Neurological Interventions in OT

A client presents with decreased memory resulting from dementia. What is the MOST EFFECTIVE strategy for a COTA® to implement to intervene with this cognitive impairment?

• Chunking or grouping similar items together

• Repeating information over and over again to oneself

• Rhyming strategies to recall information

• Cuing through cards or signs in key places

Answer explanation

Adaptations, as opposed to targeted interventions, are the most effective strategy for decreased memory in clients with dementia.

A client presents with decreased orientation. What is the most effective strategy for a COTA® to implement to assist with this cognitive impairment?

• Use an orientation poster in a common area with personal and daytime information listed.

• Provide auditory reminders throughout the day that provide basic personal and daytime information.

• Provide the client with orientation information only when requested to prevent undue anxiety.

• Allow the client to establish their own routine, even if that means allowing the client to dress for the day in the middle of the night.

Answer explanation

Visual reminders are an effective strategy for deficits in orientation. Auditory reminders may be effective, but visual reminders that can be referred to throughout the day are more effective. Sticking to already established routines is best idea.

Orthostatic hypotension is a common complication of spinal cord injury (SCI). What should the COTA® do for the client when it occurs? (a)  

• Sit the client up.
• Lean the client back.
  Call the nurse.
  Nothing; the client is not

Answer explanation

• Orthostatic hypotension occurs when the person's blood pressure drops on assuming an upright posture. Leaning the client back or helping the client lie down will help restore the blood pressure back to normal. Sitting the client up or doing nothing can lead to a further drop in blood pressure.

A COTA® is performing wheelchair training with a client with T1 spinal cord injury (SCI). What is the BEST method to instruct the client in pressure relief techniques?

• Perform weight shift by pushing up on armrests with upper extremities.

• Perform weight shift by leaning toward the feet.

• Perform weight shift by enlisting aide or caregiver assistance.

• Perform weight shift by grabbing a door handle and standing.

Answer explanation

Clients with T1 SCI should be able to shift weight and relieve pressure independently and is relieved best by lifting the lower extremities from the surface by pushing up on the armrests.

To prevent skin breakdown in a client with an incomplete spinal cord injury, which method is BEST for preventing pressure sores?

• Removing cushioning from wheelchair

• Applying moist heating pads to areas of discomfort

• Encouraging the client to remain still in bed

• Teaching the client to inspect the skin on a daily basis

Answer explanation

The client must learn to perform self-inspections regularly. Removing wheelchair cushioning can result in further skin breakdown. Moisture and heat should be avoided in sensitive areas. Lying still in bed increases risk of skin breakdown.

While reviewing the chart of a client with spinal cord injury, the COTA® notices that the client has experienced past episodes of autonomic dysreflexia in the hospital. What is the BEST recommendation the COTA® can make to the client concerning dysreflexia?

• Suggest that the OTR® treat the client because the COTA® is unfamiliar with the condition.

• Suggest the client carry an emergency card describing the condition for medical personnel and others.

• Suggest the client wear elastic stockings and abdominal binders to increase blood pressure.

• Suggest the client leave sessions early if experiencing symptoms.

Answer explanation

Clients with autonomic dysreflexia are encouraged to carry an emergency card describing the condition and treatment.

COTA®s must be aware of the symptoms of and treatment for autonomic dysreflexia because it is a life-threatening situation.

Sitting the client upright, removing anything restrictive, and alerting the MD, RN, OTR are necessary.

What is an appropriate intervention for improving motor planning in a client with a CVA? (a)  

• Graded finger movements
  Sensory stimulation

  Mirror therapy

  Task-oriented training

  Answer explanation

  Task-oriented training (occupation based activities) focuses on improving motor planning by practicing functional tasks, which can help clients with CVA re-learn skills they may have lost.

Which of the following is an effective intervention for addressing hemiparesis in CVA patients? Select the 3 best responses.

• Weightbearing on the affected side

• Mirror therapy

• Constraint-induced movement therapy

• Joint Protection Techniques

• Visual Scanning exercises

Answer explanation

Wt bearing, mirror therapy, and constraint-induced movement therapy are all effective interventions for addressing hemiparesis in CVA patients.

What is the goal of NDT (Neurodevelopmental Treatment) for CVA patients?

• To improve overall strength and coordination

• To facilitate recovery of normal movement patterns

• To improve cognitive skills

• To decrease spasticity

Answer explanation

NDT is focused on a return to normal movement patterns and avoiding maladaptive or compensatory movement patterns

Which of the following interventions would be the most appropriate to do FIRST with a client with ataxia?

• Balance exercises on unstable surfaces

• Bilateral fine motor activities

• Joint mobilization

• Trunk stabilizing exercises

Answer explanation

Trunk stability needs to be addressed first before balance or distal activities (fine motor) can happen.

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