OCTA 2070 LAB WORKBOOK



OCTA 2070 LAB WORKBOOKSUMMER 2014Table of ContentsSafety/ Infection control3Confidentiality7Documentation12Evaluations21Grip/pinch/edema33MMT, A/PROM35Dexterity/VS 37Functional mobility43Biomechanics/transfers/liftsModalities49Orthotics51Therapeutic exercise/activities53Adaptive ADLs54Assistive Technology57Sexuality59Work61SAFETY/INFECTION CONTROLBLOOD BORNE PATHOGENSThe following is from: FACT SHEETPREVENTING THE SPREAD OFBLOODBORNE PATHOGENS2 Bloodborne Pathogens Training | Online Resources | ? 2011 The American National Red Cross■ Clean and disinfect all equipment and work surfaces soiled by blood or body fl uids.? Use a fresh disinfectant solution of approximately 1? cups of liquid chlorine bleach to1 gallon of water (1 part bleach per 9 parts water, or about a 10% solution) and allow itto stand for at least 10 minutes.? Scrub soiled boots, leather shoes and other leather goods, such as belts, with soap,a brush and hot water. If worn, wash and dry uniforms according to the manufacturer’sinstructions.IF YOU ARE EXPOSED, TAKE THE FOLLOWING STEPS IMMEDIATELY:■ Wash needlestick injuries, cuts and exposed skin thoroughly with soap and water.■ If splashed with blood or potentially infectious material around the mouth or nose,flush the area with water.■ If splashed in or around the eyes, irrigate with clean water, saline or sterile irrigants for20 minutes.■ Report the incident to the appropriate person identified in your employer’s exposure controlplan immediately. Additionally, report the incident to emergency medical services (EMS)personnel who take over care.■ Record the incident by writing down what happened. Include the date, time andcircumstances of the exposure; any actions taken after the exposure; and any otherinformation required by your employer.■ Seek immediate follow-up care as identifi ed in your employer’s exposure control plan.Occupational Safety and Health Administration (OSHA) regulations require employers to have anexposure control plan, a written program outlining the protective measures the employer will take toeliminate or minimize employee exposure incidents. The exposure control plan guidelines should bemade available to employees and should specifically explain what they need to do to prevent the spreadof infectious diseases.Additionally, OSHA requires that a hepatitis B vaccination series be made available to all employeeswho have occupational exposure within 10 working days of initial assignment, after appropriate traininghas been completed. However, employees may decide not to have the vaccination. The employer mustmake the vaccination available if an employee later decides to accept the vaccination.Check out OSHA’s website () or refer to your employer’s exposure control offi cer formore information on OSHA’s Bloodborne Pathogens Standard (29 CFR part 1910.1030).BLOODBORNE PATHOGENSTESTName:____________________________________________ Date:_______________Select the correct response from the questions below:1. What are the main diseases of concern when discussing the blood borne pathogen standard?a. HAV, HDV, HEV.b. PVC, BVD, HIB.c. PCP, H2O, CDCd. HIV, HBV, HCV2. Universal precautions refers to what?a. Treating all bodily fluids as if it is infectious.b. Wearing UV sunglasses outside.c. Never leaving your house.d. Protecting yourself against Universal aliens.3. Describe the technique used to remove contaminated rubber gloves.a. Have a co-worker assist you in removing the rubber gloves.b. Skin to Skin, Rubber to Rubber.c. Rubber to Rubber, Skin to Skin.d. Rubber to Skin, Skin to Rubber.4. The purpose of (rubber) gloving up is to what?a. Provide a sterile environment.b. Make you look professional.c. Keep your fingerprints out of the scene.d. Protect yourself.5. If you are exposed to a bodily fluid, what is the first thing you should do?a. Contact your supervisor.b. Seek medical treatment.c. Wash thoroughly.d. Dial 911.6. Hepatitis is an inflammation of the liver.____T__: True______: False7. Hepatitis B and C can be spread by.a. Having unprotected sex with an infected person.b. Blood-to-blood contact with an infected person.c. Eating food or drinking water infected with feces.d. Both a and b.8. Only Hepatitis A can be spread by eating food or drinking water infected with feces.__T____: True_____: False9. How many days can Hepatitis C live in dry blood?a. 1 dayb. 4 daysc. 7 daysd. 14 days10. What are the ways to protect oneself from Hepatitis A, B, or C?a. Using condoms.b. Not sharing needles.c. Not touching blood or objects with blood on them.d. All of the above.11. Human Immunodeficiency Virus (HIV) is.a. A bacterial illness treated with antibiotics.b. A virus which has no cure, but can be controlled with medicine.c. The virus that causes AIDS.d. Both b and c.12. HIV is spread from person to person by.a. Shaking hands, kissing or hugging.b. Unprotected anal, oral, or vaginal sexual contact.c. Sharing needles to inject recreational drugs.d. Both b and c.13. HIV is not present in.a. Semen and vaginal fluids.b. Sweat.c. Blood.d. Breast milk.14. How long is the “window period” for positive HIV antibodies to give a person an accurate HIV test result?a. The day after possible infection.b. Two weeks after possible infection.c. Three months after possible infection.d. One year after possible infection.15. Having a sexually transmitted disease, hepatitis, or tuberculosis can increase the risk of getting a co-infection with HIV?______: True___F___: False16. The most important parts of an effective infection control program are detecting TB disease early, and promptly isolating and treating people who have TB.___T___: True______: False17. A person who has TB infection, but not TB disease, is infectious?______: True___F___: False18. Injection of illicit drugs can increase the risk that TB infection will progress to TB disease?___T___: True______: False19. HIV infection can increase the risk that TB infection will progress to TB disease?___T___: True______: False20. What site of the human body is the most common site for TB disease?a. Brainb. Kidneysc. Lungsd. Liverfrom: HANDWASHINGUNIVERSAL PRECAUTIONSgownsmasksgloveshair bonnetshand washing vs. anti-bacterial lotionsnail check When and why?CONFIDENTIALITYEthics Principle 3Autonomy and ConfidentialityOT personnel shall respect the right of the individual to self-determinationApplication:Collaborative relationshipsObtain consents for servicesRespect the right to refuse servicesProvide students with access to accurate information regarding educationObtained informed consents for researchRespect the right to withdraw from studies Ensure confidentiality and the right to privacy Ensure security of all communications (HIPPA!) Facilitate meaningful communication and comprehension Facilitate open and collaborative dialogueHIPAA (Health Insurance Portability and Accountability Act) and YOU!As a student in a clinical training program at Augusta Technical College, you are required to learn about the health information privacy requirements of a federal law called HIPAA (Health Insurance Portability and Accountability Act). The health information privacy requirements are known as the HIPAA Privacy Rule and went into effect beginning April 14, 2003. When you are at a health care facility for clinical training, you are covered by the Privacy Rule as a member of that facility's workforce. In addition to this training, your training site may require you to complete Privacy Rule training specific to that site. When you are at a training site, you must follow that site's policies and procedures, including those concerning health information privacy. Thank you for taking time to learn about the HIPAA Privacy Rule. The HIPAA Privacy RuleThe Privacy Rule defines how health care providers, staff, trainees and students in clinical training programs can use, disclose, and maintain identifiable patient information, called "Protected Health Information" ("PHI"). PHI includes written, spoken, and electronic information and images. PHI is health information or health care payment information that identifies or can be used to identify an individual patient. The Privacy Rule very broadly defines identifiers to include not only patient name, address, and social security number, but also, for example, fax numbers, email addresses, vehicle identifiers, URLs, photographs, and voices or images on tape or electronic media. When in doubt, you should assume that any individual health information is protected under the Privacy Rule. All patients you come into contact with at a training site will have received a Notice of Privacy Practices, which describes in detail permitted uses and disclosures of PHI and patient rights (discussed below) under the Privacy Rule. Important DefinitionsUSE: the sharing, application, utilization, examination, or analysis of PHI by employees and trainees within the training site. DISCLOSURE: discussing PHI with or providing copies of PHI to persons who are not employees or trainees of the training site. Disclosure of PHI Outside the Training Site Requires Written Patient Authorization Or De-IdentificationYou may use PHI, without patient authorization, at the training site for purposes of treatment and your training at that site. However, you may not further disclose PHI in any form to anyone outside of the training site, without first obtaining written patient authorization or de-identifying the PHI. This means that you may not, for example, discuss or present PHI from a training facility with or to anyone, including classmates or faculty, who was not directly involved in your training at that facility, unless you first obtain written authorization from the patient. Therefore, it is strongly recommended that whenever possible, you de-identify PHI, as described below, before presenting any patient information outside of the training facility. If you are unable to de-identify such information, you must discuss your need for identifiable information with the faculty member supervising your training and the HIPAA Privacy Officer at your training site, to determine the appropriate procedures for obtaining patient authorization for your disclosure of PHI. In order for PHI to be considered de-identified under the Privacy Rule, all of the following identifiers of the patient or of relatives, employers, or household members of the patient, must be removed: Name; Geographic subdivisions smaller than a state (i.e., county, town, or city, street address, and zip code) (note: in some cases, the initial three digits of a zip code may be used); All elements of dates (except year) for dates directly related to an individual (including birth date, admission date, discharge date, date of death, all ages over 89 and dates indicative of age over 89) (note: ages and elements may be aggregated into a single category of age 90 or older); Phone numbers; Fax numbers; E-mail addresses; Social security number; Medical record number; Health plan beneficiary number; Account number; Certificate/license number; Vehicle identifiers and serial numbers; Device identifiers and serial numbers; URLs; Internet protocol addresses; Biometric identifiers (e.g., fingerprints); Full face photographic and any comparable images; Any other unique identifying number, characteristic, or code; and Any other information that could be used alone or in combination with other information to identify the individual. Safeguarding PHIThe Privacy Rule requires you to "safeguard" PHI at your training site. Use the following practices to ensure Privacy Rule compliance. If you see a medical record in public view where patients or others can see it, cover the file, turn it over, or find another way to protect it. When you talk about patients as part of your training, try to prevent others from overhearing the conversation. Whenever possible, hold conversations about patients in private areas. Do not discuss patients while you are in elevators or other public areas. When medical records are not in use, store them in offices, shelves or filing cabinets. Remove patient documents from faxes and copiers as soon as you can. When you throw away documents containing PHI, follow the facility procedures for disposal of documents with PHI. Never remove the patient's official medical record from the training site. Avoid removing copies of PHI from the training site; if you must remove copies of PHI from the training site, e.g., to complete homework, take appropriate steps to safeguard the PHI outside of the training site and properly dispose of the PHI when you are done with it. You should not leave PHI out where your family members or others may see it. All copies of PHI should be shredded when they are no longer needed for your training purposes. The U.S. Department of Health and Human Services has issued another set of HIPAA rules (the Security Rules) regarding safety and security of electronic data files and computer equipment. In the next few months you will be hearing more about electronic safeguards and how the HIPAA Security Rules may affect you at clinical training sites. Use Only the Minimum Necessary InformationWhen you use PHI, you must follow the Privacy Rule's minimum necessary requirement by asking yourself the following question: "Am I using or accessing more PHI than I need to?" If you are unsure of the PHI you may use or access while providing health care for a patient at your training site, please contact your preceptor, supervisor or the HIPAA Privacy Officer at your training site. Discussing PHI With a Patient's Family MembersBefore you may discuss a patient's condition, treatment or other PHI with his or her family member, it must be determined if the patient would object to such a disclosure. You should confirm with your supervisor that the patient has agreed to allow or in some other way has expressed no objection to such disclosures before you may discuss a patient's condition, treatment, or other PHI with his/her family members. Patients' Rights Under the Privacy RuleEach training site covered by the HIPAA Privacy Rule will have policies and procedures for implementing the following patient rights under the Privacy Rule: The right to request alternative communications. Under the Privacy Rule, patients can ask to be contacted in a certain way. For example, a patient may ask a nurse if she/he can leave a message on the patient's home voicemail instead of contacting the patient at work. If a patient's request is reasonable, as is the previous example, the health care provider or facility must follow it. The right to look at (and obtain copies of) records. Patients can ask to read their medical and billing records, and have copies made. The right to ask for changes to medical and billing records. Each facility must review and consider all requests for changes to medical and billing records. The right to receive a list of certain disclosures. Your training site must make and keep a list of certain disclosures of PHI (excluding disclosures for treatment, payment, and health care operations) that are made without patient authorization. Patients have the right to see and receive a copy of this list. The right to request restrictions on how PHI is used and disclosed. Patients can ask health care providers and facilities to limit the ways they make use of and disclose the patient's PHI for treatment, payment, and health care operations. Providers and facilities are not required to agree to such requests. You, as a trainee, must never agree to such restrictions on behalf of the training site. The right to receive a "Notice of Privacy Practices". Each health care facility that provides direct patient care must give every patient/client a copy of their Notice of Privacy Practices. The notice describes their privacy practices and the Privacy Rule. The facility must make reasonable efforts to have each patient sign a form acknowledging he or she received the notice. We recommend that you obtain a copy of the Notice of Privacy Practices from your training site and become familiar with it. The HIPAA Privacy OfficerEach facility at which you train, that is covered by the Privacy Rule, will have a HIPAA Privacy Officer. If you have questions about the implementation of the Privacy Rule at a training site, you should contact the site's Privacy Officer. If you have general questions regarding the Privacy Rule, you should contact your program director.DOCUMENTATIONClinical UM GuidelineSubject:Occupational TherapyGuideline #:?? CG-REHAB-05Current Effective Date:??04/15/2014Status:ReviewedLast Review Date:?? 02/13/2014DescriptionOccupational therapy (OT) is a form of rehabilitation involving the use of activities that have a purpose and are goal-directed to restore or improve functional performance and increase the ability to perform life tasks.Occupational therapy addresses the physical, cognitive, psychosocial, sensory, and other aspects of performance in a variety of contexts to support engagement in everyday life activities that affect health, well being, and quality of life for people of all ages. These services are performed in the outpatient, office, or home setting which emphasize techniques that assist the client in acquiring the knowledge, skills and attitudes necessary for the performance of required life tasks including activities of daily living (ADLs), instrumental activities of daily living (IADLs), and daily life functional skills. ADLs include bathing, dressing, eating, feeding, functional mobility, personal device care, personal hygiene, grooming, and toilet hygiene. IADLs include care of others, providing the care and supervision to support the developmental needs of a child, communication device use, community mobility, financial management, meal preparation, and cleanup. Other occupational therapy services include the design, fabrication, and use of orthoses, and guidance in the selection and use of adapted equipment. Occupational therapy does not include diversional, recreational, and vocational therapies (such as hobbies, arts and crafts).Note: Many benefit plans include a maximum allowable occupational therapy benefit, either in duration of treatment or in number of visits. When the maximum allowable benefit is exhausted, coverage will no longer be provided even if the medical necessity criteria described below are met.Note: Please see MED.00107 Medical and Other Non-Behavioral Health Related Treatments for Autism Spectrum Disorders and Rett SyndromeClinical IndicationsMedically Necessary:Occupational therapy (OT) services are considered medically necessary when ALL following criteria are met:The therapy is aimed at preventing disability or improving, adapting or restoring functions which have been impaired or permanently lost as a result of illness, injury, loss of a body part, or congenital abnormality; andThe therapy is for conditions that require the unique knowledge, skills, and judgment of the occupational therapist for education and training that is part of an active skilled plan of treatment; andThere is an expectation that the therapy will result in a practical improvement in the level of functioning within a reasonable and predictable period of time; and An individual's function could not reasonably be expected to improve as the individual gradually resumes normal activities; andAn individual's expected restoration potential would be significant in relation to the extent and duration of the therapy service required to achieve such potential; andThe therapy documentation objectively verifies progressive functional improvement over specific time frames; andThe services are delivered by a qualified provider of occupational therapy services. A qualified provider is one who is licensed where required and performs within the scope of licensure; andThe services require the judgment, knowledge, and skills of a qualified provider of occupational therapy services due to the complexity and sophistication of the therapy and the medical condition of the individual.DocumentationEvaluationA comprehensive evaluation is essential to determine if OT services are medically necessary, gather baseline data, establish a treatment plan, and develop goals based on the data. The initial evaluation is usually completed in a single session. An evaluation is needed before implementing any OT treatment. Evaluation begins with the administration of appropriate and relevant assessments using standardized assessments and tools. The evaluation must include:Prior functional level, if acquired condition;Specific standardized and non-standardized tests, assessments, and tools;Analytic interpretation and synthesis of all data, including a summary of the baseline findings in written report(s);Objective, measurable, and functional descriptions of an individual's deficits using comparable and consistent methods;Summary of clinical reasoning and consideration of contextual factors with recommendations;Plan of care with specific treatment techniques or activities to be used in treatment sessions that should be updated as the individual's condition changes;Frequency and duration of treatment plan;Functional, measurable, and time-framed long-term and short-term goals based on appropriate and relevant evaluation data;Rehabilitation prognosis;Discharge plan that is initiated at the start of OT treatment.Treatment SessionsAn occupational therapy session can vary from fifteen minutes to four hours per day; however, treatment sessions lasting more than one hour per day are rare in outpatient settings. Treatment sessions for more than one hour per day may be medically appropriate for inpatient acute settings, day treatment programs, and select outpatient conditions, but must be supported in the treatment plan and based on an individual's medical condition. These sessions may include:Evaluation;Therapeutic use of everyday life activities;Treating underlying impairments in preparation for the individual's engagement in purposeful activity (occupation);Compensation, modification, or adaptation of activity or environment to enhance performance;Management of feeding, eating, and swallowing to enable eating and feeding performance;Basic activities of daily living, self-care, self-management, and home management;Higher level independent living skills instruction and community/work integration;Modification of environments (home, work, school, or community) and adaptation of processes, including the application of ergonomic principles;Assessment, design, fabrication, application, fitting, and training in assistive technology, adaptive devices, and orthotic devices;Training in the use of prosthetic devices;Functional community mobility;Functionally oriented upper extremity exercise programs;Cognitive, perceptual, safety, and judgment evaluations and training;Training of the individual, caregivers, and family/parents in home exercise and activity programs;Skilled reassessment of the individual's problems, plan, and goals as part of the treatment session;Coordination, communication, and documentation;Reevaluations, if there is a significant change in the individual's condition.Documentation of treatment sessions must include:Date of treatment;Specific treatment(s) provided that match the procedure codes billed;Total treatment time;The individual's response to treatment;Skilled ongoing reassessment of the individual's progress toward the goals;Any progress toward the goals in objective, measurable terms using consistent and comparable methods;Any problems or changes to the plan of care;Name and credentials of the treating clinician.Progress ReportsIn order to reflect that continued OT services are medically necessary, intermittent progress reports must demonstrate that the individual is making functional progress. Progress reports should include at a minimum:Start of care date;Time period covered by the report;Medical and therapy treatment diagnoses;Statement of the individual's functional level at the beginning of the progress report period;Statement of the individual's current status as compared to evaluation baseline data and the prior progress report, including objective measures of the individual's function that relate to the treatment goals;Changes in prognosis and why;Changes in plan of care and why;Changes in goals and why;Consultations with other professionals or coordination of services, if applicable;Signature and title of qualified professional responsible for the therapy services.ReevaluationA reevaluation is usually indicated when there are new significant clinical findings, a rapid change in individual's status, or failure to respond to occupational therapy interventions. There are several routine reassessments that are not considered reevaluations. These include ongoing reassessments that are part of each skilled treatment session, progress reports, and discharge summaries.Reevaluation is a more comprehensive assessment that includes all the components of the initial evaluation, such as:Data collection with objective measurements based on appropriate and relevant assessment tests and tools using comparable and consistent methods;Making a judgment as to whether skilled care is still warranted;?Organizing the composite of current problem areas and deciding a priority/focus of treatment;?Identifying the appropriate intervention(s) for new or ongoing goal achievement;?Modification of intervention(s);Revision in plan of care if needed; ?Correlation to meaningful change in function; andDeciphering effectiveness of intervention(s).Providers of OT ServicesThe services are delivered by a qualified provider of occupational therapy services who is certified, licensed, or otherwise regulated by the State or Federal governments. Occupational therapy assistants may provide services under the direction and supervision of an occupational therapist. Benefits for services provided by these practitioners are dependent upon the member's contract language.Aides, athletic trainers, exercise physiologists, life skills trainers, and rehabilitation technicians do not meet the definition of a qualified practitioner regardless of the level of supervision. Aides and other nonqualified personnel as listed above are limited to non-skilled services such as preparing the individual, treatment area, equipment, or supplies; assisting a qualified therapist or assistant; and transporting individuals. They may not provide any direct member treatments, modalities, or procedures.Not Medically Necessary:Occupational therapy (OT) services are considered not medically necessary if any of the following is determined:The therapy is not aimed at preventing disability or improving, adapting or restoring functions, which have been impaired or permanently lost as a result of illness, injury, loss of a body part, or congenital abnormality.The therapy is for conditions for which therapy would be considered educationally-based (i.e., via school systems) or involves routine education, training, conditioning, or fitness. ?This includes treatments or activities that require only routine supervision.The expectation does not exist that the therapy will result in a practical improvement in the level of functioning within a reasonable and predictable period of time: If function could reasonably be expected to improve as the individual gradually resumes normal activities, then therapy is considered not medically necessary.If an individual's expected restoration potential would be insignificant in relation to the extent and duration of the therapy service required to achieve such potential, the therapy would be considered not medically necessary.The therapy documentation fails to objectively verify functional progress over a reasonable period of time.The physical modalities are not preparatory to other skilled treatment procedures.Treatments that do not generally require the skills of a qualified provider of OT services are considered not medically necessary. Examples include general range of motion or exercise programs, maintenance therapy, repetitive activities that an individual can self-practice independently or with a caregiver, swimming and routine water aerobics programs, and general public education/instruction sessions.Routine reevaluations not meeting the above criteria.Treatments that are not supported in peer-reviewed literature.Duplicate TherapyDuplicate therapy is considered not medically necessary. When individuals receive physical, occupational, or speech therapy, the therapists should provide different treatments that reflect each therapy discipline's unique perspective on the individual's impairments and functional deficits and not duplicate the same treatment. They must also have separate evaluations, treatment plans, and goals.Maintenance ProgramMaintenance programs are considered not medically necessary. A maintenance therapy program consists of treatments or activities that preserve the individual's present level range, strength, coordination, balance, pain, activity, function, etc. and prevent regression of the same parameters. Maintenance begins when the therapeutic goals of a treatment plan have been achieved or when no further functional progress is apparent or expected to occur. In certain circumstances, the specialized knowledge and judgment of a qualified therapist may be required to establish a maintenance program, however, the repetitive OT services to maintain a level would be considered not medically necessary.CodingThe following codes for treatments and procedures applicable to this document are included below for informational purposes. ?Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. ?Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.CPT?92605Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour92618Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes92606Therapeutic service(s) for the use of non-speech-generating device, including programming and modification92607-92608Evaluation for prescription for speech-generating augmentative and alternative communication device92609Therapeutic services for the use of speech-generating device, including programming and modification92610Evaluation of oral and pharyngeal swallowing function92611Motion fluoroscopic evaluation of swallowing function by cine or video recording94667Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation94668Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent97003Occupational therapy evaluation97004Occupational therapy re-evaluation97010-97028Application of a modality to one or more areas (supervised) [includes codes 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028]97032-97036Application of a modality to one or more areas (constant attendance) [includes codes 97032, 97033, 97034, 97035, 97036]97039Unlisted modality [when not specified as a procedure that is considered investigational and not medically necessary]97110-97139Therapeutic procedure, one or more areas [includes codes 97110, 97112, 97113, 97116, 97124, 97139]97140Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes97150Therapeutic procedure(s), group? (2 or more individuals)97530Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes97532Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes97533Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes97535Self care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes97537Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment, direct one-on-one contact, each 15 minutes97542Wheelchair management (eg, assessment, fitting, training), each 15 minutes97545-97546Work hardening/conditioning97597-97598Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session97602Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session97750Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes97755Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes97760Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes97761Prosthetic training, upper and/or lower extremity(s), each 15 minutes97762Checkout for orthotic/prosthetic use, established patient, each 15 minutes97799Unlisted physical medicine/rehabilitation service or procedure [when not specified as a procedure that is considered investigational and not medically necessary]??HCPCS?G0129Occupational therapy requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per session (45 minutes or more)G0152Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutesG0158Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutesG0160Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutesG0281Electrical stimulation (unattended), to one or more areas, for chronic Stage III and Stage IV pressure ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of careG0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of careG0329Electromagnetic therapy, to one or more areas for chronic stage III and stage IV pressure ulcers, arterial ulcers, and diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of careS8950Complex lymphedema therapy, each 15 minutesS8990Physical or manipulative therapy performed for maintenance rather than restorationS9129Occupational therapy, in the home, per diem??ICD-9 Diagnosis[For dates of service prior to 10/01/2014]?All diagnoses??ICD-10 Diagnosis[For dates of service on or after 10/01/2014]?All diagnoses??ReferencesPeer Reviewed Publications: ????????Legg LA, Drummond AE, Langhorne P. Occupational therapy for patients with problems in activities of daily living after stroke. Cochrane Database Syst Rev. 2006; (4): CD003585.?Moyers, P.A. The guide to occupational therapy practice. American Occupational Therapy Association. Am J Occup Ther. 1999; 53(3):247-322.?Reitz SM, Austin DJ, Brandt LC, et al. Guidelines to the Occupational Therapy Code of Ethics. Am J Occup Ther. 2006; 60(6):652-668.?Steultjens EM, Dekker J, Bouter et al. Evidence of the efficacy of occupational therapy in different conditions: an overview of systematic reviews. Clin Rehabil. 2005; 19(3):247-ernment Agency, Medical Society, and Other Authoritative Publications:American Occupational Therapy Association. Guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. American Journal of Occupational Therapy. 2004; 58(6):663-667.Centers for Medicare & Medicaid Services (CMS). Pub. 100-02, Chapter 15, Section 220. Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance and Section 230 Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology. January 7, 2014. Available at: . Accessed on January 07, 2014.Centers for Medicare & Medicaid Services. Manuals. Available at: . Accessed on January 07, 2014. Home Health Agency Manual. Pub. 11. Chapter 2, Section 205.2. Coverage of Services Which Establish Home Health Eligibility. Skilled Therapy Services. Last updated September 8, 2005.Hospital Manual. Pub.10. Chapter 2, Section 210.9. Coverage of Hospital Services. Occupational Therapy Furnished by the Hospital or by Others Under Arrangements With the Hospital and Under its Supervision. Last updated September 8, 2005.Outpatient Physical Therapy Comprehensive Outpatient Rehabilitation Facility and Community Mental Health Center Manual. Pub. 9. Chapter 2, Coverage of Services and Chapter 5, Section 503. Intermediary Medical Review for Part B Outpatient. Occupational Therapy (OT). Last updated September 8, 2005.Centers for Medicare & Medicaid Services. National Coverage Determination for Institutional and Home Care Patient Education Programs. NCD#170.1. Effective date not posted. Available at: . Accessed on January 07, 2014.NIH Consensus Statement. Rehabilitation of persons with traumatic brain injury. 1998 Oct 26-28; 16(1): 1-41. Available at: . Accessed on January 07, 2014.IndexOccupational TherapyOT (Occupational Therapy)HistoryStatusDateActionReviewed02/13/2014Medical Policy & Technology Assessment Committee (MPTAC) review. Websites and Coding updated.Reviewed02/14/2013MPTAC review.Reviewed08/09/2012MPTAC review. References and Websites updated.?01/01/2012Updated Coding section to include 01/01/2012 CPT changes; removed revenue codes 0430-0439.Reviewed08/18/2011MPTAC review. References and Websites updated.?01/01/2011Updated Coding section with 01/01/2011 CPT and HCPCS changes.Reviewed08/19/2010MPTAC review. Websites and references updated.?01/01/2010Updated Coding section with 01/01/2010 HCPCS changes.Reviewed08/27/2009MPTAC review. Removed Place of Service/Duration. References and coding updated.Reviewed08/28/2008MPTAC review. References updated.Reviewed08/23/2007MPTAC review. Coding section updated.Revised09/14/2006MPTAC review. Minor revision to Not Medically Necessary statement. References updated. Coding updated: removed CPT 97504, 97520, 97703 deleted 12/31/05 (see historical document).Revised12/01/2005MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.Pre-Merger OrganizationsLast Review DateDocument NumberTitleAnthem Midwest08/06/2004RA-008 (Midwest Medical Review & UM criteria)Physical Therapy / Occupational Therapy For NASCO, Prestandardized Medicare Supplement Plans, Group Blue Retiree Products, and FEPWellPoint Health Networks, Inc.04/28/200510.01.07Occupational Therapy??SOURCE: ?? CPT Only – American Medical AssociationEMR vs HEREMR vs EHR – What is the Difference?January 4, 2011, 12:07 pm / Peter Garrett / Former Director, Office of Communications , andJoshua Seidman PhD / Director Meaningful Use, ONC What’s in a word? Or, even one letter of an acronym?Some people use the terms “electronic medical record” and “electronic health record” (or “EMR” and “EHR”) interchangeably. But here at the Office of the National Coordinator for Health Information Technology (ONC), you’ll notice we use electronic health record or EHR almost exclusively. While it may seem a little picky at first, the difference between the two terms is actually quite significant.The EMR term came along first, and indeed, early EMRs were “medical.” They were for use by clinicians mostly for diagnosis and treatment.In contrast, “health” relates to “The condition of being sound in body, mind, or spirit; especially…freedom from physical disease or pain…the general condition of the body.” The word “health” covers a lot more territory than the word “medical.” And EHRs go a lot further than EMRs.What’s the Difference? Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:Track data over timeEasily identify which patients are due for preventive screenings or checkupsCheck how their patients are doing on certain parameters—such as blood pressure readings or vaccinationsMonitor and improve overall quality of care within the practiceBut the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.”The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. In comparing the differences between record types, HIMSS Analytics stated that, “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” EHRs are designed to be accessed by all people involved in the patients care—including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of “meaningful use” of EHRs.And that makes all the difference. Because when information is shared in a secure way, it becomes more powerful. Health care is a team effort, and shared information supports that effort. After all, much of the value derived from the health care delivery system results from the effective communication of information from one party to another and, ultimately, the ability of multiple parties to engage in interactive communication of information.Benefits of EHRs With fully functional EHRs, all members of the team have ready access to the latest information allowing for more coordinated, patient-centered care. With EHRs:The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious.A patient can log on to his own record and see the trend of the lab results over the last year, which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers.The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests.The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow-up care and enable the patient to?move from one care setting to another more smoothly.So, yes, the difference between “electronic medical records” and “electronic health records” is just one word. But in that word there is a world of differenceSOAPrefer to your text!INTRO TO EVALUATIONSFIMSLink to instrumentUniform Data System for Medical Rehabilitation (external link)? Title of AssessmentFunctional Independence Measure? AcronymFIMTMInstrument Reviewer(s)Initially reviewed by the Rehabilitation?Measures Team; Updated by Eileen Tseng, PT, DPT, NCS, Rachel Tappan, PT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Tammie Keller, PT, DPT, MS and the TBI EDGE task force of the Neurology Section of the APTA; Updated by Dev Kegelmeyer, PT, DPT, MS, GCS and the PD EDGE task force of the neurology section of the APTA in 2013. Summary Date1/18/2013? PurposeProvides a uniform system of measurement for disability based on the International Classification of Impairment, Disabilities and Handicaps; measures the level of a patient's disability and indicates how much assistance is required for the individual to carry out activities of daily living. DescriptionContains 18 items composed of: 13 motor tasks 5 cognitive tasks (considered basic activities of daily living)Tasks are rated on a 7 point ordinal scale that ranges from total assistance (or complete dependence) to complete independence Scores range from 18 (lowest) to 126 (highest) indicating level of function Scores are generally rated at admission and discharge Dimensions?assessed include: Eating Grooming Bathing Upper body dressing Lower body dressing Toileting Bladder management Bowel management Bed to chair transfer Toilet transfer Shower transfer Locomotion (ambulatory or wheelchair level) Stairs Cognitive comprehension Expression Social interaction Problem solving MemoryFIM Scoring Criteria: (refer to the users manual for more information) FIM Scoring Criteria: No Helper Required Score Description 7 Complete Independence 6 Modified Independence (patient requires use of a device, but no physical assistance) Helper (Modified Dependence) Score Description 5 Supervision or Setup 4 Minimal Contact Assistance (patient can perform 75% or more of task) 3 Moderate Assistance (patient can perform 50% to 74% of task) Helper (Complete Dependence) Score Description 2 Maximal Assistance (patient can perform 25% to 49% of taks) 1 Total assistance (patient can perform less than 25% of the task or requires more than one person to assist) 0 Activity does not occur Area of AssessmentActivities of Daily Living? Body PartNot Applicable? ICF DomainActivity? DomainADL; Cognition; Motor? Assessment TypePatient Reported Outcomes? Length of Test31 to 60 Minutes? Time to Administer30-45 minutesNumber of Items18? Equipment RequiredMay vary based on level and impairment category measuredTraining RequiredYes, Certification in administering the FIM is required prior to use of the FIM.? Training is available through UDSMR at: .Type of training requiredReading an Article/Manual? CostNot Free? Actual CostThe FIM is available for purchase through Age RangeAdult: 18-64 years; Elderly adult: 65+? Administration ModePaper/Pencil? DiagnosisGeriatrics; Multiple Sclerosis; Pain; Spinal Cord Injury; Stroke? Populations TestedBrain Injury? Geriatrics? Multiple Sclerosis? Orthopedic Conditions including Low Back Pain? Parkinson's Disease Spinal Cord Injury? StrokeBERG BALANCE SCALEPatient Name: _____Stephanie Huff_______________________ Rater Name: ___Chandler Newman_________________________ Date: ___7/21/14_________________________ Balance Item Score (0-4) 1. Sitting unsupported __4_____ 2. Change of position: sitting to standing ___4____ 3. Change of position” standing to sitting __4_____ 4. Transfers ___3____ 5. Standing unsupported ___4____ 6. Standing with eyes closed __4_____ 7. Standing with feet together __4_____ 8. Tandem standing __4_____ 9. Standing on one leg __4_____ 10. Turning trunk (feet fixed) __4_____ 11. Retrieving objects from floor __4_____ 12. Turning 360 degrees __4_____ 13. Stool stepping __3_____ 14. Reaching forward while standing ___4____ TOTAL (0–56): ___54____ Interpretation 0–20, wheelchair bound 21–40, walking with assistance 41–56, independent References Berg K, Wood-Dauphinee S, Williams JI, Maki, B: Measuring balance in the elderly: Validation of an instrument. Can. J. Pub. Health, July/August supplement 2:S7-11, 1992. Berg K, Wood-Dauphinee S, Williams JI, Gayton D: Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada, 41:304-311, 1989. Provided by the Internet Stroke Center — DASHDASH stands for "Disabilities of the Arm, Shoulder and Hand."The DASH Outcome Measure is a 30-item, self-report questionnaire designed to measure physical function and symptoms in people with any of several musculoskeletal disorders of the upper limb. The tool gives clinicians and researchers the advantage of having a single, reliable instrument that can be used to assess any or all joints in the upper extremity.A shorter version called the QuickDASH is also available. Both tools are valid, reliable and responsive and can be used for clinical and/or research purposes. However, because the full DASH Outcome Measure provides greater precision, it may be the best choice for clinicians who wish to monitor arm pain and function in individual patients.Conditions of UseUse of the DASH and QuickDASH, without charge, including the use of the translated versions of the DASH and QuickDASH on this website, is limited to clinicians using them only for treatment or assessment of a patient, to researchers using them only for non-commercially related research and to other not-for-profit users.The instruments may not be sold or incorporated into a product to be sold, by anyone. The instruments may not under any circumstances, be changed in any way as even minor changes may alter performance. Any other use requires advance written permission from the Institute for Work & Health and requires strict compliance with all conditions attached to such permission including payment in some cases.Those who wish to use a translated version of the DASH and/or QuickDASH may wish also to notify the translator as provided on the DASH website: DASH translations.Copyright in the DASH Outcome Measure and the QuickDASH is the sole property of the Institute for Work & Health, which reserves all rights in connection therewith. Users must give credit to the developers when using or referencing any DASH tool. If using a translated version of the DASH/QuickDASH, translators should also be acknowledged.Note: If you are unsure whether your intended use falls within the above Conditions of Use, please complete and submit a DASH/QuickDASH User Profile form and a response will be provided.?Development InformationThe DASH Outcome Measure and the QuickDASH are the property of the Institute for Work & Health (IWH). These instruments were jointly developed by the Institute for Work & Health and the American Academy of Orthopaedic Surgeons (AAOS). The project was supported by the American Association for Hand Surgery, the American Orthopaedic Society for Sports Medicine, the American Shoulder & Elbow Surgeons, the American Society for Surgery of the Hand, the Arthroscopy Association of North America and the American Society of Plastic and Reconstructive Surgeons.The DASH is currently administered by the Institute for Work & Health. If you have read and understand these conditions, please click on the links below to download the documentsDASH Outcome Measure (PDF – 127k)QuickDASH (PDF - 118k)BARTHEL INDEXPatient Name: _____Stephanie Huff______________________Rater Name: ______Chandler Newman_____________________Date: ______7/21/14_____________________Activity ScoreFEEDING0 = unable5 = needs help cutting, spreading butter, etc., or requires modified diet10 = independent __5____BATHING0 = dependent5 = independent (or in shower) __5____GROOMING0 = needs to help with personal care5 = independent face/hair/teeth/shaving (implements provided) __5____DRESSING0 = dependent5 = needs help but can do about half unaided10 = independent (including buttons, zips, laces, etc.) __10____BOWELS0 = incontinent (or needs to be given enemas)5 = occasional accident10 = continent __10____BLADDER0 = incontinent, or catheterized and unable to manage alone5 = occasional accident10 = continent __10____TOILET USE0 = dependent5 = needs some help, but can do something alone10 = independent (on and off, dressing, wiping) __10____TRANSFERS (BED TO CHAIR AND BACK)0 = unable, no sitting balance5 = major help (one or two people, physical), can sit10 = minor help (verbal or physical)15 = independent __15____MOBILITY (ON LEVEL SURFACES)0 = immobile or < 50 yards5 = wheelchair independent, including corners, > 50 yards10 = walks with help of one person (verbal or physical) > 50 yards15 = independent (but may use any aid; for example, stick) > 50 yards _15_____STAIRS0 = unable5 = needs help (verbal, physical, carrying aid)10 = independent __15____TOTAL (0–100): __100____Provided by the Internet Stroke Center — The Barthel ADL Index: Guidelines1. The index should be used as a record of what a patient does, not as a record of what a patient could do.2. The main aim is to establish degree of independence from any help, physical or verbal, however minorand for whatever reason.3. The need for supervision renders the patient not independent.4. A patient's performance should be established using the best available evidence. Asking the patient,friends/relatives and nurses are the usual sources, but direct observation and common sense are alsoimportant. However direct testing is not needed.5. Usually the patient's performance over the preceding 24-48 hours is important, but occasionally longerperiods will be relevant.6. Middle categories imply that the patient supplies over 50 per cent of the effort.7. Use of aids to be independent is allowed.ReferencesMahoney FI, Barthel D. “Functional evaluation: the Barthel Index.”Maryland State Medical Journal 1965;14:56-61. Used with permission.Loewen SC, Anderson BA. “Predictors of stroke outcome using objective measurement scales.”Stroke. 1990;21:78-81.Gresham GE, Phillips TF, Labi ML. “ADL status in stroke: relative merits of three standard indexes.”Arch Phys Med Rehabil. 1980;61:355-358.Collin C, Wade DT, Davies S, Horne V. “The Barthel ADL Index: a reliability study.”Int Disability Study.1988;10:61-63.Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.”Maryland State Med Journal 1965;14:56-61. Used with permission. Katz Index of Independence in Activities of Daily Living (ADL) By: Mary Shelkey, PhD, ARNP, Virginia Mason Medical Center, and Meredith Wallace, PhD, APRN, BC, Fairfield University School of Nursing WHY: Normal aging changes and health problems frequently show themselves as declines in the functional status of older adults. Decline may place the older adult on a spiral of iatrogenesis leading to further health problems. One of the best ways to evaluate the health status of older adults is through functional assessment which provides objective data that may indicate future decline or improvement in health status, allowing the nurse to plan and intervene appropriately. BEST TOOL: The Katz Index of Independence in Activities of Daily Living, commonly referred to as the Katz ADL, is the most appropriate instrument to assess functional status as a measurement of the client’s ability to perform activities of daily living independently. Clinicians typically use the tool to detect problems in performing activities of daily living and to plan care accordingly. The Index ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence, and feeding. Clients are scored yes/no for independence in each of the six functions. A score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment. TARGET POPULATION: The instrument is most effectively used among older adults in a variety of care settings, when baseline measurements, taken when the client is well, are compared to periodic or subsequent measures. VALIDITY AND RELIABILITY: In the forty-eight years since the instrument has been developed, it has been modified and simplified and different approaches to scoring have been used. However, it has consistently demonstrated its utility in evaluating functional status in the elderly population. Although no formal reliability and validity reports could be found in the literature, the tool is used extensively as a flag signaling functional capabilities of older adults in clinical and home environments. STRENGTHS AND LIMITATIONS: The Katz ADL Index assesses basic activities of daily living. It does not assess more advanced activities of daily living. Katz developed another scale for instrumental activities of daily living such as heavy housework, shopping, managing finances and telephoning. Although the Katz ADL Index is sensitive to changes in declining health status, it is limited in its ability to measure small increments of change seen in the rehabilitation of older adults. A full comprehensive geriatric assessment should follow when appropriate. The Katz ADL Index is very useful in creating a common language about patient function for all practitioners involved in overall care planning and discharge planning. MORE ON THE TOPIC: Best practice information on care of older adults: . Graf, C. (2006). Functional decline in hospitalized older adults. AJN, 106(1), 58-67. Hartigan, I. (2007). A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people. International Journal of Older People Nursing, 2(3), 204-212. Katz, S. (1983). Assessing self-maintenance: Activities of daily living, mobility and instrumental activities of daily living. JAGS, 31(12), 721- 726. Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970) Progress in the development of the index of ADL. The Gerontologist, 10(1), 20-30. Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185(12), 914-919. Kresevic, D.M. (2012). Assessment of physical function. In M. Boltz, E. Capezuti, T.T. Fulmer, & D. Zwicker (Eds.), A. O’Meara (Managing Ed.), Evidence-based geriatric nursing protocols for best practice (4th ed., pp 89-103). NY: Springer Publishing Company, LLC. Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety only for not-for-profit educational purposes only, provided that The Hartford Institute for Geriatric Nursing, New York University, College of Nursing is cited as the source. This material may be downloaded and/or distributed in electronic format, including PDA format. Available on the internet at and/or . E-mail notification of usage to: hartford.ign@nyu.edu.Katz Index of Independence in Activities of Daily Living ACTIVITIES POINTS (1 OR 0) INDEPENDENCE: (1 POINT) NO supervision, direction or personal assistance DEPENDENCE: (0 POINTS) WITH supervision, direction, personal assistance or total care BATHING POINTS:___________ (1 POINT) Bathes self completely or needs help in bathing only a single part of the body such as the back, genital area or disabled extremity. (0 POINTS) Needs help with bathing more than one part of the body, getting in or out of the tub or shower. Requires total bathing. DRESSING POINTS:___________ (1 POINT) Gets clothes from closets and drawers and puts on clothes and outer garments complete with fasteners. May have help tying shoes. (0 POINTS) Needs help with dressing self or needs to be completely dressed. TOILETING POINTS:___________ (1 POINT) Goes to toilet, gets on and off, arranges clothes, cleans genital area without help. (0 POINTS) Needs help transferring to the toilet, cleaning self or uses bedpan or commode. TRANSFERRING POINTS:___________ (1 POINT) Moves in and out of bed or chair unassisted. Mechanical transferring aides are acceptable. (0 POINTS) Needs help in moving from bed to chair or requires a complete transfer. CONTINENCE POINTS:___________ (1 POINT) Exercises complete self-control over urination and defecation. (0 POINTS) Is partially or totally incontinent of bowel or bladder. FEEDING POINTS:___________ (1 POINT) Gets food from plate into mouth without help. Preparation of food may be done by another person. (0 POINTS) Needs partial or total help with feeding or requires parenteral feeding. TOTAL POINTS = ______ 6 = High (patient independent) 0 = Low (patient very dependent) Modified Ashworth Scale30=No increase in muscle tone1=Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end range of motionwhen the part is moved in flexion or extension/abduction or adduction, etc.1+=Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (lessthan half) of the ROM2=More marked increase in muscle tone through most of the ROM, but the affected part is easily moved3=Considerable increase in muscle tone, passive movement is difficult4=Affected part is rigid in flexion or extension (abduction or adduction, etc.)Quick StretchStimulus: quick stretch to tapping over a muscle belly or tendonResponse: activates agonist to contract; reciprocal inhibition of antagonist; activation of synergistsReceptors: Ia muscle spindles (detect change in length and velocity)Prolonged StretchStimulus: maintained stretch in a lengthened rangeResponse: dampens (inhibits) muscle contractionReceptor: Ia and II muscle spindles and GTOResistanceStimulus: resistance given manually or with body weight or gravity; may use mechanical weightsResponse: enhances muscle contraction through recruitment; facilitates synergist; enhances kinesthetic awarenessReceptors: muscle spindlesApproximationStimulus: compression of joint surfaces (manual or mechanical)Response: enhances neuromuscular co-contraction, proximal stability and postural extension; increases kinesthetic awareness and postural stabilityReceptors: joint receptorsTractionStimulus: joint surfaces distracted, usually manually and at the beginning of movementResponse: facilitates muscle activation to improve mobility and movement initiationReceptors: joint receptorsInhibitory PressureStimulus: firm pressure manually or with body weight over muscle belly or tendonResponse: inhibits muscle activity (dampening effect)Receptors: GTO, muscle spindles, tactile receptorsLight TouchStimulus: brief, light contact to the skinResponse: increased arousal, withdrawal responseReceptors: rapidly adapting tactile receptors, autonomic nervous system (sympathetic division)Maintained TouchStimulus: maintained contact or pressureResponse: calming; desensitization of the skin; provides general inhibitionReceptors: slowly adapting tactile receptors, autonomic nervous system (parasympathetic division)Manual ContactsStimulus: firm, deep pressure of hands over a body areaResponse: facilitates contraction of muscles beneath handsReceptors: tactile receptors, muscle proprioceptorsSlow StrokingStimulus: slow, firm stroking with flat hand over the neck or trunk extensorsResponse: produces calming effect; general inhibition; induces feeling of securityReceptors: tactile receptors, autonomic nervous system (parasympathetic system)Neutral WarmthStimulus: warm towel or elastic wrap of body or body partsResponse: provides general relaxation and inhibition; decreased muscle tone; decreased agitation or painReceptors: thermoreceptors, autonomic nervous system (parasympathetic division)Slow Vestibular StimulationStimulus: slow rocking, slow movement on a ball/hammock/rocking chair etc.Response: produces calming effect; decreased arousal; generalized inhibitionReceptors: tonic vestibular receptorsGRIP/PINCH/EDEMAGRIP AND PINCHEssential for many activities is the ability to grasp and pinch. As OT practitioners, you need to be familiar with the methods to measure grip strength and 3 types of pinches: lateral pinch, tip pinch, and 3-jaw pinch.RESOURCESLippert, Clinical Kinesiology and AnatomyEarly, Physical Dysfunction Practice Skills for the OTAReed: Quick Reference to Occupational TherapyThe Guide to OT PracticeSTUDY QUESTIONSDescribe the position of the upper extremity in testing strength using the dynamometer.Seated with the shoulder adducted and neutrally rotated, the elbow flexed at 90 degrees, the forearm in the neutral position, and the wrist between 0 and 15 degrees of ulnar deviationDescribe the position of the thumb and fingers for the following:Lateral pinch – thumb pulp to lateral aspect of the middle phalanx of the index fingerTip pinch – thumb tip to index fingertip3-jaw pinch – thumb tip to tips of index and long fingersWhat are alternative names for the tip pinch and the 3-jaw pinch?Tip-to-tip and 3 Jaw chuckIdentify methods to functionally test grip and pinch strength.Sitting in a chair with feet flat on the floor at 90 degrees. Keep body at a 90/90/90 degree angleACTIVITYFollowing demonstrations of the techniques, measure and record the following grasp and pinch strengths on your lab partner, using the dynamometer and pinch meter, respectively. Record your results and compare them with standard norms.LEFTNORMRIGHTNORMGRIP50696579LATERAL PINCH19262326TIP PINCH151816183-JAW22252526EDEMADESCRIPTIVE TERMSVOLUMETEREDEMA TAPE MEASURERETROGRADE MASSAGEPRECAUTIONSCHFDVTMMT AND A/PROMMUSCLE TESTINGSuggested Reading:Lippert, Clinical Kinesiology and AnatomyEarly, Physical Dysfunction Practice Skills for the OTAReed: Quick Reference to Occupational TherapyThe Guide to OT PracticeYou may work with clients who have muscle weaknesses for a variety of reasons. Knowledge of a client’s baseline strength is vital for effective interventions. At times your muscle testing will take a functional approach and at other times you will need to perform a more formal assessment of manual muscle strength.STUDY QUESTIONSWhat are the differences between functional muscle testing and manual muscle testing?FMT –Screens for normal muscle strength and assesses the general strength and motion capability of the patientMMT – measures maximal muscle or muscle groupUsed to determine the amount of muscle power and to record gains and losses of strengthWhat criteria are used to determine muscle grades?Evidence of muscle contractionsAmount of ROM through which the joint passesAmount of resistance against which the muscle can contract including gravity as a form of resistanceList and describe the muscle testing grades that are commonly used (include number grade and word or letter grade). List 3 purposes for assessing muscle strength.Determine the amount of muscle power available and thus establish a baseline for treatmentAssess how muscle weakness is limiting performance of occupationPrevent deformities that can result from imbalances of strength of agonist and antagonist musclesDetermine the need for assistive devices to compensate for reduction of strengthAid in the selection of activities within the patients compatibilitiesEvaluate the effectiveness of treatmentDefine endurance and discuss its correlation with muscle strength.Endurance: exertion or work sustained over timeMuscle endurance: number of times the muscle can contract at maximal levelDefine what is meant by substitution.When the brain, “thinks in terms of movement not contraction of individual muscles.” Thus a muscle or muscle group may attempt to compensate for the function of a weaker muscle to accomplish the desired movementOutline the procedural steps in performing a manual muscle test and a functional muscle test.Manual Muscle Test:PositionStabilizePalpateObserveResistGradeFunctional Muscle Test:Outline the suggested sequence for positioning your client to complete a manual muscle test.Correct PositioningCareful StabilizationPalpation of musclesObservation of movementDraw a picture that describes the functional muscle testing position used in each of the following movements:Scapular evaluationShoulder flexionElbow flexionInstruction ''Bend your arm up like this. Pull your fist towards your nose. Don't let me straighten it.''Figure 2:Biceps C5, C6 Musculocutanous nerveExaminer Allow the person to almost fully flex the arm. Support the elbow with one hand (this is important in weak patients) and attempt to straighten the flexed, supinated forearm, pulling on the lower forearm, not the hand, since if the patient has weakness at the wrist the test of elbow flexion will fail. Remember test across just one joint. The forearm should be supinated to decrease the effect of brachioradialis.Elbow extensionInstruction ''Push your arm to me, and don't let me bend it''Figure 3:Triceps C6, C7, C8 Radial nerveExaminer Support the arm at the elbow and push toward them holding the forearm at the wrist. As an alternative technique to demonstrate subtle weakness have the person hold their elbows in to their sides with forearms flexed at 90 degrees. Holding both wrists pull upward. Weakness of one or both sides will be obvious.Wrist flexionInstruction ''Keep your wrist down, don't let me pull it up/straight.''Figure 5:Flexor Carpi Radialis C6, C7 median n. Flexor Carpi Ulnaris C7, C8, T1 ulnar nerveExaminer Hold the lower forearm, and firmly attempt to straighten the flexed wrist. Wrist flexion is not a critical part of screening arm strength. Disproportionate weakness of wrist and finger flexion is a striking feature of the chronic condition inclusion body myositis, often encountered in specialist clinical examinations.Wrist extensionInstruction ''Keep your wrist back, don't let me pull it down/straight.''Figure 4:Extensor Carpi Radialis C5, C6 radial n. Extensor Carpi Ulnaris C7, C8 Posterior Interosseous br, radial nerveExaminer Hold the lower forearm, and firmly attempt to straighten the dorsiflexed wrist OF MOTIONRange of motion may be measured both formally (goniometry) as well as informally. ROM measurement may be completed as part of an assessment. In using a goniometer, practice is vital as well as choosing the right size and type of goniometer. You must also fully understand all of the methods through which each joint passes so that you can use ROM activities in either an active or passive manner during your treatment interventions.Suggested Reading:Lippert, Clinical Kinesiology and AnatomyEarly, Physical Dysfunction Practice Skills for the OTAReed: Quick Reference to Occupational TherapyThe Guide to OT PracticeSTUDY QUESTIONSDefine range of motion (ROM).-The extent of movement that occurs at a jointDescribe what is meant by active range of motion (AROM).The arc of motion through which the joint passes when voluntarily moved by muscles acting on the jointDescribe what is meant by passive range of motion (PROM).The arc of motion through which the joint passes when moved by an outside forceDescribe what is meant by active assisted range of motion (AAROM)The patient uses the muscles surrounding the joint to perform an exercise but requires some help from the therapist or equipmentWhat is a goniometer?A goniometer is a tool most widely used to measure range of motionUsing the 180° system, what row of figures do you read on the goniometer in measuring the elbow? The shoulder?The top row of numbersOn what does glenohumeral joint motion depend?Factors such as the degree of muscle weakness, presence or absence of joint pain, and whether passive range of motion or active range of motion are being usedWhy is it important to assess scapula mobility?Because the scapula is where many joint motions are performedList several causes of joint limitation. Severe spasticity, significant burn injuries, trauma, and disease processes such as rheumatoid arthritisWhat is the importance of looking at functional activities in doing ROM?Functional activities can provide meaning to the clientWhat can be done if a particular joint has a permanent ROM limitation?Passive range of motion or active assistive range of motionList several reasons why a ROM assessment may be needed.Loss of joint range of motion, to assess flexibility, to assess patients general health statusDescribe the general procedures for evaluating ROM.Have the patient comfortable and relaxed Explain and demonstrate the what, why, and how of goniometry Establish bony landmarks Stabilize joints proximal to the joint being measured Movie part passively through range of motion to estimate available range of motion Record the number of degrees at the starting pointIdentify the movements the following symbols represent:/ - extension√ - flexion828675698500 - rotationACTIVITIESPerform an UE functional ROM screening by having your partner name ROM movements as you demonstrate how you would complete the motion. Place a check mark in the column below as you complete the movement successfully. Reverse roles and check off your partner’s performance. Additionally, have your partner silently perform a movement as you identify the movement by name. Remember, Practice! Practice! Practice!MOVEMENTMOVEMENT PERFORMEDMOVEMENT IDENTIFIEDTrunk forward √ and /XXXXTrunk lateral √XXXXShoulder √ and /XXXX11811002012950012287252984500Shoulder external XXXXShoulder internalXXXXShoulder abductionXXXXPronation and supinationXXXXElbow √ and /XXXXFinger √ abd /XXXXThumb oppositionXXXXWrist √ and /XXXXWrist radial and ulnar deviationXXXX Using your goniometers, measure and record the following movements on your partner. Use all three types (180°, 360°and finger) and both sizes (large and small). You may use a textbook for practice. Record the typical range and then check to see whether your partner’s measurements are within the range specified. If measurements are not in the specified range, check your accuracy first, and then ask your partner if he or she has a limitation. Continue to practice until the technique is mastered.MOVEMENTSPARTNER MEASURETYPICAL RANGESHOULDERFlexion1561631611611580-170Extension54524956520-60Abduction1571651571601590-170Horizontal adduction1281221241221280-130Horizontal abduction33273035360-40Internal rotation66656659620-70External rotation87858582810-90ELBOW AND FOREARMFlexion1361381351461410-135/150Supination82848181820-80/90Pronation80848381800-80/90WRISTFlexion78737472780-80Extension70666369620-70Radial deviation20191718140-20Ulnar deviation29262630280-30FINGERSMetacarpophalangeal (MP) Flexion48424850500-50 ExtensionProximal interphalangeal (PIP) Flexion1051061081091030-110 ExtensionDistal Interphalangeal (DIP)THUMBMP flexion49474248470-50IP flexion79828581890-80/90Abduction48474045490-50AdductionThe material in this section was adapted from Clinical Competencies in Occupational Therapy, C.A. Kief, C.R. Scheerer; Prentice Hall; New Jersey 2001DEXTERITY/VITAL SIGNSDEXTERITY5 Ways to Assess Dexterity and CoordinationPin It See all 3 photosThis dexterity test involves filling a punch card with pegs. Source: Minnesota Manual Dexterity TestWho Uses Dexterity Testing?Dexterity testing is used by many different professions. Here are the most common:Occupational therapists: Dexterity tests are used to evaluate patients who have suffered injuries or who otherwise need rehabilitation for their occupational pursuits.Human resources and staffing agencies: Dexterity tests are used to evaluate the skill level of applicants for jobs and to screen out those who are not qualified.Researchers: Neurological, physiological, and medical researchers use dexterity tests to understand the human brain, hand-eye coordination, and dexterity capabilities of groups of people to advance medicine and for educational purposes.Measuring Dexterity and Skill LevelDexterity (also referred to as manual dexterity) typically refers to the ability of a person to use their hands and arms to perform a task. Some people are ambidextrous, meaning they can perform a group of tasks with the same or similar skill level using their right and left hands.Dexterity is an important component of every society and affects the economies and collective lifestyles of every group of people on the planet. Dentists need to be able to manipulate tools to perform teeth cleaning or oral surgery tasks. Baseball pitchers need to be able to grip a ball and manipulate its trajectory while hurling it towards a target. Magicians must develop a unique set of dexterity skills that focus on making their hands quicker than the eyes of those watching. A mechanic must learn how to manipulate wrenches, gauges, and other devices to diagnose and fix cars.These examples show the complexity of understanding dexterity. Dexterity skill levels are as varied as the tasks performed by humans every day. How can these tasks be grouped and understood so that one person's skill level can be compared to another or so that improvement can be motivated and measured?Thankfully, there are several dexterity tests that have been developed based upon physiological research. These tests allow staffing agencies, occupational and physical therapists, and clinical researchers to compare each individual test to the standards for a group of people to determine skill level. They also allow therapists to develop a skill advancement or rehabilitation plan for patients and measure the effectiveness of their programs.Pin It See all 3 photosThere are several different dexterity tests available that can be used for assessing various skills and functions related to employment and rehabilitation. Reliability of Popular Dexterity TestsThe University of Delaware published research performed by Katie E. Yancosek and Dana Howell that evaluated the psychometric properties (reliability and validity) of several dexterity tests. The tests evaluated in their study include the following:Box and Block TestCrawford Small Parts Dexterity TestFunctional Dexterity TestGrooved Pegboard TestJebsen-Taylor Test of Hand FunctionMinnesota Manual Dexterity TestMinnesota Rate of Manipulation TestMoberg Pick-up TestNine-hole Peg TestO’Connor Finger Dexterity TestPurdue Pegboard TestSequential Occupational Therapy Dexterity AssessmentWolf Motor Function TestSome of these tests and their purposes will be described below.Administering the TestPurdue Pegboard TestThe Purdue Pegboard Test includes four different tests that require a user to place pins in holes and to assemble pins and washers.This test is used for assessing fine motor skills. The test is especially useful for screening applicants for jobs that involve performing assembling related tasks accurately and quickly.Administering the TestMinnesota Manual Dexterity TestsThe Minnesota Manual Dexterity Test (MMDT) involves having a test subject place round pegs into holes on a punched-out sheet. This test evaluates a person's ability to grab and place objects quickly.There are several different applications of the MMDT, including assessment of limitations caused by carpal tunnel and dexterity problems other hand and wrist injuries. It is also used to assess a person's ability to perform manufacturing and assembly line work.Administering the TestO'Connor Finger Dexterity TestThe O'Connor Finger Dexterity Test is similar to the Purdue test, but it's slightly simpler. It tests the fine motor skills of test subjects and requires the extensive use of finger tips to place pins into a peg board. As with the other dexterity tests discussed here, the O'Connor test is timed, so accuracy and speed are considered in the test scoring.Administering the TestBox and Block TestThe Box and Block Test is similar to the Minnesota Manual Dexterity Test, except that the objects being moved are cubes rather than cylinders. The Box and Block Test focuses less on the placement of the objects being moved and more on picking up the cubes. Precise placement of the blocks is not required. Instead they are dropped into a container adjacent to the container from which they are picked up.Pin It See all 3 photosThe Grooved Pegboard Test requires the test subject to orient the pins so that they'll fit in the slotted holes. Source: Grooved Pegboard TestGrooved Pegboard TestThe Grooved Pegboard Test involves placing pins in holes on a board. The major difference in this test is that the pegs are have to be oriented correctly to fit in the slots. This test involves more visual acuity to perform. Rather than simply feeling for a cylindrical hole, test subjects have to watch to ensure that the pins are turned so that they will fitsource: SIGNSVital signs are an indication of a client’s physiological status and need to be monitored in working with a client with cardiopulmonary complications. One’s heart rate, respiratory rate, and blood pressure—three of the most commonly monitored vital signs—change in response to one’s age, health, and participation in activity. You will need to be knowledgeable about your client’s vital signs at rest and monitor them as you gauge their response to your therapeutic interventions. You also need to be able to identify and recognize signs of cardiopulmonary distress and know the appropriate safety procedures to follow.RESOURCESEarly, Physical Dysfunction Practice Skills for the OTAReed: Quick Reference to Occupational TherapyThe Guide to OT PracticeSTUDY QUESTIONSDefine the following terms:Vital sign – Measurements of the bodies most basic functionsPulse – Rate at which the heart beatsRespiratory rate – Inspiration rate. Number of breaths per minuteBlood pressure – Force of the blood pulsating against the artery wallsTachycardia – abnormally fast heart rateBradycardia – abnormally slow heart rateHypotension – Low blood pressureHypertension – High blood pressureDyspnea – difficulty breathingArrhythmia – Irregular heartbeatsBradypnea – Abnormally slow breathingPulse oximeter – Instrument to measure oxygen saturationWhy, when and with whom is it important for an occupational therapy practitioner to monitor vital signs?For patients who suffer from cardiac or respiratory disorders. During therapy process. Practitioners need to recognize signs of distress to prevent health complicationsList the location of the pulse measurement sites that can be located on the body.Radial artery – volar surface of the wristBrachial artery – above the elbow creaseCarotid – lateral to Adams AppleDescribe the procedure necessary to measure pulse.Apply second and third fingers flat to the pulse site. If pulse is even, count the beats for 10 seconds and multiply by six. If irregular, count beats for full minuteIdentify the normal adult pulse rates and blood pressure ranges.Pulse is 60-100 per minute, BP is 120/80Describe the procedure necessary to measure blood pressure by auscultation.Procedure with stethoscope is described in Early “Physical Dysfunction” book, pp. 681-682Describe the procedure necessary to measure respiration and give the normal adult respiration plete rise and fall of the chest (breathing) is one respiration. Norm is 12-20 breathing per minuteDescribe how pulse, blood pressure and respiration are affected by physical activity.When person performs physical activities, muscles within the body use more energy that requires more oxygen intake. Person is breathing harder and faster to get oxygen, the heart is working harder to pump increased load of oxygen in the blood, thus increasing blood volume pressure on the artery wallsDescribe the signs of cardiopulmonary distress.Dypsnea - difficulty breathing, Angina - chest pain, Orthopnea - difficulty breathing with change of positions, nausea, diaphoresis - excessive sweating, orthostatic hypotension -drop of blood pressure from supine to rising positionRECORD OF VITAL SIGNSVital signsInitial reading at restNormAfter taking off and putting on shoes and socksAfter 5 minute restAfter wiping off table and chairs at the tableAfter 5 minute restPulseBlood pressureRespirationFUNCTIONAL MOBILITYFrom an OT perspective, functional mobility is incorporated into interventions as it relates to occupational performance of activities that are necessary or meaningful to the patient (e.g., ambulating to the bathroom for ADLS with whatever gait aids are appropriate/necessary; mobility around the kitchen for IADLs related to preparing a meal; working on balance, standing endurance, etc.). () BIOMECHANICS/TRANSFERS/LIFTSBIOMECHANICS: SAFETY FIRST!TRANSFERSBED TO WHEELCHAIRWHEELCHAIR TO SHOWER CHAIRWHEELCHAIR TO CARBED TO GERICHAIRWHEELCHAIR TO TOILETPIVOT TRANSFERSSLIDING BOARDSMECHANICAL LIFTSTRANSFERS AND POSITIONINGTransfers allow a client to move from one position or surface to another. You may be performing, assisting, supervising or training in transfer techniques. It is vital that both you and your client remain safe in the process. Several pieces of equipment may be used to maximize the safety of the transfer. Positioning of the patient is also critical once the transfer has been completed. Proper transfers and positioning will maximize the ability of your client to as independent as possible.RESOURCESRyan: Ryan’s OTA: Principles, Practice Issues, and TechniquesEarly: Physical Dysfunction Practice Skills for the OTAReed: Quick Reference to OTThe Guide to OT PracticeSTUDY QUESTIONSList the basic principles of body mechanics.When Moving Equipment:Keep load close to bodyMove with feet firstAvoid forward bending and twisting the waistMaintain three back curvesUse wide base of support and staggered stanceWhen Working with ClientsPosition yourself close to the patientMove yourself around the client to assess body structuresFace the client during interventions when possibleAdjust your work surface to the appropriate height for the activityRemain upright while performing standing manual therapiesAlternate use of the thumb with other parts of the body when creating pressure during manual therapiesKeep your joints aligned in your shoulders, elbows, forearms, wrists, and handsAlternate scheduling of hand-intensive interventionsName several factors that could affect a client’s ability to learn how to transfer or benefit from transfer training.Assuming that a patient has some physical, perceptual and behavioral, cognitive limitations, it will be necessary for the OTA to assist in or supervise a transfer. List and briefly describe the types of transfers.STAND PIVOT: Patient must be able to come to a stand position and pivot on one/both feet.SLIDING BOARD: Sliding board transfers are best used with those who cannot bear weight on the lower extremities and who have paralysis, weakness, or poor endurance in their upper extremities.BENT PIVOT: Used when patient is unable to initiate/maintain standing position; clinician keep patient in bent knee position to maintain equal weight bearing.ONE/TWO PERSON DEPENDENT TRANSFER: The dependent transfer is designed for use with the patient who has minimal to no functional ability. This transfer should be practiced with able-bodied persons and initially used with the patient only when another person is available to assist. The purpose of the dependent transfer is to move the patient from surface to surface. The requirements are that the patient be cooperative and willing to follow instructions. With heavy patients, it is always best to use a two-person transfer or at least to have a second person available to spot the transfer.Answer these questions about sliding board transfers:For whom are sliding board transfers best suited?Sliding board transfer is most often employed with persons who have LE amputations or individuals with SCI.What physical attributes are required of the client to do a sliding board transfer?Good UE strengthWhat piece of equipment may need to be used at the beginning of transfer training? When during the transfer training can it be eliminated?Ambulation aides, change in functional status and adherence to safety precautionsWhat equipment is needed to ensure the safety of the practitioner as well as the client?WC, gait belt, sliding board, and mechanical liftWhat guidelines should the practitioner consider before attempting to have the client transfer?Medical precautionsIs it safe with just one person or do you need assistance?Enough time for safe transferDoes patient understand what is going to happen?Equipment in good working orderHeights in relation to one another (ex. Bed to w/c)Equipment placed in correct positionNo obstructions in wayPatient dressed properlyLeg management and bed mobilityDescribe the steps in a standing pivot transfer.1. Help patient scoot to the edge of the surface and put his or her feet flat on the floor. Patient's ankles should be pointed towards the surface to which the patient is transferring2. Stand on the patients affected side with hands either on the patient's scapula or around the patients waist or hips. Stabilize the patients foot and knee with your own foot and knee. Provide assistance by guiding the patient forward as the buttocks are lifted up and toward the transfer surface Either reaches toward the surface to which he or she is transferring or pushes off the surface from which he or she is transferring 4. Guide the patient toward the transfer surface and gently help him or her down to a sitting positionWhat precautions must be considered in positioning a client with a Neurological impairment?Muscle weakness, impaired sensitivity, pain, UE weakness, trunk weaknessSpinal cord injury?Use bolsters, pillows, or splints when client is awakeEducate client on bed positioning: rotate every two hours, avoid prolonged pressure on bony prominences.Provide support for trunk for UE activitiesWhen positioning a client who has had a cerebral vascular accident, describe how you would properly place the involved arm for the following resting positions:Lying on affected sideAffected arm flexed forward at shoulder, elbow extended and hand supported, palm up, unaffected arm supportedLying on unaffected sideHemiplegia arm supported forward on 2 pillowsLying on backHead of bed 0-30 degrees, affected arm on the pillowACTIVITIES Practice positioning a classmate who will role play having a right- or left-sided hemiplegia in a bed. Have a peer and/or your instructor check your technique. Record how you correctly placed the upper extremities, lower extremities, and the positioning pillows for each position listed below. POSITIONCORRRECT UE PLACEMENTCORRECT LE PLACEMENTCORRECT PLACEMENT OF PILLOWSRIGHT-SIDED HEMIPLEGIAOn affected sideOn unaffected sideSupineLEFT-SIDED HEMIPLEGIAOn affected sideOn unaffected sideSupineDescribe and demonstrate a method for moving a client up in bed, down in bed, rolling to the side, and coming to a sitting position for the following client conditions.CLIENT CONDITIONHEMIPLEGIAQUADRIPLEGIAPARAPLEGIAOTHERMoving up in bedMoving down in bedRolling side to sideComing to a sitting positionWatch your instructor perform standing pivot and sliding board transfers from a wheelchair to various surfaces as indicated on the chart. After the demonstration, perform the same transfers with a partner, checking your progress as you complete each PONENT OF TRANSFERSTUDENTSTANDING PIVOTSLIDING BOARDBedCOMMODEBATH BENCHBedCOMMODEBATH BENCHcorrect placement of wheelchair XXXXXXCorrect direction of transferXXXXXXHandled wheelchair appropriatelyXXXXXXProper application of transfer beltXXXXXXCorrect instructions given to patientXXXXXXProper placement of practitioner’s bodyXXXXXXCorrect body mechanics usedXXXXXXProper speed in moving patient from wheelchair to surfaceXXXXXXCorrect placement of sliding board if usedXXXXXXComments:The material in this section was adapted from Clinical Competencies in Occupational Therapy, C.A. Kief, C.R. Scheerer; Prentice Hall; New Jersey 2001MODALITIESINTRO TO PHYSICAL AGENT MODALITIES (PAMS) (will also be covered in OCTA 2130)This serves as an introduction to PAMS. In Georgia, you must have a specialty certification attached to your practice license in order to use PAMS as a precursor to an intervention. PAMS in itself is NOT an intervention! As defined by AOTA, PAMS use in occupational therapy is only as a precursor to a functional intervention. PAMS usage is not considered an entry level skill.PAMS includes the following: thermal (hot and cold), electrical (such as a TENS unit) or, under some practice laws, sensory (such as essential oils). PAMS elicit a soft tissue response to improve functional capability in the client. An example would be using a paraffin bath to improve ROM in an arthritic hand to allow for functional grip. RESOURCESEarly, Physical Dysfunction Practice Skills for the OTAReed: Quick Reference to Occupational TherapyRyan: Ryan’s OTA: Principles, Practice Issues, and TechniquesThe Guide to OT PracticeState licensure lawsSTUDY QUESTIONS Describe the following PAMS and list a corresponding treatment implication as well as a contraindication to treatment.PHYSICAL AGENTDESCRIBETREATMENT IMPLICATIONCONTRA-INDICATION(S)ParaffinClient repeatedly dips hand into tub of wax until thick, insulating layer of paraffin is applied to the extremity. Hand is wrapped in plastic bag and towel for about 10 to 20 minutes. RA, OA, ArthritisSevere edema, phlebitis, open wound, scar, varicose Hot packsPacks are submerged in a heated water tank and then applied to affected extremities Myofacial pain, before soft tissue mobilization, and prior to activities requiring elongating contracting tissueOpen wounds, varicose, edema, impaired sensations, acute conditionsCryotherapyExtremities are place in a bowl of ice cold water until the point of numbnessEdema, pain, inflammationVascular DisordersWhirlpoolHands are dispersed in warm spinning waterWound ManagementImpaired sensation, circulation, malignanciesElectrical stimulationElectrical current to reduce painTendonitis, nerve impingementPacemakers, cardiac conditionsFluidotherapyA machine agitates finely ground cornhusk particles by blowing warm air through themRaises tissue temperature, benefits effect on desensitization, Warm up before exercises, dexterity tasks, functional activities, work simulation tasksCorn allergies, burns, open wounds, infected woundsTranscutaneous electrical nerve stimulationElectrical current to reduce painTendonitis, Nerve impengmentPacemaker, eczema, cardiac conditionIontophoresisTopical introduction of ionized drugs into the skin using direct currentExcessive sweating of the hands and feetOpen woundDescribe the role of the occupational therapy practitioner in the use of PAMS.Practitioner selects the PAM and delegate them to competent OTAsBriefly summarize AOTA’s position on the use of physical agent modalities in OT.They published a statement saying that, “The exclusive use of physical agent modalities as a treatment method during a treatment session without application to a functional outcome is not considered occupational therapy.”Briefly summarize your state licensures laws regarding the use of plete minimum of 90 hours of instruction or trainingNo less than 36 contact hours must be directly related to specific theories and practical application of physical agent modalitiesThe material in this section was adapted from Clinical Competencies in Occupational Therapy, C.A. Kief, C.R. Scheerer; Prentice Hall; New Jersey 2001INTRO TO ORTHOTICSMATERIALSMETHODSUSESPRECAUTIONSOrthotics (splint) are made to restore or facilitate function. Frequently, a pre-fabricated splint may be ordered for a client and adjustments are made once it is received. Often, though, you may be required to fabricate a custom splint to meet the individual needs of a client. There are many types of splinting materials, styles, and methods. Instructing a client in the use of the splint, the wearing schedule, and associated precautions will be part of your role. RESOURCESEarly, Physical Dysfunction Practice Skills for the OTAReed: Quick Reference to Occupational TherapyRyan: Ryan’s OTA: Principles, Practice Issues, and TechniquesThe Guide to OT PracticeSTUDY QUESTIONSDescribe the role of occupational therapy in splintingInstruct client to use splint, the wearing schedule, and associated precautionsDescribe several purposes of splinting.Restore of facilitate functionSummarize the biomechanical principles of splinting.Protect, support, or immobilize joints to permit healingPosition and maintain alignmentTo correct deformity or prevent further deformityTo substitute for weak or absent muscle functionTo Increase ADL functionList precautions associated with splinting.Open woundsIncision sitesEdemaPoor fittingMedical ConditionsDescribe the anti-deformity (functional) position of the hand for splintingSimilar to holding a soda can or ball. The wrist is in 20 to 30 degree of extension. Thumb is abducted and opposed to the pad of middle finger. Metacarpals are flexed to 30 degreeand IP joints flexed to 45 degreesACTIVITIES Trace several of your classmates hands and identify the following landmarks on your drawing:ArchesDistal transverse archProximal transverse archLongitudinal archCreasesDistal digital creaseMiddle digital creaseProximal digital creaseDistal palmar creaseThenar creaseWrist dorsal/volar Find examples of the following splints in either your resource books, catalogues or on line. Complete the information on the chart.SPLINTDESCRIPTIONCONDITION(S) USED FORVolar wrist cock-upholds the wrist in extension but allows for functional use of the thumb and fingerscarpal tunnel syndrome, wrist sprains or tendinitis, wrist arthritis or following forearm and carpal surgeries or fracturesDorsal wrist cock-upIdeal for any condition requiring maintenance of the wrist in a functional position or a tone inhibiting position. May be used as a base for dynamic splinting.This splint is often used for flaccid or hypertonic hand for such conditions as hemiplegia, brachial nerve plexis injury and radial nerve palsy.Resting handSupports the fingers, thumb and wrist in a functional and/or resting position and allows simple adjustment of the wrist and thumbIt effectively combats mild to moderate hand-finger contracture and moderate to severe wrist contractures; InflammationThumb spicaHelps protect wrist and thumb following injury through immobilization, helps decrease pain and inflammation from tendinitis, helps arthritis, two metal stays help immobilize wrist and thumbScaphoid injuries, Lunate injuries, First metacarpal fractures, Injury to the ulnar collateral ligament, Positioning for de Quervain tenosynovitisFinger spreaderFingers and thumb are place in an abducted and slightly flexed positionSpasticity in the handHard cone designWhen a spastic hand grips the cone, deep pressure to the flexor tendons in the hand will inhibit flexor toneStrong flexion synergy of the hand and fingersArthritis-mitt splintImmobilizes the wrist and MCPs while allowing movement of the IPsRheumatoid arthritis of the hand and wristSoft splintsAlleviates pain and tightness in arch and Achilles tendon placing foot in dorsiflexed positionOther:Other:The material in this section was adapted from Clinical Competencies in Occupational Therapy, C.A. Kief, C.R. Scheerer; Prentice Hall; New Jersey 2001THERAPEUTIC EXERCISE/ACTIVITIESTherapeutic ExerciseTherapeutic exercise -- CPT code 97110 -- involves instructing a patient in specific exercises to address weakness or loss of joint mobility due to disease or injury. These exercises are not typically functional tasks. For example, overhead shoulder presses using dumbbells is a therapeutic exercise. Stronger shoulders will improve function, however the actual exercise does not mimic an everyday task.Several types of exercise are included in this category. Active exercise is movement of a body part against gravity, or with additional weight for resistance. Active-assisted exercise is movement of a body part with help from another part of the body -- using one arm to help lift the other, or with help from the therapist. Passive exercise fully relies on the therapist or another part of the patient's body to lift the injured limb.Therapeutic ActivitiesTherapeutic activities -- CPT code 97530 -- involves the use of functional, dynamic tasks from everyday living to improve range of motion and strength. For example, overhead shoulder movement can be strengthened by reaching up to place a weighted object on a shelf. This is a functional task that directly mimics real-life activity. Therapeutic activities cover a broad range of functional tasks. Movements including pushing, pulling, squatting, bending, lifting, carrying, catching and throwing qualify as therapeutic activities.ConnectionTherapeutic exercises are often performed in conjunction with therapeutic activities. For example, after a hip fracture, a person typically has difficulty lifting the injured leg. Therapeutic exercises are performed to strengthen the leg to enable the person to lift it up against gravity. As strength improves, weight is added to the leg to make the exercises more difficult. Therapeutic activities are also performed to improve function. Sit to stand activities continue to improve leg strength while practicing a daily task. Lunging and squatting activities are performed to improve tasks such as laundry and getting in and out of a car. Therapeutic exercises are sometimes a gateway to therapeutic activities. After shoulder surgery, movement of the arm is often strictly limited for a period of time to protect the repair. However, therapeutic exercises -- usually passive -- begin early in the rehab process to keep the joint from getting stiff. Once the repaired structures have healed, therapeutic activities such as reaching, pushing and pulling are used to restore function.source: ADAPTIVE ADLSActivities of daily living (ADLs) is a primary focus area for OT intervention with a physical dysfunction. These skills are frequently the main focus for the client, their family/caregivers, and the rehab team. The OT practitioner needs to be skilled in ADL retraining with a focus on helping the client achieve the maximum level of safe, independent functioning possible, from return to premorbid functioning to many forms of adapted independence.RESOURCESEarly, Physical Dysfunction Practice Skills for the OTAReed: Quick Reference to Occupational TherapyRyan: Ryan’s OTA: Principles, Practice Issues, and TechniquesThe Guide to OT PracticeSTUDY QUESTIONSDefine basic ADLs and list terms that are frequently substituted for the same.ADL require basic skills and are oriented toward the care of one’s own body or person.ADL is also known as BADL (basic activities of daily living)Describe what is meant by instrumental activities of daily living (IADLs).Requires advanced problem solving. Increased social skills required as well as complex social interaction with the environmentIdentify the performance area as indicated by the OTPF that classifies each of the following tasks.TASKPERFORMANCE AREATransfersADLGroomingADLTelephoningIADLVacuumingIADLShoppingIADLPreparing mealsIADLOperating light switchesIADLHandling medicationIADLAbility to call 911IADLDescribe the role of the OT practitioner in treating clients with deficits in the performance of ADLs.Assess ADL performanceDetermine problems that interfere with independence Select treatment objectivesProvide training/equipment to enable higher level of independenceReduce/remove physical, cognitive, social, and emotional barriers that interfereGive a description of each of the terms used to describe performance levels:Independent – pt able to perform 100% w/o assistanceModified independence – pt requires AE, verbal, or physical cuesSupervised – caregiver not required to give hands on assistanceMinimal assistance – caregiver give 25% physical/cueing assistModerate assistance – caregiver give 50% physical/cueing assistMaximal assistance – caregiver give 75% physical/cueing assistDependent – patient requires cannot perform any part of the activity and requires 100% assistanceDescribe several methods that an OT practitioner may use to teach improved functioning in ADLs.Demonstration and verbal instructionStep-by-step approach; Break down activity into small steps and progress through them slowly, one at a time assistance is reduced gradually as success is achievedBackward trainingList a technique or adaptive device that may be used to assist a client with the following performance area deficits in ADLs. The first one is completed for you.PERFORMANCE AREATECHNIQUE OR DEVICE FOR LIMITED ROM AND/OR STRENGTHTECHNIQUE OR DEVICE FOR PROBLEMS OF INCOORDINATIONDressingShoe hornFeeding and eatingUniversal CuffGroomingOral hygieneFunctional communicationFunctional mobilityToilet hygieneWhen teaching a person with hemiplegia to dress:Which arm or leg should be put in the garment first?AffectedWhich should be taken out first?UnaffectedACTIVITES As a group, discuss and record conditions that interfere with successful completion of self-care activities. CHF, COPD, TBI, SCI, Arthritis, Fibromyalgia Watch your instructor demonstrate adaptive techniques in dressing for individuals with the diagnosis in the following chart. Practice and then teach a partner, who will role-play a person with the diagnosis listed, how to perform these skills. Write comments on the chart about your performance as you solicit feedback from your peers and instructor.DRESSING SKILLCVAPARAPLEGIAL4-5 LAMENECTOMYHUMERUS FXFront-opening shirtUsed teeth to pull up cuff on unaffected side; Requires much dexterity of the unaffected armLack of trunk stability ROMNo twistingNo bendingSafety precautionsSafety precautionsNo trunk twistingUse AE long handlesSlipover shirtEasier to put more involved arm first; Ball up sleeve with unaffected arm and slide over affected arm; For taking off, just reach behind and pull over head; Or with dressing stick, pull neck of shirt overhead and then pull the rest off with unaffected handLack of trunk stability and balanceNo Twisting No Bending Safety PrecautionsDress the affected arm first with assistance of unaffected armPantsUse reacher to start pants over the feet; When just below the hip line, pt can stand in unaffected side and pull up the rest of the wayLying flat on the bed you can use reacher to put pants one leg and then the leg lift to place the other leg into the other side. Use side to side rolling to pull up the rest of the pants with handsAU usage precautionsUse unaffected armSocksFeed sock onto sock aid before placing on foot; Place aid on foot and use ropes to pull up sock on leg. May use reacher if pt has hip precautionsTrunk stability, ROM, and GripAE usage (sock aide, long handle grip such as reacher)One arm technique (unaffected arm)ShoesTie knot at the bottom of the shoe so that lace will not slip out; Used shoe horn at heel of shoe to slide in footSame as aboveAE usageSame as aboveBraRequired good trunk rotation and lateral bending when bringing bra around back; Fasten bra while hook is on stomach; Needs good dexterity in unaffected armNo problemNo problemOne hand technique or sports bra Watch your instructor demonstrate adaptive techniques in bathing, toileting, and grooming for the diagnoses in the following chart. Practice and then teach a partner, who will role-play a person with the diagnosis listed, how to perform these skills. Write comments in the chart about your performance as you solicit feedback from your peers and instructor.BATHINGGeneralized weaknessCVAParaplegiaTotal hip replacementIn bedSponge BathSponge BathNo problemSitting on the side of the bedNeed setup assist due to weaknessMay need assist with balanceHip precautionsIn chair at bedsideOne hand techniqueIn chair at sinkMore timeDominance reeducationSliding boardIn the tubShower benchShower benchShower benchIn showerShower benchShower benchShower benchTOILETINGBedside commodeUse w/cSliding boardTHR precautionRaised commodetransferTransferRegular commodeBalance precautionsUse walker or w/cTHR precautionGROOMINGShaving faceElectrical deviceTransfer techniqueShaving legsSafety, energy conservationApplying deodorantNo problemUnaffected handAffectedBrushing teethElectrical portable deviceAppling make-upEnergy conservationNo problemCombing hairMore timeHand over hand The material in this section was adapted from Clinical Competencies in Occupational Therapy, C.A. Kief, C.R. Scheerer; Prentice Hall; New Jersey 2001ASSISTIVE TECHNOLOGYAssistive Technology and Adaptive TechnologyThe term Adaptive Technology is often used as the synonym for Assistive Technology, however, they are different terms. Assistive Technology refers to "any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities," while Adaptive Technology covers items that are specifically designed for persons with disabilities and would seldom be used by non-disabled persons. In other words, "Assistive Technology is any object or system that increases or maintains the capabilities of people with disabilities," while Adaptive Technology is "any object or system that is specifically designed for the purpose of increasing or maintaining the capabilities of people with disabilities."[1] Consequently, Adaptive Technology is a subset of Assistive Technology. Adaptive Technology often refers specifically to electronic and Information Technology access.[2]Assistive technology (often abbreviated as AT) is any item, piece of equipment, software or product system that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities.?AT can be low tech like communication boards made of cardboard or fuzzy felt.AT can be high tech such as special purpose computers.AT can be hardware such as prosthetics, attachment devices (mounting systems), and positioning devices.AT can be computer hardware, like special switches, keyboards, and pointing devices.AT can be computer software such as screen-readers or communication software.AT can be inclusive or specialized learning materials and curriculum aids.AT can be specialized curricular software.AT can be much more, including electronic devices, wheel chairs, walkers, braces, educational software, power lifts, pencil holders, eye-gaze, and head trackers.?Different disabilities require different assistive technologies.?Assistive technology includes products and services to help people who have difficulty speaking, typing, writing, remembering, pointing, seeing, hearing, learning, walking, etc.Who pays for assistive technology??There is no one answer to this question.?It will depend upon the particular technology, its user, and its use.?First, however, and most importantly, you have to find out what assistive technology you need.?Many kinds of assistive technology may cost you little or nothing – and that is true even for some very expensive items.?Here are some examples:?Schools systems pay for general special education learning materials as well as technology specified in an ernment programs (whether Social Security, Veteran’s benefits, or state Medicaid agencies) pay for certain assistive technology if it is prescribed by a doctor as a necessary medical device.Private health insurance pays for certain assistive technology if it is prescribed by a doctor as a necessary medical device or used for rehabilitation.Rehabilitation and job training programs, whether funded by government or private agencies, may pay for assistive technology and training to help people get a job.Employers may pay for assistive technology that is determined to be a reasonable accommodation, so an employee can perform essential job tasks.There may be other sources of funds in your state or community, including private foundations, charities and civic organizations.? ATIA has developed a Funding Resources Guide to provide you with sources and resources that you can investigate and explore as prospective funding options.In addition, almost all companies that sell assistive technology can give you more specific answers about funding opportunities for their products and may help you find financial support from these or other funding sources.?Sometimes people have to use their own money for the assistive technology they think is important.?But remember that persistence pays.?Funding availability has changed over the years, and some technology that was not covered only a few years ago is now funded.?Find the technology you need first – then look for the money.SEXUALITYSexuality and the Role of Occupational TherapySexuality is a core characteristic and formative factor for human beings. It is a state of mind, representing our feelings about ourselves, what it’s like to be male or female, how we relate to people of our own gender and those of the opposite gender, how we establish relationships, and how we express ourselves. It is basic to our sense of self. As such it is an important part of development and growth. It is the ability to be intimate with another in mutually satisfying ways. Sexual feelings and actions can cover a gamut of expressions. Holding hands, flirting, touching, kissing, masturbating, and having sexual intercourse are just some of the ways in which sexuality can be expressed (MacRae, 2010). Religion, culture, ethnicity, and education can also affect how sexuality develops and is expressed (e.g., how sexuality was handled within one’s family can affect how one’s own sexuality develops).The Occupational Therapy Practice Framework: Domain and Process, 2nd Edition (AOTA, 2008) lists sexual activity as an activity of daily living (ADL). As such occupational therapists include sexuality as part of a routine evaluation of clients, and occupational therapists and occupational therapy assistants address this area in occupational therapy interventions. Following an acute health crisis or as part of a chronic condition, clients may worry about how their health issues will affect their sense of self, their ability to function physically, and their opportunities to engage in sexual activity. Concerns may also relate to misconceptions or expectations of others, including partners, caregivers, and health care providers.? Occupational Therapy Interventions As a basic part of the human condition, sexuality is an ADL addressed with older adults; clients who are lesbian, gay, bisexual, and transgendered; clients with physical disabilities; clients with developmental disabilities or delays; and other recipients of occupational therapy services as part of a holistic approach to treating the whole person.Occupational therapy is a safe place for addressing sexuality, allowing the client to express fears and concerns, and offering assistance with problem solving. Empathy, sensitivity, and openness are necessary aspects of the therapeutic relationship, the foundation of occupational therapy, and are used in addressing sexuality. Partners are often included in occupational therapy interventions to achieve goals of mutual concern, such as sexual expression and satisfaction.?? Sexuality can be addressed by practitioners in any setting. Intervention can occur in homes, group homes, nursing homes, rehabilitation centers, community mental health centers, pain centers, senior centers, hospitals, retirement communities, and other venues. The following are types of interventions offered by occupational therapy practitioners.Health promotion: This approach consists of support groups, educational programs, and stress-relieving activities. For example, an occupational therapy practitioner could offer an educational program about safe sex for teenagers with developmental delays. Occupational therapy practitioners may also provide in-service training to assist caregivers in institutions such as skilled nursing facilities to understand the sexual needs of older adults and those with diverse sexual orientations. Such in-services might include introducing ways for insuring privacy when partners are visiting. Remediation: This approach consists of restoring skills, such as range of motion, strength, endurance, effective communication, and social engagement, as part of meeting sexual needs. An example is rehabilitation for clients following a hip replacement and addressing their concerns about physically being able to have sexual intercourse during the recovery process. Another example is developing leisure interests to help meet potential romantic partners when working with clients who report social isolation.? ??Modification: This approach consists of changing the environment or routine to allow for sexual activity. Examples include resting prior to sexual activity for those with poor endurance; placing pillows under stiff or painful joints or preceding sexual activity with a warm bath; learning new positions to compensate for amputated limbs; and using positions that incorporate weight bearing to compensate for tremors. Conclusion Enhancing an individual’s ability to participate in sexual activities can have a profound effect on that person’s life. By acknowledging the importance sexuality plays in all of our lives and displaying sensitivity to the personal nature of this ADL, occupational therapy practitioners help ensure that all aspects of their clients’ lives are addressed in therapy. Providing empathy and appropriate information, devising adaptations, and encouraging experimentation to find resolutions can be invaluable services to clients. When practitioners routinely discuss sexuality as an ADL, clients can talk about and address any issues in this area. Collaborative problem solving can empower clients to gain control over this most intimate of areas. It can be self-validating, allow personal expression of sexuality in ways that are meaningful, strengthen self-esteem, and allow that person to become whole again. ReferencesAmerican Occupational Therapy Association. (2008). Occupationaltherapy practice framework: Domain and process (2nded.). American Journal of Occupational Therapy, 62, 625–683. doi:10.5014/ajot.62.6.625MacRae, N. (2010). Sexuality and aging. In R. H. Robnett & W. C. Chop (Eds.), Gerontology for the Health Care Professional (pp. 235–258). Sudbury, MA: Jones and Bartlett. By Nancy MacRae, MS, OTR/L, FAOTA, for the American Occupational Therapy Association. Copyright ? 2013 by the American Occupational Therapy Association. This material may be copied and distributed for personal or educational uses without written consent. For all other uses, contact copyright@.PLEASE PLAN ON ATTENDING THE JULY EAST REGION GOTA MEETING. THE PRESENTATION ON JULY 8 WILL BE ON THIS TOPIC!WORKWork RehabilitationDownload a printable copy of this fact sheet here.Work rehabilitation is a broad term that encompasses many aspects of intervention, all geared toward facilitating independence at work as well as satisfactory fulfillment of the worker role.The goals of work rehabilitation are to:maximize levels of function following injury and/or illness to maintain a desired quality of life for the worker; facilitate the safe and timely return of individuals to work following injury and/or illness; remediate and/or prevent future injury or illness; and assist individuals in resuming their role as a worker, which can contribute to self-confidence and a view of self as a productive member in society, and prevent deconditioning as well as the negative psychosocial consequences of unemployment. Who Can Benefit From Work Rehabilitation?Anyone who is experiencing an occupational performance problem (i.e., having difficulty fulfilling the worker role) due to an illness or injury, and who desires to return to work or enhance work performance, can benefit from work rehabilitation.Occupational Therapy’s RoleOccupational therapy practitioners, through their education and training, possess the unique ability to evaluate individuals’ interactions with their work demands and the work environment through detailed and scientifically based task analysis. Using a holistic perspective, occupational therapists evaluate and understand the impact of wellness, cognition, physical disabilities, psychosocial factors, and medical conditions on work performance. The occupational therapy evaluation can identify supports and barriers to success in the work environment that, if indicated, can be addressed in the intervention plan in order to facilitate work performance. These specialized evaluation skills allow the occupational therapist to understand and deliver results in the complex psychosocial and physical work environment (Ellexson, 2000).Occupational Therapy Roles in Various Aspects of Work RehabilitationAcute Injury and Illness Management: The occupational therapy practitioner works with the client to determine gaps between the job demands and the individual’s existing performance abilities, and remediates or compensates for the differences in a timely manner. The occupational therapist will determine the history of the current condition or injury. The occupational therapist will then develop a comprehensive and individualized intervention plan to address problem areas.Work Conditioning: The occupational therapist uses a systematic approach to restore the work performance skills of workers recovering from long-term injury or illness. There is a focus on restoring musculoskeletal and cardiovascular systems as well as safely performing work demands. This is typically achieved through circuit training and work simulation that occurs 3 to 5 days per week for 2 to 4 hours per session.Work Hardening: This approach is similar to work conditioning; however it is multidisciplinary and can involve psychomedical counseling, ergonomic evaluation, job coaching, and/or transitional work services. Treatment is typically provided 5 days per week for 2 to 4+ hours per day. Work-hardening clients may progress to transitional work programming with actual performance of job duties at their site of employment. If necessary, final determination of adaptations and/or reasonable accommodations can be made during this period of transition.Functional Capacity Evaluation (FCE): The occupational therapist uses standardized and validated advanced testing in order to: (a) determine safe job matches for return to work; (b) determine the level of reasonable accommodations necessary for reinstating an injured worker; and (c) make recommendations regarding future interventions. The results of the FCE may be used by the physician to make a disability rating for insurance purposes. Environmental Modification: The occupational therapist, together with the worker and the employer, makes recommendations for modifications to the workplace environment to facilitate successful employment? performance. Examples of environmental modifications to meet the needs of a returning worker can include changing the lighting, creating a new layout of the workspace, modifying work-related tools and devices, and minimizing distractions.Transitional Work Programs: Transitional work uses the actual work tasks and environments as a form of rehabilitation. After becoming familiar with the individual’s job requirements and measuring the individual’s functional abilities, the occupational therapist determines tasks that the individual can safely and dependably perform at work. The occupational therapist works with the employer to identify environmental and task modifications that will support work performance, and makes detailed recommendations to the treating physician, who releases the individual to modified work within these parameters. Work performance is closely monitored and discussed among the occupational therapist, employer, and individual.Where and How Are Services Provided?Possible Location of Services: Outpatient rehabilitation centers, hospitals, private industry (e.g., on-site clinics), private practicesReferral Sources: Medical providers, insurance case managers and adjusters, attorneys, state agencies, rehabilitation team membersPayer Sources: Workers’ compensation carriers, state and local agencies (e.g., Bureaus of Vocational Rehabilitation), legal settlements, private insurance, private payConclusionOccupational therapists are uniquely qualified to provide work rehabilitation services due to their understanding of the complex and dynamic relationship between the person, the environment, and the occupation, and their ability to address barriers to performance. Evaluation and intervention are tailored to the holistic needs of the client and take into account the work environment and work demands to facilitate successful performance.ReferenceEllexson, M. (2000). Blueprint for ergonomics. Work, 15(2), 107–112. Retrieved January 14, 2008, from More Information: American Occupational Therapy Association. (2011). Occupational therapy services in facilitating work performance. American Journal of Occupational Therapy, 65, S55–S64. doi: 10.5014/ajot.2011.65S55Revised by Julie Dorsey, MS, OTR/L, CEAS; Faye Fick, MS, OTR/L; Michael Gerg, MS, OTR/L, CHT, CEES, CWCE; and Vicki Kaskutas, BS, MHS, OTD, OT/L, for the American Occupational Therapy Association. Copyright ? 2012 by the American Occupational Therapy Association. This material may be copied and distributed for personal or educational uses without written consent. For all other uses, contact copyright@. ................
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