# data[].attributes.body
Autonomic Dysreflexia - (if symptoms present, remove restrictive clothing, such as stockings, and check catheter tubing)

Seizures - 1) to be prepared and maintain safety, ask the pt if an aura is typically associated w/ their seizures

Aphasia

Global Aphasia

Wernicke's Aphasia

Myasthenia gravis - autoimmune disorder that affects neuromuscular transmission, leading to muscle weakness. Symptoms often include muscle fatigue, ptosis (drooping eyelids), diplopia (double vision), and difficulty with speech and swallowing.

Spinal Muscular Atrophy (SAM) - genetic disorder resulting in the degeneration of motor neurons in the spinal cord leading to progressive muscle weakness starting in hands, atrophy, low muscle tone, difficulty w/ oral motor skills, cramps and fasciculations, dysarthria, fatigue

Cerebral Palsy - has visual impairments that need to be screened prior to power mobility training

Mild Diplegic Cerebral Palsy

Spastic Diplegic Cerebral Palsy - motor involvement of LEs that may affect toileting and  clothing management

Moderate Anthetoid Cerebral Palsy

Mild Ataxic Cerebral Palsy

Parkinson's Disease

Multiple Sclerosis - visual loss and dysphagia are associated w/ cranial nerve dysfunction. Heat tolerance is diminished.

Tardive Dyskinesia

Schizophrenia - antipsychotic medications may cause extrapyramidal symptoms (i.e. lip smacking, tongue protrusion, and facial grimacing) and should be reported to the pt's physician

Osteogenesis Imperfecta - bones can fracture easily such as in a minor fall or injury

Guillain-Barré syndrome - weakness & tingling in hands/feet, double vision & difficulty moving eyes, unstable gait, difficulty chewing/speaking/swallowing, bladder/bowel difficulty, high/low bp, inc heart rate, labored breathing.  1) During initial acute phase intervention methods to prevent complications (positioning and passive ROM) are ideal 2) precaution during intervention: ensure hemodynamic stability - check bp and heart rate prior to body position changes and transfers

Deep Vein Thrombosis - edema, pain, localized warmth in a flaccid extremity

Ehlers-Danlos Syndrome - a connective tissue disorder affecting skin, bones, organs, and blood vessels. Pts may experience joint hypermobility, stretchy skin, bruising easily, and fragile blood vessels.

Autism Spectrum Disorder - scheduling and routines are very beneficial

Absence (petit mal) seizure - common symptoms include abruptly stopping an activity w/ blank stare and fluttering eyelids

Simple focal  (partial) seizure - sudden movement of a body part w/ no change in vital symptoms

Congenital torticollis - type of dystonia, characterized by tight sternocleidomastoid muscle interfering w/ ability to turn head side to side

Constructional Disorder - difficulty or inability to assemble separate parts to build an end-product

Bipolar disorder - (acute manic phase) limit distractions in the environment during task performance

Dyspnea - shortness of breath

Perseveration - inability to stop an activity or action

Glaucoma - peripheral vision affected and closes in to center of vision???

Macular Degeneration -

Alzheimer's Disease

Stage 1: no impairment

Stage 2: basic forgetfulness, unlikely to be detected

Stage 3 mild cog impairment, start to notice decline by family, friends, and coworkers. Inc forgetfulness, short-term memory lapses, struggling w/ planning/organizing.

Stage 4: mod cog decline, including impaired concentration and decreased knowledge of recent events, struggle w/ complex tasks, forget one's personal history, personality changes (withdrawal, moodiness, depression, inc anxiety), sleep pattern changes

Stage 5: mod cog decline, can NOT be under their own care. benefits from ADL assistance and assistance preparing meals. Difficulty recalling personal details (phone number), emotional changes (delusions, paranoia), cognitive problems (inability to learn new things)

Stage 6: moderately severe, constant supervision. Needs help w/ finding clothing, trouble w/ remembering personal history, bladder/bowel difficulty, wandering or getting lost.

Stage 7: loss of ability to respond to environment, no conversations possible, abnormal reflexes and movement, physical impairment

Osteogenesis Imperfecta - affects the connective tissue and is characterized by extremely fragile bones that break or fracture easily (brittle bones), often without apparent cause. Besides being associated with brittle bones, the following features are also linked to OI: Blue sclerae, dentinogenesis imperfecta (disorder of tooth development), increased joint mobility, short stature, and hearing loss.

Radial Nerve Injury - can result in weak or absent wrist and finger extensors

Ulnar Nerve Injury - impairs hypothenar muscles and first dorsal interosseous muscles

Type I Chiari Malformation -

Axonotmesis - loss of protective sensation to the affected nerve distribution, requires visual compensatory skills for protection d/t issue typically resolving in 6 months

Trigger Finger initial intervention w/ pt should include static immobilization orthosis to position affected MCP joint at 0 degrees while allowing the DIP and PIP full active ROM and instructions to avoid MCP flexion

Carpal Tunnel Syndrome - initial actions include volar wrist orthosis and Phalen's Test for median nerve

Contractures of Thumb Web Space - pressure garments, night orthotics, HEP -> serial static orthoses and polymer gel sheeting

CMC thumb arthroplasty - (initial intervention plan) ROM program for shoulder, elbows, fingers, and IP joints. (post 1 week) immobilize wrist and thumb CMC and MCP joints while allowing AROM of the IP joint

Acute flare-up of stage 1 rheumatoid arthritis - isotonic and isometric exercises of both hands w/in pain-free ROM to preserve joint mobility and prevent deformities

Impingement syndrome - overhead wall pulleye is contraindicated for pt w/ mod-severe flexor spasticity and scapular immobility

Dysmetria - inability to perform accurate, smooth movements. You can either overshoot (hypermetria) or undershoot (hypometria) your movements when they’re directed at a target.

# data[].attributes.body
Ecology of Human Performance - interaction between the context/environment and the person; Assessing the context for which a client performs preferred occupations

Individual Placement and Support (IPS) model - supportive employment approach involving securing a job placement site, then teaching specific job skills for the workplace

Primary prevention model - focuses on anticipating potential circumstances or conditions that threaten the function or well-being of healthy individuals and developing an associated prevention plan

Multicontext Approach - emphasizes self-awareness and prediction of performance abilities as the initial step to assisting the client to determine if the use of a cognitive compensatory strategy is needed for a given task

MOHO - Occupation is assessed based on the three components of volition, habituation, and performance capacity, within the environmental context.

Rehabilitation - focuses on the patient’s ability to return to the fullest physical, mental, social, vocational, and economic functioning as is possible INCLUDING compensatory; emphasis is placed on the patient’s abilities and using the current abilities coupled with technology or equipment to accomplish occupational performance

Neurodevelopmental Treatment (NDT) - assumes that posture and movement impairments are changeable. It is a hands-on treatment approach which is used for rehabilitation for neurological conditions. It focuses on specific handling techniques to facilitate normal posture and movement patterns while inhibiting abnormal patterns.

Proprioceptive Neuromuscular Facilitation - reference developed to address neurological conditions such as a traumatic brain injury (TBI).

Psychodynamic Theory is a frame of reference that primarily relates to people with mental health disorders

Sensory Integration - the interaction between the sensory systems including auditory, vestibular, proprioceptive, tactile, and visual systems, provides integrated information that contributes to learning and adaptive behaviors

Psychoeducation is a frame of reference commonly used in psychiatric settings and although TBI can result in psychiatric symptoms, it is not necessarily considered a psychiatric diagnosis.

Neurofunctional Approach - The NFA is a patient-centered and goal driven approach that targets function, not impairment. It is essentially an occupation-based model which emphasizes “learning by doing” (Bottom Up Approach).
Treatment focuses on learning by participation in tasks

Person-Environment-Occupation-Performance model (PEOP). Highlights the complexity of the interaction between the person and their environment and how this influences their participation and occupational performance. Competence in occupational performance is required to attain occupational participation. .

Brunnstrom Movement - There are 6 stages of recovery:
1. Flaccidity or no voluntary motion.
2. Developing synergies.
3. Voluntary mvt begins within synergy pathways.
4. Initial movt to deviate from synergy.
5. Independent from basic synergy.
6. Isolated, near normal movt with minimal spasticity.

Occupational Adaption - mastery via adaption to task over functional skills; involves the person, environment, and their interaction.

Proprioception Neuromuscular Facilitation (PNF) - A treatment model that focuses on motor development through the shift in flexor and extensor muscles, using diagonal movement patterns to facilitate mature motor movements.

Psychoeducation (Cognitive-perceptual reference) - patients and their families are educated about their diseases in order to change their thinking and behavior.

Rood - A neurological treatment approach in which motor patterns are facilitated and normalized through the application of sensory stimulation to specific sensory receptors. Techniques: heavy/light joint compression, manual pressure, neutral warmth, vibration, vestibular stimulation, tapping, quick stretch

Research Theories

Grounded Theory - continuous comparison between collected data and interpretation, results in a set of categories and an emerging theory

Participation Action Research -

Critical Theory Study -

Phenomenological Study -

Hierarchy of Evidence

Level 1 - Systematic Reviews/Meta-Analysis

Level 2 - Critically appraised Topics

Level 3 - Randomized Controlled Trials

Level 4 - Cohort Studies

Level 5 - Case-Control Studies and Case Series Reports

Level 6 - Expert Opinion/Background information

systematic sample, individuals are selected from a population list at specified intervals. Selecting every fifth name on a list is an example of systematic sampling.

Grounded Theory Method involves the discovery of theory through the analysis of data. Grounded theory method is a research method which operates almost in a reverse fashion from traditional social science research. Rather than beginning with a hypothesis, the first step is data collection through a variety of methods. From the data collected, the key points are marked with a series of codes, which are extracted from the text. The codes are grouped into similar concepts in order to make the data more workable. From these concepts, categories are formed, which are the basis for the creation of a theory, or a reverse engineered hypothesis. This contradicts the traditional model of research, where the researcher chooses a theoretical framework, and only then applies this model to the phenomenon to be studied.

# data[].attributes.body
Allen Cognitive Levels (ACL)

ACL 1 (Total Assist) - Cog profoundly impaired, 24-hour care to elicit or produce automatic activities for locating stimuli, rolling in bed, raising body parts, and swallowing.

Intervention: Sensory Stimulation

ACL 2 (Max Assist, attention for 3 mins max) - severely impaired cognition. 24-hour care for transfers and ADLs. May show righting reactions, can encourage while seated. Pts start to wander, important to prevent unsafe activities

Interventions: multisensory activities (sensory/safe environment)

ACL 3 (Mod Assist, attention for 30 min) - spontaneous manual actions in response to tactile cues. Simple tasks (self-care) can be completed w/ task components in front of them, require tactile cues and is easily distracted. Actions unpredictable

ACL 4 (Min Assist, attention up to 1 hour) - (Goal-Directed Actions) can complete basic ADLs and familiar tasks (walking familiar places, making a sandwich) w/ visual cues, will not recognize error w/out clear visualization of error. May live alone w/ assistance for safety.

Interventions: goal-directed activities w/ visual cues

ACL 5 (Standby assist, attention for weeks) - cog mildly impaired, SBA for safety but new learning is possible through trial and error problem solving. Pts may have poor judgement and impulsive behavior. May live alone w/ weekly checks

Interventions: possibly memory/planning aids if necessary, assist in future planning d/t impulsive decisions

ACL 6 (Ind)

Alzheimer's Disease

Stage 1: "Is there a problem?" (very mild -> mild decline) ADL/IADL intact, mild memory problems, perceived loss of control, anxious and fearful, socially and physically intact

new tasks possible w/ grading and cues for success

Stage 2: "I just want to be alone" (mild -> mod decline) ADL intact w/ mild difficulty, IADL w/ mod difficulty, moderate memory loss, denial/moody/paranoia, difficulty learning new task, lose valued objects

no new tasks, simple and clear instructions. Use pictures as reality orientation, maintaining socialization and exercise is important.

Stage 3: "Go away, who are you?" (mod -> mod severe decline) no ADL/IADL, dissoriented to time and place, sleep disturbance/repetitive behavior, wandering, impaired visual & spatial orientation

overlearned tasks w/ 2-3 steps possible, simplify tasks, use good lighting,

Stage 4: "err no ber" (severe cog & physical decline) no ADL/IADL, generalized motor slowing leading to bedridden, incontinent, unable to communicate (1 word)

maintain proper positioning

Gross Motor 0 - 12 months Video

Babies start from hunched over, butt in the arm, arms curled in, and head down; around 12 months they are walking around

0 - 2 months "new world" - governed by reflexes, bonding, and visual play (dont have the coordination or skills to play)

In prone: lift head briefly, turn head cheek to cheek, bear weight on forearms

In supine: turn head side to side, kicks, swipes at objects w/ clenched hands

In sitting: rounded back, head bobbing

Rooting reflex

Suck/swallow reflex

ATNR (fencing position)

Moro?

3 - 4 months "Stronger World" - greater strength (and vsion/depth perception), symmetry, midline control

In Supine: tracks objects side to side crossing the midline, capitol flexion/chin tuck

In Prone: lift higher up to elbow and holds head steady

5 - 6 months "Sitting World" - prone on extended arms, prop sit, rolling both ways

month 5: lift up w/ arms extended in prone, prop sitting (propped up by arms extended)

month 6: sits alone, rolling both ways intentionally

7 - 10 "The Mobile World" - belly crawl, creep (crawl) on hands and knees, rise to sitting, pull to stand, and cruise

In Prone: pivoting in belly crawl (coordinating top and lower half of body), gets to hands and knees position (STNR and rocking back and forth)

approx. month 8 babies crawl and can rise into sitting position from prone

11 - 12 months "the Walking World" - stand briefly and take few steps forward

# data[].attributes.body
Performance Assessment of Self-Care Skills (PASS) measures a person’s performance of daily life tasks including five functional mobility tasks (i.e., bed mobility, stair use, toilet mobility and management, bathtub and shower mobility, and indoor walking), three personal self-care/ADL tasks (i.e., oral hygiene, trimming toenails, dressing) and fourteen IADL tasks with a cognitive emphasis (i.e., shopping, bill paying, check book balancing, mailing bills, telephone use, medication management, obtaining critical information from auditory and visual media, flashlight repair, home safety, playing bingo, oven use, stove top use, and the use of sharp utensils), and four instrumental IADL tasks with a physical emphasis (i.e., taking out the garbage, changing bed linens, sweeping, and clean up after meal preparation).

Miller Function and Participation Scales (M-FUN) is a standardized, developmental performance measure that is used to identify children with mild, moderate, or severe motor delays who are age two years, 6 months to 7 years old. It has no relevance to adolescents planning their transition post-secondary life.

Participation Scale (P Scale) measures restrictions in social participation related to community mobility, access to work, recreation, and social interaction with family, peers, neighbors, and others.

Cognistat Cognitive Assessment (Neurobehavioral Cognitive Status Examination) is a screening and assessment tool for rapid testing of people with conditions that can result in cognitive dysfunction (i.e., CVA, TBI, and neurocognitive, psychiatric, substance abuse and neurocognitive disorders) and those with mild cognitive impairments (MCI). The Cognistat includes testing in three general areas of cognition (i.e., consciousness, orientation, simple attention) and five major cognitive domains (i.e., language, constructional ability, memory, calculation skills, and executive skills)

Abnormal Involuntary Movement Scale (AIMS) -

Behavior Rating Inventory of Executive Function (BRIEF) - Age range (??-??) evaluates self-regulation and executive function in adolescents w/ neurological/developmental conditions

ASIA Impairment Scale - (A) complete impairment, no motor or sensory (B) incomplete impairment, sensory function preserved below neurological level and some preserved in s4/s5 (C) incomplete impairment, motor and sensory preserved below

JFK Coma Recovery Scale -

International Normalized Ratio (INR) Value - INR = 5, pt is at risk for bleeding and typically is placed on bedrest or activity restrictions

Modified Ashworth Scale - measure spasticity of an effected extremity (0= no increase in muscle tone, 4= affected parts rigid in flexion or extension), lower score after x time indicates a decrease in overall muscle tone

Barthel Index of ADL -

Montreal Cognitive Assessment - quick eval tool for cog impairment

Functional Independence Measure (FIM) - can predict the discharge disposition for pts w/ a stroke

COPM - collaboration, client-centered, can measure change in the client's self-perception of occupational performance over time

Kohlman Evaluation of Living Skills -

Executive Function Performance Test (EFPT) -

WEE-FIM - (good for initial pediatric TBI eval)

Bruininks-Oseretsky Test of Motor Performance (BOT) - measures skills and abilities for school-related occupational performance

Evaluation Tool of Children's Handwriting (ETCH) - measures skills and abilities for school-related occupational performance

Hawaii Early Learning Profile (HELP) -

Piers Harris Children's Self-Concept Scale - evaluates self-concept

Adolescent Role Assessment - evaluates role development

Phalen's Test - tests the median nerve (used for carpal tunnel,

5 point voice volume scale

Childhood Autism Rating Scale (CARS) - distinguishes children w/ autism from children w/ developmental delays for children 2 and over

School Function Assessment - performance in school-related tasks and the supports needed for tasks

BOT-2 - ages 4-21, assesses fine motor coordination, manual coordination, body coordination, strength, and agility in four motor areas via speed, accuracy, and duration

Occupational Self-Assessment - self-report of perceptions of occupational performance efficacy and importance of 21 activities

# data[].attributes.body
Sub-Acute Rehab -

Inpatient Rehab -

long term acute care -

Halfway House - pts are typically responsible for rooms, personal items, and house maintenance (IADLs focused in this setting such as laundry, meal prep, etc.)

# data[].attributes.body
Developmental

Hawaii

Sensory

# data[].attributes.body
Cushion Purpose: distribute pressure and reduce pressure on bony prominence, create postural support, and accommodate or correct deformity. Also comfort

planar cushion is the same as a flat cushion, used with someone who has good postural support, is able to independently repositioning,

Contoured cushion (standard or custom), provides more support and distributes pressure better. Is more expensive especially if it is customized to pt. Transfers can be more challenging d/t customized cushion not adjusting.

Cushion Materials

Foam: cheap and lightweight, used for general comfort. Poor durability and does not even pressure relief depending on the density of the foam.

Gel-filled: good postural stability d/t a good base support and better pressure relief than foam; however, it is heavy, can leak, and is temperature sensitive.

Air-filled: lightweight, best at pressure distribution; however, has terrible postural support and can leak.

Honeycomb: good pressure relief, fairly stable, easy to clean, not as heavy as gel-filled but is thick.

Hybrid cushion: different layers of the other materials

Alternating pressure cushion: mechanical cushion that provides alternating pressure on a schedule, expensive

Wheelchair measurements

Width: measure client at widest part of their hips or thighs and add 1-2 inches

Depth: measure from the pt's butt to popliteal fossa (back of knee) and subtract 1-2 inches to prevent chair from digging into back of knee

height of full wheelchair: footplate should clear the floor by two inches. ankles and knees at 90 degrees, thighs parallel to floor, adjust if using a seat cushion

height of back: dependent on person, low enough (generally the lower the back, the higher function the pt can have) for the pt to function but high enough to provide support

back height for max function = below scapula

armrests should be at a height that allow for the shoulders neutral position, arms at side, elbows at 90 degrees

low armrests can promote slouching forward

Environment

golden rule of 36 inches (wide) for hallways, walkways, sidewalks, and ramps. Countertops should be 36 inches high. Doors can be included, but 36 inches considers someone walking alongside the wheelchair which is not necessary through a door.

for a wheelchair to be able to do a 360 turn, the space requires 60 in x 60 in (5 ft. x 5 ft.)

Doors:

Minimum door width for wheelchairs is 32 inches (allows for bariatric WC accommodations)

offset hinges allow for an extra 1-2 inches

Ramps

a ramp should have one foot (12 inches) of slope per 1 inch of rise (i.e., 6 steps w/ 7 in rise each -> 6x7 = 42 in slope)

5 ft x 5 ft landing is required to allow for pt to go behind, close, and lock door

will also need 5 ft x 5 ft landing to rest if the ramp is too big, typically halfway

Wheelchair Attachments:

Armrests

Removeable - good for transfers

Height adjustable - good for support,

Wrap-around armrests (space saver armrests) reduces the overall width of the wheelchair by 1 inch

Armrest Attachements: arm trough (good for stroke or unilateral neglect for safety), lap board (good for keeping an arm safe or for activities), mobile arm support (good for high level spinal cord injuries to assist w/ moving their arm)

Leg rests

removeable leg rests - might be preferable if extra space is needed for transfers

swing away leg rests

elevating leg rests - good for lower extremity swelling

Footplates (typically folds up and down)

Heel loops - support at back of the foot plate to prevent foot falling off plate from behind

Anti-tippers - back of wheelchair, helpful for pts w/ lower extremity amputations (center of mass shifts d/t amputation, increases risk of tipping backward)

Break extender - good for individuals w/ upper extremity amputation, short, or anyone w/ limited mobility/ROM. Also reduces force required to pull break down

Seat belts and harnesses - only for postural support, not restraining

Head supports - helps w/ feeding, communication

Propulsion - manual, attendant, and power chairs (big, bulky, heavy, need a lot of space to maneuver, need a special vehicle for driving)

Positioning - both are good for postural adjustments (if pt can't self-adjust or has difficulty getting out of the chair) and pressure relief

reclining - angle of back changes, quickly adjusts (helpful for individuals prone to episodes of hypotension or autonomic dysreflexia), must be careful if individual has hip precautions and spasticity (inc hip extension can trigger spasticity)

tilt-in-space - angle stays the same, individual moves

Religious organizations and private clubs are exempt from ADA accessibility requirements

A rigid frame WC is better than a manual WC for most clients w/ SCI at the thoracic level d/t better functional independence support, it is lightweight and maneuverable but does not collapse/fold

bulbar onset refers to when the muscles of the face, throat, and neck become impaired. This impacts speech and swallowing. In regards to swallowing, the client may present with symptoms of dysphagia and be more at risk for choking and aspiration. Ensuring proper sitting posture is important to reduce these risks.

# data[].attributes.body
Most to least supervision: close, routine, general, minimal

Close - daily contact, direct contact at site of work.

Routine (“routes” = two choices = two weeks) - contact every 2 weeks, interim (phone/written)

General (“Dollar General” = once a month) - at least monthly direct contact, other methods as needed

Minimal - as needed, may be less than a month

COTAs can not train volunteers for tasks such as transfers; as they are not health care professionals

# data[].attributes.body
Beneficence: concern for the well-being and safety for the client

chooses appropriate interventions and assessments

be honest in termination of services in a timely manner

doing literature reviews and keeping up to date on information to provide best and safe services

consider potential risks and benefits conducting research

Non-maleficence: refrain from actions causing harm

dont harm the patient

don't neglect or abandon the patient

avoid complicated relationships or use your role for exploitative pain

Autonomy: right to self-determination, privacy, confidentiality, and consent

respect patients' desires and right to deny services

respect patients' right to engage in actions that we believe are harmful to them

right to make decisions about their care (however, help them stay informed prior to decision-making)

Justice: promote fairness and objectivity in the provision of OT services

timely services, equal access to care (no preferential treatment)

uphold the required license, obtain and maintain

maintain high standards and additional trainings

be aware of current laws, accurate billing, refrain from gifts that may bias your care, obtain necessary approvals for study, maintain transparency for conflicts of interest

Veracity: verify for the truth. Comprehensive, accurate, and objective info when representing the profession

honest about services provided in documentation

honest and refering your references accurately

Fidelity: treat clients and colleagues with respect, fairness, discretion, and integrity

understand your roles and responsibilities, collaborate with other professions (no slander or gossip)

Core Values

Altruism - Think about the welfare of others

Equality - Treat all patients objectively

Freedom - Patients have choices

Justice - Every person is included

Dignity - Respect your patients

Truth - Provide accurate information

Prudence - Use good judgement

# data[].attributes.body
Six stages of function:
1. Walking, independent with ADLs.
2. Walking, moderate weakness.
3. Walking, severe weakness. (interventions - provide smart tech)
4. Wheelchair bound, some assistance with ADLs, severe lower extremity weakness.
5. Wheelchair bound, total assistance with ADLs, severe upper and lower extremity weakness.
6. Bedbound, hospice or palliative care, severe respiratory distress.

# data[].attributes.body
Spina Bifida - can be open (aperta) or closed (occulta)

Spina Bifida oculta (hidden)

common symptoms: bowel and/or bladder issues (constipation/incontinence), back pain, leg muscle weakness, scoliosis

may require back brace, walker, or wheelchair

Spina Bifida Aperta (open) - two types (meningocele and myelomeningocele)

Meningocele - spinal meninges protrude from the spinal opening

Myelomeningocele - most severe form of spina bifida, both the spinal cord and the spinal meninges protrude through spinal opening

Spina bifida can lead to hydrocephalus (spinal fluid accumulates in brain and creates pressure) on the and ultimately Chiari II malformation (increased pressure in brain causes cerebellum and brain stem are pushed towards the vertebral canal). This malformation can difficulty swallowing, breathing problems, muscle weakness, balance and coordination issues, and developmental delays.

# data[].attributes.body
pressing a spoon down firmly on the center of the tongue decreases the tonic bite reflex

A chilled dental examination mirror helps elicit the swallowing reflex d/t the cold stimulation

lightly placing a tongue depressor between the upper and lower teeth can elicit the tonic bite reflex

For children with a reflexive bite; the use of a narrow, shallow, and coated spoon is preferred to help food slide off

Walking a tongue depressor from the front of the tongue to the back can desensitize a hyperactive gag reflex

rooting reflex - stroke the corner of the mouth, child turns head and tongue protrudes toward stimulus, integrates (disappears by 3 months)

Suck-swallow reflex - place finger in infants mouth, causes strong and rhythmic sucking, integrates (disappears by 3 months)

Jaw Jerk Reflex - tap on the mandible and the jaw moves

munching begins at 4-5 months

at 12 months rotary chewing begins

by 24 months children can chew most foods and respond to different tastes

By 4 months of age, most infants have gained fair head control and are able to remain in an upright position with support, and parents are beginning to introduce puréed foods. By this time, the anatomical structure of their jaws and tongues have dropped forward to support munching patterns. They also may open their mouth when a spoon is presented and are able to manage thin purees with minimal difficulties.

Between 7 and 9 months of age, FINGER feeding begins. Infants are now moving into unsupported sitting, quadruped and crawling. This development supports jaw stability, breath support and fine motor development for self-feeding skills. Infants at this age now begin to be able to successfully manage “lumpy” purees, bite and munch softer foods, and the development of rotary chewing begins.

Banging a spoon (playing with a spoon) is appropriate for a 10-12-month-old

12-14 months- Dips spoon in food, brings spoonful of food to mouth, but spills food by inverting spoon.

15-18 months- Scoops food with spoon and brings it to mouth and holds cup and drinks from cup independently.

The consensus is that by 36 months, a child can use a fork to pierce soft foods and bring it to their mouth.

5-7 months: Take cereal/baby food from spoon
6-8 months: Attempt to hold bottle
6-9 months: Sucks more than bites and grab spoon and bangs or sucks
9-13 months: Finger-feeds self soft table foods (macaroni, peas, dry cereal)
12-14 months: Dip spoon in food, bring to mouth
15-18 months: Scoop food and bring to mouth

Assessing - How do you assess swallowing in infants?

# Answer:

To assess swallowing in infants, conduct a bedside swallowing evaluation, which includes:

1. Evaluating the infant's level of alertness and ability to follow directions.

2. Assessing sensory and motor components of swallowing, including oral sensitivity and motor control of the jaw, lips, tongue, and cheeks.

3. Observing the infant's ability to manage secretions and performing auscultation.

4. Conducting trials with different boluses to evaluate swallowing function.

5. If necessary, recommend further testing such as a modified barium swallow study or fiberoptic endoscopic evaluation of swallowing (FEES).

What are the signs of swallowing difficulties in infants?

Signs of swallowing difficulties in infants include:

1. Coughing or choking during feeding.

2. Gagging or difficulty managing food or liquids.

3. Changes in skin color (flushed or ashen) during or after eating.

4. Refusal to eat or drink.

5. Excessive drooling or difficulty closing the mouth.

6. Arching of the back or unusual body postures during feeding.

7. Frequent respiratory infections, which may indicate aspiration.

8. Signs of distress or discomfort during feeding.

How can occupational therapy help with swallowing issues?

Occupational therapy can help with swallowing issues by providing direct therapy techniques such as modifying the consistency and amount of food, using postural interventions (like chin tuck or head turn), and employing specific swallowing adaptations (such as the supraglottic swallow technique). Therapists also work on creating a pleasant feeding environment to promote social interaction and bonding during meals.

If a child has an issue with tongue control, various food textures could be a choke hazard because they don’t have the ability to maneuver the food properly within the mouth.

Children with spastic quadriplegia are more likely to experience oral-motor deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. The goal of OT is to develop a good oral motor foundation. With jaw stability and lip closure, his tongue movements will improve, which are essential for tongue control and swallowing.

# data[].attributes.body
Akathisia - restlessness, inability to sit still, pacing, fidgeting, and sometimes anxiety or agitation. It is often a side effect of antipsychotic medications.

Tardive dyskinesia- irreversible neurological condition caused by prolonged use of neuroleptic medications; involuntary and repetitive movement of face, mouth, and limbs

Pseudo-parkinsonism - side-effect that appears as behaviors similar to the symptoms of advanced Parkinson’s disease; that is, rigidity, pill-rolling tremors, masked face, and a shuffling gait

Valsalva Maneuver - a person "bears down" or holds their breath while engaging in strenuous activity to gain more power; causes SOB and stresses cardiovascular system by elevating bp. Contraindicated for cardiopulmonary conditions

Emergent awareness - deficits involve difficulty or inability to recognize and correct errors in performance

Environmental gnosia

Closed Kinetic Chain Movement - distal upper extremity being stabilized and in constant contact w/ object

Concrete thinking - interprets events and information in literal sense

Premotor Perseveration - repetition of movements and difficulty transitioning from one aspect of an activity to another

Anticipatory Awareness - pts ability to accurately complete a self-assessment and predict performance errors based on current strengths/weaknesses

Confabulation - misremembering something, filling in memory gaps w/ fabricated memories

Apraxia

Ideational apraxia: breakdown in the knowledge of what is to be done and how to perform specific activities (best to use physical cues) (tasks that have multiple, sequential movements such as dressing, eating, and bathing)

Conceptual apraxia is characterized by a difficulty in selecting adequate tool for that action. more specific and is basically the misuse of objects for its intended purpose due to not understanding what the object is used for.

Accounts payable: payments that are due for purchases by or services rendered to a program, setting, or institution; debts in the budget

Accounts receivable: payments received by a program, setting, or institution for services rendered, the assets in the budget

Capital Assets: improvements or purchases that cost more than a set amount ($500 or $1000) and are expected to last more than a year (i.e., ADL kitchen, computer equipment)

Productivity Standard: amount of direct care and reimbursable services each therapist must provide each day

Positive Symptoms: any change in behavior or thoughts (hallucinations or delusions)

Negative Symptoms: where people withdraw from the world around them, no interest in social interactions, appears emotionless or flat

Dysmetria: undershooting or overshooting a target

Dyssynergia – breakdown/decomposition in movement resulting in joints being moved separately to reach a desired target.

Dysdiadochokinesia – impaired ability to perform rapid alternating movements.

Constructional apraxia refers to the inability to accurately copy drawings or three-dimensional constructions. It is a common disorder after right parietal stroke, often persisting after initial problems such as visuospatial neglect have resolved. Constructional apraxia is characterized by an inability or difficulty to build, assemble, or draw objects.

Apraxia is a neurological disorder in which people are unable to perform tasks or movements even though they understand the task, are willing to complete it, and have the physical ability to perform the movements.

Primary visual agnosia is a rare neurological disorder characterized by the total or partial loss of the ability to recognize and identify familiar objects and/or people by sight. This occurs without loss of the ability to actually see the object or person. The symptoms of visual agnosia occur as a result of damage to certain areas of the brain (primary) or in association with other disorders (secondary).

Ideational apraxia is a disturbance of voluntary movement in which a person misuses objects because they have difficulty identifying the concept (idea) or purpose behind the objects. Due to the conceptual loss, sequencing errors are common in this form of apraxia. Motor movement is not lost in ideational apraxia. However, the person’s movements appear confused because they cannot form a plan on how to sequence those movements when using an object.

Backward chaining refers to teaching an activity beginning with the last step: you would completely prompt the entire chain of behaviors except the last step. When using backward chaining to teach a patient to make French toast, the OT would prompt every step and have the patient independently use a spatula to move the toast from the pan to a plate. So the most work (independent step) led to the biggest reinforcement (consuming the food). Once the last step is mastered at an independent level, then the OT can teach the last 2 steps, then the last 3 steps, etc.

Autogenic training (AT) is a well-established self-induced relaxation technique based on autosuggestion. It is a relaxation technique that can be used to help reduce anxiety. It utilizes the power of the mind to help calm and relax the body. Autogenic Training restores the balance between the activity of the sympathetic (flight or fight) and the parasympathetic (rest and digest) branches of the autonomic nervous system. This has important health benefits, as the parasympathetic activity lowers blood pressure, slows heart rate, and promotes functions of the immune system.

# data[].attributes.body
Moro - "startle" reflex, reaction to response in a sudden stimulus (extensor posture w/ extremities) integrates by 6 months, but can stay in children w/ cerebral palsy.

Landau - "superman pose" child is suspended in the air in prone, the child’s head is in an upright extended position with a little bit of a convex arch in their back, and their legs slightly flexed. (present at 3 months, integrates at 2 years)

ATNR - "fencing reflex" child turns their head to one side, the extremities on that side of the body extend and the extremities on the opposite side flex. beginning of the development of eye-hand coordination as the baby is seeing their hand for the first time

STNR - (4 month?) flexion of UEs and extension of LEs; flex neck and legs extend, extend neck and flex legs. assists in the development of bilateral patterns of body movement, allows the baby to move up against gravity and assume a quadruped position (for crawling).

Tonic Labyrinth Reflex - when held in a prone suspension: (1) when the infant's neck is flexed, their shoulders protract and their hips flex (2) when the infant's neck is extended, their shoulders retract and their hips extend. (Helps children develop strength in neck and core to manage head and limbs against gravity, related to vestibular system.

Parachute reflex- Infant prone in air and brought to the surface with the head down. Infant reacts as if trying to cushion a fall with their arms abducted and extended and fingers spread. Develops around 8-9 months and present throughout life.

Forward Protective Extension - postural reflex evident between 6-9 months, continues throughout life

Protective Response - (14 month?) sitting position and gentle pushes forward, backward, and each side

Body on Body Righting - child in supine, OT moves child's hips side to side

Head Righting Reaction - (typically develops in 3-4 months) child in vertical suspension, observe head position while gently tilting the child side to side and front to back

Placing Reflex - tactile stimulation of hand or foot, lifts and moves onto surface (present at birth, integrates at 1 year)

TLR (supine and prone) allows the baby’s posture to adapt to that of the head and helps prepare an infant for rolling over.

STNR promotes coordination of the upper and lower body, while ATNR facilitates visual attention and helps stabilize the trunk during movement.

Radial Digital Grasp - typically develops between 6-12 months

Emotional Regulation - best observed when reacting to the feelings of others

Vestibular - activate the vestibular system by spinning, rocking, moving fast.

Proprioceptive - (stomping while walking is proprioceptive)

Occipital lobe - responsible for impairments of visual reception and visual memory

Figure Ground Perception - ability to distinguish foreground from background

Visual closure - impaired skills would have difficulty identifying an object when there is an inability to see the object entirely

Developmental Sequence of Gross Motor Movement and Mobility Skills: Four Point Positioning -> Rocking on Hands and Knees

Progression of TX for tactile defensiveness: brushing -> firm consistent touch -> light moving touch as tolerated.

# data[].attributes.body
~3 y/o "typical" developing child has the prewriting skill of tracing intersecting lines

between 4-5 y/o - Copying familiar letters and numbers

The first toileting skill developed is recognition of being wet/soiled as uncomfortable

Creative play (coloring, playing w/ dolls, cutting and pasting pictures onto cards) is developed between 4-7 years old

The exploration of relationships between actions and consequences is typical of the cognitive development of a 9- to 12-month-old.

Between the ages of 5-6 years old, a child can complete a 3-step visual motor task of tracing her hand, coloring a picture, and cutting. Cutting complex shapes begins between ages of 5-6.

Babies begin to roll from as early as 3-4 months from prone to supine. And by 6 months, a baby is typically rolling segmentally from prone to supine and from supine to prone.

Movement Milestones

0 months: uncoordinated moving arms and legs on back

2 months: push up off the ground, some head control

4 months: use all 4 limbs to roll onto back, head control/does not need head support, can hold some toys

6 months: come to sitting using arms to keep self propped up (6 looks like a child sitting), can roll belly <-> back

9 months: can use hands to pull to stand, can crawl, and sit w/out support

1 year: cruising w/ using furniture

1.5 years: walk up stairs, cant go down

2 years: run, up/down stairs (holding on), tip toe, climb, kick, and throws

3 years: run, up/down stairs, climb

4 years: goes to school, can hop/skip on one foot (looks like 4) for a few seconds

5 years: stand on one foot longer, swing, summersault

Fine Motor Milestones

0 - 2 months: hands clenched in palmar grasp reflex, hand to mouth to try to self soothe

2 - 4 months: reach for objects w/ poor coordination, unable to grasp

4 - 8 months: pick up small objects, shake a rattle, trap an object between thumb and side of finger

8 - 12 months: transfer objects between hands, hold baby bottle, pick up tiny objects to finger feed

1 - 2 years: pick up small cubes, stack blocks, play w/ large puzzles, scribble w/ crayon, use a spoon and sippy cup

2 - 3 years: stacks several blocks, open simple containers, wind-up toys, string large beads, copy simple shapes, snip w/ scissors, begin electronics

3 -4 years: simple un/dressing w/ simple fasteners (large buttons), can use a pencil, colors in lines, cut out large shapes

4 - 6 years: able to tie shoes, work w/ zippers and snaps, use a fork and knife, copy letters/numbers/short sentences

7 - 10 years: craft projects (hole punches, glue, needles, staples), cursive writing, proficient in eating and hygiene (nail clippers, styling hair), texting and computer use

10+: inc keyboard speed, electronic devices, and improve fine motor skills in interests (art, music, etc.)

Pencil Grasp Patterns

1) Fisted Grasp (1-2 years)

2) Digital Pronate Grasp (2-3 years)

3) Quadropod Grasp (3-4 years)

4) Static Tripod Grasp (4-5 years)

5) Dynamic Tripod Grasp (5-6 years)

Toileting Milestones

1 year 1-year-old whine when wet

1.5 years will sit on the toilet if put on toilet

(1 half to sit on the toilet)

2.5 years can tell others when they have to go

(I half 2 go)

3 years can sit and toilet, but needs help w/ hygiene

(3 help me with the TP)

4-5 years independent toileting

(4, close the door, dont need help no more)

6-9 months, a baby masters transferring an object between hands, starts to isolate their index fingers and uses an immature pincer grasp.

10-12 months, a baby develops a mature pincer grasp. The child may begin to mark a piece of paper with a crayon.

At 12 months- Scribbles after demo.
At 14-15 months- Spontaneous scribble.

18-24 months- The next pre-writing skill after scribbling, is imitating horizontal and vertical lines at 24 months.

Loop scissors: Trains the child to use the “opening and closing” hand movement.

# data[].attributes.body
OT can uniquely help w/ juvenile ideopathic arthritis through sleep hygiene.

In the public schools, children are re-evaluated every three years to determine if they continue to qualify for special education services.

Documentation must be specific, measurable, and behavioral.

A complete tendon rupture results in muscle weakness but it is painless. Tendonitis would result in pain but the muscle would remain strong; incomplete muscle tear would decrease strength and be painful. Good muscle strength that is pain-free is within functional limits.

OT Process follows the following steps, in sequential order: Referral, Screening, Evaluation, Intervention Plan, Intervention Implementation, Re-evaluation/outcomes, and Discharge

Using an incentive spirometer after surgery encourages the pt to take deep breaths to prevent pulmonary complications such as pneumonia (it expels anesthesia and improves lung function)

Elevated levels of troponin (greater than 0.04 ng/mL) is a diagnostic marker for acute myocardial infarction

Weakened lower abdominal muscles make it difficult to lift LEs when supine in bed

A surgeon may leave a deep wound open to heal through the granulation process, this requires skilled wound care and close monitoring of infection

Diabetes, atherosclerosis, and AIDS are associated w/ poor blood circulation and would make wound healing more difficult

Suicidal ideation in a student requires immediate contact of the interprofessional team AND referral to primary physician

Play-based activities for children are more intrinsically motivating for children and can help the child learn skills

Discharge planning in IPR occurs throughout the intervention phase and should be reassessed as needed

The purpose of a criterion-referenced test: assess the child's performance against specific criterion or measure, not comparing to same-age peers. Results can be used to identify specific tasks to use as the focus of intervention (developmentally appropriate activities)

The brachioradialis can substitute for weak biceps causing the forearm to go into mid-position when attempting active flexion of the elbow against gravity

Poor impulse control can be helped with a structured and consistent environment; successful experiences can help build self-concept

ADL and IADLs are considered modifiable risk factors

For pts w/ paranoid personality disorder: Avoid confrontation and progressively engage the client to develop good rapport and an effective therapeutic relationship

Section 504 - regulates the provision of reasonable accommodations for a student w/ a disability to have equal access to academic programs in sport, after-school care, and extracurriculars

Americans with Disabilities Act - reasonable accomodations

Letter of appeal for pre-authorized visit requires evidence of functional outcomes and medical necessity.

S: O: A: Impressions OTR forms about client's status/progress based on clinical data

Medicare documentation for INITIAL Eval must include: plan of care certified by physician, justification of skills for OT, and services specific to pt needs

Inc of 10 BPM above resting heart rate is appropriate cardiovascular response (continue and monitor)

IEP MUST include start/end dates and location of OT services

Documentation of medical necessity for wheelchair prescription must include: results of a face to face mobile eval, justification for each recommended feature, and a statement related to the client's enhanced participation in frequently performed activities

Correct Sequence for PPE - gown, mask, gloves

Enteric Contact Precautions - use transmission precautions

OTR must know and understand policies and procedures related to reimbursement when establishing the intervention plan

National Provider Identification number must be obtained from Centers for Medicare and Medicare Services by all providers billing Medicare

Correlation = r value ( r value less than 0.70 is unacceptable or inadequate) Pearson’s r value of +1 indicates a perfect straight line correlation between the independent variable and the dependent variable in a research study. To achieve a Pearson’s r value of +1, all subjects included in the study would have shown an improvement in attention to task while chewing sugar free gum.

VRE (vancomycin-resistant enterococci) requires contact precautions

Aging in place (singular person-ish) vs Universal Housing (universal design - community, visit-ability)

Intervention goals for someone w/ cerebellar dysfunction are focused on strengthening proximal muscles, improving postural responses, and increasing stability.

Reality orientation is ineffective for people with neurocognitive disorders, their memory deficits, confusion, and distractibility result in inaccurate responses.

When you see the person is wandering, do not get their attention by tapping them on their back to immediately redirect them. the OT practitioner should approach the person from the front at eye level. Immediate and sudden surprising approaches may increase confusion.

You do not need to send your course completion to the board. You will be required to certify that you completed the required number of units on your renewal form and list the activities on the back of the renewal form. You must maintain copies of course completion certificates and documentation of other activities completed for a period of four (4) years following the renewal period. The Board will conduct periodic random audits. Failure to complete continuing competency requirements or provide documentation during an audit can result in your license being placed on inactive status, a citation and fine, or other disciplinary action.

CEU is a unit of credit equal to 10 hours of participation in an accredited program designed for professionals with certificates or licenses to practice various professions. A single hour of participation in a course is equal to 0.1 CEUs. If the OT practitioner attends a 2-hour lecture, the OT practitioner will receive .2 CEUs. (2 x 0.1).

1 PDU equals 1 contact hour spent in structured learning, a 2-hour video course would meet the 2 PDU requirement. The video course must be in the clinicians’ area of practice and must be directly related to occupational therapy treatment. While the required facility in-services contain essential information, they are not directly related to occupational therapy treatment.

Overhead suspension sling is best suited for individuals presenting with proximal weakness with muscle grades in the 1/5 to 3/5 range.

Angled/curved utensils and tools are useful for individuals with range of motion limitations.

Environmental control units are used for individuals who have significant motor deficits, proximally and distally, and who cannot independently perform tasks such as controlling the switches on electronic equipment.

C6 spinal cord injury (SCI) can independently don underwear and pants while lying in bed. Minimal assistance is needed to don socks and shoes.

Serial casting provides a stretch over time to the limb to prevent contractures and reduce tone. A therapist will slowly cast the individual into the correct positioning over multiple months using this method.

# data[].attributes.body
The classes of heart disease are typically categorized by the New York Heart Association (NYHA) Functional Classification:

1. Class I: No objective evidence of cardiovascular disease; no symptoms and no limitations in ordinary physical activity.

2. Class II: Objective evidence of minimal cardiovascular disease; mild symptoms and slight limitation during ordinary activity; comfortable at rest.

3. Class III: Objective evidence of moderately severe cardiovascular disease; marked limitation in activity due to symptoms, even during less-than-ordinary activity; comfortable only at rest.

4. Class IV: Objective evidence of severe cardiovascular disease; severe limitations; experiences symptoms even while at rest.

# data[].attributes.body
Sleep

a wedge cushion under the head at night can promote better sleep by decreasing the amount of workload on the lungs

pillow under chest while in prone can increase discomfort, restrict chest wall expansion, and limit breathing

Supported supine or supported side-lying are options for people w/ SOB when laying flat

Sitting

people need repositioning every 15-30 minutes to relieve pressure

# data[].attributes.body
Dynamic Orthoses - splints w/ moving parts (elastic bands or springs) to assist in PROM or AROM, promotes movement and prevents stiffness

Ex: dynamic splints, balanced forearm orthoses (supports weak muscles), opponens splints (support thumb in abduction and opposition), shoulder slings (flaccid arms)

Used for tendon injuries, joint contractures, spasticity, muscle weakness, and post-surgical recovery

Benefits: inc. ROM, support and stability, prevent deformations, facilitates functional activities, pain reduction

90 degree to the joint for tendon repair is the ideal force to prevent unwanted traction on the joint and sheer stress

# Question:

Why does a tendon repair require 90 degrees at the joint?

# Answer:

A dynamic orthosis aids in tendon repair by allowing controlled movement while providing support. It promotes early mobilization, which helps prevent adhesion formation and facilitates tendon healing. The orthosis increases tendon excursion, improves strength at the repair site, enhances joint range of motion (ROM), and prevents adhesions. Additionally, it allows for gradual and safe progression of activities, ultimately assisting individuals in resuming meaningful roles and occupations.

wrist-driven flexor hinge orthosis is designed to assist individuals with limited wrist function, particularly those who have lost active wrist extension. This orthosis allows for wrist flexion and extension through a mechanism that utilizes the movement of the forearm to drive the hand, making it beneficial for tasks requiring grasp and release. Can not be used for C5 SCI

Hands

Silver ring orthoses can be used to prevent Boutonnierre deformities, but not help hold objects. It provides stability and alignment; and can be used for OA, RA, swan neck, Boutonnierre, and Ehlers-Danlos syndrome

SaeboStretch resting hand orthosis is a good inhibitory, tone normalizing orthosis option for a person who has minimal to moderate tone

A boutonniere deformity is caused by a lengthening or rupture of the extensor digitorum communis tendons and is expressed by distal interphalangeal (DIP) hyperextension and proximal interphalangeal (PIP) flexion.

A swan-neck deformity can result from the rupture of the lateral slips of the extensor digitorum communis or flexor digitorum superficialis tendon and results in DIP flexion and PIP hyperextension.

A trigger-finger deformity results from a thickening of the flexor digitorum superficialis tendon at the flexor tunnel, also called a tendon sheath. The affected joint tends to stay open upon attempt to close or fist the hand.

Synovitis of the MP joints can cause damage to the MP ligaments with palmar dislocation in conjunction with, or independent of, ulnar drift.

Shoulder

Flail Arm: recommended for brachial plexus injury, involves full UE. Provides stability at shoulder and elbow to allow functional positioning of hand

Figure of 8: used for combined median and ulnar nerve injury to prevent MP hyperextension

Deltoid Sling: used for UE muscle weakness

Rotator cuff surgery begins with PROM which may be initiated anytime from 0 to 6 weeks. Intervention then progresses to AAROM/AROM which is commonly initiated from 6 to 8 weeks. This treatment protocol then progresses to strengthening with isometric exercises followed by isotonic.

A positive Tinel’s sign at the forearm is consistent with this syndrome which is a medial nerve compression between the two heads of the pronator teres.

Symptoms are similar to carpal tunnel syndrome (CTS) except there is aching pain in the forearm and no night symptoms. A person with CTS has paresthesias occurring at night, does not have pain in the forearm, and has a positive Tinel’s sign at the wrist.

A positive Tinel’s sign that is noted at the Guyon’s canal indicates Guyon’s canal syndrome which is a compression of the ulnar nerve with sensorimotor symptoms reflecting ulnar nerve distribution.

A positive Tinel’s sign at the elbow is indicative of cubital tunnel syndrome. This is an ulnar nerve compression at the elbow that has the symptoms of numbness and tingling along the ulnar aspect of the forearm and hand, and pain at the elbow with extreme elbow flexion.

Positive Froment’s sign: Froment’s sign tests for the action of adductor pollicis, which is weak with ulnar nerve palsy. With ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure, causing a pinching effect.

Quick hand screening: Ulnar nerve use the “peace sign”,
Radial nerve use “thumbs up”/”hitchhiker”, Median nerve use the "Ok sign" (three entrapment syndromes: carpal tunnel, anterior interosseous syndrome, and pronator teres syndrome)

Radial tunnel syndrome (RTS): Compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. With RTS, placing the elbow in extension, forearm in pronation and wrist in flexion along with resisting long finger extension will often provoke symptoms of dull pain or aching and burning in the lateral forearm. Fabricating a long arm orthosis with the wrist in extension, elbow in flexion, and forearm in pronation to neutral rotation is the classic recommended position .

Passive range of motion (ROM) exercises are contraindicated for individuals with rheumatoid arthritis (RA) primarily because they can exacerbate inflammation and pain in the joints; do AROM instead for joint function and anti-deformity.

# data[].attributes.body
Medicare - for people 65+ and some under 65 w/ conditions such as end stage renal disease and ALS

expects durable medical equipment to last 5 years

Medicare A (inpatient)

helps pay for inpatient care you get in hospitals, critical access hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care.

Medicare B (outpatient)

Medically necessary services: Services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition.

prevention services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best.

Medicare C

Additional coverage for A and B

Medicare D

Drug prescriptions

A sock aid, grab bars, and a reacher are used for self-help and are not covered by Medicare. DME requires that the item must be medically necessary and reasonable to treat an illness or when the patient has a decline in function.

Medicaid - helps cover medical costs for some people with limited income and resources, eligibility and requirements vary by state

covers shower chairs, may cover toilet safety frame

# data[].attributes.body
Prosthetics

preprosthetic phase - manages healing process, prepares limb for prosthetic use, and helps pt adapt to physical and emotional changes

consider emotional support, phantom limb pain, hygiene, desensitization, assist in shrinking and shaping limb, and special considerations for individual pt

Treatment - education on hygiene (wound care, use of long handled mirror, e-stim), education on wrapping and compression stump shrinker, pain management and desensitization (tapping to reduce to reset nerve endings, massage, vibration, fluidotherapy, and Weight-bearing), mirror box therapy, scar management (breakup and flatten scar tissue, use deep heat and massage), ROM (P/AROM to prevent contracture and improve mobility at the site), strengthening (isometrics, e-stim, isotonics and general endurance for reconditioning), muscle learning and re-education

body-powered prosthetic - proprioceptive feedback, robust, reliable, easy to learn, helps the body to learn what remaining muscles to use to make a prothesis work

Static, passive prostheses are primarily used for cosmetic appearance. They can be passively adjusted to assist with carrying and grasping items

Amputations

blank (elbow, shoulder, etc.) disarticulation - think distal portion of body is amputated at said joint

Forequarter - clavicle, scapula, and entire UE is removed

transmetacarpal - fingers removed through the metacarpals

hemipelvecotomy - half the pelvis and LE removed

complete tarsal - ankle, foot, and toes

partial tarsal - part or all of foot and toes

complete phalanges - all or some of toes

digital - at any MP joint of the finger

Training

For grasp/release: elbow flexed at 90° with neutral degrees of pronation/supination is the easiest position in which to begin grasp and release activities. It is also the most functional and natural.

# data[].attributes.body
What are the specific characteristics of each Rancho Level?

# Answer:

The Rancho Los Amigos Levels of Cognitive Functioning Scale includes the following levels:

1. Level I - No Response: Total assistance; no observable response to stimuli.

2. Level II - Generalized Response: Total assistance; generalized reflex responses to stimuli.

3. Level III - Localized Response: Total assistance; localized responses to stimuli, may follow simple commands.

4. Level IV - Confused, Agitated: Maximal assistance; heightened state of activity, confused and disoriented.

5. Level V - Confused, Inappropriate, Non-Agitated: Moderate assistance; responds to simple commands, but with confusion.

6. Level VI - Confused, Appropriate: Moderate assistance; can attend to familiar tasks, follows simple directions with cues.

7. Level VII - Automatic, Appropriate: Minimal assistance; can carry out daily routines but lacks insight into condition.

8. Level VIII - Purposeful, Appropriate: Stand-by assistance; can independently complete familiar tasks and has improved insight.

# data[].attributes.body
# Question:

What interventions improve stability?

# Answer:

Interventions to improve stability in occupational therapy include:

1. Upper extremity weightbearing during self-care activities to enhance shoulder girdle stability.

2. Bed mobility and bedside ADLs to promote functional independence.

3. Strengthening exercises for the upper extremities.

4. Functional ambulation and transfers using appropriate assistive devices.

5. Instruction in the use of assistive devices to support mobility and safety.

# data[].attributes.body
Activity Groups

Task-Oriented: tasks are used as a means to facilitate our thoughts and feelings, enhance self-awareness, and insight to learn new behaviors (like psychodynamic model)

Thematic: tasks and end products are important through a structed activities, skill development is the goal (making a bird house, woodworking project, simple projects that can be graded) (thrive through thematic, skill development allows you to thrive)

Topical

Topical-concurrent: verbal discussion to support current roles (parenting, caretakers, etc.)

Topical-anticipatory: verbal discussion to support for something that has not happened yet (retirement planning, coping strategies when family member returns home, etc.)

Evaluation: evaluate group interaction

Instrumental: maintain the highest optimal function and quality of life through socialization and meaningful activities

Development Groups (helps improve group interactions with others; least to most group interaction required)

Parallel: group interaction is not required during task, but can share tasks or tools or having similar activites that may encourage interaction (slot machines, painting) OT is directive, choses activity and provides structure and positive support

Project: interaction is required to complete task, short term w/ 2+ people (slideshow, etc.) OT selects activity,

Egocentric-Cooperative: activity selected by members, long term w/ 5-10ish people, big emphasis on cooperation (AOTA presentation, etc.) role of OT is a role model, assistance as needed

Cooperative: fulfilling the needs is more important than the tasks (what gives you a sense of fulfillment, completion is secondary, activity is a means not a result) OT is an advisor

Mature: carry out all social, emotional, and functional roles and tasks (feel a sense of competence and belonging); both completion of the project and the group interaction is equally important. OT is a peer at this level

# data[].attributes.body
# Question:

what are the different types of cerebral palsy?

# Answer:

Cerebral palsy is classified into several types based on the location of the brain injury and the resulting motor control issues:

1. Spastic Cerebral Palsy: Characterized by increased muscle tone and stiffness, resulting from a lesion in the motor cortex. It can manifest as hypertonia and hyperreflexia.

2. Dyskinetic Cerebral Palsy: Caused by a lesion in the basal ganglia, leading to fluctuating muscle tone. It includes subtypes like dystonia (involuntary muscle contractions) and athetosis (writhing movements).

3. Ataxic Cerebral Palsy: Results from a cerebellar lesion, causing hypotonia and coordination difficulties, leading to unsteady movements.

4. Monoplegia: Affects one limb.

5. Hemiplegia: Affects one side of the body (one arm and one leg).

6. Paraplegia: Affects only the lower limbs.

7. Quadriplegia: Affects all four limbs.

8. Diplegia: Primarily affects the lower limbs more than the upper limbs.

What is spastic diplegia?

# Answer:

Spastic diplegia is a form of cerebral palsy characterized primarily by muscle stiffness (spasticity) in the lower extremities, leading to difficulties in movement and coordination. It typically affects the legs more than the arms, resulting in challenges with walking and balance. Individuals with spastic diplegia may have normal intelligence but experience significant motor impairments. The condition is non-progressive, meaning it does not worsen over time, but can lead to complications such as deformities and contractures if not managed appropriately.

# data[].attributes.body
Dementia

The Global Deterioration Scale (GDS) consists of seven stages that describe the progression of cognitive decline in dementia:

1. No Cognitive Decline - No memory problems.

2. Very Mild Cognitive Decline - Forgetfulness of everyday events.

3. Mild Cognitive Decline - Noticeable memory problems affecting work or social life.

4. Moderate Cognitive Decline - Difficulty with complex tasks; forgetfulness of personal history.

5. Moderately Severe Cognitive Decline - Assistance needed for daily activities; confusion about time and place.

6. Severe Cognitive Decline - Significant memory loss; requires assistance with basic needs.

7. Very Severe Cognitive Decline - Loss of ability to respond to the environment; requires full-time care.

Alzheimer's

1. very mild to mild

2. mild to moderate

3. moderate to mod severe cog decline

4. severe cog and physical decline

# data[].attributes.body
Phases:

Rehabilitation - During the rehabilitation phase of burn recovery the client’s wounds will be closed and the main focus of OT intervention would be: scar massage, compression therapy (worn over light dressing), therapeutic exercise & activity (massage w/ lotion prior to exercise to avoid shearing forces and blistering), Edema management (coban/coflex can be used on fingers), ADLs, splinting (reduce contracture, inc. ROM, functional assistance), client education

# data[].attributes.body
Inhibitory techniques to reduce tone of spastic muscles:
• Light joint compression – also called as joint approximation. Used to inhibit tone in hypertonic muscles.
• Slow stroking – slow stroking of posterior rami with a firm but slow pressure inhibits the tone. It is done for 3-5 minutes until patient relaxes.
• Slow rolling of the patient from supine to side lying or slow rocking movements may be done.
• Neutral warmth – it refers to maintaining the body heat by wrapping the specific area to be inhibited. It is done for 10 – 20 minutes.
• Pressure on insertion of a muscle inhibits that muscle through the receptors located there.
• A maintained stretch or maintenance of a lengthened position for a period of time ranging from several minutes to several weeks relapse the muscle spindle to longer positions. The balance of tone between agonists and antagonists will be disturbed if prolonged positioning is allowed.

Icing, quick light stretch, tapping and heavy joint compression are all facilitatory techniques to improve tone of flaccid muscles.

# data[].attributes.body
MET 1 – 2
• Eating
•Transfers
• Grooming
• Knitting
• Driving (automatic)

MET 2-3
• Dusting, kneading dough, washing dishes, golfing
• Walking 1mph
• Seated sponge bath

MET 3-4
• Warm standing shower
• Making the bed
• Sweeping
• Mopping

# data[].attributes.body
Precautions for an anterolateral total hip arthroplasty are:
1. No extension of the hip.
2. No external rotation of the hip.
3. No hip extension.

Precautions for a Posterolateral total hip arthroplasty are:
1. No hip flexion greater than 90 degrees
2. No internal rotation of the hip.
3. No hip adduction.

# data[].attributes.body
IDEA part B

IDEA part C - early intervention, special education, and related services for Children from birth to 2 years of age, mandates early intervention is in natural environment (including toys child would have at home for carry over) 1) typically associated w/ early intervention Pediatrics (family centered - consider strengths, concerns, and priorities of the family)

# data[].attributes.body
3 levels of prevention:
1. Primary prevention—those preventive measures that prevent the onset of illness or injury before the disease process begins.
B. An educational program for senior citizens on safety at home is an example of primary prevention.
2. Secondary prevention—those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury to prevent more severe problems developing.
C and D. Treatment for oral motor skills for a 2-year-old through a birth-to-three program and adapting the home of a man recovering from a total hip replacement are examples of secondary prevention.
3. Tertiary prevention—those preventive measures aimed at rehabilitation following significant illness.

# data[].attributes.body
Being burned out means feeling empty and mentally exhausted, devoid of motivation, and beyond caring. People experiencing burnout often don’t see any hope of positive change in their situations

General Contributors: work causes, lifestyle causes, and personality factors

Common OT factors: student debt, lack of voice in workplace, lack of encouragement for development at work, productivity requirements, repetitive nature of work, physical and emotional demands

Stages: Honeymoon, onset of stress, chronic stress, burnout, and habitual burnout

Coping: Recognize, reverse, resilience

turn to other people, reframe the way you look at work, reevaluate your priorities, exercise, diet

Strategies: physical self-care, emotional self-care, social self-care, spiritual self-care, intellectual self-care, environmental self-care (clean space), vocational self-care

Limiting burnout in the workplace: stress management, personal needs assessment, and self-advocacy

# data[].attributes.body
Primary: aimed at reducing the risk of disease or disability in a healthy population; before the onset of a disease.

Secondary: prevent the early stages of a disease advancing through early diagnosis and treatment; attempts to prevent the disease from progressing by detecting it early.

Tertiary: Attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability; maximize the remaining capabilities and functions of an already disabled patient. Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease.

# data[].attributes.body
Referral

Screen

Evaluation

Intervention

Discharge

Reasonings:

Procedural - emphasis is often placed on patient factors and body functions and structures. A connection between the problems identified and the interventions provided is sought using this form of reasoning.

Interactive - Understanding the disability from the patient’s point of view is fundamental to this type of reasoning; used during the evaluation to detect the important information provided by the patient and to further explore the patient’s occupational needs. During intervention, this form of reasoning is used to assess the effectiveness of the intervention. The therapeutic use of self fits well with this form of clinical reasoning as a therapist employs personal skills and attributes to engage the patient in the intervention process.

Conditional - therapist imagines possible scenarios for the patient. The therapist engages in conditional reasoning to integrate the patient’s current status with the hoped-for future. Intervention is often revised on a moment-to-moment basis to proceed to an outcome that will allow the patient to participate in various contexts.

Narrative - storytelling in order to identify problem areas and solutions. It requires interaction between the patient and therapist in order to gain an understanding of the situation. Therapists also use narrative reasoning to plan the intervention session, to create a story line of what will happen for the patient as a result of therapy. The therapeutic use of self is critical when using this type of clinical reasoning

Pragmatic - focuses on logistics such as cost, time, resources, therapist’s skills, patient’s wishes, and physical location. It looks at the problems and focuses on developing practical and realistic solutions. These challenges to providing intervention would be considered when developing an intervention plan.

Intervention Levels

Adjunctive - prepares the pt for occupational performance; Education, physical agent modalities, and resources are used at this level.

Enabling Activities - range of motion, muscle conditioning, schedules, pacing activities, coping strategies, time management, and medication management.

Purposeful Activities - includes compensatory strategies and adaptations to facilitate a patient’s involvement in activities.

Occupation-based activity - client-centered activities and goals. The therapist’s involvement begins to decrease as the client performs ADLs, IADLs, play, and leisure to his or her own maximum capacity.

Summary of Intervention Approaches
1. Health promotion and wellness to enable or enhance performance in everyday life activities.
2. Establishment, remediation, or restoration of a skill or ability that has not yet developed or is impaired.
3. Maintenance and enhancement of capabilities without which performance in everyday life activities would decline.
4. Compensation, modification, or adaptation of activity or environment to enhance performance.
5. Prevention of barriers to performance, including disability prevention.

# data[].attributes.body
1. A perception of individuality – recognition of each person as a unique whole

2. Respect for the dignity and rights of each individual

3. Empathy – ability to enter into the experience of another person without losing objectivity

4. Compassion or sympathy – willingness to engage with another person’s suffering

5. Humility – recognition of the limits of one’s own knowledge and skill

6. Unconditional positive regard – concern for the individual without moral judgements on their thoughts and actions

7. Honesty – telling the truth to the people they work with; this is an aspect of being respectful

8. A relaxed manner

9. Flexibility – ability to modify own actions to meet the demands of a situation

10. Self-awareness – ability to reflect on one’s own reactions to the world and on the effect one is having on the world in any given situation

11. Humor – a lightness of approach which, used appropriately, can facilitate the therapeutic process.

Modes

Advocacy

Collaborating

Empathizing

Encouraging

Instructing

Problem-solving

Techniques

Attunement - be completely present with the patient, developing a feeling of connectedness with them

Providing the pt w/ unconditional positive regard

Self-disclosure - can help build rapport

Power Differential

# data[].attributes.body
Response to intervention tiers (usually occurs over the course of one grading period, quarter/trimester)

Tier 1 - group intervention, changing the classroom for all including those "at risk"

Tier 2 - targeted small group, additional instruction to students who do not respond to intervention in tier 1

Tier 3 - Intensive individual, 1:1 instruction to target skill deficits. Will be referred to for comprehensive eval for special ed services if student does not respond to tier 3

Eval Process

Referral

Consent to evaluate(by guardian)

Testing (w/in 60 calendar days of consent)

Determination of Disability - meet w/ guardian to explain results, team (guardian, special ed teach, regular teach, all related services, other staff/family) decides if student qualifies

Development of IEP (w/in 30 days of determination of disability) - parents review recommendations and accept/reject, parts of IEP reviewed separately (IEP team must include the parent or guardian, the regular education teacher, the special education teacher or speech therapist, the LEA representative.)

Disability Categories

1. ASD
2. Intellectual Disability (previously known as Cognitive Disability)
3. Emotional Behavioral Disability
4. Hearing Impairment
5. Visual Impairment
6. Orthopedic Impairment
7. Other Health Impairment
8. Speech/Language Impairment
9. Significant Developmental Delay (only used for students under the age of 9)
10. Traumatic Brain Injury

IEP Parts: Invitation of Meeting to IEP team, cover page, students strengths/parent concerns, Present level of Performance (PLOP), special factors, annual goals, program summary, assessments, transition services, changes to IEP w/out meeting, extended school year (needed for students to maintain skills developed during school year)

Students must be re-evaluated every 3 years to see if they still qualify for disability

Dismissal from special services if the student makes sufficient progress in all skill areas allowing for access of education in regular classroom.

Dismissal of OT services must be agreed upon between all IEP team members

Special IEP review: student is not making sufficient progress, student has met all goals, significant change in condition, or parents are not satisfied

Transitions from kindergarten, middle school, high school, and post-high school can be reviewed if the IEP team deems it necessary. Students who will be age 18-21 at the beginning of the next school year may continue to attend high school for vocational and independent living skills if the IEP team determines that they continue to require intervention in these areas.

# data[].attributes.body
Part C (birth to 36 months)

IFSP is created before Part C services start; IFSP describes the child’s present level of development, the family’s strengths and needs, the specific services to be provided to the child and the family, and a plan to transition to public school.

5 parts of service: Identifying a child who needs services and referring them appropriately, Determining if they are eligible for services, Developing the Individualized Family Service Plan (IFSP), Service Delivery, Transitioning the child from early intervention to another program at age 3

Referral to early intervention, screening, categories of eligibility (functional information, dev. information, academic achievements), child is evaluated in (adaptive, cognitive, communication, physical, and social-emotional), IFSP may include (assistive technology, audiology, OT, PT, ST, psychological services, social work, vision services, etc.) in the NATURAL environment, transition planning begins at 2 years and 6 months.

Part B (3 - 21 years old, free through public school)

IEP must be developed before services start

Referral (from any source), screening, evaluation, eligibility, IEP development, transition planning (beginning at 16 or younger if determined by IEP team)

if not eligible under IDEA, student may be covered under Section 504 (focuses on accommodation of the student’s educational environment and adaptations to functional tasks so that the student is able to participate in public school in the least restrictive manner), but cannot get OT under IDEA 2004

To qualify for OT under Section 504

1. The student must be ineligible for special education services under IDEA 2004.
2. The student must have a documented physical or mental disability. This usually means a medical diagnosis documented by a physician or other qualified health professional.
3. The student’s disability must impair his or her ability to:
a. Walk, breathe, eat or sleep
b. Communicate, see, hear or speak
c. Read, concentrate, think or learn
d. Stand, bend, lift or work

An eval then follows to see if student qualifies for Section 504 special ed services

OT must focus on functional independence in school through adaptations, skills may be focused on if required to utilize adaptions and accomodations

Disability must be clearly identified and documented, usually by a physician

The school does not receive reimbursement of OT services under Section 504

# data[].attributes.body
Cerebrum - initiates and coordinates movement and regulates temperature. Other areas of the cerebrum enable speech, judgment, thinking and reasoning, problem-solving, emotions and learning. Other functions relate to vision, hearing, touch and other senses.

Midbrain - hearing and movement to calculating responses and environmental changes; also contains the substantia nigra, an area affected by Parkinson’s disease that is rich in dopamine neurons and part of the basal ganglia, which enables movement and coordination

Pons - range of activities such as tear production, chewing, blinking, focusing vision, balance, hearing and facial expression.

Medulla - regulate many bodily activities, including heart rhythm, breathing, blood flow, and oxygen and carbon dioxide levels. The medulla produces reflexive activities such as sneezing, vomiting, coughing and swallowing.

Cerebellum - coordinates voluntary muscle movements and to maintain posture, balance and equilibrium.

Frontal Lobe - involved in personality characteristics, decision-making, and movement. Also involved in the recognition of smell and contains Broca’s area, which is associated with speech ability.

Parietal Lobe - helps a person identify objects and understand spatial relationships, interpreting pain and touch in the body. The parietal lobe houses Wernicke’s area, which helps the brain understand spoken language

Occipital Lobe - vision

Temporal Lobe - involved in short-term memory, speech, musical rhythm and some degree of smell recognition.

Pituitary Gland - governs the function of other glands in the body, regulating the flow of hormones from the thyroid, adrenals, ovaries and testicles

Hypothalamus - regulates body temperature, synchronizes sleep patterns, controls hunger and thirst and also plays a role in some aspects of memory and emotion.

Amygdala - regulate emotion and memory and are associated with the brain’s reward system, stress, and the “fight or flight” response when someone perceives a threat.

Hippocampus - supports memory, learning, navigation and perception of space

# data[].attributes.body
CN 1 - olfactory nerve, which allows for your sense of smell.

CN 2 - optic nerve governs eyesight.

CN 3 - oculomotor nerve controls pupil response and other motions of the eye

CN 4 - trochlear nerve controls muscles in the eye

CN 5 - trigeminal nerve conveys sensation from the scalp, teeth, jaw, sinuses, parts of the mouth and face to the brain, allows the function of chewing muscles, and much more.

CN 6 - abducens nerve innervates some of the muscles in the eye

CN 7 - facial nerve supports face movement, taste, glandular and other functions.

CN 8 - vestibulocochlear nerve facilitates balance and hearing

CN 9 - glossopharyngeal nerve allows taste, ear and throat movement, and has many more functions.

CN 10 - vagus nerve allows sensation around the ear and the digestive system and controls motor activity in the heart, throat and digestive system.

CN 11 - accessory nerve innervates specific muscles in the head, neck and shoulder.

CN 12 - hypoglossal nerve supplies motor activity to the tongue

# data[].attributes.body
1. Safety

2. Trustworthiness and Transparency

3. Peer Support and Mutual Self-Help

4. Collaboration and Mutuality

5. Empowerment, Voice, and Choice

6. Cultural, historical, and gender issues

4 R's of Trauma informed care: realize, recognize, respond, and resist re-traumatization

# data[].attributes.body
Interest -> hold and manipulate -> learn it opens and closes -> random snipping -> forward motion -> lateral motion -> cut in a straight line -> Circles -> squares (other geometrics) -> simple figure shapes -> complex figure shapes -> non-paper cutting

2-3 y/o Random snipping Cuts

2.5 cut across 6 inch paper (crude)

3 cut a 6 inch straight line

3.5 y/o can cut circles

4.5 years can cut squares and simple figures

6 can cut different materials, not paper

By 2 years of age: Can make one snip at a time
By 3 years of age: Can snip forward along a line (not continuous motions forward)
By 4 years of age:
Can cut 6 inches along a straight line (¼ inch wide) after demonstration and without assistance, staying within ¼ inch of the line.
Can cut 6 inches along a curved line (¼ inch wide) after demonstration and without assistance, staying within ¼ inch of the line
Can cut out a circle of at least 6 inches in diameter without assistance, staying within ½ inch of the line
By 5 years of age:
Can cut out a square at least 3 inches wide without assistance, staying within ½ inch of the line
Can cut out a triangle at least 3 inches wide without assistance, staying within ½ inch of the line
Can cut out pictures after demonstration that are at least 6 inches in length and width and whose outlines are no more than ¼ inch wide, while following the general shape
By 6 years of age:
Can cut cloth for at least 6 inches using sharp scissors under close, careful supervision
By 6 ½ years of age:
Can cut out complex pictures by following the outlines without assistance

# data[].attributes.body
Myelomeningocele Spina Bifida (SBM) is the most severe form of spina bifida. The physical impairments in SBM include motor and sensory deficits of the lower limbs (weakness or paralysis) leading to difficulties with stance and locomotion and poor balance

# data[].attributes.body
Stage 1. Unilateral – no or very limited loss of function.
-may be changes in posture, facial expressions, walking.
-tremor or other motor symptoms occur on one side of the body only.
Stage 2.Bilateral
-tremor and rigidity affect both sides of the body.
-difficulty with trunk mobility, postural reflexes.
Stage 3. Impaired balance
-loss of balance and falls.
-slowness of movement.
Stage 4.Decreased postural stability
-symptoms severe.
-unable to walk without a walker or assistance.
-assistance required with ADL tasks.
-unable to live alone.
Stage 5. Total dependence
-wheelchair or bed bound.
-total assistance with ADLs.
-may experience hallucinations or delusions