Midterm Flashcards
(74 cards)
1
Q
Age Related Changes: Cardiovascular
A
-Fibrotic changes result in abnormal cardiac impulse
-Heart pumps less effectively
-Blood vessels Not pumping effectively as when you were younger
•Overall reduced physical capacity and reserve
•Functional capacity needs to remain above functional threshold to perform day to day tasks
•MET: Metabolic equivalent
•1 MET = 3.5mL O2/kg of bodyweight per minute
•Aerobic = sufficient intensity, frequency, and duration
2
Q
Age Related Changes:Muscle / skeletal
A
Skeletal/cartilage/joints/tendons
•Collagen fibers make up connective tissue of bone, tendon, ligaments, and cartilage
•Collagen becomes more dense and stiff
•Elastic decreases
•Decrease in water, decreased hydration, decreased elasticity, and increased fibrous growth all lead to stiff joints
•Peak bone mass 20s, declines in 30s
Muscle
•Maximal muscles strength
•Sarcopenia = loss of muscle tissue as a natural part of the aging process.
•Disuse atrophy = decrease in the size of muscles in the body
•Increase fat and connective tissue results in decreased muscle quality
•LE muscle power predicts self reported disability (gait speed, chair rise time, stair climb time)
•Decline strength due to:
•Decreased innervations
•Decreased protein synthesis and increase in protein turnover
•Decrease in number of capillaries
•Hormonal and immunological alterations
3
Q
Age Related Changes:Nervous system
A
Cerebral atrophy Frontal (cognition) Temporal (auditory) Occipital (vision) Parietal (sensorimotor) Decrease in number of dendrites Neurons shrink Decrease cerebral blood flow Plaque deposits and neurofibrillary tangles
4
Q
Age Related Changes: Somatosensory
A
Minimal changes to touch and vibration senses
Minimal decrease in pain perception
Different people have different thresholds
5
Q
Age Related Changes:coordination/proprioception
A
Slowing eye-hand coordination
Poor inter-limb coordination
Decreases in homolateral hand and foot movements
Decreases in motor coordination
Overall decrease in awareness of limbs in space
6
Q
Medicare / CMS Rules & Regs:
Medicare Part A
A
paid by medicare payroll taxes, inpatient (hsp, snf), home health, hospice; paid by PPS; have to have a min of 3 days of a hsp stay- have access for 30 days; up to 100 days that they will cover 100%, 00 day can change if diagnosis changes ; requires a physician order
7
Q
Medicare / CMS Rules & Regs:
•Medicare Part B
A
deductible they have to pay, medicare covers 80% 20% deductible; covers preventative, doctor services, home health, outpatient care, OT/PT/SPT, don’t have to be 65
8
Q
Modes of treatment: Individual
Part A
Part B
A
- Treatment of one patient at a time by one therapist
- The patient is receiving the therapist’s full attention
•Part A & Part B: Treatment session minutes may be billed in full
9
Q
Modes of treatment:
Co-treatment
Part A
Part B
A
- Two different disciplines treat one patient as a “team” while focused on different treatments
- Part A: Both disciplines may bill the treatment session in full. The decision to co-treat a patient must be made on a case by case basis and each therapist must document the reason within the contact report
- Part B: Two therapists working together as a “team” to treat one or more patients cannot both bill for the same or different services provided at the same time to the same patient. The time must either be divided or one therapist may bill for the entire time. (CMS, 2019)
10
Q
Modes of treatment: Concurrent
Part A
Part B
A
- Treatment of two patients at the same time who are performing different activities with one therapist
- The therapist is dividing attention between the two patients
- Part A: Treatment should be billed as concurrent when the above is true, if the patients are performing the same or similar activities then it should be billed under group
- Part B: Concurrent treatment is not an option, if the above is true it will be billed as group, this is true whether the patients are performing different activities or the same or similar activities
11
Q
Modes of treatment: Group
Part A
Part B
A
- Treatment of 2-6 patients at the same time who are performing the same of similar activities with one therapist (Part A)
- Treatment of 2 or more patients at the same time who are performing either the same or similar activities or different activities with one therapist (Part B)
- Part A: Treatment should be billed as group when one therapist is treating 2-6 patients
- Part B: Treatment should be billed under group anytime the therapist is working with more than one patient at any given time
12
Q
Supervision rules:
OT to OTA
A
- Role of supervisor – professional, ethical, and legal responsibilities of own behavior and behavior of OTAs supervised
- Both gather data for assessments but only OT can interpret data and develop treatment plans and goals
13
Q
Supervision rules:
OT to Aide
A
- Cannot provide skilled services
- Only time spent on setup can be included in MDS
- Must be under direct supervision of therapist or assistant
14
Q
Supervision rules:
Utilization of an OT Student
A
•Vary depending on setting/ Regulations of Setting, and State
15
Q
Supervision rules:
- Medicare Part A
- Medicare Part B
A
- Medicare Part A
- Line of site is not required. The appropriate manner of supervision should be determined based on state and local laws and practice standards.
- The time the student sees a patient in skilled services will be billed as if the supervising therapist provided the services (students time is not separately reimbursable).
- The supervising therapist may not be engaged in any other activity other than documenting. (CMS, 2018) (AOTA, 2016)
- Medicare Part B
- “Students can participate in the delivery of services when the qualified practitioner (OT) is directing the service, making the skilled judgment, responsible for the assessment and treatment in the same room as the student, and not simultaneously treating another patient. The qualified practitioner is solely responsible and must sign all documentation” (AOTA, 2016).
- Group
- Student does not count as group member
16
Q
Understand: PDPM
Effective as of…?
IMPROVE Payment, what does this mean?
A
•PDPM- •Effective October 1, 2019
Improve payment
- Increase accuracy and appropriateness
- Reduce burden
- Increase access without a rise in costs
17
Q
Understand: PDPM
Concurrent & Group therapy
A
There is a 25% combined limit per discipline (PT, OT, SLP), per patient, per Part A SNF stay.
18
Q
Understand: PDPM
SNF PPS Assessments- what are the 3 assessments?
A
1) 5-day Assessment
2) Interim Payment Assessment (IPA)
3) the PPS Discharge Assessment.
19
Q
Understand: PDPM
Define interrupted stay
A
Interrupted stay
•The patient returns to the same SNF (not a different SNF)
•The patient returns within 3 days or less (the “interruption window”)
20
Q
Attention / Memory - various subtypes:
Attention: Selective attention
A
focus on one set of stimuli while ignoring other stimuli
21
Q
Attention / Memory - various subtypes:
Attention:´Sustained attention
A
maintain attentional performance over time
22
Q
Attention / Memory - various subtypes:
Attention:Alternating attention
A
shifts attention between multiple tasks
23
Q
Attention / Memory - various subtypes:
Attention: Divided attention
A
respond to more than one task at a time
24
Q
Attention / Memory - various subtypes:
Memory: Prospective memory:
A
remember future oriented tasks without external aide
25
Attention / Memory - various subtypes:
Memory: ´Procedural:
motor based skills, behaviors, habits, emotional associations
26
Attention / Memory - various subtypes:
Memory: ´Declarative
Semantic & Episodic
27
Attention / Memory - various subtypes:
Memory: ´Long term memory:
memory responsible for the storage of information for an extended period of time.
28
Attention / Memory - various subtypes:
Memory: ´Working memory
short term holding and manipulation of new information.
29
Attention / Memory - various subtypes:
Memory: ´Short term memory:
holding information for a short time without rehearsing
30
Types of Dementia /characteristics:
| ´Alzheimer’s Disease
´Most prevalent form of progressive dementia
´DSM-V : Replaced the term “dementia” with major neurocognitive disorder and mild neurocognitive disorder
´National Institute of neurologic and communicative disorders: decline in 3 or more areas
´Memory, language, perception, praxis, calculations, conceptual or semantic knowledge, executive function, personality or social behavior, and emotional awareness or expression
´Accumulation of plaques outside neurons in the brain and tangles inside neurons lead to damage
´Risk factors include:
´Non-modifiable
´Modifiable
31
Types of Dementia /characteristics:
´Vascular Dementia
´Dementia syndrome as a result of cerebral vascular damage
´Diagnosis criteria (poor sensitivity)
´DSM- V: Onset of cognitive deficits is temporarily related to CV incident; decline prominent in complex attention and frontal-executive function
´All based on criteria for AD
´Vascular Cognitive Impairments
´Cognitive changes attributed to cerebral vascular insufficiency
´Preventable and treatable to avoid progression
´Deficits vary depending on number, size, and location of infraction
´Typical Cognitive impairments include:
´Initial symptom is often impaired ability to make decisions, plan, or organize.
´Dysexecutive syndrome – impairments in attention, working memory, planning, sequencing, abstraction, and speed of mental processing rather than memory
´Preservative behaviors
´
Difficulty with verbal fluency
´Prevalence : 40% of all dementia, Most common after AD
´Risk Factors : advancing age, male gender, history of strokes, HTN
32
Types of Dementia /characteristics:
´Presence of Lewy bodies in the brain = round neurofilament inclusion bodies that contain damaged nerve cells deposits
´
Typically have amyloid pathology and senile plaques similar to AD
´Key features:
´Parkinsonism
´Cognitive fluctuations
´Recurrent, well formed, and detailed visual hallucinations
´Clinical diagnosis strengthened with:
´Prevalence
´14 – 20% of those with dementia
´Males 2 x more likely over age of 65 most often
´2nd most common after AD
33
Types of Dementia /characteristics:
´Focal conditions: primary progressive aphasia, semantic aphasia, and frontal dementia with motor neuron disease
´Prevalence
´3rd most common after AD
´
Average age of onset 57 years (typical 51 – 63)
´Insidious onset with slow gradual progression
´Characteristics:
´
Gradual but prominent changes in personality, behavioral disturbances, changes in social awareness
´Lack of social tack, fail to demonstrate acceptable manners, violate interpersonal space, touch inappropriately
´Emotional blunting:
´Loss of initiative, inactive, neglect in personal hygiene
´Inability to regulate own behavior
´Difficulties in abstract thinking, planning, problem solving
´Able to recall with cues, recognition better than AD
34
Types of Dementia /characteristics:
| Parkinsons
´Slow and insidious development of dementia, usually obvious 10 years after diagnosis with PD
´Movement disorder precedes dementia
´Presents similar to Dementia with Lewy Bodies
´
Characteristics:
´Delayed recall, semantic knowledge, executive functioning, speech, language, visuospatial
´Problems with specific aspects of memory –
´Executive Functioning problems –
35
Types of Dementia /characteristics:
Classification Stages / Scales
What are they and describe each
´3 Stages...
´Preclinical Alzheimer’s Disease: occurs before symptoms develop in contrast for Alzheimer's for Alzheimer to be diagnosed (memory/thinking ability declines); early signs, at risk for Alzheimer's , no biomarkers
´Mild Cognitive Impairment (MCI): due to Alzheimer's disease due to bio markers show cognitive decline
´Dementia due to Alzheimer’s Disease: noticeable memory/thinking/behaviors that impairs everyday life
36
´Reisberg’s Functional Assessment Staging (FAST):
How many stages ?
7 stages
| Stage 1- 7
37
´Reisberg’s Functional Assessment Staging (FAST):
| Stage 1
´FAST Stage 1, GDS 1, BCRS 1, ACL 5.8 - 6
´No decrement in normal functioning
38
´Reisberg’s Functional Assessment Staging (FAST):
| Stage 2
´Stage 2, GDS 2, BCRS 2, ACL 5.4 - 6
´Subjective deficits in word finding or recalling location of objects
´Normal aging changes
39
´Reisberg’s Functional Assessment Staging (FAST):
Stage 3
´What type of interventions are appropriate at this level?
´Stage 3, GDS 3, BCRS 3, ACL 5 – 5.2
´Difficulties in demanding work, forget appointments, difficulty finding way in unfamiliar environments
´Difficulty with attention, remembering new info, confusion/disorientation
´May try to disguise/conceal deficits - How?
´Descriptions lack detail/ informative content
´Word finding difficulties
´Unable to recall names
´Able to manage everyday lives
40
´Reisberg’s Functional Assessment Staging (FAST):
Stage 4
´What type of interventions are appropriate at this level?
´Stage 4, GDS 4, BCRS 4, ACL 4.4 – 4.8
´Assistance with more complex community and domestic tasks
´Impairments in orientation and memory more pronounces
´Repeat stories more, ask same question over and over
´In conversation difficulty staying on topic
´Impaired comprehension
´Task performed with less efficiency and greater effort
´Obtain new information slowly
41
´Reisberg’s Functional Assessment Staging (FAST):
| Stage 5
´Stage 5, GDS 5, BCRS 5, ACL 3.6 – 4.2
´Moderate AD
´No longer able to live alone safely
´Able to dress but may not pick appropriate clothing
´Changes in tone, reaction time, movement time, & gait evident
42
´Reisberg’s Functional Assessment Staging (FAST):
| Stage 6
´Stage 6, GDS 6, BCRS 6, ACL 3 – 3.4
´Moderately Severe AD
´Assistance for basic tasks and self care
43
´Reisberg’s Functional Assessment Staging (FAST):
| Stage 7
´Stage 7, GDS 7, BCRS 7, ACL 2 – 2.8
´Severe dementia, Incoherent speech, disorientated to time/place/and person
´Unable to recognize close relatives
´Complete dependence on others
44
´Global Deterioration Scale (GDS) /´Brief Cognitive Rating Scale (BCRS)
What are the 5 clinical axes?
´´Brief Cognitive Rating Scale (BCRS):
Clinician’s judgment of objective rating criteria. Excludes mood changes.
´5 clinical axes: Concentration, recent memory, past memory, orientation, and functioning/self care. Each rated 1- normal/not present to 7 very severe.
45
Common Visual Disorders - characteristics
| Cataract
- Lens undergoes protein degeneration and aggregation resulting in lenticular opacity
- Reduced light to the retina
-Lens of the eye will appear cloudy and yellow
Individual will experience: Decreased acuity, hazy blurred vision, altered color perception, increased sensitivity to glare, difficulty with night vision, difficulty seeing low contrast objects, image distortion (straight lines appear wavy)
46
Common Visual Disorders - characteristics
Macular degeneration - wet vs dry
- More common in Whites, Smokers, Blue iris, HTN, hypercholesterolemia, and genetic link
- Retinal atrophy and scarring, hemorrhages of the macula resulting in gradual loss of central vision
Two Types of AMD:
-Dry AMD: yellow deposits of extracellular material in the macula. Areas of retinal atrophy may lead to vision loss over time. Most common.
-Wet AMD: rapidly progressing. Proliferation of abnormal blood vessels that leak blood and fluid into the macula.
- No known treatment to prevent or reverse vision loss
- Glaucoma
- Diabetic Retinopathy
47
Common Visual Disorders - characteristics
| Glaucoma
¥Group of disease characterized by progressive optic nerve damage. Loss of Peripheral vision
¥More common in African Americans & Hispanics (African Americans at earlier age)
¥Several types. Two most common:
Primary open angle glaucoma (POAG
Angle-closure glaucoma (ACG
48
Common Visual Disorders - characteristics
Diabetic retinopathy
Whats the Nonproliferative stage/Proliferative stage
¥Damage to blood vessels of retina due to diabetes
¥Result of poor control of blood sugars – increased with increased blood sugars
¥Diabetic Neuropathy
- Nonproliferative stage (initial stage)
- Proliferative stage (later stage)
Symptoms: fluctuating and blurred vision, decreased contrast sensitivity, problems driving at night, difficulty with color discrimination, spotty visual loss, complete blindness
49
Common Visual Disorders
What are some assessment tools to assess low vision (7)
¥Occupational and Vision Profile Obtained
¤Visual activities Questionnaire
¤Activities of Daily Vision Scale Questionnaire
¤Visual Disability Assessment
¤National Eye Institute Visual Functioning Questionnaire – 25
¤Catquest Questionnaire
¤Lighthouse International Functional Vision Screening Questionnaire (FVSQ)
50
Visual Disorders Interventions?
```
¥Clock Drawing -
Scanning to expected and unexpected -
Reading skills-
Environmental modification -
Non-optical -
Computer tech -
Resources -
```
¥Clock Drawing - best retina for visual acuity; eccentric viewing
Scanning to expected and unexpected - scanning
Reading skills - scrolling, font, size, bold, spacing
Environmental modification - size of object, magnify, distance, color, contrast, illumination, figure-ground, angle of viewing
Non-optical - magnification mirror, trailing techniques, auditory
Computer tech - closed circuit tv, computer systems, document readers, personal organizers, books on tape, digital readers
Resources - Apps for low vision
51
Rehab Precautions: Spinal precautions
* Post surgical Spinal precautions
* Do not cross knees while in sitting/standing
* Do not twist trunk while performing any activity
* Do not bend forward at the waist more than 90 degrees
* Always log roll out of bed with pillow between knees
* Maintain normal curve of your back
§What functional considerations are there?
§What are the risks of not following precautions?
52
Rehab Precautions: Sternal Precautions
* Length – 4 weeks or MD orders
* Do not lift more than 8 pound
* Do not push or pull with your arms
* Do not flex shoulders over 90 degrees
* Avoid reading too far across body
* Avoid twisting or deep bending
* Brace chest when cough or sneeze – How?
* No driving for 4 weeks (AMA)
* How will it affect for function? What tasks?
* Warning Signs
53
Rehab Precautions: Total Hip precautions
| know the diff between anterior and posterior
```
§Primary precautions
§Anterolateral
§Posterior
¥No adduction
¥No bend past 90
¥No internal rotation
§Common Complications
§Functional Considerations?? Sleeping, toileting, cars
§New research using no hip precautions
```
54
Rehab Precautions: Incision precautions
```
§Caring for your incision
¥Keep incision dry and clean
¥Use only soap and water to clean
¥Do not apply ointments, oils, salves or dressing unless MD ordered
¥Do not soak incision
¥May shower when staples or stitches are removed/ or cover area
§Warning signs
§Increased draining or oozing
§Increased opening
§Redness/warmth
```
55
Rehab Precautions: Cardiac precautions
§Borg Scale not higher than 13
§Low METs
§Be careful of extremes
¥Monitor Vitals
56
Rehab Precautions: Total Knee replacement
* As OTs we facilitate this process but do not address formally as it falls under PT
* No specific Precautions unless specified by Surgeon
* Each surgeon will have a different approach and they will specify if any precautions
* Rotation of the knee – not encouraged
* Nothing to cause pain or twisting, no kneeling encouraged in general
* May specify knee immobilizer until able to complete straight leg raises (per MD or PT to d/c)
* No pillow underneath knee (prevents full extension of knee)
* Do not give AE unless necessary, as they should be reaching and bending knee
* No Weight Bearing precautions unless stated
57
Rehab Precautions: Weight bearing precaution
* Non Weight bearing: NWB
* Touch down or Toe Touch weight bearing: TTWB
* Partial Weight bearing: PWB
* Weight bearing as tolerated: WBAT
* Full weight bearing
58
Rehab Precautions: Standard precautions
1. Hand hygiene
2. Gloving
3. Mouth, nose eye protection
4. Gowning
5. Device handling
6. Laundry handling
59
FAST STAGE 1
No decrement in normal functioning
60
FAST STAGE 2
´Subjective deficits in word finding or recalling location of objects
´Normal aging changes
61
FAST STAGE 3
´Difficulties in demanding work, forget appointments, difficulty finding way in unfamiliar environments
´Difficulty with attention, remembering new info, confusion/disorientation
´May try to disguise/conceal deficits - How?
´Descriptions lack detail/ informative content
´Word finding difficulties
´Unable to recall names
´Able to manage everyday lives
62
FAST STAGE 4
´Assistance with more complex community and domestic tasks
´Impairments in orientation and memory more pronounces
´Repeat stories more, ask same question over and over
´In conversation difficulty staying on topic
´Impaired comprehension
´Task performed with less efficiency and greater effort
´Obtain new information slowly
63
FAST STAGE 5
´Moderate AD
´No longer able to live alone safely
´Able to dress but may not pick appropriate clothing
´Changes in tone, reaction time, movement time, & gait evident
64
FAST STAGE 6
´Moderately Severe AD
´Assistance for basic tasks and self care
65
FAST STAGE 7
´Severe dementia, Incoherent speech, disorientated to time/place/and person
´Unable to recognize close relatives
´Complete dependence on others
66
Global Deterioration Scale (GDS) STAGE 1
No cognitive decline
| appears normal/cover up lapses
67
Global Deterioration Scale (GDS) STAGE 2
Very mild cognitive decline
| forget thing but appears normal- age related memory impairment
68
Global Deterioration Scale (GDS) STAGE 3
Mild Cognitive Decline
| difficult @ work; becomes anxious and family becomes aware
69
Global Deterioration Scale (GDS) STAGE 4
Moderate Cognitive Decline
| reduced ability to count; traveling is difficult; no longer can manage own affairs= mild dementia
70
Global Deterioration Scale (GDS) STAGE 5
Moderately Severe Cognitive Decline
| needs help getting dressed and w/ ADL= moderate dementia
71
Global Deterioration Scale (GDS) STAGE 6
Severe Cognitive Decline
(needs help w/ eating, toileting, may be incontinent, disoriented to time/place, forgets who others are= moderately severe dementia)
72
Global Deterioration Scale (GDS) STAGE 7
Very Severe Cognitive Decline
(severe speech loss, forgets who they are, motor stiffness, incontinence, needs feeding, total disorientation= severe dementia)
73
Sarcopenia
loss of muscle tissue as a natural part of the aging process.
74
Disuse atrophy
decrease in the size of muscles in the body
