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Questions for Presentation 1 by Hayley Parker (Lindsay Vest)

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Questions for Presentation 1 by Hayley Parker (Lindsay Vest)

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1. Did you find that your client was more or less motivated in the comfort of his home?

2. Had he been in a SNF or other rehab facility prior to receiving OT services in home?

3. What strategy was most effective for helping this client with his dizziness/lightheadedness due to the orthostatic hypotension?

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1. Question 1: Was the client dominant in his right or left hand? And what specific digits were amputated?

2. Question 2: Did he have any mental health concerns due to his amputation?

3. Question 3: What goal was the most important to him?

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1. How old was your client?

2. Was the lack of care in between injury and surgery due to him being in denial of his condition?

3. You mentioned he had increased edema. Did you ever formally measure it for your treatment sessions?

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1- Given the intensity of the accident, were there any signs of trauma around the incident or injury?

2- How long was the gap in care between injury and therapy? Do you know the reason for this gap?

3- Did you have special training at your clinic for the MHP?

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1. While there was a great focus for this individual’s physical rehabilitation, where there any assessment of the client’s mental status throughout the process?

2. Was the client motivated to participate in therapy? Was there carryover of instruction that was given in therapy that could be utilized in the home environment?

3. What were the typical timeframes given for STGs and LTGs for the client being discussed and other clients at the clinic?

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1. Will he be able to return to his line of work or will he require a change in profession due to his injury?

2. How long was in between his injury and beginning OT services?

3. Did he have restrictions/precautions associated with the surgery from the traumatic amputation?

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Question 1: If not the DASH, what other assessments could you use to address client's UE performance?

Question 2: Why did your clinic use a low complexity eval for amputation?

Question 3: Did you consider/perform any massage for edema management? Was this necessary for the clinic or did it resolve by the next visit?

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1.  Why did you choose “the finger” method to assess the edema measurement data as opposed to another method? Which digit was affected/injured?

2.  How many days a week did you work with your client?

3.  What other STG would you have potentially implemented other than the two you listed?

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1. What edema measurements did you take?

2. Were there any differences when working with this client due to him being there for workers comp?

3. What types of functional activities did you include with your client?

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1. Did this client have any other conditions affecting his therapy?

2. Did you use any assessments that gave you insight to how he was completing ADLs/IADLs?

3. Did you notice any emotional/behavioral impacts from this client's loss of independence due to his loss of digits?

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1. What was his dominant hand, if it was his R hand how well did he adapt his occupations?

2. How long after his surgery did he come to outpatient therapy?

3. Did you have any concerns with the pt's acceptance of his amputation? If so, how did you go about addressing these concerns?

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1. Were there any other injuries or prior medical hx affecting the session progress?

2. What was the most important goal/occupation that the client wanted to get back to?

3. When using the desensitization sticks, was there any regression with those depending on how he felt that session?

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Question 1: D/t the level of trauma involved in this case, did you apply the trauma-informed approach while working with this pt?

Question 2: Was the hand injured his dominant hand?

Question 3: What interventions would you provide to the pt if he returned to the clinic down the road with hopes of increasing his performance with the use of an orthotic?

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Question 1: As this patient was an injured worker, was this case considered Work Comp? If so, how did you manage the requirements to only target work-related tasks?

Question 2: If asked to make sensory desensitization work-focused, how could you adapt the textures to reflect textures this patient encountered on the job?

Question 3: How could his HEP represent more functional activity, especially in regard to work-tasks?

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1. Were you eventually able to assess grip strength using the dynamometer? Or did you assess it in a non standardized way?

2. How did you determine what ROM was appropriate as determined by the goals?

3. Upon discharge, did the client have any restrictions as far as how much weight he could hold at the gym?

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1.  What are some additional examples of desensitization activities?

2. How did you measure increased strength of R UE digits?

3. What benefits did you see in fluidotherapy with this client?

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1. Did the client report pain throughout therapy sessions? How was pain addressed?

2. You mentioned the client was motivated. Was he compliant with HEP, and did he ever display mental health concerns such as depression/anxiety as a result of his change in employment status?

3. Did the client have a sound support system at home?

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1: Did you consider a depression screen following his amputation?

2: Did the spirituality component of CMOP-E influence the plan of care for this client?

3: How did you incorporate functional activities into your session?

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Question 1: While utilzing the Adaptation model, what adaptations were utilized to assist in the client's occupational performance and participation?

Question 2: Is there any other modified method of measuring grip strength that could have been used due to the dynomometer not being able to be used?

Question 3: Was the client initially RH dominant and was the goal for him to return to using his RH as dominant or was he expected to transfer most common UE usage to his LH?

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1) When you evaluated the client was the injury very recent? How limited was his care in between injury, surgery, and therapy?

2) Was grip strength formally assessed since he was unable to grip dynamometer?

3) Were activities with his children targeted during therapy session?

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Question 1: Did he have any phantom limb pain in that left hand?

Question 2: From eval to discharge, did his grip increase? if so how much? Would it be considered functional now?

Question 3: Did he ever get frustrated during the session? If so how did you handle that?

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Prior to the client's injury, was the client R hand dominant?

How much edema was present on the R hand digits versus the L hand digits?

Will the client be able to return to original position or will he be transitioned to a new occupation secondary to injury?

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Question 1: Were there any other specific assessments that you could've administered besides the DASH?

Question 2: Were there any other physical agent modalities provided to the client that you didn't speak about?

Question 3: Were there any barriers with his motivation to get back to his daily life so quick with the length of his recovery?

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Question 1: Is there a modified method of measuring grip strength due to the amputation?

Question 2: Was the injury to his dominant or non-dominant hand?

Question 3: How often was the client instructed to complete the exercises included in the HEP?

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1) How do you think his inability to work affected his overall motivation and performance?

2) How was edema measured for this client? Is it assessed the same way for every client?

3) How did his ROM and MMT scores differ in his right and left UEs?

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1. How many weeks or days post-op was the patient before coming to therapy?

2. To measure a composite fist, did you take individual joint ROM measurements or was it by observation for your goal?

3. What was the communication like with the doctors for workers' comp?

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1. what other assessments did you use?

2. what are some specific occupations that are affected by grip/gasp?

3. what type of job did he have?

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Questions for Presentation 1 by Morgan Burgess (Lindsay Vest) 

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Questions for Presentation 1 by Morgan Burgess (Lindsay Vest) 

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1. How soon did you see him after the amputation?

2. Do you know why he had a lapse in treatment after/during his stay at the hospital

3. I thought the desensitization sticks were very interesting- I have never seen those- did you get to see how much progress he made with desensitization?

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1) Were there any psychological impacts of the traumatic amputation that effected his ability to participate in therapy sessions?

2) Why would the dynamometer be an appropriate tool for assessment when the client had received a partial amputation of all digits?

3) What was your reasoning behind using desensitization sticks in sessions? Is there another form of desensitization that you would have used with this client?

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1. Since the hand-clinic is mostly biomechanically related, did you have a hard time finding a variety of occupation-based interventions to complete in this setting?

2. How long after amputation of his digits, did he begin OT treatment at this clinic?

3. How often did you complete the desensitization activities with the sticks? Was this more of a slowimprovement task or did he still improve fast like he did with your other interventions?

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1. Was the injury to the client’s dominant hand and which digits were amputated?

2. Would the client be a good candidate for a prosthetic to help with hand function?

3.  Were you able to help connect the client with community resources to help him navigate returning to work or finding other employment?

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1. How did you manage his edema and educate him on use?

2. How did his grip strength look when compared to the non-injured hand?

3. How did this client respond to the texture sticks?

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1. Was he right hand dominant prior to the amputation? If so, what was the biggest challenge for him to overcome using his left hand?

2. Did you do any throwing/catching interventions to simulate when he plays catch with his kids?

3. What was the fluidotherapy intervention and how did it impact his occupational performance?

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Question 1: Did your patient come in with any splints, wraps, or braces when first getting referred to therapy?

Question 2: Was this your client's dominant or nondominant extremity?

Question 3: Did you use vibrating tools to assist with desensitization and scar massaging?

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1. Why did you select the DASH for this patient?

2. Did you test his non-affected extremity?

3. What evidence did you find to support your selected interventions?

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Q's for Morgan Burgess (Katelyn Schreiber)

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Q's for Morgan Burgess (Katelyn Schreiber)

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Question 1: Has the client undergone any post-surgical interventions (wound care, pain management) to promote healing?Question 2: Does the client have any contraindications or precautions that may limit the use of certain PAMS?

Question 3: Has the client received any support from their employer or workers' compensation to assist with returning to work or making the workplace more accessible?

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1. How old was your client?

2. What were his ROM and MMT test scores?

3. Due to the injury being traumatic, did it affect his mental health?

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1. How old was your client? Do you feel like his age played a role in his motivation to get back to his occupations?

2. What were some of the areas that your client specifically stated that he would like to get back to? How did you target these areas in your interventions?

3. How many weeks post-op did your client present to OT services?

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Question 1: Does the client have access to prosthetics or has any experience with them?

Question 2: Is there a way to modify using a dynamometer if the client is unable to provide an accurate result independently?

Question 3: What type of occupations is the client trying to improve grip and muscular strength?

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1. How was working with workers’ compensation for this client? Did you have any periods where you could not treat the client d/t not receiving approval for coverage in time?

2. Did you formally measure edema for the purpose of progress monitoring with objective data or did you informally observe it?

3. What was your client’s dominant hand? How far out from the traumatic amputation did your client come in for his initial evaluation?

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Did you monitor pain during the treatment session?

How would you address grip strength in assessments other than dynamometer?

What digit was affected in the amputation?

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1. Why did you have to do a skin assessment at the beginning? What does this look like?

2. How did you address his noncompliance with using the RW?

3. Did you provide any physical handouts to go along with the education administered?

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Question 1: How did you keep the session skilled for insurance purposes if his vitals were too concerning to carry out your initial treatment plan?

Question 2: Did you ever have to call EMS when you were unable to reach his primary care/cardiology or was EMS not needed d/t the type of dx and understanding of it?

Question 3: At discharge was he still using the walker to ambulate around his home? If so do you believe he would ever return to ambulating without any equipment?

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Q's for Hayley Parker (Katelyn Schreiber)

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Q's for Hayley Parker (Katelyn Schreiber)

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Question 1: How is the client’s orthostatic hypotension currently being managed at home?

Question 2: How has the client been educated about energy conservation and postural management techniques to prevent dizziness or fatigue during daily tasks?

Question 3: What specific balance exercises have been provided to the client and how does the client handle it due to anxieties surrounding falls?

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1. What are examples of modifications to your interventions that directly relate to his medical history of A-fib and orthostatic hypotension?

2. Since we can't bill for education, what strategies did you use to keep him engaged in therapeutic activities while continuing to educate him?

3. Are there more specifics about the education provided for his wife since she is his primary caregiver?

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1. How did his orthostatic hypotension impact therapy sessions?

2. How did his HEP for orthostatic hypotension management consist of?

3. How was therapy changed by seeing if his vitals were abnormal? What types of interventions would you do sitting due to this?

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1) How does his diagnosis and level of function relate to his difficulty with contralateral tasks?

2) How did you change the client's environment as his performance changed throughout your treatment sessions?

3) When utilizing materials in client's homes, did you ever struggle with finding things to use and if so, how did you tackle this challenge?

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Question 1: How did his anxiety diagnosis affect his performance patterns in his daily life and did this have an affect to his intervention process and progression towards his goals?

Question 2: Did the client demonstrate any cognitive deficits or was his unawareness of his condition just due to lack of medical literacy?

Question 3: Was it ever revealed why the daughter stopped attending sessions with the client and was there information/education that was not able to be provided to her due to her absense?

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1. Did you complete any cognitive assessments (formal or informal) during the assessment phase of the client?

2. With the client’s motivation to return to his community involvement, what are some other theories or models that you could have applied to this client’s intervention?

3.With the client’s motivation to go back to life before his diagnosis and the client’s struggle to recognize different signs and symptoms in his body, were there any signs of impaired safety awareness? If so, what did you do to address those possible impairments?

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1. What was the time duration between initial eval and re-eval?

2. Was berg only utilized at that facility, why choose berg if not?

3. Was the daughter staying home full time to aid the father throughout the day or when d/c did the individual have a home aid?

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How did you modify the home?

Did you monitor vitals multiple times through treatment sessions?

Was his daughter supportive with care and engaging in education on the client?

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1. Were there any precautions you had to take due to your client's cardiovascular/respiratory conditions other than taking your standard vital signs?

2. Do you think that carrying out your entire plan of care including the evaluation in your client's home environment was more or less effective than in an outpatient/inpatient setting?

3. What were the challenges posed while completing evaluations/treatment sessions in clients' home settings?

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1. Question 1: If he was on medications did those have any effects on his ability to participate in specific interventions?

2. Question 2: If clients vitals were abnormal at the beginning of the session, what would you implement to get them back to normal?

3. Question 3: Was the daughter present for most sessions?

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1. Did your client progress through his goals in the timeline you set in his goals, or did he progress faster/slower due to any environmental

2. What was the most creative/unexpected thing in his home that you used for interventions?

3. How was he educated on managing his orthostatic hypertension and how was his education understanding assessed?

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1. What type of precautions or limitations were taken into account d/t to the client medical hx?

2. Was there a specific time of day that the client had the best BP reading? Was it possible to have OT services at that time?

3. Regarding his medications, did you feel that after education he had the necessary skills to be independent with it?

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Questions for Presentation 1 by Hayley Parker (Lindsay Vest)

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Questions for Presentation 1 by Hayley Parker (Lindsay Vest)

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1. Did you have any difficulty motivating him to do therapy since he was in his home or do you think it motivated him more?

2. Had he been in a SNF or hospital prior to receiving home health?

3. How do these exercises help his orthostatic hypertension? Did he ever struggle with the hypertension during these exercises?

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Question 1: Was medication management ever an issue you came about with this pt?

Question 2: How long did you see this pt and how many times a week?

Question 3: Did he as the patient have any goals, to get back to independence, or something he wanted specifically?

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1. Did the client sustain any injuries from his fall or was his admission solely related to the orthostatic hypotension?

2. With the client’s improvements in balance/discharge from OT, were you able to safely clear him to return walking without an assistive device?

3. What concerns did the skin assessments address for this particular client?

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1.     Did you implement any simulated functional activities during tx such as transferring to the commode or shower?

2.     You mentioned he had a shower bench at home, did he also have grab bars to ensure safe transfers into the shower?

3.     What type of meal preparation activities did you implement during tx sessions, if any?

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1. How did you manage blood pressure rates during interventions, especially therapeutic exercises?

2. Did you use the 4Ps, or a different strategy for energy conservation?

3. What did the client’s support system look like?

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Question 1: Given the presence of Orthostatic Hypotension, how often did you have to assess blood pressure? Did you have to bring tools into the home to get a blood pressure read daily, or was this based on onset of symptoms?

Question 2: What evidence is out there about Orthostatic Hypotension management through the use of lower body exercising?

Question 3: Did you find that being within the home was ever limiting compared to the experience of being in a clinic? Or vice versa?

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Question 1: Were there any barriers in the home environment?

Question 2: How did you go about educating the client on the importance of using his walker?

Question 3: Were there any family or friends nearby who could check on him from time to time or assist him with tasks when necessary?

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1. What was the purpose of the ramp at his home if he was independent in all ADLs prior to being referred to home health?

2. How did you convince/educate the client to use his AD around his home?

3. How often did you bring your own games/activities to the session?

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1. How did you address orthostatic hypotension during treatment sessions, were many of your treatment sessions affected by symptoms of orthostatic hypotension?

2. When going into the home to complete sessions, did the environment need adapting when completing the assessments such as Berg Balance?

3. When completing interventions how often did you take vitals?

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1- How did you find working and treating in the home environment?

2—With health management and education becoming prominent intervention components, did you have ways to test clients' understanding of materials, such as repeating or demonstrating?

3- You mention his curiosity and motivation to return to the YMCA. Did you see a difference in his progression compared to other clients who may have been less motivated?

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1. what are the components of the adult learning theory?

2. how did goals in a home health setting differ from typical goals?

3. does the client have any social supports?

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1. What types of energy conservation techniques did you teach your client?

2. What fall prevention techniques did you give the client in order for him to complete safe transfers?

3. Was your client's daughter educated during the process surrounding his orthostatic hypotension, or was she not present during any of the sessions?

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1. Did you make the client demonstrate clear understanding and accurate completion of the exercises you gave him to complete prior to him doing them on this own?

2. Would you only do the orthostatics while sitting and standing or would you also do it while laying down to see that position change as well?

3. When in the home health setting, do you often complete the exercises/interventions in a variety of locations in the home or typically stay in one general area?

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1) Did your client ever experience a syncopal episode during treatment? How did or would you handle that situation in a client’s home?

2) Did you administer a cognitive assessment at any point?

3) Had the client received any education on orthostatic hypotension prior to being referred to home health?

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1: How did the client’s anxiety impact his occupational performance?

2: How did you complete a skin assessment?

3: How did you proceed when he experienced a drastic change in blood pressure?

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1. How much time was there between the client’s initial evaluation and his re-evaluation?

2. What kind of skin assessment did you do on your client?

3. When did you provide your client with a HEP?

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1. Did it make you nervous to get your patient up and moving knowing he had orthostatic hypotension? Did you keep a bp cuff on him?

2. Did you assess cognition?

3. Do you think that it is realistic for the patient to return to the YMCA?

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1.  Did you ever feel unsafe in the HH setting?

2.  Do you feel the patient’s mental and emotional state assisted in his desire to progress during his HH OT sessions?

3.  What other FOR would you have potentially implemented other than PEO and why?

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Question 1: How did you manage the client's Orthostatic Hypotension throughout your interventions and exercises?

Question 2: Why did you use two different balance assessment for initial eval and re-assessment?

Question 3: Considering the client factors, such as impairments with balance, what specific challenges did you face during interventions day to day and how did you support him?

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Question 1: How difficult did all of your client's comorbidities make for your treatment sessions?

Question 2: How did you manage any hypotension issues if they arose during sessions?

Question 3: Did you ever get to the client's house and he was not there due to appointments so something else and how did you manage that?

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Question 1: How long has the client had his prior comorbidities?

Question 2: How long did it take to assess and check client vitals? Was it completed in one session?

Question 3: Was the client's house permanently modified in any way after receiving OT services?

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1. Even though he lived with his daughter, did he have a lot of support at home from her to complete ADLs/IADLs safely?

2. Were there any other vital signs that you had to take other than blood pressure?

3. What are some of the ways that you educated the patient that helped him understand precautions?

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Question 1: Were there any barriers to home care? If so what were they?

Question 2: How long did his evaluation take with all the different assessments you had to administer?

Question 3: Was there any caregiver education given?

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1. What did you do when his vitals were abnormal?

2. Did you administer any cognitive assessments?

3. Did your client have anybody else there at his home with him to help him or did he have family nearby?

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Question 1: Is there a correlation between falls resulting in impact to the head and increased symptoms of dementia?

Question 2: With the BORG, are there standardized descriptions on the various levels of ratings 1-10? How is the patient educated on what an "8" entails, or is it fully subjective?

Question 3: When recommendations for equipment are given, are they provided by the setting you worked at? What roles does insurance play in this?

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1. Question 1: If the patient was going back home to a caregiver, did you have to meet with the CG to give them education during any of the sessions?

2. Question 2: Did you have difficulties communicating with client due to hearing loss?

3. Question 3: Was he receiving PT as well and if so did you co-treat?

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Question 1: Has the client had any previous falls or incidents similar to this one?

Question 2: Are there any concerns about medication management?

Question 3: What adjustments or techniques were used during bed mobility to ensure the client’s safety, reduce fatigue, and promote independence?

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Response to type of practice question from Prof. Rhyne- Lacy Pierce

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Response to type of practice question from Prof. Rhyne- Lacy Pierce

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Upon reviewing the definitions of blocked practice vs random practice in relation to motor learning, a mixed of both approaches were used during interventions. During transfer training there was more of a focus on blocked practice, while functional mobility interventions tended to follow a random practice approach.

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1) Was it common for patients to be referred to home health for orthostatic hypotension? How long would someone receive OT services for this diagnosis?

2) Did patient suffer any injuries following his fall that impacted his function in daily life?

3) Did you complete further education on purpose of RW and why it would benefit him?

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1. Was contacting the family for more information regarding the evaluation part of the initial session or did you find time in between patients?

2. How did the client’s cognitive decline impact how you led the sessions for the day?

3. Was the client in a wheelchair prior to the skilled nursing facility

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1. What kinds of interventions did you use that were linked to the Motor Learning Theory?

2. What kind of modifications and techniques did you provide him for transfers, mobility, and dressing?

3. Did your client have any specific interests you included to your intervention process?

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Question 1: What specific ther-exercises did you use to address the patient's impairments in standing and sitting balance?

Question 2: How did the patient's cognitive deficits affect his participation in treatment?

Question 3: Did you have any concerns with discharging the client home with HEP with family care?

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Question 1: D/t the pt's age and level of impairment at the start of care what did you initially assume his rehab potential was and did your opinion change at all throughout the course of his stay?

Question 2: Did you find it challenging trying to address your plan of care while PT was cotreating? If so how did you communicate with them and alter your session?

Question 3: Was living alone something the client wanted to continue to do after discharge? If so how did he take the recommendation for 24/7 care?

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1. When your sessions get really repetitive due to limited mobility, did you have difficulty finding ways to keep things from getting monotonous?

2. What kinds of fine motor interventions did you do with this client? I heard a lot of examples of functional mobility exercises that targeted lower extremities such as balance and gait training. But you also mentioned he had difficulty cleaning his dentures.

3. Were there any interventions that targeted his cognitive deficits?

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1.  What factors contributed to the patient’s lack and/or loss of hearing? Earwax, prior environmental/occupational factors?

2.  Is there a cap on the number of ST and LT goals for insurance purposes?

3.  What is a 3 in 1 commode?

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1. What adaptations or environmental modifications did you add to the interventions to make them more functional for him?

2. Were any home modifications made before he was discharged back home?

3. Did the client have any cognition impairments prior to his injury?

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1. Did you find it difficult to provide education to your client due to the fact that he was cognitively impaired?

2. Did you provide your client/client’s caregiver with any energy conservation techniques?

3. Did you find it challenging to co-treat with PT due to role confusion?

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1.  What were the client's personal goals? Did he have a particular hobby he was motivated to get back to?

2. Was the client in any pain at the initial evaluation? Did you access pain levels before each intervention?

3. How compliant was the client in using the recommended AE?

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Question 1: How were interventions altered to account for the client’s severe cognitive impairment?

Question 2: How was safety awareness provided to someone with cognitive impairment such as your client?

Question 3: Was there caregiver education including family and hired CG support?

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Question 1: How did the client’s cognitive deficits affect the intervention process?

Question 2: How were PT’s involved during co-treatment?

Question 3: Were any PAMs appropriate to use during the intervention process?

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1. Did he use any assistive devices/adaptive equipment prior to the fall?

2. How did you approach gait training for the pt?

3. How long did the pt’s plan of care last at the Shaire Center?

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1. was there one adl that was most challenging or were they all equally challenging?

2. what type of impulses did the client have?

3. why do you think the client did not make any progress with his other goals?

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1. How did you use his assessment results on the BIMs and BORG to guide your interventions moving forward?

2. How do you go about selecting interventions when a pt has so many goals to work towards?

3. How did his cognitive deficits impact interventions and progress toward goals?

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1: What were some specific interventions you did to address balance?

2: How did you ensure your client understood instructions with regard to his cognitive deficits?

3: How did you incorporate occupational based interventions when co-treating with PT?

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1- Is it hard to gauge what is typical for levels of strength/endurance for a client in their 90's?

2- What was it like to co-treat with PT? Was it ever disuptive to your intervention plan?

3- Is it typical in that setting to not meet all goals before discharge?