiate contact, hold and release, vision,

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Needs identification (decision making for seating and positioning)

Contexts and concerns: setting, caregiver support, physical contexts, accessibility, transportation, previously used systems, goals of consumer, family, and caregiver

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Decision making for seating and positioning

Physical skills, sensory skills, functional skills, cognitive and behavior skills

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Always assess in order

Needs, human factors, context: physical, social, institutional

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Modifications

Examples: mobile arm supports, seat belts, chest straps, head arrays and straps, blocks for feet

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Orthopedic conditions

Increased tone and muscle tightness can lead to orthopedic deformities, orthopedic deformities can also be congenital in nature

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Scoliosis

Lateral bending of the spinal column
Rotation of the spinal column
Can be flexible or fixed

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Lordosis

Excessive inward curvature of the spine
Usually at the lumbar area

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Kyphosis

Excessive rounding of the spine
Usually at the thoracic or thoracolumbar area

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Often occur in children with neuromuscular disorders such as cerebral palsy, muscular dystrophy and spina bifida

Due to an imbalance in muscle tone surrounding the vertebral column
Can cause problems with posture, digestion, breathing and motor control

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Hip dislocation

Head of the femur does not articulate with the acetabulum (hip socket)
In those with neuromuscular disorders, caused by excessive tone or lax ligaments

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Pelvic obliquity

One side of the pelvis is higher than the other side

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Pelvic rotation

One side of the pelvis is rotated forward of the other side

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Pelvic tilt

Posterior: Top of pelvis is tipped backward
Anterior: Top of Pelvis is tipped forward

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Windswept deformity

One hip is adducted and one hip is abducted
Usually occurs with hip subluxation or dislocation, pelvic obliquity, and scoliosis

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Contractures

Permanent, fixed shortening of muscles, tendons, ligaments or the skin

The elastic connective tissue is replaced by inelastic fibrous tissue that is resistant to stretch and prevents normal movement

Causes: injury, scarring such as with a burn, lack of use of affected body part, damage to or degeneration of the nerves, alterations in muscle tone

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Three overall categories of seating intervention

Management of deformities and postural control
Pressure management (prevention of skin breakdown)
Comfort and postural accommodations

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Many potential outcomes of proper seating and positioning

Normalization or decreased influences of tone and reflexes
Control or prevention of deformity or contractures
Enhanced function through maximized stability
Enhanced organ function
Increased comfort and decreased fatigue

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Eval physical skills

Orthopedic factors: range of motion, skeletal condition

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Eval neuromotor factors

Muscle tone, reflexes, postural control, movement

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First area to be addressed

Alignment and stabilization of pelvis

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Neutral position

Pelvis is level side to side and front to back
Hips flexed at 90° for most individuals
Inhibits extensor tone and reduces posterior tilt of the pelvis
Maintains position of individual in their seat

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Modifications to the seating surface may be necessary to accommodate deformities to allow for a level pelvis

Wedge seat, lateral supports along the legs, anti-thrust seats, tilted seat or one side built up higher, strategically placed lap belts

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Position of the pelvis impacts,

Individuals ability to access their environment,
If pelvis is positioned poorly, the individual may have difficulty using one of both arms for mobility for function, their head may be out of alignment affecting vision, tone may be increased or decreased affecting trunk control

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Ideal position of lower extremities

Ideal position is approximately 90° flexion of knees and legs in neutral abduction and feet flat with 90° ankle flexion

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Conditions affecting position of lower extremities

Tone: increased tone, especially of the hamstrings, may prevent positioning knees at 90° flexion

Knee contractures may prevent knees from extending or flexing causing a need for modifications to the seating surface

Tone and/or contractures may affect positioning of the feet flat and with 90° flexion

Leg length discrepancies may also affect position of feet

Presence of the Positive Supporting Reaction reflex may affect positioning of feet

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Modifications for positioning of lower extremities

Shorten the seat depth or undercut front of seat to allow legs to come under the seat
Support legs in position they are fixed in
For leg length discrepancies provide foot rests of different heights
Angle footrests to accommodate ankle contractures
Straps across the top of the feet, behind the heels or across the ankles can help

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Trunk

Desired position is upright with trunk aligned in midline
Spinal deformities discussed earlier will affect this position
Control of the trunk and tone of the muscles supporting the trunk also affect position

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Modifications for trunk positioning

Lateral supports – greater control when placed high on trunk and close to the body
Tilt – placing a person with poor trunk control at a slight backward tilt eliminates gravity slightly and helps the person maintain a more symmetrical posture
Anterior Supports – help person maintain upright position (straps, panels, rigid shoulder supports)

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Natural position vs. "normal" position

When positioning the trunk, it is important to attempt to support the individual in their natural position instead of forcing them into a more “normal” position

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Head and neck

Position of head is important in inhibiting reflexes and promoting visual skills
Common problems with head position are related to tone and primitive reflexes
Hyperextension of the neck
Lateral flexion of the neck
Neck rotation
Weak neck muscles

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Head and neck modifications

Head rests
Headbands that provide anterior support
Lateral supports applied at temporal area, neck or side of face (May be useful in inhibiting the ATNR)
May need support for fatigue, travel or for changes in position only

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Skin integrity

Important to note areas of increased pressure
Many types of materials are available to make seating systems
The right material may be found through trial and error
Important that positioning provides ways for pressure relief (tilt, recline, etc.)

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Mouse keys

Instead of using the mouse, you can use the arrow keys on the numeric keyboard to move the pointer

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Sticky keys

Instead of having to press 3 keys at once, you can press 1 key at a time when sticky keys is turned on

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Toggle keys

Hear a tone when you press CAPS lock, NUM lock, and SCROLL lock helps to orient user to where they are on keyboard

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Filter keys

Ignore key strokes that occur in rapid succession and key strokes that are held down for several seconds unintentionally