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COTA Musculoskeletal Dx and Biomechanical Interventions > Misc > Flashcards

Flashcards in Misc Deck (42):

4-year-old client sustained full-thickness burns on the volar surfaces of both wrists and forearms 4 months ago. In spite of using pressure garments and splinting for position, the child has developed thick scars across the wrists. Which activity would be MOST EFFECTIVE in improving wrist mobility?

Crawling though a tunnel maze

Because the burns are on the volar surface, the client has the most limitation in both active and passive wrist extension movement. Crawling is a developmental activity that can develop both flexibility and strength at the wrists through weight bearing.


A 4-year-old child with right hemiparesis has a goal to pick up and hold toys with the right hand. What type of orthosis would be MOST appropriate to help increase functional use of the hand?

A neoprene thumb loop splint helps reduce spasticity and enables an optimal position to pick up and hold toys.


A COTA is working with a child with autism who gets easily frustrated with challenging tasks. The child’s current goal is to learn how to hit a ball with a bat. The COTA decides to use shaping as an intervention strategy. Which technique describes shaping as a teaching strategy?

Successively approximating or learning intermediate behaviors that are prerequisite components of the final behavior is part of the shaping technique; such as picking up the bat, swinging the bat, and tapping a ball with the bat.


An OTR®; is facilitating a group therapy session focused on social skills training that comprises five children with autism spectrum disorders. The OTR decides to use the Self-Determination Model to facilitate this group session. Which approach applies this model?

Children are facilitated to make choices, indicate their own activity preferences, and problem solve during therapy sessions.

The Self-Determination Model facilitates satisfaction of needs for autonomy, competence, and promotion of one’s own well-being.


Superficial Burn

1st degree burn

Epidermis only

Min pain and edema, no blisters

Healing: 7-10d


Superficial Partial-Thickness Burn

2nd degree burn

Involves epidermis and upper portion of dermis

Red, blistering, and wet

Painful, no grafting needed

Healing: 7-21d


Deep Partial-Thickness Burn

2nd degree burn

Involves epidermis and deep portion of dermis; hair follicles and sweat glands

Red, white, and elastic

Sensation may be impaired

Potential to convert to full-thickness burn due to infection

Req skin graft

Healing: 21-35d


Full thickness

3rd degree

involves epidermis and dermis, hair follicles, sweat glands, and nerve endings

pain free, no sensation to light touch

pale and nonblanching

requires skin graft, potential for hypertrophic scar is extremely high


subdermal burn

4th degree burn

full thickness burn with damage to underlying tissue such as fat, muscle, and bone

charring present

peripheral nerve damage is significant

requires surgical intervention for wound closure or amputation

potential for hypertrophic scar is extremely high


Emergent Burn Phase
Treatment, Eval, Intervention

0-72hrs after injury

Treat: focuses on sustaining life, controlling infection, and managing pain

Eval: clinical observation of joints affected by burns; info gathering on prior functional status

OT Intervention
splinting in antideformity patterns
hands: intrinsic plus
extension for neck, elbows, hips and knees
shoulder: abduction
anti-frog leg and anti-foot drop
opposite client's posture


Acute Burn Phase
Treatment, Eval, Intervention

72 hours after injury until wound is closed (may be days or months)

Treat: focuses on infection control and grafts; psych support and team communication are important

Eval: clinical observation of joints affected by burns; info gathering on prior functional status

OT Intervention
anti-deformity splinting and positioning, edema management, early participation in ADLs, client and caregiver education

remember that the position of greatest comfort is usually the position of contracture


anticontracture position: neck

neutral to slight extension


anticontracture position: chest and abdomen

trunk extension, shoulder retraction


anticontracture position: axilla

shoulder abduction to 90, external rotation


anticontracture position: elbow

extension, forearm neutral


anticontracture position: dorsal wrist

wrist in neutral to 30 degree extension


anticontracture position: volar wrist

30-45* extension


anticontracture position: hand

metacarpal extension, 70* flexion; interpalangeal extension, thumb abducted and extended


anticontracture position: hip

10*-15* abduction, neutral extension


anticontracture position: knee


with anterior burn: slight flexion


anticontracture position: ankle

neutral to 5* dorsiflexion


edema management

elevation of extremities
AROM exercises if movement allowed
wrapping with elastic bandage, unless bulky wound dressing is used


what to remember with dorsal hand burns:

take care to maintain Boutonniere precaution and avoid having the client form active or passive composite flexion of the fingers


Hypertrophic scar

*Most common with deep second & third degree

*Appears 6-8 weeks after wound closure

*One or two years to mature

*Compression garments should be worn 24 hrs/day for 1-2 years or until scar is matured

*ROM, skin care, ADL, role activities, patient/family ed.


Rehabilitation Burn Phase
Treatment, Eval, Intervention

When wound is healing and closure is stable

Skin Conditioning: lubrication several x a day; massage; sunblock/avoid sun exposure

Scar Management: includes massage and pressure garments

Therapeutic exercise/actv (massage and lubrication prior to)




A COTA® is treating a client who sustained a tibial fracture and has been told that the client is at risk for compartment syndrome. What symptoms would indicate compartment syndrome in the leg?

Sensory changes, swelling, and loss of voluntary movement of the involved muscles are all symptoms of compartment syndrome.


A COTA® is treating an inpatient who has myasthenia gravis and is preparing for discharge to live alone at home. What information is MOST IMPORTANT for the COTA® to discuss with the patient?

Overexertion, emotional stress, and temperature elevations may exacerbate the symptoms of myasthenia gravis, and patients should be educated to minimize these situations.


An assembly-line worker is returning to work after being treated for cubital tunnel compression at the left elbow from prolonged pressure on surfaces. What is the MOST appropriate height for this client's workstation?

For a worker with recent nerve compression at the elbow, the workstation should be just below elbow height, eliminating all pressure at the elbow.


Which example is an indirect intervention that an OTR®; can provide to support a child with mental and behavioral challenges?

Caregiver education is a form of indirect intervention.

An indirect intervention is defined as working with and through one or more members of the team surrounding the child. During indirect intervention, the OTR does not directly work with the child to remediate difficulties.


A worker participating in back–neck rehabilitation is receiving education on proper standing workstations. The worker is required to move 10 lb. discs onto a dowel. Which design element should be considered for the client’s workstation?

Workstation height should allow some elbow extension during the task.

A standing workstation is ideal for tasks requiring downward force; heavier tasks should be done with some elbow extension to minimize forces applied to the elbow musculature.


A COTA® is working with a client who slipped and fell on an outstretched arm and hand. The client presents with a Colles fracture at the distal radioulnar joint. What motions may be limited after Colles fracture?

Wrist extension and flexion
Radial and ulnar deviation
Supination and pronation


An OTR®; is setting social skills goals with a child with autism and the parent. The OTR decides to use Goal Attainment Scaling (GAS) to establish a baseline and measure outcomes of intervention. Which statement reflects the correct application of GAS?

GAS sets five levels of performance from ranging from −2 to +2; 0 is set as the expected outcome;

-2: much less than expected
-1: somewhat less than expected
0: as expected
+1: somewhat more than expected
+2: much more than expected


A student in the second grade has sensory modulation disorder. When handwriting in class the student consistently places excessive force on the pencil, causing the pencil point to break. Which activity would provide the child with proprioceptive input for regulating the amount of pressure applied to the pencil during handwriting?

Proprioceptive input is provided through firm pressure to skin or joints, which the student would receive from kneading modeling clay.


A client has C6 complete tetraplegia. Which hand functions can this client be expected to demonstrate?

Ability to pick up an object by stabilizing it between the palms of both hands

Radial wrist extension allows the client with C6 tetraplegia to stabilize the hands for compensatory grasp activities such as picking up a bottle or sliding an object to the edge of the table.


Cognitive reframing

a cognitive–behavioral therapy that uses positive self-talk to remove self-defeating and negative thoughts.

ex. COTA facilitates the child to talk about and rate his or her fears.


What is necessary for wheelchair safety for a client with bilateral lower-extremity amputations?

Rear antitippers

a person who has undergone a bilateral lower-extremity amputation has a different weight distribution when seated, the wheelchair is more likely to tip backward with less weight in the front. Antitippers prevent this.


The Ayres Sensory Integration Intervention program is applied to

individuals rather than in groups.


“goal, plan, do, check” approach

a cognitive strategy from the CO-OP program that can be used to promote ability to complete daily occupations and tasks such as transfers.


A client with a C5 spinal cord injury wants to read a book. Which assistive technology devices will help the client perform this activity?

Speech recognition software to operate switches and other devices in the home.

Long opponens splint provides support for muscles that are weak as a result of this level of injury. There is absence of wrist and hand movement.

Adaptive devices for page turning


Tuckman's Stages of Group Development

Forming is characterized by dependence.

Storming is characterized by conflict and competition.

Norming is characterized by initiation of cohesion.

Performing is characterized by group productivity derived from a sense of trust, unity, and supportiveness.


A myoelectric hand is paired with an __________ _______ __________.

externally powered prosthesis

which involves the placement of an electrode to pick up electromyographic signals to move the electric hand.


A COTA® was asked to treat a client in the acute phase of spinal cord injury. What is most likely the COTA®'s INITIAL role during this phase?

Evaluation of total body positioning to prevent problems associated with body functions (ROM) or body structures (skin).