Pass the NBCOT - OTR Exam, Summer 2022. Big Ideas: Describe OTs role in Driving - - Assess cognition, vision, and motor skills - Teach compensatory strategies - Train in adaptive equipment (prima... ry, secondary, and tertiary controls) - Behind-the-wheel training (stationary, closed route, open road fixed route, open road variable route) - If driving cessation is indicated, make a plan for community mobility - Report to appropriate source (physician, medical advisory board, department of motor vehicles, etc.) What is the SAFETEA-LU act? - Keyword: Safe. Legislation that funds state and local transportation agencies to address safety concerns for individual users. E.g. The Safe Routes to School Program gave federal money to states to promote safe ways for kids to bike and walk to school. In 2012 these initiatives were combined with the federal Transportation Alternatives program. How to be confident - Keep the promises you make to yourself. Earn a good reputation with yourself, and you can trust yourself to do anything. Think of something you can do, that you WILL do, to make things a little better today. Acknowledge every single emotion you're feeling. Breathe out. Let the negative ones go. They might be true, or they might not be, but you don't have time to dwell on them. Let them go. The only thing in the world you have to do right now is take one step forward. Describe the three types of driving controls: primary, secondary, and tertiary. - Primary controls are those that control the car when it is in motion (gas, brake, steering wheel) Secondary controls are used when in motion but do not control the car (horn, blinker, wipers, cruise, etc.) Tertiary controls are not used when the vehicle is in motion, but still need to be accessible to the driver (ignition, A/C, gearshift [standard only]) Clinical Reasoning: Describe the difference between procedural, interactive, and conditional reasoning - Procedural reasoning: Take the next best step. What does the client need to function? Interactive reasoning: Face-to-face collaboration. What is the client's perspective on their disability? Conditional reasoning: The big picture. Takes into account prior level of function, current level, and what the client needs to be able to do What are some adaptive equipment options for primary driving controls? (Steering, brake, gas) - - Extended pedals for shorter clients - L foot accelerator (always comes w/ a guard to block the normal accelerator) - Hand controls (control gas/brake with hands, usually push/pull a lever mounted near the steering wheel. Can also get a twisty throttle like a motorcycle. Come with guards for the foot pedals) - Alternative steering controls (usually a joystick or spinner) You are completing an initial screening with a client and want to consider their driving. What are four areas you should ask about in regard to their vehicle? - 1. Vehicle choice (how high/low is it, right features, good fit?) 2. Vehicle entry (can the client get in and out independently?) 3. Mobility device storage (Can the client stow and retrieve a walker, cane, etc.?) 4. Wheelchair accessible (Do they need a van, truck, lift, or ramp?) You are working with a client on driving. What are some compensatory strategies typically used to address impairments in vision? - - Drive on reduced speed or familiar roads - Avoid night driving or driving in bad weather - Corrective lenses (acuity), prism lenses (diplopia, visual field limitations) - Increase follow distance - Teach extra head turns and eye movements (visual field deficits) - Teach scanning techniques (oculomotor deficits) - Teach sequential strategies (E.g. SMOG: Signal, Mirror, look Over shoulder, Go) - Learn sequence of traffic lights and shape of road signs - Awareness training for neglect and its impact on driving You are working with a client on driving. What are some compensatory strategies typically used to address impairments in cognition? - - Drive on familiar roads in the daytime - Tell someone about your destination and ETA - Minimize distractions and complications - Train/make a plan for how to respond to unexpected situations You are working with a client on driving. What are some compensatory strategies typically used to address impairments in motor skills? - - Seating strategies (e.g. swivel chair, transfer device, 8-way adjustable chair) - Hand controls (Control brake/gas with UEs) - Use cruise control - Plan the route ahead of time and schedule breaks - Increase follow distance, decrease speed You are treating a client with visual neglect post-stroke. The client is anxious to return to driving and wants to know why they haven't been cleared yet. Why is the OT more likely to discuss the impact of visual neglect on driving safety than to teach compensatory strategies? - Clients with visual neglect are usually anosognostic (unable or refuse to acknowledge a defect or disorder that is clinically evident). They are usually unable to gain insight into their impairment and the effect it has on their performance, so compensatory strategies don't really work. Visual neglect usually means the client won't be able to drive safely. The recommended intervention is to discuss neglect with the client, try to increase their insight, and explain the impact on safety. Often results in driving cessation. Should on-road driving assessments be conducted in the client's personal vehicle? - No. Even though this fits with the occupational therapy principle of making interventions transferrable to the client's specific context and environment, on-road assessments should be conducted in In what ways is poor visual acuity likely to impact driving performance? - - Difficulty adapting to light and dark - Difficulty recognizing road signs at a distance - Delayed response to stimuli in the environment In what ways are visual field deficits likely to impact driving performance? - - Difficulty with lane positioning - Difficulty with timing of turns/taking them smoothly - Difficulty avoiding road hazards What is contrast sensitivity and how does it impact driving performance? - Contrast sensitivity is the ability to visually assess the luminance or color that makes an object visible. Allows you to detect differences in shade/pattern and distinguish an object from its background. E.g. When driving with impaired contrast sensitivity, it may be difficult to see an oncoming gray car on a cloudy day. What are the 4 types of attention? - 1. Sustained: sustain focus on a single task for a continuous period without distraction 2. Selective: disregard irrelevant information and focus on relevant information. Allows drivers to visually select features that differentiate objects). 3. Alternative: switch attention back and forth between tasks 4. Divided: Multi-tasking. Process >2 responses or react to >2 demands simultaneously Define "stereopsis" - Stereopsis is depth perception. It requires binocular vision, which is visual input from both eyes at once. When gathering background information to determine whether a client is fit to drive, is it appropriate to contact the Department of Motor Vehicles and ask for their driving history? - Yes, it is legal and appropriate for an OTR to request this information. It is necessary to gather information from multiple sources to determine a client's fitness-to-drive background. The OTR in this situation should do a chart review, contact the DMV, and collect collateral information. What visual acuity must a person have to be considered legally blind? - Legal blindness is considered to be best-corrected vision of 20/200 or less in the better eye. How will impaired oculomotor skills likely impact driving performance? - Results in impaired pursuits, saccades, or scanning. - Stare at road scenes too long; eye fatigue - Difficulty with lane positioning - Difficulty tracking other vehicles - May miss cues in the environment (e.g. road signs) - Difficulty sequencing mirror use, crossing traffic, going through intersections. Intervention: Teach visual search patterns and scanning techniques. Teach sequential strategies for driving maneuvers like SMOG (signal, mirror, over shoulder, go). What are the three general performance domains that underly the task of driving? - Vision, cognition, and motor skills Michon's Hierarchy of Driving categorizes driving behaviors into which three categories? (Hint: sounds miltary) - Breaks driving behaviors up into three levels with inherent difficulty and risks. 1. *Strategic* - high level decisions such as navigation, mapping, making trip decisions 2. *Tactical* - decisions made while driving such as turning, passing. scanning for weather 3. *Operational* - Basic skills used to safely control the vehicle Name the 4 types of behind-the-wheel assessments used in driving rehabilitation. - Describe ACL 1: Automatic Actions - - *TOTAL Assist* 24-hr care - *INTERNAL CUES* pain, survival instincts - *AWARENESS* - Attention span is *SECONDS* - Intervention: Sensory stimulation, music, aromatherapy, prevent contractures and bed sores Describe ACL 2: Postural Actions - - *MAX Assist* - *PROPRIOCEPTIVE CUES* - *GROSS BODY MOVEMENTS*, no cause/effect thinking - Attention span is *A FEW MINUTES* - *SAFETY* - Pt. prone to wander, impulsive, may climb out of bed, may be aggressive/strike out - Intervention: Hand-over-hand ADLs, rhythmic stim (music/rocking), hit a target, proprioceptive input (sweeping, pushing a wheelchair, etc.) Describe ACL 3 - Manual Actions - - *MOD Assist* (Running Stitch) - *TACTILE CUES* - Spontaneous movements, repetitive behaviors - Attention span is *UNDER AN HOUR* - *Performs ADLs and manipulates objects* - Intervention: Set up activities, gross motor games, simple crafts, basic cleaning and kitchen tasks Describe ACL 4: Goal Directed Actions - - *MIN Assist* (Whip Stitch) - *VISUAL CUES* - out of sight, out of mind - Completes *SIMPLE TASKS*, no new learning or problem solving - Attention span is *HOURS* - Can *LIVE ALONE AT 4.4-4.8 WITH DAILY SUPPORT* - Intervention: Skills training, games, more complex cooking and craft activities than level 3 Describe ACL 5: Exploratory Actions - - *STANDBY Assist* (Cordovan Stitch) - Can *LEARN NEW ACTIVITIES* & reason w/ trial & error. Impulsive, unable to plan or anticipate mistakes - Can *LIVE INDEPENDENTLY WITH WEEKLY CHECK-INS* (Russell) - Attention span is *DAYS/WEEKS* - Intervention: Time management, supported employment, community outings, psychosocial problem solving (e.g. role play), cook a meal with a recipe Describe ACL 6 - Planned Actions - - *INDEPENDENT* - Considers *CONSEQUENCES & PLANS WELL* - Can learn from spoken, written, or visual instruction *******************************CONTINUED********************************* [Show More]
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