COTA Exam
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| dysphagia | upright position when feeding, understand prescribed foods and liquids, observe client closely while eating, educate, demonstrate competence for emergency procedures for choking and aspiration |
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| balance impairment | supportive devices: lateral trunk supports, seat belts, lapboards |
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| ROM | prom, self-rom, aarom, arom | prom should be performed at least twice daily and continued indefinitely if sufficient active movement does not return |
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| subluxation/shoulder pain | can be prevented through proper positioning, prom exercises, and education on handling techniques. the affected UE should be supported at all times | when upright during functional ambulation, the client may benefit from kinesotaping the arm at the shoulder. | the use of arm slings is controversial because they tend to increase the flexed adducted posture while reducing sensory feedback, w/o reducing risk of subluxation. clients with severe edema may require a sling temporarily during transfers or gait training
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| ifluencing muscle tone | active movement of hypotonic muscles can be facilitated through stimulation of various sensations | in the presence of increased tone, slow and controlled movements should be encouraged. clients should be discouraged from excessive effort. tactile and proprioceptive input can decrease high tone | specialized training in this area is required
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| bilateral integration | the affected UE should be properly positioned and kept within the client's view during one-handed activities | as motor function returns, the affected arm initially serves as a stabilier and progresses to being a gross assist, then partial assist, and may eventually become functional in all tasks |
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| strengthening and endurance | strengthening of the unaffected side is appropriate if increased resistance does not increase spasticity of the hemiplegic side |
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| elevation and retrograde massage | the presence of severe edema may be an early sign of reflex sympathetic dystrophy (rsd), also known as complex regional pain syndrome, and should be addressed immediately | edema can be prevented by: elevation, AROM, elastic stockings, compression devices, and retrograde manual massage of the elevated hand (beginning at the fingertips and moving toward the elbow) can be performed by client, family, or clinician |
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| motor retraining | select and engage client in activities that are goal-directed, task-oriented, and meaningful. match activities with client's skill level and grade activity up as client improves | provide opportunities for client to perform activities in different positions (sitting, standing). teach client to think about movement while performing activity. allow client opportunities to practice |
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| impaired attention | brief, frequent sessions in activities of high interest in a nondistracting environment | time and difficulty are increased as the client's capacity increases. these activities can be provided in a group format or individually | orientation methods include reality orientation, reminiscence therapy, use of family pictures, labeling client's belongings, using calendars and watches, or using props for holidays
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| positioning techniques | alternate between supine and side-lying at 2-4 hour intervals. symmetry of trunk alignment is desirable | the affected arm should be supported in supine and side-lying on the unaffected side to reduce edema and prevent injury. the affected leg should be positioned to encourage hip and knee flexion | in upright sitting, the trunk should be symmetrical and erect. the affected arm should be supported with pillows, bedside table, or lap tray. feet should be supported at all times
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| resting hand splint | most commonly used to protect affected forearm, wrist, and hand and to prevent contractures and deformities | the splint must be removed periodically during the day to prevent learned nonuse, to promote sensory awareness of the hand, and to encourage functional use | maintains and supports hand in clients with hypotonia. maintains tissue length and provides a gentle stretch for clients with spasticity
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