With a nondisplaced fracture of the humeral neck, ______ ____ _ ____ and __________ ________ lead to the most desirable outcome.
support from a sling and supervised exercise nondisplaced fracture- the bone cracks either part or all of the way through, but does move and maintains its proper alignment
A COTA® is working with a client who has chronic congestive heart failure. The client is displaying limited tolerance for light to moderate homemaking activities. Which compensatory strategies should the COTA demonstrate to the client to improve activity tolerance?
Incorporation of sitting into homemaking activities Use of lower extremities instead of upper extremities during activities when possible Avoidance of extreme temperatures and high humidity in the house
Wheelchair Seat Width
measure the widest part of hips or thighs, then add 1-2"
Wheelchair Seat Depth
measure from the base of the back to the popliteal space of the knee, subtract 1-2" so that the edge of the seat does not reach the knee and cause restriction of movement or circulation
Wheelchair Seat Height
measure from the popliteal space to the bottom of client's heal. Foot rest should have 2" clearance from the flr Seat cushions raise the overall seat height
Wheelchair Seat-Back Height
measure from seat surface (including cushion) to top of client's shoulder higher back need if poor trunk control
Wheelchair Armrest Height
measure from seating surface to bottom of client's flexed elbow, armrest should be about 1" higher
W/c width Wheelchair Accessibility Requirements
24-26" rim to rim
Doorway clearance Wheelchair Accessibility Requirements
32" (minimum), 36" (ideal) --> You can remove a doorstop or replace existing hinges with offset hinges for extra width
Hallway clearance Wheelchair Accessibility Requirements
W/c length Wheelchair Accessibility Requirements
360° w/c turning space Wheelchair Accessibility Requirements
Min/Max Height for Forward and Side Reaching Wheelchair Accessibility Requirements
15" min (to prevent tipping) and 48" max. 46" when obstructed by items such as countertop or shelf
Countertop height Wheelchair Accessibility Requirements
Parking spaces Wheelchair Accessibility Requirements
adjacent 4 foot aisle
Pathways and walkway width Wheelchair Accessibility Requirements
Ramp width Wheelchair Accessibility Requirements
Slope to rise ratio of ramp Wheelchair Accessibility Requirements
1:12 (for every 1" of rise, 12" of ramp required)
Railings height Wheelchair Accessibility Requirements
29-36" high (average = 32")
Ramp curb height Wheelchair Accessibility Requirements
4'x4' ramp landing required when Wheelchair Accessibility Requirements
ramp is excessively long or person has limited UE strength/cardiopulmonary capacity (req to allow for rest break); sharp turns (90° requires 4'x4', 180° requires 4'x8')
If the ramp leads to a door Wheelchair Accessibility Requirements
5'x5' platform required before the door that extends at least 12" (18" preferred) along the side of the door so person doesn't need to back up
Work readiness programs
aim to identify a person's skills and interests to develop his or her readiness for work and to achieve the person's goals related to work.
Individuals with Prader-Willi syndrome often present with food-seeking behaviors, which might make waiting to eat until lunchtime difficult.
During PROM exercises for a client with stroke, the client’s shoulder is resistant to flexion beyond 90°, although the client reports being pain free. What does this finding suggest to the COTA?
The scapula is not gliding to produce full flexion. The muscles supporting the scapula have likely shortened from disuse and are limiting the full range of shoulder motion. Both the humerus and the scapula must move to support full shoulder motion.
A COTA® completes a home assessment of a person with Parkinson’s disease who lives at home but has begun to have mobility challenges. Which intervention is BEST to facilitate lifestyle changes to improve safety?
Introduce use of a rhythmic beat to facilitate mobility The use of rhythm has been shown to support mobility in people with Parkinson’s disease. This approach can minimize the impact of the immobilization that may occur from this disease.
an intraarticular fracture of the thumb metacarpal bone.
the result of a clenched fist hitting an object with enough force to break the metacarpophalangeal neck, most commonly seen in the fourth and fifth digits.
A client who has Parkinson's disease reports increased tremors, problems knocking items over while eating, and poor articulation, leading to recent social isolation. Which intervention strategy would be MOST effective for this client?
Educate about timing social activities when medication is most effective.
Dementia with Lewy bodies
Distinguishing features of dementia with Lewy bodies are visual hallucinations and Parkinson-like motor symptoms.
Relevant Understandable Measurable Behavioral Achievable in the time frame
a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation. Causes Symptoms may occur because of a psychological conflict. Symptoms usually begin suddenly after a stressful experience. People are at risk of conversion disorder if they also have: A medical illness A dissociative disorder A personality disorder
Slow progressive disease of the nervous system
Bradykinesia; Muscle Rigidity; Resting Tremor; Cog-wheel Rigidity; Micrographia; Dementia; Memory Deficits; Voice softens-becomes monotone; Reduced facial expression; Shuffling Gait; Freezing
Parkinson's Disease Stages
I- Unilateral symptoms, no or minimal functional implications, usually a resting tremor
II- Bilateral symptom involvement, no balance difficulty, mild problems with trunk mobility and postural reflexes
III- Postural instability, mild to moderate functional disability
IV- Postural instability increasing, though able to walk; functional disability increases, interfering with ADL; decreased manipulation and dexterity
V- Confined to wheelchair or bed
Amyotrophic Lateral Sclerosis ALS
Degenerative motor neuron disease of unknown etiology; more prevalent in men; avg onset 57yrs; life expectancy 2-5yrs Symptoms
Affects Voluntary Muscles
Spasticity and Stiffness Weakness, low tone and atrophy
Speech deficits, swallowing and respiratory involvement
Eye Muscles; external sphincters controlling bowel and bladder management; five senses; heart, liver, and kidneys are spared.
Result of trauma, pressure paralysis, forcible over-ext of a joint, hemorrhage into a nerve, exposure to cold or radiation, or ischemic paralysis.
Symptoms include pain, weakness, and paresthesias in the distribution of the affected nerve
Inflammatory disease that causes demyelination of axons in peripheral nerves
Etiology unknown; may occur after an infectious disorder, surgery, or immunization
Onset and Acute: acute weakness occurs in at least two extremeties and advances (20-30% req mechanical ventilation)
Plateau: sypmtoms most disabling with little/no change for days-weeks
Recovery: starts head/neck moves distally; sig-complete return of func, may have residual fatigue
OT TBI Acute Treatment Focus
OT TBI Rehab Treatment Focus
Regaining func in ADLs, IADLs, executive func skills, and community reintegration
Stages of ALS
I: Independent in walking and ADLs, some weakness
II: Can walk; mod weakness
III: Can walk; severe weakness
IV: Req w/c for mobility; some assist w/ADLs; severe weakness in legs
V: Req w/c for mob; dependent for ADLs; severe weakness in arms and legs
VI: Confinded to bed; req assist for ADLs and most self-care