Autism

A syndrome of extreme withdrawal and obsessive

behavior that manifests in early childhood. Notable
impairment in socialization, communication, activities,
and other interests. Evidence suggests that the disease
is hereditary or possibly linked to predisposing factors
of maternal rubella, encephalitis, and phenylketonuria.
Treatment includes Risperidone, behavioral therapy,
antidepressants, and antiepileptics.

What are some OT interventions for autism?
Symbolic play therapy to improve social skills, sensory
integration to reduce sensory defensiveness and
overload, and increasing body awareness through the
use of obstacle courses.

Asperger's Disorder
Symptoms are similar to autism but clients tend to
have average or above average intelligence.
Additionally, they tend to have a very narrow range of
interests, may have difficulty concentrating, experience
poor coordination, and have trouble adjusting to
changes.

Developmental Delay
This condition indicates delay in one or more of the
following developmental areas: cognitive, physical
(including vision and hearing), communication, social
or emotional, and adaptive. Can be caused by heredity,
infectious disease, birth trauma, in utero growth
retardation/drug use, and accidents.

What are some OT interventions for Developmental
Delay?
Improve hand use and function by dropping objects
into containers to practice grasp-release patterns,
improve hand-eye coordination by using games such as
ring stack/ring toss, and reduce tactile sensory
defensiveness while increasing tactile exploration
through the use of brushing, vibration, and touching of
textured materials.

Duchenne's Muscular Dystrophy
Progressive degeneration and weakening of the skeletal
muscles where muscle fibers are abnormally
vulnerable to injury, usually diagnosed soon after birth
or during early childhood. This condition is caused by a
X-linked recessive genetic defect characterized by the
absence of dystrophin and affects the muscles of the
shoulders, hips, thighs, and calves, causing a
characteristic waddling gait and toe walking.
Treatment includes PT, exercise, surgery,
corticosteroids, and orthoses to preserve mobility.

What are some OT treatments for Duchenne's
Muscular Dystrophy?
Adaptive equipment to help the person perform basic
ADLs, prevent contractures by providing AROM and
PROM, and promote energy conservation by allowing
time for rest periods.

Down's Syndrome
Genetic syndrome where the individual has an extra
copy of the chromosome 21 resulting in mild to severe
mental retardation accompanied by characteristic
facial features and distinctive physical abnormalities of
small head, slanted eyes, flat nasal bridge, protruding
tongue, short stubby fingers, simian line, and
exaggerated space between the big and little toes.

What are some OT treatments for Down's Syndrome?
Compensate for vestibular deficits by using balancing
boards, improve visual-spatial skills by playing with
nesting cups, and using a stability ball and strengthen
trunk/core muscles.

Fetal Alcohol Syndrome
Birth deficits and other associated problems in infants
born to alcoholic mothers who consume alcohol during
the gestational period. Infants are short and below
average in weight with characteristic facial features of
small eye openings with eyes spaced widely apart and a
thin upper lip. These patient may also experience CNS
problems and heart defects. Treatment is supportive
because neurological damage cannot be reversed.

What are some OT treatments for Fetal Alcohol
Syndrome?
Sensory integration building blocks, Play-Doh, and a
"sensory box", and group-based or play therapy to
focus on improving social skills and reinforce
appropriate behavior.

Athetoid CP
A subtype of CP characterized by involuntary writhing
"wormlike" muscle movements and reduced muscle
tone, and trouble with speech. Treatment includes a
multidisciplinary approach which may include
PT/ST/OT and special education. Orthopedic
intervention with casts, braces, and traction or surgery
may be required.

What are some OT treatments for Athetoid CP?
Adaptive equipment such as an adapted toilet seat or
tub/shower chair to provide postural stability during
performance of basic ADLs. Patient can also be taught
to use electronic devices to aid in socialization, leisure,
and communication performance areas. Also, play
activities that focus the activity toward the midline are
helpful in compensating for simultaneous head/trunk
movements.

Hypotonic CP
A subtype of CP characterized by decreased muscle
tone, and loose, floppy limbs. It is the CP subtype with
the worst prognosis. Joint subluxation and
contractures are common.

What are some OT treatments for Hypotonic CP?
Hippotherapy can be used to address posture, gross
motor function, and coordination. Also, adaptive
equipment can be used such as customized dining
chairs with head support to aid in the ADL of eating.

Ataxic CP
A subtype of CP characterized by lack of control over
voluntary movements, poor balance, and wide gait.

What are some OT treatments for Ataxic CP?
Prevent contractures with AROM/PROM (especially in
the lower extremities), compensate for delayed speech
and language development by providing alternative
methods to communicate with, and suggest clothing
adaptations to facilitate self-dressing.

Spastic CP
A subtype of CP characterized by hyperactive reflexes
or rapid muscle contractions and scissor gait. Can
affect one or more extremities simultaneously, usually
with hypertonicity in one extremity and hypotonicity in
the opposing muscle group and tone levels may
fluctuate.

What are some OT treatments for Spastic CP?
Brushing to reduce tactile defensiveness,
AROM/PROM to prevent contractures, and adaptive
seating to promote appropriate postural support and
stability.

CVA (Cerebrovascular Accident)
A neurologic emergency that occurs when the brain is
damaged by a sudden disruption in the flow of blood to
a part of the brain, or by bleeding inside the brain.
Symptoms include sudden severe headache, sudden
aphasia, sudden dysphagia, sudden
weakness/numbness/paralysis of the face, confusion,
visual changes, and loss of balance and coordination.
Treatments include anticoagulants, thrombolytic
agents, antiplatelet medication, and surgical repair.

What are some OT Treatments for CVA?
Environmental modification to promote spatial
awareness to orient the person toward neglected side,
i.e. placing alarm clock on the nightstand of the
affected side. Hand-over-hand guiding as well as verbal
cues can be used to guide the client toward the
unattended side. "Clock method" of food plating and
thickening agents can aid with self-feeding. Proper
positioning in bed can aid in preventing shoulder
subluxation in the case of a hemiplegic shoulder.

TBI (Traumatic Brain Injury)
This occurs when an external force injures the brain.
Symptoms can be mild (concussion) to severe
(depressed skull fractures). Treatments include bed
rest, craniotomy, and monitoring of vital signs and
behavior.

What are some OT treatments for TBI?
Promote the completion of self-care ADLs by having
the client set up items in plain view and in the
appropriate order of completion. Visual cues (labeling
items) can help orient the client. Sensory integration
techniques can also help the client improve sensory
processing (sensory box).

Multiple Sclerosis
Inflammatory disease of the CNS affecting the myelin
sheath and causes scarring of the nerve fibers. It it
thought to be autoimmune. Treatment includes
interferon, corticosteroids, immunosuppressive
therapy, muscle relaxants, and vitamins.

What are some OT treatments for MS?
Adaptive equipment to perform self-care ADLs can be
used to conserve energy. Progressive resistance
exercises to improve upper extremity strength within
the person's limits of fatigue.

Parkinson's Disease
A slowly progressive neurologic disorder characterized
by the onset of recognizable disturbances: "pill-rolling"
tremor, muscular rigidity, slowness of movement,
postural instability, and shuffling gait. Treatment
includes antidepressants, anticholinergics, dopamine-
based drugs, and deep brain stimulation.

What are some OT treatments for Parkinson's?
Compensate for tremors by using both hands
simultaneously or use one hand/extremity to stabilize
the other in order to perform ADL of eating/drinking.
Prevent contractures by stretching tight muscles and
performing AROM/PROM. Can also use a metronome
to provide a rhythm for practicing posture and balance
activities.

Myasthenia Gravis
Chronic, progressive neuromuscular disease that is
thought to stem from the presence of autoantibodies to
the acetylcholine receptor. Symptoms include extreme
muscle weakness without atrophy, drooping eyelids,
diplopia, and difficulty with talking, chewing, and
swallowing. Treatment includes plasmapheresis,
thymectomy, anticholinesterase drugs, corticosteroids,
restricted activity, Mestinon, and immunosuppression.

What are some OT treatments for Myasthenia
Gravis?
Adaptive equipment to conserve energy while
performing basic ADLs, ptosis crutches to remediate
visual problems caused by eyelid drooping, and non-
resistive exercises to increase strength and endurance.

Guillain Barre Syndrome
An acute, rapidly progressive disease of the spinal
nerves characterized by ascending paralysis and
demyelination of the nerves. It is thought to be
autoimmune in nature and treatment includes
plasmapharesis and IVIG.

What are some OT treatments for Guillain Barre
Syndrome?
Gentle, nonresistive activities and games can help
improve muscle strength and prevent contractures and
muscle atrophy. Task simplification methods can be
used to conserve energy while completing work/home
tasks.

(ALS) Amyotrophic Lateral Sclerosis
Progressive, destructive motor neuron disease that
results in muscular atrophy and is characterized by
fasciculations and weakness/atrophy in the forearms
and hands. Symptoms progress to include difficulties
with speech, chewing, swallowing, and breathing. The
disease is thought to be autosomal in nature and
treatment includes drug therapy, muscle relaxants, and
other supportive measures.

What are some OT interventions for ALS?
Hand splints, neck supports, overhead slings, or
mobile arm supports can help compensate for muscle
weakness and provide stabilization. Passive stretching
and range of motion can be used to prevent
contractures. Changing the consistencies of foods can
help facilitate swallowing.

COPD (Chronic Obstructive Pulmonary Disease)
A condition of slow and irreversible progressive airway
obstruction that encompasses several different
diseases of the lungs including chronic bronchitis,
bronchiectasis, asthma, emphysema, cystic fibrosis,
and pneumoconiosis. Etiology may be viral, allergic, or
related to foreign bodies (dust/chemicals). Treatments
include oxygen therapy, corticosteroids, antibiotics,
bronchodilators, and nebulizer treatments.

What are some OT treatments for COPD?
Provide adaptive equipment to assist the person in
performance of ADLs while conserving energy
(reachers, shoe horns, etc.). Modifications can also be
made to provide easier access to patient's daily
medications such as nebulizers and inhalers. Also,
gravity-resistive exercises can be used to increase
muscle strength and endurance.

Ischemic Heart Disease
This disease occurs when blood flow and oxygen flow
are decreased in the heart muscle. This condition may
lead to MI. Treatments include changes in diet and
lifestyle, anti-platelet agents, lipid-lowering
medications, beta blockers, ACE inhibitors, and
treatment/control of associated disorders such as
diabetes mellitus.

What are some OT treatments for Ischemic Heart
Disease?
Patient can be instructed in work simplification,
pacing, and energy conservation. Also, patient can
modify existing leisure activities to fit within permitted
energy expenditure levels. Exercises to prevent muscle
loss can be graded so that client can complete them
within their limits. They can be taught to monitor their
heart rate and bp.

Congestive Heart Failure
Acute or chronic inability of the heart to pump enough
blood throughout the body to meet the demands of
homeostasis. This usually leads to distended neck
veins, edema, liver and spleen enlargement, and
respiratory difficulties. This disease is usually the
result of MI, chronic hypertension, coronary artery
disease, COPD, cardiac valve damage, arrhythmias,
and cardiomyopathy. Treatment includes digitalis
preparations, ACE inhibitors, ARBs, diuretics,
vasodilators, aldosterone antagonists, reduced fluid
and sodium intake.

What are some OT treatments for CHF?
Patient can be instructed to modify activities to
conserve energy. Modifications can be made to help
person adhere to medication routines (medication
alarms or journals). Suggestions for possible
modifications of the home/work environment based on
ergonomics can be suggested to reduce cardiac stress.

What are some OT treatments for total hip
replacement?
Adaptive equipment can be used to help independently
perform self-care ADLs (reachers, raised toilet seats,
bath chairs, etc.). Walkers will help promote mobility
as soon as tolerated/recommended by doctor. Good
circulation can be promoted through the use of
compression stockings. Modifications to
clothing/shoes should be recommended to help client
dress themselves easily while maintaining precautions.

What are some OT treatments for total knee
replacement?
CROM to improve circulation and prevent
development of a thrombus is recommended soon after
surgery. Adaptive equipment (walker, cane) to promote
mobility should be introduced soon after surgery.
Home evaluation/modification can be performed to
assess for any risk factors that may cause re-injury to
the knee (throw rugs, uneven stairs, etc.).

What are some OT treatments for Colles' Fracture?
Splinting can be done if surgery is not required. This
will immobilize the arm and promote stability of the
arm/joints and healing. After the fracture has healed,
OT can practice ROM and grip-strengthening exercises
to help client regain function and strength lost during
the healing phase.

Congenital Hip Dysplasia
Abnormal development of the hip joint that ranges
from an unstable joint to dislocation of the femoral
head from the acetabulum that occurs shortly before,
during, or shortly after birth. Treatment is aimed at
using various devices - such as harnesses, splints, or
casts - to reduce the hip dislocation.

What are some OT treatments for Congenital Hip
Dysplasia?
Prevent dislocation of the hip joint by educating
parents on proper swaddling techniques. Adaptive
equipment (walkers) can be introduced when the
patient is ready to start being mobile. Also, upper
extremities can be used to compensate for lower
extremity weakness.

(AMC) Arthrogryposis Multiplex Congenita
Nonprogressive condition that involves multiple
congenital contractures and may affect other body
systems. The disease may involve the extremities only,
the extremities and other body systems, and
extremities along with the CNS. It is thought to be
caused by decreased movement of the fetus in the
uterus.

What are some OT treatments for AMC?
Maintain joint mobility and prevent additional
contractures with ROM exercises. Use of adaptive
equipment can be used to help complete ADLs
(adapted dining chair, strollers, etc.). Promote
achievement of gross and fine motor skills through the
use of graded grasping activities.

Osteoarthritis
Type of arthritis that results from the breakdown and
eventual loss of cartilage in one or more joints. It is the
most common type of arthritis and most people 75+
have some sort of manifestation. Heberden's and
Bouchard's nodes are classic manifestations of the
disease. Treatment includes physical and drug therapy
aimed at reducing inflammation and pain, and
maintaining joint function.

What are some OT treatments for Osteoarthritis?
Aquatic therapy is very beneficial because it increases
strength and endurance with minimal stress to the
joints. Maintain mobility by encouraging the patient to
take daily walks or by using a treadmill during OT
intervention. Compensate for pain flare ups by
suggesting patient wear loose-fitting clothing with
front openings to make dressing easier.

Carpal Tunnel Syndrome
Compression of the median nerve of the wrist,
resulting in numbness, tingling, and/or pain in the
thumb, index, middle, and radial half of the ring finger.
This is caused by repetitive overuse. Treatment
includes PT, identification/cessation of the repetitive
motion, antiinflammatory drugs, ice packs, splints,
oral corticosteroids, local injection into the affected
area, and surgical intervention if necessary.

What are some OT interventions for Carpal Tunnel?
Splinting to compensate for pain and to prevent
repetitive flexion while performing occupation.
Ergonomic modifications can be made in the work
environment. Maintain joint mobility through
activities such as crafts, games, cooking, etc.

Rheumatoid Arthritis
Chronic, inflammatory, systemic disease that affects
the joints and commonly causes deformity and
disability. "Swan Neck" deformity in the fingers is a
classic sign of the disease. It is thought to be
autoimmune and heredity may predispose some
persons. Treatment is aimed at reducing inflammation
and pain, preserving joint function, and preventing
joint deformity. This may include medication, rest,
special exercises, joint protection, antiinflammatory
meds, NSAIDs, corticosteroids, and antirheumatic
drugs.

What are some OT treatments for Rheumatoid
Arthritis?
Maintain muscle strength and joint mobility through
aerobic exercises during periods of remission.
Compensate for exacerbation periods by employing
energy conservation methods and allowing for periods
of rest. Splinting, and using the opposite hand for
twisting motions - such as opening a jar - can also be
used to prevent ulnar deviation deformity.

Describe the treatment of TMJ syndrome.
For symptoms related to rheumatoid or traumatic
arthritis, immobilization of the mandible is
recommended. For symptoms caused by inflammation,
NSAIDs, mouth guards, and hydrocortisone injections
are used. Worn or broken teeth may require
orthodontic and/or comprehensive restorative dental
treatment.

Explain the etiology and signs/symptoms of Crohn's
Disease?
Chronic inflammatory disorder of the GI tract that
causes the layers of the bowel wall to become
edematous and inflamed. Patients may have chronic
diarrhea, intermittent abdominal pain, weight loss,
malaise, nausea, anorexia, fever, and a feeling of
abdominal fullness. Etiology is unknown but it is
thought to be autoimmune and/or genetic in nature.

Describe the treatment of oral thrush?
A fungal infection that involves the oral mucosa. It is
treated with antifungal medication.

Describe the treatment and patient education for
diverticulitis?
Diverticulitis is an infection of one or more diverticula
(outpouches in the muscular layer of the large
intestine). Treatment includes antibiotics, stool
softeners, and a liquid diet. Patient education should
include explanation of the suspected etiology of the
diverticula and that a diet containing higher amounts
of roughage and water, and lower amounts of refined
foods may help prevent the inflammation and
subsequent infection(s) from reoccurring.

Describe and explain the treatment of
Gastroesophageal Reflux Disease.
Treatment includes elevating the head of the bed about
6 inches, eating a light meal no less than 4 hours
before bedtime, and antacids. If the GERD is thought
to be weight-related, the patient should be advised to
lose excess weight. Alcohol use and smoking should be
ceased. H2-receptor antagonist medications can also
be used to inhibit acid secretion and allow time for the
esophagus to heal.

Describe the treatment of renal calculi.
Treatment of kidney stones includes analgesic therapy
and hydration in an attempt to get the calculi to pass
naturally. If this is unsuccessful, surgical procedures
such as lithotripsy or electrohydraulic lithotripsy
where shock waves or lasers are utilized to break up
the calculi into smaller pieces that can be passed
naturally. If this is unsuccessful, more invasive
methods such as cystoscopy and percutaneous
nephrolithotomy are performed where a small incision
is made directly into the kidney and the stone(s) are
shattered by ultrasound or EHL.

Explain the signs/symptoms and treatment of
diabetic nephropathy.
This condition refers to changes in the kidneys
associated with diabetes mellitus. These symptoms
include urinary retention, hypertension, nausea, and
protein in the urine. UTI and pyelonephritis commonly
occur with diabetic neuropathy. Treatment includes
control of the diabetes mellitus and blood pressure,
drug intervention, balanced fluid intake, low-protein
low-fat diet, and prompt treatment of any infections
that may occur. If ESRD is a factor, patient may be a
candidate for dialysis or kidney transplantation.

Describe treatment of neurogenic bladder? What is
the difference between reflex neurogenic bladder and
autonomous neurogenic bladder?
Neurogenic bladder is a dysfunction of the urinary
bladder that consists of difficulty in emptying the
bladder or incontinence in some patients. Patients with
reflex neurogenic bladder experience a loss of
sensation, uncontrolled bladder contractions, and
spontaneous voiding of urine. Patients with
autonomous neurogenic bladder experiences a loss of
all sensations and has absent contractile functions,
which results in the inability to void without manual
pressure to the suprapubic area.
Treatment involves preventing UTIs and restoring
function to as normal as possible. Patients are
provided with devices to store urine and empty the
bladder. Catheterization and surgery are possible
interventions. Drug therapy can also be indicated in
certain cases.

Describe hemodialysis and peritoneal dialysis.
Hemodialysis involves removing impurities or wastes
from the patient's blood by using an artificial kidney
(hemodialyzer machine) that passes the blood through
a semipermeable membrane and returns the cleansed
blood back into the patient via an internal fistula. This
process takes 3 to 4 hours and can take place in the
home or hospital 2 or 3 times per week. 

Peritoneal dialysis involves using the patient's

peritoneal membrane as the means of filtering out
harmful toxins and excessive fluids. Clean dialyzing
fluid passes through the peritoneal cavity via a
permanent indwelling peritoneal catheter and wastes
are diffused across the peritoneal membrane. The
contaminated fluid is drained and subsequently
replaced with fresh fluid. This process can be
continuous ambulatory where the dialysis fluid drains
into a bag worn around the patient's waist and done 3
or 4 times a day in 15-minute intervals and once a
night. Continuous cycling involves using a cycling
machine and is performed nightly while the patient
sleeps. Intermittent peritoneal dialysis is done 3 to 5
times a week, takes several hours, and usually takes
place in a clinic environment.

Explain the treatment and patient teaching for
infectious urethritis.
Urethritis is a common form of UTI caused by
inflammation of the urethra due to the accumulation of
bacteria in the urinary tract. Treatment involves
antibiotic therapy that is organism-specific. Pyridium
is sometimes prescribed to decrease painful urination.
Patients are advised to increase fluid intake, especially
water as soon as symptoms are experienced. Female
patients should be instructed on proper wiping
procedures after toileting (front to back) to prevent
fecal matter from being brought toward the urinary
meatus causing an infection. Females should also be
advised to empty their bladder after sexual activity.

Epilepsy
A chronic brain disorder, characterized by sudden
episodes of abnormal intense electrical activity in the
brain.

Partial Seizures
Seizures that do not involve the entire brain but arise
from a localized area of the brain and effects may
involve motor twitching of the hands or face,
compulsive lip smacking, or picking at clothing with or
without aura. Patients often experience amnesia of the
attack but no actual loss of consciousness occurs.

Generalized Seizures
Seizures that cause diffuse electrical abnormality
within the brain.

Petit Mal Seizures
Consist of a brief change in the level of consciousness
indicated by staring, blinking, or blankly staring with
loss of awareness of surroundings.

Grand Mal Seizures
May begin with a loud cry, followed by falling to the
ground and loss of consciousness with rhythmic
muscle spasms followed by relaxation.

What steps should be followed if you witness
someone having a seizure?
1) Cushion head 
2) Loosen tight neckwear
3) Turn on side
4) Nothing in mouth
5) Look for I.D.
6) Don't hold down
7) As seizure ends, offer help
Brain hemispheres & functions
Left = Language, logic, & literalism;
controls right side of body
Right = Spatial/perceptual
information, metaphorical and
symbolic meanings, controls left side
of body

Star this term
You can study starred terms together


Cerebral lobes & functions
Frontal = most anterior lobe;
cognition, motor planning, working
memory, expressive language
Occipital lobe = most posterior lobe;
visual data interpretation
Parietal = posterior to frontal lobe;
sensory-perceptual interpretation
Temporal = most inferior lobe;
hearing, language comprehension,
long-term memory

Thalamus function
Sensory & motor gateway to/from
cortex - mediates between conscious
& unconscious sensory-motor
processing

Hypothalamus function
Regulates the autonomic nervous
system (hormones, temperature,
hunger, etc)

Corpus Callosum function
Allows right and left cerebral
hemispheres to communicate with
one another

Brainstem function
Controls vegetative functions -
respiration, gag reflex, swallowing
reflex, & pupillary response

Basal Ganglia function & common
dysfunctions
Controls stereotypic/automatic
motor patterns - think of riding a
bike. Works as a give & take between
excitatory and inhibitory impulses in
movement - dysfunction in this
balance results in either too much
excitation (tics, purposeless
movements, tremor) or too much
inhibition (slow movements)...both
of which are the key symptoms of
Parkinson's Disease.

Common dysfunctions are

Parkinson's Disease and ADHD.

Cerebellum function
Controls proprioception and
contributes to spatial organization &
memory

Limbic system function
Source of raw emotions before being
modulated by the cortex and stores
our long-term memory

How many vertebrae in each spinal
division?
7 cervical, 12 thoracic, 5 lumbar, & 5
sacral vertebrae

Two main enlargements of the
spinal cord and their functions
1. Brachial plexus - nerves C5 to T1 -
innervate the upper extremities
2. Lumbar plexus - nerves L1 to S3 -
innervate the lower extremeties

Know the locations of the
dermatomes

Define vertebral disc herniation
Herniation occurs when the disc
nucleus extends beyond the vertebral
disc (leaks out) which can then
compress a nerve root, causing e.g.
sciatica depending on the
dermatomal level of the nerve
impingement

Define degenerative disc disease
As vertebral discs age, their water
content decreases, decreasing their
cushioning power. This creates an
increased physical load on the spine.

Define spinal stenosis
Narrowing of the spinal canal,
usually as a result of disc herniation
(s). Most commonly occurs either in
the lumbar or cervical spine. Cervical
stenosis is less common but much
more serious. Symptoms are pain,
numbness, parasthesia, and loss of
motor control. Often treated via
laminectomy.

Define spondylolisthesis
Anterior sliding of one vertebra over
another. Occurs most often in the
lumbar spine due to injury. Often
results in kyphosis and waddling
gait.

List and define the five most
common types of vertebral
fractures
1. Posterior column fractures -
Fractures of the of the transverse or
spinous processes. Can be managed
via OT/PT & steroid injections.
2. Anterior column fractures -
Compression fractures due to flexion
injuries. Managed with medication.
3. Anterior/Middle column fractures
- Compression fracture due to
extreme downward force (e.g. a fall
landing on feet). Treatment varies
based on SC involvement.
4. Anterior/Posterior column
fractures - Flexion/distraction
combination typically from seat-belt
in a motor vehicle accident. Treated
via bracing in hyper-extension or
surgery.
5. Osteoporotic compression
fractures - Compression fractures
due to vertebral bone weakening.
Treatment focuses on pain
management.

Define laminectomy
Spinal surgery where laminae of a
vertebrae are removed to widen the
spinal canal with the hope of
decreasing pressure on the spinal
nerves. Often used to treat spinal
stenosis.

Define diskectomy
Spinal surgery to remove a herniated
vertebral disc which is placing
pressure on a spinal nerve root.

Define spinal fusion
Spinal surgery to fill the space
between vertebrae using bone
grafting and (sometimes) metal
plates and screws. The result is
increases vertebral stability and
reduced unwanted movement. Often
done after a diskectomy.

List and explain the patient
precautions after spinal surgery
No bending or twisting of the
back/trunk
Use log rolling for bed mobility
No lifting or carrying items over 10
pounds
Cervical patients should not reach
above shoulder height
Avoid sitting or standing for more
than 30 minutes without changing
position

Describe the principal guidelines
for training a post-spinal surgery
patient in functional mobility, and
body mechanics
1. Teach log-rolling for bed mobility
to avoid bending/twisting of back
2. Teach proper body mechanics for
lifting objects from floor (squat not
bend, hold objects close to body)
3. Teach posterior pelvic tilt when
standing for extended periods by
placing one foot on step stool. This
reduces lumbar strain.
4. Teach patient to stand using hip
flexors while keeping back straight.
5. Promote walking for exercise.

Name the principal blood suppliers
to the spinal cord
The anterior vertebral artery and the
two posterior vertebral arteries

Explain the concept of a spinal
reflex arc
In conscious motor activity, the PNS
receives sensory information via the
hand/foot etc and sends this
information upward to the CNS
where the cortex formulates a
conscious motor response and sends
this to the skeletal muscle in the
hand/foot etc. Spinal reflexes work
on the same principal except the
sensory information from the PNS
ascends to a motor cell body on the
ventral horn where it immediately
sends motor information downward
to the skeletal muscle for a motor
response before the sensory
information ever reaches the cortex
for conscious decision-making. Think
of when your arm withdraws after
touching a hot stove before you have
the chance to process a response.

Explain the difference between an
upper motor neuron and a lower
motor neuron
Upper motor neurons carry motor
messages from the primary motor
cortex to the skeletal muscle and
cranial nerves resulting in conscious
motor response. They are part of the
central nervous system.
Lower motor neurons carry motor
messages from the motor cell bodies
in the ventral horn to the skeletal
muscles resulting in reflexive motor
response. They are part of the
peripheral nervous system.

Explain the neurological effects of
an upper motor neuron lesion
(spinal cord injury)
Spinal cord injuries at the vertebrae
C1 to T12 are considered UMN
lesions. They result in flaccidity at
the injury level and spasticity at all
levels below the injury. This is so
because the conscious pathway is
broken (so no conscious movement is
available) but the reflexive pathway
(LMN) is still present below the
injury level. This results in non-
regulated reflexive response
(spasticity) at the levels below the
lesion site.

Explain the neurological effects of a
lower motor neuron lesion (spinal
cord injury)
Spinal cord injuries at the vertebrae
L1 and below are considered LMN
lesions. They result in flaccidity at
the level of the lesions and at all
levels below the lesion. This is so
because the entire pathway (both
upper and lower) from the CNS to
the PNS to the muscles is severed
resulting in no movement (either
active or reflexive).

Name and define the seven most
relevant cranial nerves to an
occupational therapist and how to
test them
1. The optic nerve (CN 2) - Visual
acuity and pupillary reflexes. Test by
testing visual acuity.
2. The oculomotor nerve (CN 3), the
trochlear nerve (CN 4), and the
abducens nerve (CN 6) - All control
oculomotor movement. Test by
testing oculomotor function and
looking for strabismus and
nystagmus
3. Trigeminal nerve (CN 5) -
Mediates face sensation and controls
jaw mastication. Test by testing face
sensation and deviation of jaw to
affected side with movement.
4. Vestibulocochlear nerve (CN 8) -
Hearing and balance. Test by testing
hearing, balance, and LE extensor
tone.
5. Accessory nerve (CN 11) -
Innervates sternocleidomastoid and
upper trapezius muscles. Test for the
movements of those muscles (head
rotation and lateral movements, any
shoulder movement over 90 degrees)

Define Multiple Sclerosis and list
some treatment approaches
Degenerative disease caused by
random de-myelination of the CNS.
Characterized by periods of
exacerbation and remission over
many years. Symptoms vary based on
location of de-myelination and
include numbness, parasthesia,
causalgia, abnormal gait, fatigue,
vertigo, and ataxia.

OT Treatment:
1. Increase strength and endurance
with exercise
2. Maintain coordination/decrease
tremor using weighted objects
3. Use stretching to prevent joint
deformity
4. Teach energy conservation and
work simplification
5. Cognitive retraining using memory
aids

Define Amyotrophic Lateral
Sclerosis (ALS) and list some
treatment approaches
Severe degenerative disorder of the
motor neurons. Sensory and
cognitive function remains intact as
the degeneration is completely
motor-based. Symptoms are muscle
weakness, spasticity, and
coordination deficits. Typical
progression is distal LE weakness &
cramping --> atrophy of one distal
UE --> proximal movement of
weakness/spasticity until respiratory
muscles weaken to the point of death

OT Treatment:
1. Splinting to maintain functional
position
2. Assistive devices to maintain
function
3. Diet modification and positioning
to maintain swallowing
4. Exercise and aquatic therapy to
maintain ROM and endurance (there
will be no strength increase, so do
not make this a goal)
5. Teach pain management and
energy conservation
6. Functional mobility training
7. ADL retraining

Define Myasthenia Gravis and list
some treatment approaches
Chronic auto-immune disorder
affecting the neuromuscular junction
of voluntary muscles resulting in
severe weakness and fatigue. Typical
progression is from eye and head
muscles to the limbs with periods of
exacerbation and remission.

OT Treatment:
1. Non-resistive exercise to maintain
ROM, strength, and endurance 
2. Teach energy conservation
3. Functional mobility training
4. ADL retraining
5. Recommend adaptive equipment

List the functions of the vestibular
system
Maintains equilibrium and balance
and the upright position of the head
in space in concert with the visual
and proprioceptive systems. When
one of the above is dysfunctional, the
other systems compensate...this
means that vestibular function often
goes unnoticed until either the visual
or proprioceptive senses are
occluded. The vestibular system also
influences extensor tone.

Star this term
You can study starred terms together


List the symptoms of vestibular
dysfunction
Nystagmus, tinnitus, vertigo, loss of
balance, hearing loss

Explain the Romberg Test and why
it is used
The Romberg Test is used to assess
vestibular dysfunction/balance
problems.

Procedure:
Patient stands with feet together and
shoulders flexed to 90 degrees in
front of patient. Patient closes eyes to
occlude vision, and postural sway
and arm stability is observed.
Impairment is indicated by patient
by sway or falling toward affected
side.

Explain the concept of referred pain
Unfamiliar pain in a dermatome is
referred to another area along the
same dermatome that is more
familiar. The brain cannot process
the unfamiliar pain as it is "new" so it
reverts to a familiar sensation within
the same dermatome. An example is
shoulder and medial arm pain during
a heart attack, e.g. both the heart and
shoulder lie on the T1 dermatome.

Define parasthesia
Unusual sensory feelings such as
"pins and needles"

Define dysesthesia and causalgia
Dysesthesia is unpleasant sensations
such as burning. Causalgia is intense
burning pain accompanied by skin
changes along the distribution of a
nerve.

Star this term
You can study starred terms together


Define allodynia
A condition where normally
innocuous stimuli produce pain

Play audio for this term

Explain the effects of a complete
severance of a peripheral nerve and
the approximate nerve regeneration
speed
A complete peripheral nerve
severance results in complete loss of
motor control, sensory perception,
and reflexes in the structures
innervated by the peripheral nerve.
Regeneration occurs at
approximately 1 mm per day or 1
inch per month.

Explain the effects of a peripheral
nerve compression over time and
the recovery sequence once the
compression is resolved
Peripheral nerve compression results
in a progressive loss of function in
the following order:
Proprioception and discriminative
touch --> cold --> fast pain -->heat
--> deep aching pain
Recovery occurs in the opposite
order.

Define carpal tunnel syndrome and
list some intervention approaches
Carpal tunnel syndrome is the
compression of the medial nerve of
the forearm within the carpal tunnel.
It is usually due to tendon
inflammation secondary to repetitive
movement or trauma. Symptoms are
paresthesia, numbness, and
weakness along the medial nerve.

OT Treatment:
1. Graded activities to increase hand
strength
2. Splinting at 10 to 20 degrees
extension to open the tunnel
3. Tendon-gliding exercises
4. Friction massage to prevent
adhesions
5. Maintain ROM with exercise
6. Teach body mechanics of upper
extremity
7. Adapt handles to facilitate relaxed
grip (built-up handles)

Define sciatica
Compression of the sciatic nerve in
the lumbar plexus. Causes pain and
numbness down the length of the
nerve

List and define the four types of
peripheral neuropathy
1. Mononeuropathy - damage to a
single nerve
2. Radiculopathy - impingement of a
nerve root 
3. Polyneuropathy - damage to
multiple nerves, e.g. from a disease
such as diabetes
4. Plexopathy - damage to either the
brachial or lumbar plexus

Define Guillain-Barre Syndrome
and list some intervention
approaches
Guillain-Barre Syndrome is an acute
inflammatory poly-radiculopathy
preceded by an infectious disease. It
is characterized by edema and
demyelination of peripheral spinal
nerve roots. Progression occurs in
proximal to distal in both the upper
and lower extremities beginning with
stocking and glove syndrome with
flaccid paralysis in the effected areas.
Most patients eventually recover
completely. 

OT Treatment:
(Be aware of heightened risk of
orthostatic hypotension)
1. Maintain ROM (passive and active)
through exercise
2. Use exercise to increase strength
(focus is to move patient to next
MMT level)
3. Splint to prevent deformity
secondary to muscle atrophy
4. Increase endurance through
exercise/functional tasks
5. Teach energy conservation and
joint protection

Explain synkineses and how they
develop
A synkinese is an unintended
movement resulting from the
innervation of the incorrect muscle
by the motor axon following
peripheral nerve injury and
regenerative sprouting. They are
usually short-lived and resolve once
new motor learning occurs.

Define praxis
Praxis is the ability to plan and
execute a motor task. Ideational
praxis --> Motor planning --> Motor
execution

Explain what a primitive reflex is
and list the main categories
Primitive reflexes are reflexes which
develop during gestation and infancy
and become integrated within the
CNS during the first years of life in
order to facilitate normal movement.
The two main categories are spinal
level reflexes and brainstem level
reflexes. These reflexes sometimes
re-emerge after neurological damage.

List and define the three spinal
level primitive reflexes
1. Flexor withdrawal - when the sole
of the foot is stimulated the toes
extend, leg flexes, and foot
dorsiflexes. Interferes with standing
in adults.
2. Crossed extension - when
extended leg is passively flexed, the
opposite leg extends. Interferes with
transfers in adults.
3. Extensor thrust - when the ball of
foot of flexed leg is stimulated, the
leg extends. Interferes with transfers
in adults.

List and define the five brainstem-
level primitive reflexes
1. Assymetrical tonic neck reflex -
when head is rotated, the opposite
shoulder and elbow flex in a bow and
arrow position
2. Symmetrical tonic neck reflex -
when the head flexes, the arms flex
and the legs extend. When the head
extends, the arms extend and the legs
flex
3. Symmetrical tonic labyrinthine
reflex - when placed in prone, arms
and legs flex. When placed in supine,
the arms and legs extend
4. Positive support reaction - When
foot contacts floor, legs experience
rigid extensor tone
5. Associated reactions - Voluntary
movement in one limb causes
involuntary movement in the
opposite limb

Define hemiballismus
A lesion of the basal ganglia which
causes violent thrashing of the
contralateral extremity

Define athetosis
Slow, continuous flailing of the
extremities, often with a twisting
quality to the movements, as a result
of basal ganglia lesion

Define chorea
Sudden, involuntary, jerky
movements that may appear to have
a dancing quality, as a result of a
basal ganglia lesion

Define dystonia
Muscle contractions which produce
twisting, repetitive movements and
abnormal posture. Timing varies
from lasting only seconds to lasting
hours at a time. Results from a lesion
of the basal ganglia

Define dyskinesia
Rhythmic, repetitive movements,
usually of the face and mouth, as a
result of a basal ganglia lesion

Define Parkinson's Disease and list
some treatment approaches
Parkinson's Disease results from
damage to the basal ganglia which
leads to an imbalance in the
excitatory/inhibitory impulse cycle
which regulates automatic learned
movements. Symptoms are
hypertonicity, cogwheel rigidity,
bradykinesia, resting tremor, a
shuffling gait, and a mask-like facial
appearance.
OT Treatment:
1. Exercise to maintain ROM
2. Stretch to prevent contracture
3. Improve coordination with
repetitive tasks
4. Improve balance and movement
initiation with rhythmic dance
5. ADL retraining

Define apraxia, list the four
principle types, and outline some
intervention strategies
Apraxia is a motor planning
impairment resulting in the patient
having a distorted perception of the
motor strategies needed to complete
a task. 

Types:
1. Ideational apraxia - inability to
understand motor demands of the
task
2. Ideomotor apraxia - inability to
retrieve the motor plan for the task
or to implement the motor plan for
the task
3. Dressing apraxia - inability to
dress oneself due to impairment in
body scheme perception
4. Two and three-dimensional
constructional apraxia - inability to
copy two and three dimensional
designs

OT Treatment
1. Hand-over-hand guidance during
activities
2. Forward and backward chaining to
teach functional tasks
3. Guided visualization during motor
activities
4. Copying block or pegboard designs
5. ADL retraining with visual cues -
lots of repetition!

Explain the functional difference
between a complete and incomplete
spinal cord injury
Complete - Loss of all sensory and
motor functions below the lesion
level
Incomplete - Partial preservation of
sensory and motor functions below
the lesion level with better prognosis
than a complete injury

List and define the five most
important spinal tracts to clinically
evaluate
1. Lateral corticospinal tracts -
voluntary motor control on the
contralateral side
2. Dorsal columns - discriminative
touch, pressure, vibration, and
proprioception on the contralateral
side
3. Lateral spinothalamic tracts -
conscious pain and temperature on
the contralateral side
4. Spinocerebellar tracts -
unconscious proprioception
5. Vestibulospinal tracts - facilitation
of extensor tone

Define neurogenic shock
A state of areflexia below the lesion
level that occurs immediately post-
spinal cord injury which may last for
hours, days, or weeks. Patient
experiences loss of all reflexes and
autonomic response as well as flaccid
paralysis.

Define autonomic dysreflexia
Exaggerated sympathetic reflex
response in a spinal cord injury
patient secondary to loss of the reflex
regulation pathway. Symptoms are
severe hypertension and headache,
bradychardia, vasodilation and
flushed skin, and sweating above the
lesion level. Notify doctor
immediately and elevate patient's
head while removing stimulus.
Causes: Full bladder or rectum due
to catheter overfill, pressure ulcers,
ingrown toenails, dressing changes

Define orthostatic hypotension
Sudden hypotension on response to
postural change as in moving from
supine to sitting. Presents as
dizziness, pale face, blurred vision,
and fainting. Can be prevented often
by moving gradually from supine to
sitting to standing. More common in
spinal cord injury patients of T6 and
above

Define deep vein thrombosis
A blood clot in the legs which have
potential to break away and travel to
the lungs (pulmonary embolism).
Occurs with spinal cord injury
patients and patients post- surgery of
the lower extremities.

Explain the effect of a spinal cord
injury on bladder function
Spinal cord injuries of the upper
motor neurons (C1 to T12) result in a
spastic bladder. This means there is
no voluntary control of voiding, while
the uncontrolled reflexes may result
in incontinence and the inability to
fully empty the bladder. Spinal cord
injuries of the lower motor neurons
(L1 and below) result in a flaccid
bladder. This means there is no
voiding, either voluntary or reflexive.

Explain the effect of a spinal cord
injury on bowel function
Spinal cord injuries on the levels of
S2 to S4 result in flaccid defecation
reflex which means there is no stool
evacuation. Spinal cord injuries
above the level of S2 result in spastic
defecation reflex which means that
there is no voluntary control of
defecation but reflexive control
remains and causes bowel
incontinence.

Define the general functional ability
of a patient with a spinal cord
injury at the level C1 to C3
Head and neck sensation intact.
Some neck control intact. Dependent
for respiration and ADL.

Define the general functional ability
of a patient with a spinal cord
injury at the level L4 to L5
Knee extension present but weak,
ankle dorsiflexion intact. Trunk and
upper extremity function intact.
Ambulation is possible with bilateral
LE orthotics.

Define the general functional ability
of a patient with a spinal cord
injury at the level C4
Head and neck sensation intact.
Scapular elevation and respiration
intact/weak.

Define the general functional ability
of a patient with a spinal cord
injury at the level T12 to L4
Hip and knee movement intact.
Trunk and upper extremity function
intact. Ambulation is possible with
bilateral LE orthotics.

Define the general functional ability
of a patient with a spinal cord
injury at the level C5
Head and neck sensation/control
intact. Shoulders weak but functional
to 90 degrees. Elbow flexion and
supination possible. ADL limited but
possible.

Define the general functional ability
of a patient with a spinal cord
injury at the level T6 to T12
Trunk and upper extremity function
intact. Ambulation limited but
possible with bilateral LE orthotics.

Define the general functional ability
of a patient with a spinal cord
injury at the level C6
Full shoulder and forearm
movement. Tenodesis grasp intact.
ADL possible but limited for lower
extremities.

Define the general functional ability
of a patient with a spinal cord
injury at the level T1 to T6
Some trunk control present due to
upper trunk muscle preservation.
Upper extremity function intact.
Standing is possible but difficult.

Define the general functional ability
of a patient with a spinal cord
injury at the level C7
Full shoulder, arm, and forearm
movement present. Finger extension
and tenodesis grasp present. ADL
independence is possible.

Define the general functional ability
of a patient with a spinal cord
injury at the level C8 to T1
Full shoulder, arm, and forearm
movement present. Full grasp
present. Independent ADL possible.

Define bradykinesia
Slow and labored voluntary
movement. Common in Parkinson's
Disease

Define rigidity and explain the two
most common types
Rigidity is hypertonicity of both the
agonist and the antagonist muscles
within a group causing resistance in
both degrees of ROM. Cogwheel
rigidity is characterized by a "catch
and release" during PROM. Lead
pipe rigidity is uniform constant
rigidity at all joint ranges.

Define cauda equina syndrome
Flaccid paralysis secondary to
vertebral fractures below L2

Define anterior spinal cord
syndrome
Loss of all sensation (except
proprioception) and motor function
below the injury level secondary to
anterior spinal artery injury

Define central cord syndrome
Destruction of the central spinal cord
with the periphery intact, usually due
to spinal stenosis. Results in
paralysis and sensory deficits in the
upper extremities with the lower
extremities being affected less.

Define Brown-Sequard syndrome
Damage to one side of the spinal cord
only due to trauma. Results in motor
paralysis on the side of the injury and
sensory loss on the contralateral side.

Explain the concept of a zone of
partial preservation following a
complete spinal cord injury
The zone of partial preservation is
the level of partial innervation of
dermatomes following a complete
spinal cord injury. It is usually
confined to the level directly below
the neurological level, and is where
the vast majority of any recovery will
take place, so should be the focus of
remediative therapy.

Explain how an occupational
therapist can use adaptive
equipment to help a spinal cord
patient with bowel and bladder
function
Provide a magnifying mirror and
lamp for low vision, use chaining to
train for the task, provide a dill stick
to compensate for finger paralysis.

Demonstrate routine bed
positioning for spinal cord patients
to maintain ROM and prevent pain
Trombly pp. 1180, Figure 43.6

Name some of the most important
intervention focuses for acute care
spinal cord injury patients
1. Maintaining ROM @ all joints
2. Patient pain reduction
3. Patient education on disease
progression
4. Facilitate independence in room
(provide adaptive equipment)

Demonstrate the PROM technique
to facilitate tenodesis grasp
Trombly pp. 1186, Figure 43.7 - Wrist
flexion with finger extension -->
wrist extension with finger flexion
--> repeat