Medicare

• For people 65+, certain payroll contributions, spouses of eligible, or permanently disabled
• Part:
  • A àhospital based insurance
    • RUGS (special needs plan, ultra high, high, medium, low)
    • Home Health (HHRGs based on OASIS)
    • Inpatient Rehab (CMGs from IRF-PAI)
  • Bà supplemental medical insurance
    • RVU (resource value unit- minutes)
  • Cà “Medicare Advantage”; Part A & B; uses comparable private insurers
    • HMOs, PPOs, private FFS, & Medicare Special Needs Plans
  • Dà prescription drugs

Medicaid

• Federal: state match
• Means tested insurance to meet societal need for poor, disabled, or children
  • Mandatory categories
  • Medically needy
  • Special groups
  • Medicaid waiver program

Functional Independence Measure

Levels		Description
7	Complete Independence	Fully independent
6	Modified Independence	Requiring the use of a device but no physical help
5	Supervision	Requiring only standby assistance or verbal prompting or help with set-up
4	Minimal Assistance	Requiring incidental hands-on help only (subject performs > 75% of the task)
3	Moderate Assistance	Subject still performs 50–75% of the task
2	Maximal Assistance	Subject provides less than half of the effort (25–49%)
1	Total Assistance	Subject contributes < 25% of the effort or is unable to do the task

 

Manual Muscle Testing

Grades			Descriptions
0	0	Zero	No muscle contraction can be seen or felt
1	T	Trace	Contraction can be observed or felt, but there is no motion
2-	P-	Poor Minus	Part moves through incomplete ROM with gravity minimized
2	P	Poor	Part moves through complete ROM with gravity minimized
2+	P+	Poor Plus	Part moves through less than 50% of available ROM against gravity or through complete ROM with gravity minimized against slight resistance
3-	F-	Fair Minus	Part moves through more than 50% of available ROM against gravity
3	F	Fair	Part moves through complete ROM against gravity
3+	F+	Fair Plus	Part moves through complete ROM against gravity and slight resistance
4	G	Good	Part moves through complete ROM against gravity and moderate resistance
5	N	Normal	Part moves through complete ROM against gravity and maximal resistance

Occupational Therapy Practice Framework 2ed.

AREAS OF OCCUPATION	Activities of Daily Living (ADL)* Instrumental Activities of Daily Living (IADL) Rest and Sleep Education Work Play Leisure Social Participation
CLIENT FACTORS	Values, Beliefs, and Spirituality Body Functions Body Structures
PERFORMANCE SKILLS	Sensory Perceptual Skills Motor and Praxis Skills Emotional Regulation Skills Cognitive Skills Communication and Social Skills
PERFORMANCE PATTERNS	Habits Routines Roles Rituals
CONTEXT AND ENVIRONMENT	Cultural Personal Physical Social Temporal Virtual
ACTIVITY DEMANDS	Objects Used and Their Properties Space Demands Social Demands Sequencing and Timing Required Actions Required Body Functions Required Body Structures

 

Common Assessments/ Evaluations

• Allen Cognitive Level Screen
  • Cognition
• Allen Diagnostic Module
  • Cognition
• Assessment of Motor and Process Skills (AMPS)
• Barthel Index
  • ADLs
• Beck Depression Inventory II (BDI-ii)
  • Depression
• Behavior Rating Inventory of Executive Function (BRIEF)
  • Executive Functioning
• Berg Balance Scale
• Borg Numerical Pain Scale
• Canadian Occupational Performance Measure (COPM)
• Functional Reach Test
  • Balance and max forward reach
• Galveston Orientation and Amnesia Test
  • Memory and orientation
• Glascow Coma Scale
  • <8/ 9-12/ >13 TBI

• Global Assessment of Functioning Scale (GAF)
  • ADLs/ social skills
• 9-hole peg test
• Home Falls Accidents Screening Tool (HOME-FAST)
• Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI)
• Kohlman Evaluation of Living Skills (KELS)
• Mini-Mental State Exam (MMSE)
  • Orientation, memory, attention, calculation, recall, language
• Outcome and Assessment Information Set (OASIS)
• Performance Assessment of Self-Care Skills (PASS)
  • Functional mobility, personal care, home management
• Purdue Peg Board
• Rivermead Behavioral Memory Test
  • Memory
• Role Activity Performance Scale (RAPS)
• Tinneti Assessment Tool
  • Balance
• OT Intervention Approaches
  • Create, Promoteà doesn’t assume a disability is present or that factors would interfere with performance
  • Establish, restoreà treatment used to change client variables to establish a skill or ability
  • Maintainàtreatment used to provide support that will allow a client to preserve current performance capabilities
  • Modify finding ways to revise the current context to support performance in the natural setting
  • Preventàfor clients at risk for occupational performance problems; to prevent barriers to a client

• Therapeutic Use of Occupations and Activities
  • Occupation-based interventions: completes morning dressing and hygiene using AD
  • Purposeful activity: Practices how to select clothing and manipulate clothing fasteners; role playing
  • Preparatory methods: ROM arc; Theraband; theraputty

• Hip Precautions
  • Anterolateral THR avoid:
    • Hip external rotation
    • Hip adduction
    • Hip extension

• Posterolateral THR avoid:
  • Flexion >60-90 degrees; “knee above hip”
  • Internal rotation of leg
  • Adduction of leg
  • Avoid excess trunk flexion
• Sternal/ Cardiac Precautions
  • Do not push or pull with your arms.
  • Hug a pillow or teddy bear when getting in/out of bed or up/down from a chair.
  • Do not raise your elbows higher than your shoulders.
  • Brace your chest when coughing or sneezing. Huff instead of coughing if you can.
  • No lifting objects greater than 5 to 10 pounds or as instructed by your doctor.
  • Do not reach to the side or back.
  • Avoid twisting or deep bending.
  • Do not hold your breath during activity; counting out loud or talking will help.
  • Ask clearance from your doctor before driving.
• Goals
  • A: Patient/ Client
  • B: Behavior
  • C: Condition or with what; AE
  • D: degree; frequency; measurable
  • E: effect; by when
  • F: functional

• Right CVA
  • Loss of voluntary movement, coordination and sensation on left side
  • Spatial and perceptual deficits w/ left hemianopsia
  • Unilateral neglect of left side of body and/ or environment
  • Dressing apraxia
  • Impulsive, quick behavior
  • Poor judgment

• Left CVA
  • Loss of voluntary movement, coordination and sensation on right side
  • Aphasia
  • Articulation of speech + dysarthria
  • Right hemianopsia (R-R eye; R-L eye)
  • Slow, cautious personality
  • Memory deficits for recent or past events
    • Less accidents
    • Less rehab needed

• Diabetes
  • <60 = low blood sugar
  • >120= high blood sugar

• SCI
  • Central Cord Syndrome
    • Paralysis and sensory loss are greater in the UEs
  • Brown Sequard Syndrome
    • Below the level of injury you’ll see:
      • Motor paralysis
      • IPSILATERAL SIDE: loss of proprioception
      • CONTRALATERAL SIDE: loss of pain, loss of temperature sensation, and a loss of touch sensation

• Anterior Spinal Cord Syndrome
  • Loss of pain, temperature, and touch
  • Preserves proprioception

• Cauda Equina
  • Better prognosis for recovery due to regeneration in these nerves that’s not present in the SC
  • Patterns of sensory and motor deficits are highly variable and asymmetrical
• Conus Medullaris Syndrome
  • Areflexic bladder, bowel, and LE
  • Tendency toward hypertonicity (UMN)

• TBI
  • GCS=Mild TBI (13+), Moderate TBI(9-12), or Severe TBI (<8)
  • Toglia/ Abreu Approach
    • Manipulate the environment and the task
    • Close the door
    • Turn of the tv and radio
    • Get rid of clutter
    • Set out your tools within reach
    • Provide enough light
    • Speak to the point and briefly
  • Tips for working with clients who are agitated
    • Low stimulation room
    • Night day simulation
    • Veril bed or mattress
    • Hand mit to prevent pulling at lines/ leads
    • Out of bed therapies followed by rest breaks
    • Trained “sitters”
    • Wean off medications
    • Provide orientation supports
  • Transfers
    • Lock Breaks
    • Gait Belt
    • Lift with knees bent
    • Position chair at 45-degree angle
    • Rock
    • Tell patient what you’re doing and count to 3
    • Scoot forward
    • Feet under chair
    • OT legs between theirs