OTA 140 Final Exam
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| Alzheimer's Disease: Causes and Risk Factors | Cause Unknown, Age > 65, family history, environment, diet, education, physical social and mental activities
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| Alzheimer's Disease: Cognitive deficits | Language, memory, AxOx4, personality changes and emotional instability
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| Loss of 2 or more cognitive functions that impacts daily life | Dementia
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| How does dementia impact daily life? | ADLs, IADL, education work, leisure, social
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| AD: average life span after diagnosis | 8 years up to 20 years
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| AD – early signs & symptoms | Memory loss, Diff. performing familiar task,
Problems with language, Disorientation
Impaired judgment, Decrease abstract thinking (problem solving), Misplacing items,
Mood or behavioral changes, Personality changes, Loss of initiative
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| Pre-symptom Stages of AD (1-2) | Stage 1 - No cognitive impairment
Stage 2 - Mild cognitive decline; complains of memory loss or word finding
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| Mild/Early Stages of AD (3) | Stage 3 - Mild decline , word finding deficitis, naming objects, misplacing objects, decrease in planning
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| Mild/Early Stages of AD (4) | Stage 4 - Moderate cognitive decline ; decreased knowledge of recent events, decreased ability to perform
higher level calcs, decreased memory for personal info, socially withdrawn
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| Mid/Moderate Stages of AD (5) | Stage 5 - Moderately severe cognitive decline ; major memory gaps, assist needed for complex tasks,
AxOx4 confusion, still knows own name & that of children, needs help choosing clothing for weather
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| Mid/Moderate Stages of AD (6) | Stage 6 - Severe cognitive decline ; memory worsens, personality changes emerge, max A for ADL,forgets name of spouse, OCD, hallucinations
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| Severe/Late Stages of A (7) | Stage 7 - Very sever cognitive decline ; does not respond to environment, mutism, requires feeding,
dysphagia, needs assist with walking and sitting
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| AD – what is the most important aspect of communication | Calm, reassuring voice and clear instructions, As few words as possible - less is better - keep it simple and give time to respond
Positive feedback after each step
Avoid anger/frustration triggers
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| AD- what type of intervention would we use to facilitate maximum independence in moderate stages? | Task Segmentation, Reality Orientation, address client by name, introduce yourself, review names of family, Built up utensils; scoop dishes; spill proof cups; finger foods, maintain head in neutral, thickening agent
Can use HOH
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| AD – what are OT interventions in the home environment for mild/moderate client? | Maximize safety
Remove scatter rugs
Eliminate clutter
Contrasting colors
Signs around the home
Minimize furniture
Gates and locks
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| AD – what type of activities would we use in a group or adult day care setting? Why? | Do not teach anything new
Use music based activities (music from their era)
Simple and familiar games and crafts
Pet therapy
Reminiscing games
Keeps client active and alert
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| AD – how do we respond to behavior problems? | Redirect
Use calm, reassuring voice
Approach from the front
Never argue, you will not win!
Use clear instructions
Reduce stimulation
Structured environment
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| AD – how is OT helpful in the end stages of AD (severe/very severe stages) | Joint ROM and splinting to prevent contractures
Skin integrity
SNF placement
Educate family and caregivers about disease and support groups
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| Cognition – what is it and what does it allow you to do? | Cognition allows individuals to use and process sensed and perceived information and thus is intimately connected to sensation and perception. Global Mental Function, Specific Mental Functions
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| What does the A refer to in A & O x 4? | Alert and oriented X 4
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| What are the four types of orientation (the x4) | Person, place, time and situation
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| What is attention and how does it work? | It involves the simultaneous
engagement of alertness, selectivity, sustained effort,flexibility and mental tracking
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| Know and understand the difference between automatic and controlled attention—and example of each | A. Automatic - subcortical level(unconscious) - walking and talking to a friend & not having to pay attention to where you are walking
B. Controlled - when new information is considered - you may have to wait at a light while walking with your friend
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| How do extreme variations in attention impact function? | Focused attentional deficit disorder – automatic response is replaced with a controlled response
Divided attentional deficit – client cannot process all of the info needed to complete a task. They become overloaded (have to stop to converse)
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| Which diagnosis might have difficulty with attention? | CVA, TBI, AD
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| How does memory work? | Memory is the cognitive function that allows a person to retain and recall information
Sensory Input to Working memory to Long term memory
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| Declarative Memory | Recite or reproduce
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| Episodic memory | personal history and lifetime experience
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| Semantic memory | fund of knowledge shared by a group
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| Procedural memory | memory for a skill
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| Everyday memory | info pertinent to daily life
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| Prospective memory | events in the future (doctor’s appt)
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| Confabulation | When a client fills in the memory gaps with imaginary material (not intentional). They
are unaware they are making it up or adding erroneous information
CVA , TBI, AD
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| How do you think poor insight affects progress in treatment? | results in impulsive and unsafe behavior
client cannot monitor, correct and regulate
the quality of his behavior
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| What is an example of emotional lability? | Uncontrollable mood swings. Person will laugh or cry at inappropriate moments
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| CVA – warning signs and symptoms of CVA occurring | Sudden numbness or weakness in face, arm, leg; especially on one side of the body
Confusion
Difficulty speaking
Blurred vision
Difficulty walking, dizziness, loss of balance or coordination
Severe headache of unknown origin
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| TIA – what is it? | Transient Ischemic Attack – an incomplete stroke (mini). Usually mild, develop suddenly and last for a
few minutes to 24 hours. Blood supply is temporarily reduced
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| occur when a rupture of a blood vessel results in bleeding into the brain and they account for approximately 20% of strokes by result in a significantly higher death rate | Hemorrhagic Stroke
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| cause 80% of total stroke and may be cause by a thrombus (blood clot that causes blockage) or an embolus (traveling blood clot) | Ischemic Stroke
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| What are the risk factors for CVA? (non-modifiable) | Age
Gender (male)
Race (African American or Hispanic)
Genetic Predisposition
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| What are the risk factors for CVA? (modifiable) | Hypertension
Cardiac Disease
Diabetes Mellitus
Obesity
Diet
High Cholesterol
Use of Oral Contraceptives with high dose of estrogen
Smoking
Alcohol abuse
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| What is neuroplasticity? Why is it an important concept for CVA recovery? | ability of the brain to make new neural pathways to new connections in order to
compensate for injury or changes in one's environment. It is important to have neuroplasticity to
rehabilitate to the maximum level of functional independence for the client
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| What is a DVT? | Deep Vein thrombosis, which usually develops in the veins of the legs and commonly occurs in
the paretic leg. Blood clots called pulmonary emboli, release from deep veins and lodged in the lungs, are
the most common cause of death within the first month
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| What are the signs and symptoms of a DVT? Who is at risk? | Symptoms: fever, pain, tenderness
and swelling, and tenderness in the LE. Stroke patients are at risk for DVT
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| What is the role of OT in stroke rehab? | Improving motor function of the affected side, Integrating sensory, visual-perceptual and cognitive functions, max I, Encouraging return to the life roles as possible
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| the absence of muscle tone that occurs immediately after stoke and is also known as hypotonicity. It also presents with absence of reflexes | Flaccid paralysis
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| What is the main concern with flaccid UE paralysis? | reduce the overstretching of muscles
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| separation of the joint as a result of paralysis or weakness | Subluxation
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| what does OT do for subluxation? | palpate for subluxations which can be confirmed with xray. Subluxation can be prevented through
supportive positioning and by avoiding traction when handling the affected UE
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| How do abnormal reflexes and postural mechanisms affect function? | Prolonged posturing in these positions can shorten muscle length, contracture and deformities in the
affected extremities as well as asymmetries in the trunk
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| How does motor function return (what is the pattern)? | Proximal to distal
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| Why is joint ROM important? | Incorporation of individually designed home ROM exercise programs has been found to increase motor recovery
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| Why is positioning important? | Positioning is important to minimize the effects of abnormal muscle tone
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| What is the “golden rule” of positioning (hint: danger zone)? | During position changes,
excessive effort should be avoided to prevent the influence of abnormal muscle tone on the affected side
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| How do we manage edema in an UE following a CVA? | The affected arm should be supported in supine and in side-lying while on the unaffected side to reduce edema and prevent injury
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| What visual deficits can occur? | Age related visual deficits: cataracts, macular degeneration, and glaucoma
Other visual deficits brought on by stroke: decreased distance vision, decreased peripheral awareness, accommodation, hemianopsia, diplopia
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| What does OT do to address the visual deficits? | Visual screening after stroke, then refer to opthamologist or optometrist
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| What is hemi-inattention? How does it impact function? Why is it a safety concern? | A common visual-perception problem after CVA when clients have difficulty shifting their gaze or attending to objects
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| What is agnosia? What is a functional example? | Agnosia refers to the inability to recognize objects by vision, hearing, touch, or proprioception despite intact senses
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| What cognitive deficits might you expect after a CVA? | Initiation,Motivation, Attention and Concentration, Disorientation, Confusion, Memory, Sequencing,Organization, Abstract Reasoning,Problem solving,Thought inflexibility, Insight, Judgment and Safety Awareness, Generalization and Learning,Cognitive fatigue
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| What behavior issues might you expect after a CVA? | Impulsivity and perseveration, mood and emotional impairments
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| acquired language disorder that may result in a wide variety of deficits in verbal comprehension, reading comprehension (alexia), oral expression, written expression (agraphia), ability to interpret gestures, or mathematical skills (acalculia) | Aphasia
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| word finding difficulty | Anomia
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| problems with speaking (use yes or no questions to comunicate) | Expressive Aphasia (Broca's Aphasia)
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| Problem understanding language (use gestures to communicate) | Receptive aphasia (Wernicke's Aphasia)
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| receptive and expressive aphasia, Careful consideration of what clients actually understand important, as client with global aphasia may appear to understand more than they actually do | Global aphasia
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| TBI – What area of brain is most vulnerable? | Brain stem, medulla and pons, for breathing and heartbeat
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| Contusions (bruises) occur in the frontal and temporal regions when the brain slides and strikes the rough skull. They are usually bilateral, but the severity is asymmetrical | diffuse axonal injury
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| A mass of usually clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessel. Subarachnoid-blood vessel surface of brain bleeds into space between brain and skull | Hematoma
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| Vessel that ruptures deep within brain | Intercerebral hematoma
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| blood filled pouch that balloons out from artery wall | Aneurysm
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| 3 types of hematomas | 1) Subdural (below protective layer of brain)
2) Epidural (between layer & brain)
3) Intracerebral (withing the brain tissue)
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| brain injury that can occur immediately after the injury or hours or days later and include: intracranial hematoma, cerebral edema, raised intracranial pressure, hydrocephalus, intracranial infection and seizures, Can happen by hypoxia or cranial pressur | Secondary Brain Injury
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| #1 cause of TBI | MVA (motor vehicle accident)
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| the amount of time it takes for a continuous memory to return after injury. One of the most accurate predictors in determining the severity is duration | PTA (posttraumatic amnesia)
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