Pediatric Skills for Occupational Therapy Assistants 5th Edition Solomon Test Bank Chapter 01: Scope of Practice Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which of the following is not a category in the Occupational Therapy Practice Framework
(OTPF)? a. Occupation b. Performance arenas c. Context and environment d. Client factors ANS: B
The Framework identifies the domains of occupational therapy (OT) as occupations, client factors, performance skills, performance patterns, contexts, environment, and activity demands. 2. Evaluation, intervention planning, and discharge planning are all part of a. assessment. b. OT process. c. referral process. d. screening process. ANS: B
The OTPF defines OT as a dynamic ongoing process that includes evaluation, intervention, and outcomes. 3. Which type of supervision involves direct contact between the occupational therapy assistant
(OTA) and occupational therapist at the worksite at least every 2 weeks? a. Close b. General c. Minimal d. Routine ANS: D
Routine supervision is direct contact between the OTA and the occupational therapist at the worksite at least every 2 weeks and interim contact through other means, such as telephone conversations or e-mail messages. 4. Which is not a means of establishing service competency? a. Continuing education b. Direct observation c. Performing standardized assessments d. Videotaping ANS: A
Service competency is the “determination, made by various methods, that two people performing the same or equivalent procedures will obtain the same or equivalent results.” Videotaping, cotreatment, observation, and performing the same assessment (and determining reliability) are considered forms of service competency.
5. A therapist planned a Christmas activity but later found out that her clients did not celebrate
Christmas. This shows the importance of examining which aspect of environment when planning activities? a. Cultural b. Physical c. Social d. Temporal ANS: A
Cultural context includes customs, beliefs, activity patterns, behavior standards, and expectations accepted by the society of which the individual is a member. For example, religious beliefs and customs. 6. Allison, a Certified Occupational Therapy Assistant (COTA) who works in a rehabilitation
hospital, interviews a new client, Jack. During her interview, Allison asks Jack what daily he wants to do when he leaves the hospital and what is important to him. She integrates these interests and values into the intervention session. What ethical principle is she addressing? a. Beneficence b. Veracity c. Autonomy d. Confidentiality ANS: C
Autonomy refers to the rights of consumers to choose and make decisions about their care. 7. Shameka is working with a close friend’s grandmother. During a recent visit, her friend asks
EeLkLa EenRc.ouCrO how her grandmother is doTinEgSinTB OA T.NSKhS am agMes her friend to visit her grandmother to find out how she is doing. Which principle of ethics does this scenario illustrate? a. Justice b. Nonmaleficence c. Veracity d. Confidentiality ANS: D
Confidentiality refers to the right to privacy of consumers. 8. Edgar bills a client for individual therapy. However, Edgar worked with three clients
simultaneously. Edgar is violating which principle of ethical behavior? a. Justice b. Nonmaleficence c. Confidentiality d. Autonomy ANS: A
The principle of justice refers to providing fair, equitable, and appropriate OT services for all clients. Edgar is not following the established procedures and is not providing individual therapy, and thus he should not bill for it. 9. Inca forgets to lock a client’s brakes on the wheelchair, and the client falls and fractures her
hip. Inca is violating which principle of ethical behavior?
a. b. c. d.
Nonmaleficence Autonomy Justice Beneficence
ANS: A
Nonmaleficence refers to the principle of not inflicting or imposing harm on consumers. By not adhering to proper procedures, Inca is causing harm. 10. Akita recently attended a workshop designed for fieldwork educators. She is now compiling a
student feedback on their experiences at the site to see how the OT and PT departments can work together with students. What type of scholarship is this? a. Application b. Integration c. Discovery d. Teaching ANS: B
Integration scholarship involves interpreting and synthesizing research findings to identify linkages across disciplines. 11. Akita prepares and presents a synopsis of the fieldwork educators’ workshop addressing how
to best work with students during a staff meeting. What type of scholarship is this? a. Teaching b. Discovery c. Integration d. Application ANS: A
Teaching scholarship is used to determine how the client best learns. 12. The OTA works to improve a child’s sitting posture so the child can write more clearly. How
is the practitioner viewing occupation? a. Occupation is the means to strengthen the child’s hands. b. Occupation is the end product—to help the child perform in school. c. Occupation is not considered in this scenario. d. Occupation is being used to help the child deal with frustration. ANS: B
Writing is an occupation. In this case the OTA is working to help the child perform in school. The OTPF advocates that practitioners focus on occupations instead of components. 13. Which statement best reflects the role of the OTA? a. The OTA may independently decide if a child will benefit from OT services. b. The OTA is responsible for conducting all aspects of an evaluation. c. The OTA is responsible for implementing the plan developed by the occupational
therapist. d. The OTA and occupational therapist collaborate on the intervention plan. ANS: D
The OTA and occupational therapist share responsibility of communicating with each other about their clients.
14. According to Vision 2025, which pillar addresses providing culturally responsive and
customized services? a. Effective b. Leaders c. Collaborative d. Accessible e. Equity, inclusion, and diversity ANS: D
Accessible refers to OT, which provides culturally responsive and customized services. 15. Occupational therapy assistants consider the child’s age and tasks associated with the stage of
development when establishing goals and conducting intervention. What context does this illustrate? a. Cultural b. Personal c. Temporal d. Social ANS: C
Temporal context refers to the child’s age and stage of development (for example, young children are beginning to separate from their parents).
Chapter 02: Family Systems Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. On what does the success of home-based intervention with children with disabilities most
depend? a. The conceptual framework guiding the intervention b. The degree to which the intervention is supported by research c. The extent to which the family is involved in its design and implementation d. The skill of the practitioner in implementing therapy activities with children ANS: C
Families have the most significant environmental influence on a young child’s life and development. OT practitioners enter children’s lives for relatively brief periods. Family members are the “constants” in most children’s lives. 2. Which statement best describes a family-centered approach to intervention? a. Families are told to put their children in the hands of specialists who will design
and implement therapy. b. Families receive special training and instruction about disabilities. c. Practitioners develop intervention plans in collaboration with families. d. Practitioners tell families how to treat and educate their children. ANS: C
Consulting with the family on the desired goals for the child and for the family and strategies for achieving them builds cToE llS abToB raA tiN onKaSnE dL trL usEt,Rw.hC icO hMare key ingredients for intervention success with families. 3. Which statement is not part of the PL 99-457 (1986)? a. Families play an important role in children’s assessments and evaluations. b. Families will defer to the professionals regarding all intervention decisions. c. Family concerns, resources, and priorities guide the development of individual
intervention plans. d. Families are mandated co-leaders on state-level advisory boards that make
recommendations about the way in which service systems are designed. ANS: B
According to PL 99-457 (1986) families and professionals work together to decide goals and provide intervention. 4. Which life-cycle event(s) is (are) considered normal for families with children? a. Child entering puberty b. Child having frequent hospitalizations c. Child attending school d. Child entering puberty and Child attending school ANS: D
Children enter puberty and go to school, but it is not typical to have frequent hospitalizations as a child.
5. Which factor allows you to predict how a family will adapt to a crisis? a. Cannot necessarily predict adaptation b. Income level c. Past experiences with crises d. Marital status ANS: A
Families react and adapt to crises in individualized and unique ways. Family adaptation is affected by the interaction of family resources (e.g., time, money, and friends) and perceptions (the way events are defined). Social support plays an extremely important role in family and individual well-being. For the families of children with disabilities, the informal support of extended family, friends, and neighbors appears to be more important than formal support received from professionals and institutions. Of course, an important factor is the way families define their resources. It is not necessarily possible to predict adaptation. 6. What is meant by reframing as a perceptual coping strategy? a. Giving up and asking someone else to take charge b. Ignoring a problem c. Redefining a problem so that there are parts of the problem that can be managed
and dealt with d. Taking up a hobby such as picture framing ANS: C
Reframing refers to redefining a situation in ways that make it more manageable. 7. What is meant by solution-focused curiosity? a. Analyzing family recorTdE sS anTdBdA ocNuK mSenEtL sL toEaR ss. esCs OfaMmily needs b. Finding out as much about a family as possible, even if it means asking personal
questions c. Sharing information with your colleagues about family problems you encounter in
practice d. Showing nonjudgmental interest in families as a way of developing solutions to
challenges ANS: D
People generally have an extremely positive response to practitioners who are nonjudgmentally interested in them and their situations. The focus should be on strengths, achievements, and desires rather than on the traditional problems and deficits. This “solution focus” allows the practitioner to support the adaptive (morphogenetic) potential of the family while not challenging or criticizing its current status. 8. What is the best approach if a family consistently misses therapy appointments? a. Give up because the family does not care about the child and does not understand
the value of therapy b. Keep the therapy goals and continue to make appointments in hopes that the family
will cooperate c. Report the family to the proper authorities to be investigated for negligence d. Reestablish the goals of therapy with family ANS: D
Collaborating with the family to clarify and develop a common set of goals helps practitioners efficiently and effectively manage the intervention planning process. 9. What is an important message to convey to families when first meeting them? a. You are interested in their child and respect what the family is doing to support
and parent their child. b. Professionals have all the answers. c. The road ahead with a child with disabilities will be hard. d. Therapy is the single most important activity in their child’s life. ANS: A
When meeting a family for the first time, it is important to show curiosity and interest about the unique ways in which the parents adapt to their child’s disability—the ingenious ways that they cope in their daily lives—without judging and evaluating. 10. Which general systems theory principle refers to the capacity for change? a. Equifinality b. Morphogenetic c. Morphostatic d. Volition ANS: B
General systems have a capacity for change, which has been named the morphogenetic (form-evolving) principle. Examples for families include gaining or losing a member through marriage, divorce, birth, or death, and the shifting roles of members through marriage, school progression, or aging. 11. What role is the OT practitT ioEnS erTuBsiA ngNK wS heEnLhL eE orRs.hC eO prM ovides the family with a schedule for
wearing a splint? a. Prescriptive b. Consultative c. Adaptive d. Resourceful ANS: A
When working directly with the child, the OT practitioner functions primarily in the prescriptive and directive role; when working with the family, he or she functions primarily in the consultative role. The prescriptive role involves instructing clients or providing advice for the client to follow. 12. What type of role is the OT practitioner using when developing a schedule for wearing a
splint that incorporates the natural family routines? a. Prescriptive b. Consultative c. Adaptive d. Resourceful ANS: B
Consulting with the family on the possibility of achieving the desired goals for the child and for the family builds collaboration and trust, which are key ingredients for intervention success with families.
13. Recent changes in service delivery have changed OT practitioners’ roles. Which of the
following is not part of the OT practitioner’s duties? a. Assessing family interests, priorities, and concerns b. Observing daily routines of children and their families c. Sharing information with families about intervention strategies d. Helping families develop a household budget to meet all their needs ANS: D
Recent changes in service delivery and implementation have resulted in an expansion of OT practitioners’ roles. Their duties now also include the following: • Assessing family interests, priorities, and concerns • Observing and gathering information about the daily routines of children and families in their homes and in the classrooms • Gathering and sharing information with families about development and intervention strategies • Implementing therapy in collaboration with parents, caregivers, and general educators 14. What is one of the first steps in establishing trust with a family? a. Identify outcomes that family members desire b. Prove that you are the expert and have the answers c. Use complicated language to impress the family d. Have a clear plan already established to show you are in charge ANS: A
One of the first steps in establishing trust is to identify the outcomes family members desire. Given that different family members have different priorities, helping them find verbal expression for outcomes that everyone can endorse builds that trust in a powerful way. Sometimes families simply have the basic desire to help their children grow and develop. Regardless of whether a family’s goals are vague, it is important to acknowledge the ways family members perceive the current situation and priorities while helping them agree on goals. 15. Which essential skill for successful intervention with families is most closely shown in the
following scenario? The OT practitioner asks the parents what they hope to achieve by coming to therapy. The practitioner seeks to determine how the child spends her day and what problems occur so that an intervention plan can be developed. a. Acknowledgment b. Continuity c. Collaborative goal setting d. Solution-focused interest ANS: C
A family that has requested or been referred for OT services has some goals, even if only vague ones, that they hope the services will help achieve. The practitioner may have a very different idea of what the goals should be. Collaborating with the family to clarify and develop a common set of goals helps practitioners efficiently and effectively manage the intervention planning process. Staying close to the agreed-upon plan while being willing to change the plan as family needs evolve builds trust, and family members perceive the therapist as being interested in helping them achieve their goals.
Chapter 03: Medical Systems Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which statement best describes the role of the occupational therapy (OT) practitioner in the
medical setting? a. Encourage the child’s performance in strength, endurance, and range of motion as related to medical diagnoses. b. Engage child in a variety of activities to promote educational performance upon discharge. c. Facilitate the child’s ability to engage in everyday occupations while supporting medical stability for discharge. d. Provide support to the medical team to assist child in being discharged to home. ANS: C
The role of the OT practitioner in the medical setting is to facilitate the infant’s, child’s, or adolescent’s ability to engage in everyday occupations while supporting medical stability for discharge. The OT practitioner facilitates community reentry by providing outpatient services and recommending community resources. 2. A 4-year-old child experienced a traumatic head injury and is hospitalized for observation.
The team is concerned that he may have motor deficits as a result and is monitoring his vital signs. Which level of care does this represent? a. Primary b. Secondary c. Tertiary d. Quaternary ANS: C
Third-level (tertiary) medical care involves the need for hospitalization. At this point in the medical care continuum, serious concerns have arisen regarding the child’s health and well-being that cannot be addressed outside the hospital. As in all other levels of medical care, caregiver education is provided. However, a greater level of responsibility for the child’s recuperation depends on interventions provided by medical personnel. 3. Which medical team member specializes in lung development? a. Cardiologist b. Gastroenterologist c. Pulmonologist d. Neurologist ANS: C
Pulmonologists (lung specialists), cardiologists (heart specialists), gastroenterologists (digestive specialists), neurologists (brain specialists), social workers, and respiratory therapists may be needed to address the needs of infants in the Neonatal Intensive Care Unit (NICU). 4. Which statement best reflects the role of the OT practitioner in working in the NICU? a. Assist nursing in medical care of infant and record weights.
b. Address positioning for function, range of motion, and age-related motor and
sensory development. c. Collaborate with parents on care of infant upon discharge. d. Provide lactation consultation as needed. ANS: B
OT practitioners may address positioning for function, range of motion, and age-related motor and sensory development. They may make recommendations regarding the environment for high-risk infants, promote positive oral experiences for feeding, and provide ongoing parent education and support related to infant behavior and development. The occupational therapist may address the infant’s feeding and swallowing concerns and provide support for breastfeeding. They also work with family members to help them adjust to their new parenting roles. 5. Which unit is a specialty unit for children who have cancer? a. Medical unit b. NICU c. Oncology unit d. Pediatric Intensive Care Unit (PICU) ANS: C
An occupational therapist or occupational therapy assistant (OTA) can be assigned to a specialty unit such as hematology/oncology units. Oncology units specialize in cancer. 6. What type of care is it called when the OT practitioner and team provide comfort care to the
dying child and family? a. Early intervention b. Medical management c. Palliative care d. Rehabilitative care ANS: C
Palliative care services are provided in large children’s hospitals on all medical units. Palliative care provides comfort care for the dying infant, child, adolescent or young adult by providing medical interventions and sensory interventions to calm and decrease anxiety. The palliative care team also supports families when the child has a life-limiting condition. The care team supports family members during the child’s hospitalization. The palliative care nurse consults with team members, including OT practitioners and medical social workers. 7. A 2 year-old child who has undergone open heart surgery yesterday is most likely to be
admitted to which setting? a. Acute rehabilitation program b. High Risk Infant Clinic c. NICU d. PICU ANS: D
The PICU is a specialized unit that addresses the critical medical needs of the infant, child, or adolescent from birth to 21 years. The pediatric intensivist, also referred to as the pediatric critical care medicine specialist, is the medical team leader of the PICU. The pediatric intensivist directs the care of the infant, child, or young adult by administering direct care or consulting with a variety of experts to determine the best course of intervention for these medically fragile, high-risk children. For example, the pediatric intensivist may consult with the pediatric infectious disease physician regarding a child with a rare or infectious disease. The following conditions may indicate the need for admission to the PICU: • Open heart surgery • Brain injury (e.g., trauma from accident, near drowning, and aneurysm) • Brain surgery (e.g., posterior fossa syndrome) • Significant life-threatening illness (e.g., transverse myelitis) • Respiratory complications resulting from diagnoses (e.g., Gullian Barre, multiple sclerosis) • Nonaccidental trauma (e.g., shaken baby syndrome) • Transfer from NICU 8. Along with monitoring respiratory rate, what else is important for OT practitioners to note
while working in a medical setting? a. Work of child’s breathing b. Intake and outtake c. Medications d. Muscle tone throughout ANS: A
Physiologic data provided by monitors and clinical observations provides an accurate clinical Mork of breathing” by observing the picture. Along with respiraTtoEryST raB teA , pNrK acStiE tioLnLerEsRn. otC eO “w ease of breathing and how the child breathes. 9. Which of the following is not a sign of respiratory stress in an infant or young child? a. Pursed lip b. Retractions between the ribs c. Rhythmic inhalation/exhalations d. Shoulder girdle elevation ANS: C
Practitioners observe the use of accessory muscles (e.g., shoulder girdle elevation) with breathing. The presence of “retractions,” which are observed as “indentations” between the ribs (intercostal retraction) or below the ribcage (subcostal retractions), may indicate stress. “Pursed lip” breathing may be indicative of increased respiratory effort. Practitioners observing signs of labored breathing modify the activity. If there is decline in oxygen saturations greater than 5%, therapy should be significantly modified or discontinued. 10. What kind of tube enables a child to receive nutrition through a tube from his nose to his
stomach? a. Gastrostomy b. Jejunostomy c. Nasoduodenal d. Nasogastric
ANS: D
If the infant or child is unable to take in enough nutrition, the child may need supplemental nutrition by nasogastric tube (into the stomach) or nasoduodenal tube (ND—into the duodenal section of the small intestine). The OT practitioner needs to be mindful of tube placement during handling to prevent dislodging the tube. Infants and children may need a gastrostomy or jejunostomy tube, which is surgically inserted into the stomach to allow longer term nutrition support. During OT, the practitioner needs to ensure the tube remains in the proper place and avoid any unnecessary pull on the tube. 11. “Client presents with developmental delays in areas of postural control, bilateral hand
function, and attention to task which interfere with his ability to engage in self-care, social participation, and play.” In which part of the note does this statement belong? a. S b. O c. A d. P ANS: C
Assessment section of the SOAP note includes the OT practitioners hypothesis regarding what is interfering with function. 12. What are the proper infection control measures for contact precautions? a. Wash hands when entering and leaving room. b. Wash hands when entering and leaving room; wear gown and gloves. c. Wash hands when entering and leaving room; wear gown, gloves, and mask. d. Wash hands when entering and leaving room; wear gown, gloves, and fit tested
respirator or special proTtE ecStiT veBm k.SELLER.COM AaNsK ANS: B
Contact precautions: Wash hands when entering and leaving the room; wear gown and gloves. 13. Which piece of equipment measures the amount of oxygen found in the blood? a. Apnea monitor b. Feeding tubes c. Pulse oximeter d. Ultraviolet lights ANS: C
Pulse oximeters measure pulse and oxygen saturation levels, that is, the amount of oxygen found in the blood.
Chapter 04: Educational Systems Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which provision of the Individuals with Disabilities Education Act gives children with
disabilities the right to be educated with their nondisabled peers? a. Americans with Disabilities Act b. Due process c. Least restrictive environment d. Zero reject ANS: C
The right to be educated in the least restrictive environment (LRE) allows a student who has special needs to be educated in a regular classroom whenever possible. He or she is entitled to interact with peers who do not have disabilities. Before this law was enacted, students with disabilities were placed in special schools with other students who had disabilities, or they were placed in self-contained classrooms in a separate school building with no opportunity to interact with typically developing peers. 2. What are special services such as occupational therapy (OT), physical therapy (PT), speech
therapy (ST), school health, and social work required for a child to benefit from a special education program called? a. Related services b. Resource room services c. Self-contained services d. Special education services ANS: A
According to the Education of the Handicapped Act (EHA), schools are required to provide related services as necessary for the student to benefit from the educational program. These services include transportation, PT, OT, ST, assistive technology services, psychological services, school health services, social work services, and parent counseling and training. 3. What must be true for OT services to be provided in the public-school system? a. The services must be functional, and outcome based. b. The services must be medically necessary. c. The services must be related to the child’s educational needs. d. There are no requirements or restrictions. ANS: C
IDEA mandates that related services support access to and progress in the general education curriculum or natural environment. 4. What is the role of the certified occupational therapy assistant (COTA) in the evaluation
phase? a. To choose the evaluation tool to be used b. To determine areas to be assessed c. To give tests within their competency level d. No participation in student evaluations
ANS: C
Occupational therapy assistants (OTAs) assist with data collection by making clinical observations and administering and scoring tests within their competency level. 5. What is the parent’s and child’s right to bring legal action against a school called? a. Due process b. LRE c. Part C of EHA d. Formal Complaint ANS: A
Parents have the right to due process—that is, voluntary mediation and impartial hearing—to resolve differences with the school that cannot be resolved informally. 6. Who determines if a child has an exceptional educational need and requires special services? a. The classroom teacher b. The individualized education program (IEP) team c. The occupational therapist d. The parents ANS: B
The IEP team determines the student’s eligibility once all evaluations are completed. Eligibility for services in public schools is based on exceptional educational need (EEN). The IEP team must consider the information obtained through the evaluations to determine whether the disability or condition interferes with the student’s ability to participate in an educational program and whether the student needs related services to benefit from an educational program. The T prE esSeT ncBeAoN f aKdSiE saL biLliE tyRd.oC esOnM ot necessarily mean that a student cannot participate in the regular educational program, nor does it mean that the student has an EEN. 7. Who are members of an IEP team? a. Professionals knowledgeable in the area of suspected need b. Professionals knowledgeable regarding curriculum c. The parents d. All are correct ANS: D
The IEP team consists of the student’s parent(s), general education teacher, and special education teacher or provider, a representative of the school district who is knowledgeable about the general curriculum, an individual who can interpret the instructional implications of evaluation results (i.e., the way certain factors may affect the student’s ability to learn), and related services personnel. 8. What is the term used to describe children who have difficulty with the direction or sequence
of letters? a. Sensory processing b. Dyslexia c. Poor penmanship d. Phonemic dysfunction ANS: B
Children with dyslexia do not see the direction of letters and have trouble sequencing. 9. What is the role of the OTA in the IEP team? a. To analyze and interpret test results independently of the occupational therapist b. To determine level of service along with the teacher and principal c. To negotiate changes in the child’s goals with the parent d. To report findings and recommendations under direction of the occupational
therapist ANS: D
The occupational therapist is responsible for completing the evaluation (with input from the OTA), interpreting the information, and presenting the report to the IEP team. 10. What type of service is the COTA providing by training the teacher to work on the
handwriting skills of an 8-year-old student with coordination difficulties? a. Direct service b. Monitoring c. Consultation d. Assistance ANS: B
OT practitioners following monitoring services create programs for the child that the teacher, other staff members, or family can follow. The practitioner contacts them frequently so that the program can be updated or altered as necessary. The personnel who follow the program are well trained and need to have a clear understanding of its goals. Billing procedures or state regulations may not acknowledge the monitoring service. Under this service, the practitioner is responsible for ensuring that the child’s goals are met. 11. Which strategy is recommended for working with parents? a. Ask parents for their concerns and input about their child. b. Do not ask for advice from them. c. Provide parents with a long list of problems. d. Wait until the evaluation to speak to them about their concerns. ANS: A
See tips for working with parents: Ask the parents what works or does not work at home. You may be able to provide them with strategies to help their child, or they may be able to help you with strategies. Children benefit when both the parents and professionals are working on the same page. 12. Which strategy is recommended for working with teachers? a. Use the lunch hour to discuss children. b. Provide the teacher with literature and a long list of things to do. c. Provide solutions and resources to teachers concerning children with special needs. d. Schedule regular hourly meetings to discuss a child’s intervention plan. ANS: C
See tips for working with teachers: Present yourself to teachers as a resource. For example, providing them with writing kits full of activities to enhance writing skills, fine motor games, visual motor games, or crafts that may be easily implemented into the classroom may be helpful. Practitioners may lead morning exercises or warm-ups to address the sensory needs of the students while modeling activities for teachers. 13. The COTA engages a child in role play activities during the OT sessions to help him learning
coping skills to deal with his frustrations so he can remain positive in the classroom. What tier of mental health services does this represent? a. Tier 1 b. Tier 2 c. Tier 3 d. Tier 4 ANS: C
Tier three interventions involve direct interventions for a child who has demonstrated areas of concern. 14. Which act encourages OT practitioners to work with children in their classroom environment
and provide support to the regular education teacher? a. PL 94-142 b. Americans with Disabilities Act c. Individuals with Disabilities Education Act—revised d. No Child Left Behind ANS: C
The EHA was renamed the Individuals with Disabilities Education Act (IDEA) in 1990; it STknBoAwNnKaS R..TChOisMact encourages OT practitioners to was revised in 1997 and isTnE ow sE IDLELAE-R work with children in their classroom environment (inclusion) and provide support to the general education teacher (integration). It also encourages schools to allow students with disabilities to work toward meeting the same educational standards as their peers. IDEA-R changed the process for the identification, evaluation, and implementation of IEPs. Under IDEA the role of the OT practitioner is to assist in the evaluation of the student to determine the need for the acquisition of a device that allows the child to remain in a regular classroom. The practitioner may consult with others on positioning, train team members, and consult with others on strategies to increase the likelihood of success in the classroom. The role of the occupational therapist under IDEA-R is to assist children with special needs so that they can participate in educational activities. 15. Which tip would help the occupational therapist work best with the teacher? a. Provide the teacher with a comprehensive list of research advocating for OT. b. Spend time in the classroom before making any suggestions. c. Schedule hourly meetings over lunch on a weekly basis. d. Discuss the intervention plan and how the teacher may assist the occupational
therapist. ANS: B
See tips for working with teachers: Spend time in the classroom without making suggestions or judging the teacher.
Chapter 05: Community Systems Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Jeannie, the Certified Occupational Therapy Assistant (COTA), is responsible for planning
and implementing an after-school exercise program for children in the second and third grades. In which of the following systems is Jeannie working? a. Family b. Community c. Educational d. Medical ANS: B
Treatment involves defining the community and working with the community in a variety of ways to support the client and enhance occupational functioning. 2. Which of the following accurately defines the term community? a. One’s natural environment b. Area with geographic boundaries c. Population with boundaries d. One’s natural environment and area with geographic boundaries e. All are correct ANS: D
One definition for community is stated as a “person’s natural environment, that is, where the TB person works, plays, and pT erE foSrm s oAtN heKr S daEiL lyLaE ctR iv. itC ieO s.M ” Another definition for community is “an area with geographic and often political boundaries demarcated as a district, county, metropolitan area, city, township, or neighborhood—a place where members have a sense of identity and belonging, shared values, norms, communication, and helping patterns.” 3. Peter, the COTA, is collaborating with the local senior citizens program to determine what
services can be implemented to promote health and wellness among the seniors who come to the center. Which of the following terms accurately describes the type of practice being provided by Peter? a. Community-based practice b. Medical-based practice c. Community-built practice d. Rehabilitative practice ANS: C
Community-based practice is defined as “skilled services delivered by health practitioners using an interactive model with clients” and community-built practice is “defined when skilled services are delivered by health practitioners using a collaborative and interactive model with clients.” 4. Which of the following is the definition of health in accordance with the World Health
Organization (WHO)? a. Absence of disease and deformity b. Absence of infirmity
c. State of well-being d. All are correct. ANS: C
The definition of health provided by the World Health Organization states that “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” 5. Which of the following is not a component of therapeutic use of self? a. Understanding client values b. Understanding personal values c. Negotiating relationships d. Documenting the child’s history ANS: D
Effective therapeutic use of self requires the therapist to have a thorough self-understanding of personal values and expectations as well as an understanding of the client’s values and cultural needs. Understanding how to negotiate a relationship most effectively by using personal skills to an advantage, while respecting the client’s values and beliefs, is a skill that one must learn to be an effective therapist. 6. Which of the following is not considered necessary for a practitioner to be culturally
competent? a. Awareness b. Knowledge c. Personal values d. Skills ANS: C
One definition of cultural competence comes from the nursing literature and defines cultural competence as a process that requires the health care professional to address five constructs: cultural awareness, cultural knowledge, cultural encounters, cultural skill, and cultural desire. 7. Mark is providing OT services for children twice monthly along with the nursing department
in a van that goes to the rural communities in his state. He provides families with information on development and shows families how to engage children in healthy movement and eating. What type of practice is this? a. Community-based practice b. Community-built practice c. Medical-based therapy d. Traditional OT ANS: B
Community-built practice is presented from a public health perspective focusing on health promotion and education. Treatment involves defining the community and working with the community in a variety of ways to support the client and enhance occupational functioning. While both types of community practice emphasize an interactive model, it is the community-built practice that involves collaboration and a strong emphasis on empowerment and wellness.
8. The occupational therapist received a referral to evaluate a child. Which is not considered in
the definition of clients by the Occupational Therapy Practice Framework (OTPF)? a. Physician who referred child b. Social environment c. Family of the child d. Child himself ANS: A
The Occupational Therapy Practice Framework: Domain and Process, 3rd Edition defines clients to include persons, groups, and populations with a community being classified as a group. When the client is a child referred for intervention, treatment may focus primarily on the child, the caregiver, or teacher. 9. When working with a child, what must the OT practitioner realize regarding therapeutic
relationships? a. The child is the most important relationship to consider. b. The practitioner must develop relationships with all those who are involved in the child’s health care. c. It is most important to establish trust with the mother. d. It is most important to stay objective and distant from the caregivers. ANS: B
When working with children, it is necessary to establish a therapeutic relationship with the child, the caretaker(s), and appropriate individuals within the community system(s) involved in the child’s health care. This requires the therapist to be acutely aware of the many different relationships that must be nurtured and maintained to promote the most successful outcomes for the child. Not only must the child be empowered but the significant figures in the child’s EeSllT. B live must be empowered asTw ThAiN s rKeS quEirLesLtE heRt.hC erO apMist to strive to maintain multiple therapeutic relationships and this may require different approaches and strategies with the different individuals involved in the child’s care. 10. What are the goals of Healthy People 2020? a. Document the need for OT services. b. Develop national health priorities. c. Increase life quality. d. Document health disparities. ANS: C
The four overarching goals of Healthy People 2020 are to increase healthy years of life for all individuals, achieve health equity and end health disparities, create healthy social and physical environments, and promote healthy behavior and quality of life. 11. What was one of the most significant shifts from hospital to community care? a. Community Health Act of 2008 b. Mental Health Center Act of 1963 c. Americans with Disabilities Act d. No Child Left Behind ANS: B
During the 1960s, there were many changes in American society. Political, social, and cultural changes resulted from the civil rights movement and activities of the time. Prolonged institutionalization of individuals with disabilities was viewed negatively and political support for deinstitutionalization increased. As a result, the Community Mental Health Center Act of 1963 was signed by President Kennedy and funds were approved to build comprehensive community mental health centers that would provide a range of mental health services. 12. What is the largest community system in which occupational therapists and OTAs are
employed? a. Hospital clinics b. Mental health centers c. School systems d. Assisted living centers ANS: C
The school system is the largest community system that employs occupational therapists and OTAs. According to the AOTA State Affairs Group (SAG), in 2017, 20% of OT practitioners worked in school systems. 13. What is it called when the practitioner hopes to learn more about the Hispanic culture? a. Cultural awareness b. Cultural desire c. Cultural skill d. Cultural encounter ANS: B
Cultural desire is the health care practitioner’s motivation to be culturally competent and motivation to work throughTE thS eT prBoA ceNssK. SELLER.COM 14. What is it called when the practitioner can remember certain traditions and practices and use
them in intervention sessions? a. Cultural awareness b. Cultural desire c. Cultural skill d. Cultural encounter ANS: C
Cultural skill is the ability to identify significant cultural data relevant to the client’s health status and therapy goals. 15. What is not considered a challenge to providing services in the community? a. Funding b. Maintaining good communication c. Cultural competence d. Natural context ANS: D
There are a variety of challenges that exist when working within a community system. The biggest challenge facing occupational therapists may be funding. Another challenge to working within community systems is the ability to maintain good communication between the practitioner and the child’s guardians, caretakers, teachers, other health care providers, and administrative or other support persons within the community system. The cultural competence of the therapist may also be a challenge when working within a community system.
Chapter 06: Principles of Normal Development Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which of the following statements is true about typical development? a. It occurs naturally. b. It is a biomechanical process. c. It is unpredictable and spontaneous. d. The rate remains the same for all children. ANS: A
The sequence of skill acquisition is predictable in the typically developing child. Although normal development is predictable and sequential, the rate of skill acquisition varies among children. 2. Which of the following statements is true about the occupational therapy (OT) practitioner’s
study of typical development? a. It has no clinical relevance unless the therapist is working with developmentally delayed children. b. It is best to memorize developmental sequences. c. It helps practitioners to problem solve developmental sequences while working with children who have special needs. d. It has limited application while working with special needs children. ANS: C
LE The OT practitioner must uTnE deSrT stB anAdNdK evSeE loL pm enRt . anCdOtM he process of typical development. The sequence of acquisition in relation to occupational performance skills and areas is the foundation for OT assessment of and intervention with children who have special needs. The sequence of skill acquisition is predictable in the typically developing child. The OT practitioner’s knowledge of normal development guides the order of expectations and choice of activities for children who are not developing typically. The practitioner relies on knowledge of typical development to assist the child in developing useful, functional skills. 3. In which context can the OT practitioner have the greatest impact? a. Chronologic age b. Environmental c. Social d. Cultural ANS: B
The physical, or nonhuman, aspects of the environment have an impact on the rate of skill acquisition in both performance and areas of occupation. For example, if a child lives in a climate that requires warm clothing, he or she will learn to don and doff a sweater or a coat more quickly than one who lives in a temperate climate. A child who lives in a two-story house will more likely learn to ascend and descend stairs before one who lives in a single-story house. 4. Which term is not a period of development? a. Adolescence
b. Early childhood c. Infancy d. Puberty ANS: D
Periods of development are intervals of time during which a child increases in size and acquires specific skills. See Box 6-2. 5. Which of the following does not describe the development progression of movement? a. Proximal to distal b. Lateral to medial c. Cephalic to caudal d. Gross to fine ANS: B
See Box 6-3. Motor development does not progress from lateral to medial (rather it is proximal to distal). When viewing the body in anatomical position proximal would include medial and distal would be lateral movement. 6. Which of the following is true about normal development? a. Development is linear. b. Development is static. c. Development is dynamic. d. Development is vertical. ANS: C
Throughout the course of normal development, changes occur in the biologic, psychological, and social systems. TherefT orE e,SdTevBeAloNpK mS enEtLisLaEdRy. naCmOicMand continuously changing process. 7. Which statement is not true concerning maturation? a. It is the process of development. b. It occurs naturally. c. It is predictable. d. It is more important than experience in the developmental process. ANS: D
Maturation and experience affect a child’s development. Maturation and experience influence the rate and direction of normal development. Maturation is the innate (natural) process of growth and development, and experience is the result of interactions with the environment. In addition, current research on motor control introduces the concepts of arousal states and motivation as additional factors that have an impact on motor learning. 8. Harry is a 10-year-old boy who is expected to make dinner each evening before his parents get
home. This expectation represents which context? a. Personal b. Social c. Cultural d. Temporal ANS: C
Cultural context includes customs, beliefs/values, standards, and expectations.
9. Which statement is not a basic principle of developmental theory? a. Development is sequential and predictable. b. Maturation and experience affect development. c. Development involves changes in biological, psychological, and social systems. d. Controlled sensory input can assist a child in organizing the central nervous
system. ANS: D
Normal development is sequential and predictable. Maturation and experience affect a child’s development. Throughout the course of normal development, changes occur in the biological, psychological, and social systems. Therefore, development is a dynamic and continuously changing process. Development progresses in two directions: vertical and horizontal. 10. You are treating Jim, a 12-month-old boy with developmental delays. He is sitting without
support, anterior propping. According to developmental theory, which skill would you work on next? a. Skipping b. Walking up stairs “marking time” c. Pulling to stand d. Sitting without support, lateral propping ANS: D
Children learn to sit with anterior propping and then lateral propping. 11. Children learn to finger-feed, use a pincer grasp, and creep simultaneously. This an example
of a. b. c. d.
cephalocaudal development. horizontal developmenT t. ESTBANKSELLER.COM spiral adaptation. vertical development.
ANS: B
A child who is simultaneously learning to finger-feed, use a pincer grasp, and creep is progressing horizontally because several different performance skills and areas (i.e., activities of daily living, fine motor skills, and gross motor skills) are involved. 12. What is the length of the typical prenatal period? a. 4 weeks b. 12 weeks c. 30 weeks d. 40 weeks ANS: D
The gestational period is also referred to as the prenatal (before-birth) period. Gestation typically lasts 40 weeks. 13. Which progression most closely reflects typical development? a. Catching a large ball using both hands and body before catching with one hand
away from body. b. Picking up small pieces of cereal with the tips of the fingers before grabbing with
the whole hand.
c. Skipping before hopping on both feet together. d. Sitting before rolling over. ANS: A
Motor development follows three basic rules. Development progresses cephalad to caudal, or head to tail. Development progresses in a proximal to distal direction, which means that children develop control of structures close to their body (such as the shoulder) before they develop those farther away from their body (such as the hand). Development progresses from gross control to fine control, which means that children gain control of large body movements before they can perform more refined movements. 14. A child learns to roll over, then crawl, then creep, and eventually walk. This is an example of
what type of development? a. Horizontal b. Lateral c. Vertical d. Dynamic ANS: C
As children progress through the various developmental levels related to the specific performance skills or areas of occupation, they are progressing vertically. For example, in the occupational area of ADLs, children learn to eat with their fingers before they learn to eat with a spoon. As children learn to roll, then crawl, and finally walk, they are progressing vertically in gross motor performance skills. 15. Which period is characterized by rapid growth, spending much time in educational settings,
and shifting of the child’s major influences from parents to peers? a. Infancy b. Early childhood c. Middle childhood d. Adolescence ANS: C
Middle childhood begins at 6 years of age and lasts until puberty, which begins at approximately 12 years of age in females and 14 years of age in males. Children in this developmental period spend most of their time in educational settings; therefore, the major influence on the child shifts from parents to peers.
Chapter 07: Development of Performance Skills Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. According to the Occupational Therapy Practice Framework (OTPF), which term refers to a
child’s gross motor, fine motor, process, and social interaction? a. Occupations b. Client factors c. Performance contexts d. Performance skills ANS: D
In the OTPF, the performance skills are motor skills (gross and fine motor skills), process skills (cognition), and social interaction skills (language and psychosocial). 2. In which period (other than fetal growth) is physical growth most rapid? a. Birth to 6 months b. Middle childhood c. Preschool d. Puberty ANS: A
During the first year, infants triple their body weight and their height increases by 10 to 12 inches. Their body shape changes, and by 4 months the sizes of their heads and bodies are more proportionate. By 12 months, average infants weigh 21 to 22 lb and are 29 to 30 inches tall. 3. Which statement best defines performance skills? a. They include the factors and underlying mechanisms enabling a child to complete
daily activities. b. They are motor movements that allow children to complete daily tasks. c. They are meaningful everyday activities. d. They are goal-directed actions that are observable as small units of engagement in
daily life occupations. ANS: D
According to AOTA (2014), performance skills refer to motor skills (gross and fine), process skills (cognition), and social interaction skills (communication and psychosocial). Performance skills are goal-directed actions that are observable as small units of engagement in daily life occupations. 4. What category of performance skill does the following observation belong: Charlie becomes
tearful when his mom takes away his toy. He reaches for it and cries. a. Motor b. Process c. Social interaction d. Emotional ANS: C
Social interaction skills refer to those needed to interact with other people and include physicality, information exchange, and relations. Examples of communication and interactions skills include gesturing to indicate intention, expressing affect, and relating in a manner that establishes rapport with others. 5. Kelly is a 4-year-old child with developmental delays. What process skill are you observing
when you see her walk up to some other children and ask if she can join them playing “house”? a. Initiates b. Disagrees c. Reaches d. Walks ANS: A
Initiates is a process skill; Reaches and Walks are motor skills; Disagrees is a social interaction skills. 6. Daniel continually drops various objects from his highchair and is fascinated by watching the
objects fall. What stage of Piaget’s sensorimotor period does this illustrate? a. Invention of New Means through Mental Combinations b. Tertiary Circular Reactions c. Primary Circular Reactions d. Secondary Circular Reactions ANS: B
During the stage called tertiary circular reactions, he or she repeatedly attempts a task and modifies the behavior to achieve the desired consequences. The repetition helps the infant understand the concept of T caE usSeT -eBffA ecNt K reSlaEtiL onLsE hiRp. s. COM 7. Which five factors are rated to make up the Apgar score? a. Heart rate, color, reflex irritability, muscle tone, and respiratory effort b. Size, color, muscle tone, movement, and mood c. Heart rate, muscle tone, size, and respiratory effort d. Crying ability, length, age, muscle tone, and respiratory effort ANS: A
The newborn’s physiological status is tested using the Apgar scoring system, which rates each of the following five areas on a scale of 0 to 2: (a) color, (b) heart rate, (c) reflex irritability, (d) muscle tone, and (e) respiratory effort. 8. How many hours of sleep to toddlers require per night? a. 6 to 8 hours b. 8 to 10 hours c. 10 to 12 hours d. 12 to 15 hours ANS: C
Toddlers and young children require 10 to 12 hours of sleep per night, whereas adolescents require 8 to 10 hours. 9. At what age are infants able to transfer objects from one hand to the other?
a. b. c. d.
3 months 5 to 6 months 7 to 9 months 12 months
ANS: C
Transferring objects from one hand to another is an example of fine motor coordination that 7-9-month-old infants develop. 10. Children in middle childhood experience a growth in vocabulary and language, in part due to
the focus on reading. This is evident in children’s ability to use all of the following except a. puns and figures of speech. b. jokes based on words with double meanings. c. secret languages with their friends. d. abstract language such as debating. ANS: D
During middle childhood, the vocabulary of children expands, partly as a result of their focus on reading. Puns and figures of speech become meaningful, and children’s jokes are based on the dual meaning of words, slang, curse words, colloquialisms, and secret languages. 11. Which of the following is true of early maturing adolescent boys? a. They are rated as less physically attractive. b. They experience greater peer acceptance. c. They are less likely to complete college. d. They try hard to seek attention. ANS: B
Boys who mature earlier than others are described more positively by peers, teachers, and themselves. They tend to be the most popular, are better at sports, and begin dating with more ease than those who mature later. 12. In which matter do peers influence adolescents more than parents? a. Academic choices b. Career c. Future aspirations d. Trying out new roles ANS: D
Even though adolescents spend more time with friends, parents still have considerable effects on them. Although adolescents seek the advice of peers on matters such as social activities, dress, and hobbies, they seek the advice of their parents on issues such as occupations, college, and money. Involvement in peer groups provides opportunities to accomplish the following: • Share responsibilities for their own affairs • Experiment with new ways of handling new situations • Learn from each other’s mistakes • Try out new roles 13. Which reflex involves a child making subtle changes in muscle tone or movement to remain
in an upright position?
a. b. c. d.
Protective extension Righting Equilibrium Moro
ANS: C
Equilibrium reactions are automatic, compensatory movements of the body parts that are used to maintain the center of gravity over the base of support when either the center of gravity or the supporting surface is displaced. These complex postural responses combine righting reactions with movements known as rotational and diagonal patterns. 14. What age range most closely represents an infant who is able to roll from prone to supine, get
into a quadruped position, has complete head control and transfers objects from hand to hand while in supine, reaches with one hand, uses radial palmar grasp, and reaches to be picked up? a. 1 to 2 months b. 6 to 8 months c. 9 to 12 months d. 13 to 18 months ANS: B
At 6 months an infant has complete head control, possesses equilibrium reactions, begins assuming quadruped position, rolls from prone to supine position, and bounces while standing. At 6 months an infant transfers objects from hand to hand while in supine position, shifts weight and reaches with one hand while in prone position, and reaches with one hand and supports self with other while seated. The 6-month infant reaches to be picked up, uses radial palmar grasp, begins to use thumb while grasping, shows visual interest in small objects, rakes small objects, and begins to hold objects in one hand. From 7 to 9 months the infant shifts weight and reaTcE heSsTwBhA ileNiKnSqE uaLdL ruEpR ed.pCoO siM tion, creeps, develops extension, flexion, and rotation movements, and increases the number of activities that can be accomplished while seated. The 7 to 9-month infant reaches with supination, uses index finger to poke objects, uses inferior scissors grasp to pick up small objects, uses radial digital grasp to pick up cube, and displays voluntary releases abilities. 15. A child turns to respond to his name being called; he questions rules of the game; and he
shows that he is having fun while playing the game. What type of performance skills does this illustrate? a. Motor b. Process c. Social interaction d. Behavioral ANS: C
Social interaction skills refer to those actions involved with engaging in activities with another person. Communication and language skills are considered part of social interaction skills. Social interaction skills include the following observable actions: approaches/starts, concludes/disengages, produces speech, gesticulates (uses socially appropriate gestures), speaks fluently, turns toward, looks, places self, touches, regulates, questions, replies, discloses, expresses emotion, disagrees, thanks, transitions, times response, times duration, matches language, clarifies, acknowledges and encourages, empathizes, heeds, accommodates, and benefits.
Chapter 08: Development of Occupations Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which oral motor behavior is not observed in 6-month-old infants? a. Incomplete lip closure b. Sucking liquid from a bottle. c. Opens mouth when spoon approaches. d. Begins Finger feeding. ANS: A
At 6 months, the infant has complete head control and more jaw stability, allowing for better control of tongue movements. This stability allows the infant to effectively suck from a bottle and take in soft food from a spoon (Table 8.1). 2. At what age is toileting training for daytime bladder control typically completed? a. 18 to 24 months b. 24 months c. 30 to 36 months d. 48 months ANS: C
Daytime bowel and bladder control are usually attained between and 3 years of age, although the child may still need assistance with difficult clothing or fasteners. 3. What can be expected of a 4-year-old? a. Ability to put on clothing; generally knowing the right and wrong side b. Ability to tie his or her shoes c. Ability to zip pants and buckle belts d. Ability to put on clothing; generally knowing the right and wrong side; Ability to
zip pants and buckle belts ANS: D
By 4 years, children recognize correct and incorrect sides; as fine motor skills progress, they can also use buckles, zippers, and laces. 4. What does the age at which children develop independent self-care skills depend on? a. Family’s cultural expectations b. Opportunities for practice c. The child’s motivation to be independent d. All are correct. ANS: D
The specific age at which young children develop independent activities of daily living (ADLs) and instrumental ADL (IADL) skills varies according to the family’s cultural expectations, opportunities for practice, and the child’s motivation for independence. 5. Which type of play is demonstrated when an infant feels his toes and puts them in his mouth? a. Sensorimotor
b. Symbolic c. Games with rules d. Constructive ANS: A
During the first 12 months, as they related to bonding with caregivers, infants’ play skills are exploratory and social. Infants explore the environment and learn through their senses, also known as sensorimotor play. They enjoy visual, tactile, auditory and movement due to the physical sensations they created. Infants will explore toys with their mouth and hands, waiving them in the air, which brings joy to the infant while also allowing for intense perceptual learning (Table 8.3). 6. Which type of play is demonstrated when an adolescent makes a model airplane? a. Sensorimotor b. Symbolic c. Games with rules d. Constructive ANS: D
Constructive play involves manipulative play (i.e., making things and putting things together, such as model airplane, craft projects, building with blocks). 7. When do infants establish a sleep-wake cycle? a. 0 to 1 month b. 3 to 4 months c. 6 to 9 months d. 9 to 12 months ANS: B
By 3 to 4 months, the infant begins to establish a sleep-wake cycle that is more in line with the parents’ sleep-wake cycle; at that point they may sleep up to 7 or 8 hours at a time. 8. Which statement does not describe play? a. Method to release surplus energy b. Attitude or mood c. Method to practice survival d. Extrinsically motivated activity ANS: D
Play has been viewed as (a) a method to release surplus energy, (b) a link in the evolutionary change from animal to human being (recapitulation theory), (c) a method to practice survival skills, and (d) an attitude or mood. 9. Which sequence describes the progression of play according to Reilly? a. Competency, achievement, exploratory b. Achievement, competency, exploratory c. Exploratory, achievement, competency d. Exploratory, competency, achievement ANS: D
Mary Reilly, a noted occupational therapist and researcher, described play as a progression through three stages: (a) exploratory behaviors, (b) competency, and (c) achievement.
10. Which scale provides a measurement of the child’s approach or attitude toward play? a. Preschool Play Scale b. Test of Playfulness c. Takata Play History d. Reilly’s stages ANS: B
Professor and occupational therapist Anita Bundy designed the Test of Playfulness to objectively measure playfulness. Bundy found that a child’s attitude about and approach to activities (i.e., playfulness) provide valuable information to occupational therapy (OT) practitioners. 11. Which OT theorist provided the profession a format to obtain play information during an
interview? a. Reilly b. Takata c. Bundy d. Knox ANS: B
Occupational therapist Nancy Takata developed Play History, a format that helps OT practitioners obtain information about a child’s play. The interview format helps describe a child’s play skills. 12. Which task represents a formal educational activity? a. Going to preschool b. Making one’s bed c. Playing school in the backyard d. Selling lemonade to friends ANS: A
Formal educational activities are structured and may be mandated by public law for specific age groups. These activities are provided in settings such as preschool programs, daycare centers, public schools, and Sunday school classes. 13. Which task represents an informal educational activity? a. Playing school in the backyard b. Making one’s bed c. Selling lemonade to friends d. Going to preschool ANS: A
Informal educational activities are less structured and occur in a variety of settings. Examples of activities in which younger children engage include playing school with an older sibling and playing a shopping game with peers. 14. What factor(s) influences a child’s participation in home management activities? a. Age b. Social environment c. Culture
d. All are correct. ANS: D
Home management activities are tasks that are necessary to obtain and maintain one’s personal and household possessions. The context significantly influences a child’s or adolescent’s participation in home management tasks. Children’s ages and their physical, social, and cultural environments determine their roles in this domain. Children and adolescents may have chores that they are expected to complete on a regular schedule. Examples of chores include making the bed, setting the dinner table, and cutting the grass. Some children and adolescents have the incentive of a monetary allowance to complete the assigned chores, whereas others do not have a monetary incentive but are still expected to assist in the maintenance of their households. 15. Which readiness skill(s) do children entering preschool programs need? a. Toileting b. Self-feeding c. Cooperative play d. All are correct. ANS: D
Children entering preschool programs need certain readiness skills, which include independence in toileting with a minimum of assistance for handling fasteners, independence in self-feeding, and cooperative play behavior. Children attending a preschool program are also expected to understand rules and schedules. They need to exhibit the beginning of behavioral and emotional maturity (i.e., controlling tempers and mood swings). 16. Which group of readiness skills describes what is expected for a child entering elementary
school? a. Sitting quietly while listening to a story, coloring and manipulating small objects, running, hopping, and jumping b. Independence in the bathroom and cafeteria, remaining in the classroom for extended periods, and remaining “on task” c. Social skills and manners; increased skill in creative thinking, problem solving, and expressive writing d. Independent learning skills and communication of ideas through writing ANS: B
Children attending elementary school are expected to have greater independence and skill in occupations than younger children. Independence in the bathroom and cafeteria is necessary. In addition to independence in eating, children in elementary school are expected to carry their lunch trays and assist in cleaning the table at the end of a meal. They must remain in their classroom chairs for extended periods. The ability to remain “on task” and attend to work while seated is termed in-seat behavior. 17. Which group of readiness skills describes what is expected in middle childhood and
adolescence? a. Sitting quietly while listening to a story, coloring and manipulating small objects, running, hopping, and jumping b. Independence in the bathroom and cafeteria, remaining in the classroom for extended periods, and remaining “on task” c. Social skills and manners; increased skill in creative thinking, problem solving,
and expressive writing d. Independent learning skills and communication of ideas through writing ANS: C
Educational readiness skills for middle childhood and adolescence build on the competencies gained during the preceding periods. Appropriate social skills and manners are expected, and increased skill in creative thinking, problem solving, and the development of ideas is required. Children learn expressive writing during this period and must be ready to perform cognitively and motorically. During middle childhood, children and adolescents also begin to seek independence. They question authority figures but must learn to work with them effectively in educational settings. 18. Which set of terms best describes the readiness skills required for setting the table? a. Sequencing, balance, dexterity, and strength b. Money management, balance, and timing c. Communication, promptness, and appropriate dress d. Endurance, communication, money management, and writing ANS: A
Setting the dinner table requires sequencing, balance, and dexterity while carrying and placing plates and silverware.
Chapter 09: Adolescent Development: Being an Adolescent, Becoming an Adult Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which age range most closely represents adolescence? a. 3 to 5 years b. 6 to 12 years c. 12 to 18 years d. 18 to 22 years ANS: C
The term adolescence defines the psychosocial and physical development that occurs during puberty. The most agreed time frame is 10 to 19 years. 2. What influences the onset of menarche? a. Race b. Socioeconomic status c. Heredity d. All are correct. ANS: D
Race, socioeconomic status, heredity, and nutrition influence menarche in girls. Ovulation typically starts 12 to 18 months after menarche and at the peak period of physical growth. 3. Which statement refers to self-efficacy? a. View of one’s body b. View of one’s physical performance c. View of one’s strengths and weaknesses d. View of how others see one ANS: B
Successful participation in these popular age-related groups can transfer beyond the context of therapy by building self-efficacy and autonomy. Furthermore, as mentioned previously, extracurricular activities are positively associated with healthy life choices. 4. What is generally true of the photographs of adolescents in teen magazines, television, and
media? a. Adolescents are generally shown as overweight. b. Media do not show a diversity of types. c. Media present a realistic body type. d. Media present an ethnic variety. ANS: B
The “ideal” is pervasive in social media and used extensively in marketing (e.g., advertisements, teen magazines, TV shows, music videos, YouTube, and the fashion industry) and in interactions with friends through social media (Tiggemann & Slater, 2017). It is not surprising that many adolescents struggle with their physical appearance and are critical of their bodies (Cash & Smolak, 2012; Croll, 2005). The images adolescents frequently see minimally represent the ethnic or physical appearance of the diverse population of American teens or their lifestyles. 5. Which statement(s) best reflects the cognitive development of adolescents? a. Thinking becomes abstract, creative, and complex. b. Adolescents have difficulty with problem solving. c. Adolescents learn the consequences of their actions. d. Thinking becomes abstract, creative, and complex; Adolescents learn the
consequences of their actions. ANS: D
The development of formal operation varies among adolescents. Their ability to think becomes creative, complex, and efficient (speed and adeptness). It is more thorough, organized, and systematic than it was in late childhood (Carswell & Stafford, 2016; Lerner & Overton 2010). Adolescents’ ability to problem solve and reason becomes increasingly sophisticated. They develop the capacity to think abstractly (i.e., they do not require concrete examples). Initially, they are less likely to apply this more sophisticated thinking to new situations (Lerner & Overton 2010; Zastrow & Kirst-Ashman, 2004). 6. For adolescents, which phase of psychosocial development is the most intense period of
development, during which peers replace parents as the primary influence and conformity with peer groups is desirabTleE?STBANKSELLER.COM a. Early adolescence b. Middle adolescence c. Late adolescence d. Early adulthood ANS: B
There is a continuation of movement toward psychological and social independence from parents. There is also an increased involvement in peer group culture, displayed in adopting peer value systems, codes of behavior, and styles of dress and appearance and demonstrating individualism and separation from family in an overt way. 7. Gerry is a 14-year-old boy who regularly breaks rules and has pierced his nose, but he holds a
steady job after school. Which statement reflects this behavior? a. Antisocial behavior b. Atypical behavior c. Destructive behavior d. Typical, contradictory behavior ANS: D
Adjusting to these physical changes and developing a healthy body image contribute to a positive self-concept. This is a process of self-evaluation related to other abilities and competencies in physical activities (e.g., competitive sports). It also involves experimenting with changing one’s physical appearance to express individuality. This can be simple and temporary, such as dying or cutting one’s hair, or a more permanent statement such as body piercing and tattoos. 8. Sixteen-year-old Harry has little interest in exploring his career or academic options. He only
wants to hang out with his friends. What term most closely describes this? a. Identity achievement b. Identity diffusion c. Identity formation d. Moratorium ANS: B
Identity diffusion, common in early adolescence, is the least defined sense of personal identity. In this identity state, an adolescent avoids or ignores the task of exploring his or her identity and has little interest in exploring options. These adolescents have yet to make a commitment to choices, interests, or values. The question “who am I” is not a significant issue. They tend to avoid or have difficulties meeting the day-to-day demands of life, such as completing schoolwork or participating in sports or extracurricular activities. 9. Sixteen-year-old Cindy has decided to go to college to become a veterinarian. She is working
in the summer to raise money for tuition. What term most closely describes this? a. Identity achievement b. Identity diffusion c. Identity formation d. Moratorium ANS: A
Identity achievement following identity moratorium is an exploration of possibilities and the healthy resolution of the quest. It is reached in the final years of high school, in college, or in the first years of work. It is characterized by a commitment to interests, values, gender and sexual orientation, political views, career or job, and a moral stance. This relatively stable sense of self enhances self-esteem. Adolescents and young adults who attain identity achievement are autonomous, exhibit mature moral reasoning, and are independent. In resolving their identity issues, they are able to change and adapt in response to personal and social demands without undue anxiety, since they are less self-absorbed, self-conscious, and less vulnerable to pressure from peers. 10. 15-year-old Bill is anxious about future goals and career choices. He is not sure whether to
pursue a job or enroll in college. He has many interests, but he does not want to do “what his parents want,” although he is not exactly sure what he wants. What term most closely describes this? a. Identity achievement b. Identity diffusion c. Identity formation d. Moratorium ANS: D
Moratorium in early and middle adolescence is emotionally healthy. It can continue into late adolescence, particularly for college students. Adolescents in this state openly explore alternatives, strive for autonomy, try out different interests, and pursue a sense of individuality. Adolescents experiencing a prolonged state of identity moratorium are likely to be undecided about the major course of study and their goals for the future and to still be actively exploring options. When the uncertainty of the moratorium state continues for too long, it is associated with anxiety, self-consciousness, impulsiveness, and depression. 11. Which statement reflects social participation in adolescents? a. Adolescents avoid cliques and enjoy solitary activities. b. Adolescents value parents and authority figures more than peers. c. Sense of belonging, acceptance, and friends play a significant role in development. d. Teen friendships involve superficial sharing and are not meaningful. ANS: C
Social integration, a sense of belonging, acceptance, and friendships, all play a significant role in an adolescent’s emotional adjustment. By engaging in a spectrum of social activities, adolescents explore and develop social roles and relationships. 12. Which strategy is not suggested when working with adolescents with cognitive impairments? a. Give specific feedback with concrete examples. b. Be consistent and use repetition. c. Select activities that match the teen’s abilities. d. Present multiple instructions at a time. ANS: D
See Box 9-3 SiEthLcLoE Mpairments are as follows: Strategies for working withTaEdSoT leB scA enNtsKw gnRit.ivCeOim • Identify how each teen learns best. Ask the teen, family, or teachers. • Identify strengths and build from existing skills. • Offer specific choices (Which of these three things would you like to do?) rather than an open-ended choice (What would you like to do?). • Select activities that match the teen’s abilities, needs, and interests. Offer activities that are age related but within the performance level of the teen (e.g., themes that deal with developmental needs such as relationships, appearance, grooming, and self-identity). • Break down activities into simple steps that are achievable, but provide a challenge. • Keep instructions simple. • Present only one instruction or step at a time. • Increase instructions only if the client consistently follows current directions. • Present directions systematically. • Use many methods of instruction (e.g., verbal instructions, demonstrations, visual cues such as pictures, step-by-step diagrams, and the hand-over-hand technique). • Help the client develop and learn a new skill in a familiar setting before using the skill in novel settings (e.g., the community). • Give specific feedback with concrete examples. Describe the correct or incorrect skill or behavior demonstrated. “Good” is an example of encouragement; it does not give clear feedback on performance. • Be consistent and use repetition.
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Do not introduce variety without a reason. Change can mean new cognitive demands for the teen and can increase the stress of learning. Flexibility and behavioral and cognitive adaptations are difficult for adolescents with cognitive impairments.
13. Which stage of adolescent development involves the teen being engrossed with self (e.g.,
interested in personal appearance), decreased compliance with parents’ rules, questioning of adults, and changing moods and behaviors? a. Early adolescence b. Middle adolescence c. Late adolescence d. All stages ANS: A
Early adolescence development is described as follows: • Being engrossed with self (e.g., interested in personal appearance) • Emotional separation from parents (e.g., reduced participation in family activities); less overt display of affection toward parents. • Decrease in compliance with parents’ rules or limits, as well as challenging of other authority figures (e.g., teachers, coaches) • Questioning of adults’ opinions (e.g., critical of and challenging their parents’ opinions, advice, and expectations); seeing parents as having faults. • Changing moods and behavior • Mostly same-sex friendships, with strong feelings toward these peers • Demonstration of abstract thinking • Idealistic fantasizing about careers; thinking about possible future self and role(s). • Importance of privacy (e.g., having own bedroom with doors closed, writing diaries, having private telephone conversations) • Interest in experiences related to personal sexual development and exploring sexual feelings (e.g., masturbation) • Self-consciousness, display of modesty, blushing, awkwardness about self and body • Ability to self-regulate emotional expression; limited behavior (e.g., not thinking beyond immediate wants or needs, therefore being susceptible to peer pressure) • Experimenting with drugs (cigarettes, alcohol, and marijuana) 14. Which fact is not true concerning American teenagers? a. Eighteen percent of adolescents are overweight. b. Depression is a significant health concern. c. Seventy-five percent of teens report using marijuana. d. Alcohol is the most widely used drug by adolescents. ANS: C
See Quick Facts: American Teenagers • In the United States, there were 20.6 million teens between the ages of 10 and 14 years and 21.2 million between the ages of 15 and 19 years. A third of the American population (31.2 million) are adolescent-young adults.
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The adolescent population is increasingly becoming more diverse racially and ethnically than the profile of the general population. White non-Hispanic adolescents make up 52.2% and this figure is expected to drop below 50% by 2050, 16.5% are Hispanic; 13.6% are Black, non-Hispanic; 3.9% are Asian; and 0.9% are American Indian/Alaskan native (www.census.gov/ipc/www/usinterimproj/). More than half of all adolescents live in suburban areas of the United States; the highest percentage of adolescents aged 10 to 19 live in the south (35.6%), followed by the Midwest, west, and east at 23.5%, 22.7%, and 18.1%, respectively. In 2004, 10.3% of adolescents between the ages of 16 and 24 years were not enrolled in school and did not have a high school credential. Dropout rates declined in 2000; more males (12%) than females (9%) dropped out of high school (2004). One-third of high school students are working. Almost 16% of all adolescents 10 to 17 years of age lived in families with incomes below the poverty threshold ($19,971 per year in 2005, for a family of four). An additional 20% of adolescents lived in families near poverty. Black and Hispanic adolescents are more likely to experience poverty. In 2005, 25% percent of white non-Hispanic adolescents, 60% of non-Hispanic Black adolescents, and 35% of Hispanic adolescents lived with a single parent (mother or father).
15. What is the occupational therapy (OT) practitioner’s role in working with adolescents with
disabilities? a. None, because OT practitioners work only with younger children. b. They help the adolescent achieve in school. c. They work on writing and motor skills as they interfere with school only. d. They facilitate the teenT ’sEtra nsBitA ioN nKtoSyEoL unLgEaRd. ulC thOoM od. ST ANS: D
Adolescents with disabilities do not always have opportunities to make choices about their appearance and to experiment with change as part of their adolescence experience. Exploring self and body image is more difficult for them, since these adolescents may depend on others for their self-care, may not have their own money, and often lack independence in community mobility. Maintaining their child-like status, rather than adjusting to the emotional and psychological changes and demands of adolescence, may be more comfortable for their parents. Within the framework of therapy, OT practitioners can facilitate experimentation and also support parents in their attempts to encourage typical adolescent activities (such as the transition to adulthood).
Chapter 10: The Occupational Therapy Process Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. For what may the Certified Occupational Therapy Assistant (COTA) be responsible? a. Administering specific assessments to clients selected by the registered
occupational therapist b. Developing the intervention plan c. Interpreting assessment findings d. Selecting assessment tools that are used during the evaluation ANS: A
The roles of the occupational therapist and occupational therapy assistant (OTA) in the occupational therapy (OT) process differ. The occupational therapist is responsible for the selection of assessments used during evaluation, interpretation of results, and development of the intervention plan. The OTA may gather evaluative data under the supervision of the occupational therapist using an approved structured format but is not responsible for the interpretation of assessment results; he or she may contribute to the process by sharing knowledge of the client gained during the assessment process. 2. Which statement best describes legitimate tools of OT practice? a. Instruments or tools that a profession uses to bring about change b. Tools that remain constant over time c. Tools commonly found in an OT clinic d. Instruments commonlyTuEseSdTtB oA evNaK luS atE eL clL ieE ntRs .COM ANS: A
Legitimate tools are the instruments or tools that a profession uses to bring about change. Legitimate tools change over time, based on the growing knowledge of the profession, technological advances, and the needs and values of both the profession and society. OT practitioners use occupations, purposeful activities, activity analysis, activity synthesis, and therapeutic use of self as tools to help children for whom they are caring. 3. Which statement best describes purposeful activity? a. A person involved in purposeful activities is more concerned with the process
required to complete the activities. b. Purposeful activities are prescribed based on analysis of their inherent characteristics. c. Purposeful activity requires active participation from the client. d. Purposeful activities are deemed by the OT practitioner to be critically important to skill development. ANS: C
Purposeful activities are defined as goal-directed behaviors or tasks that constitute occupations. An activity is purposeful if the individual is a voluntary, active participant and the activity is directed toward a goal that the individual considers meaningful. OT practitioners use purposeful activities to evaluate, facilitate, restore, or maintain individuals’ abilities to function in their daily occupations.
4. Carrie is 5 years old and unable to dress herself. Her mother must put on her clothes
completely, although Carrie is able to select the clothing by nodding to make a choice. What type of performance is this? a. Assisted performance b. Dependent performance c. Functional independence d. Supervised performance ANS: B
Dependent performance occurs when a child is unable to perform an age-appropriate task. A caregiver is required to perform the task for the child (e.g., holding a cup for a child with cerebral palsy). 5. Which statement refers to therapeutic use of self? a. The practitioner’s ability to work with a variety of clients b. The practitioner’s ability to be aware of his/her own feelings and use this
awareness to skillfully communicate with both the client and the client’s family c. The practitioner’s ability to interact with the client d. The practitioner’s ability to develop an appropriate intervention plan for the client ANS: B
Therapeutic use of self is the OT practitioner’s ability to communicate with the child and the child’s family or caregivers while being aware of his or her own personal feelings. OT practitioners use their individual characteristics to relate to families, interact with children, and help them perform occupations. As such, OT practitioners who are aware of their own strengths and weaknesses have insight into how one’s use of self can influence intervention, so they may help children and their families more effectively. 6. Which of the following statements is true about long-term goals? a. They do not need to be behavioral. b. They need to be measurable but not behavioral. c. They are the building blocks for OT intervention. d. They are the expected outcomes of OT intervention. ANS: D
Long-term goals are statements that describe the occupational goals the client should achieve after intervention. These goals should be measurable, observable, clear, and written in behavioral terms. Goals need to be very specific and address the problems that have been identified. 7. Which of the following statements is not true about short-term goals? a. They are all the things the client needs to be able to do to meet long-term goals. b. They are the statements that describe the terminal functional skills the clients
should achieve after intervention. c. They are interim steps that are used to reach long-term goals. d. They describe skills that should be mastered in a relatively short time period. ANS: B
Short-term goals are the steps the client needs to achieve so that long-term goals can be met. They are statements that describe the skills that should be mastered in a relatively short time.
8. To what does the term intervention refer? a. Therapy sessions to facilitate goals b. Progress reports, billing records, and client profile c. The evaluation, treatment plan, intervention, and discharge plan d. The plan of care ANS: A
Treatment implementation (intervention) involves working within the system through which the child is receiving therapy, working with the family, and working directly with the child. Working with the child involves planning each session, developing and analyzing activities, and then grading and adapting those activities as necessary. This process is geared toward reaching the short-term objectives first and then the long-term goals. Intervention includes the methods used to work toward meeting the goals, the media or activities used during the intervention, and documentation of the child’s progress or lack of progress. 9. Who is responsible for discharge planning? a. The registered occupational therapist b. The COTA c. The parent or caregiver d. The client ANS: A
In pediatric OT practice, discharge planning or discontinuation of intervention may be mandated by laws that govern the type of system in which the child receives OT services. Regardless of the system, the discontinuation process is the responsibility of the occupational therapist. The OTA collaborates in the discontinuation process under the supervision of the occupational therapist by reporting on the child’s progress and making suggestions regarding future needs. 10. Which approach gathers information about the child’s goals, priorities, occupational choices
and interests, habits and routines, performance, and environment? a. Biomechanical approach b. Model of Human Occupation (MOHO) c. Occupational Therapy Practice Framework (OTPF) d. Developmental approach ANS: B
Kielhofner’s Model of Human Occupation (MOHO) gathers information about volitions (e.g., the child’s or parents’ goals and priorities or occupational choices), habituation or routines (e.g., how the child spends the day), performance (e.g., the child’s physical skills and abilities), and environment (e.g., the physical layout of the home). 11. Which statement reflects the meaning of activity analysis? a. The process of determining the characteristics of an activity for use with a client b. The ability to grade and adapt an activity for intervention to meet a client’s needs c. The process of interacting with clients to allow them to succeed d. The ability of the OT practitioner to communicate with the child and family ANS: A
Activity analysis is the process of analyzing an activity to determine how and when it should be used with a client. It involves the identification of the components or client factors necessary to perform an activity. 12. Which statement best represents a top-down approach toward intervention? a. Haley will bring both hands together during play. b. Haley will pick up a Cheerio with a neat pincer grasp. c. Haley will play with a variety of toys using two hands. d. Haley will stack four cubes using both hands. ANS: C
Because OT practitioners are interested in helping children engage in their occupations, evaluation and intervention focusing on occupations are recommended. The focus of this evaluation and intervention plan is on the child’s occupations. Later in the process, the OT practitioner determines the client factors or components that are interfering with performance. However, goals for intervention can be developed on the basis of overall performance. OT practitioners are encouraged to address the concerns of parents, caregivers, and teachers when designing an intervention that focuses on occupational performance. 13. Which frame of reference is described when the practitioner identifies the level of motor skill
a child is achieving and works to help the child accomplish the next step in the sequence? a. Biomechanical b. Developmental c. Motor control d. Sensory integration ANS: B
The developmental frame oTfEreSfT erB enAcN eK isSuE seLdLtoEfRa. ciC litO atMe the child’s ability to perform age-appropriate tasks in the areas of self-care, play/leisure, education, and social participation. The developmental frame of reference targets intervention at the level at which the child is currently functioning and requires that the practitioner provide a slightly advanced challenge. Practitioners using the developmental frame of reference need a clear understanding of the logical progression of skills. 14. Which frame of reference views the child in terms of volition, habits and roles, performance,
and environment? a. Model of Human Occupation (MOHO) b. Intentional Relationship Model c. Person—Environment—Occupation d. Biomechanical ANS: A
The OT practitioner uses MOHO to guide clinical reasoning. MOHO views clients in terms of volition, habits and roles (habituation), performance capacity and considers the environment. 15. Which frame of reference targets the child’s range of motion, strength, and endurance for
occupations? a. Biomechanical b. Developmental c. Motor control d. Sensory integration
ANS: A
The goals of the biomechanical approach are to (a) assess physical limitations on the client’s ranges of motion (ROM), muscle strength, and endurance; (b) improve ROM, strength, and endurance; and (c) prevent or reduce contracture and deformities. This approach focuses on the physical limitations that interfere with the client’s ability to engage in the occupational performance areas of activities of daily living (ADLs), instrumental ADLs, sleep and rest, play and leisure activities, and work and productive activities.
Chapter 11: Anatomy and Physiology for the Pediatric Practitioner Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. What are the two major divisions of the nervous system? a. Sympathetic and parasympathetic b. Central and peripheral c. Sensory and motor d. Voluntary and involuntary ANS: B
The two major subdivisions of the nervous system are (a) the central nervous system (CNS) and (b) the peripheral nervous system (PNS). The CNS consists of the brain and the spinal cord. The PNS consists of the network of peripheral nerves, the autonomic nervous system, and the special sense organs such as eyes and ears. The autonomic nervous system consists of the sympathetic (flight or fight) and parasympathetic (rest and digest) nervous systems. 2. A physiologist is a biologist who studies a. function. b. structure. c. evolution. d. genetics. ANS: A
Physiology is the branch of biology that studies the functions of the structures of the human body. 3. What is the primary function of most epithelial tissue? a. Sensation b. Covering surfaces c. Absorption d. Connecting surfaces ANS: B
The epidermis is the thin outer layer that is composed of epithelial cells. Epithelial tissue or thin skin also lines the internal organs. The dermis is the deeper, thicker layer of skin that consists of dense connective tissue. The skin functions as the body’s first line of defense against potential invading microbes, acting as an external barrier associated with the immune system (immunological function within the Occupational Therapy Practice Framework (OTPF). It also functions in homeostasis, that is, thermoregulation (relatively stable internal body temperature) and osmoregulation (balance among water and electrolytes). The skin also has a role in sensory functions and pain. 4. Where are the eyes located on the surface of the head? a. Anterior b. Posterior c. Lateral d. Proximal
ANS: A
The eyes are located in the sockets found on the anterior surface of the head. 5. Which categories best reflect global mental functions? a. Seeing, hearing, smell, taste, and pain b. Joint mobility, muscle tone, endurance, and power c. Attention, memory, thought, and emotional d. Orientation, consciousness, energy and drive, and personality ANS: D
Global mental functions include: • Consciousness • Orientation • Temperament and personality • Energy and drive • Sleep • Level of arousal, level of consciousness • Orientation to person, place, time, self, and others • Emotional stability • Motivation, impulse control, and appetite 6. Which plane divides the body into upper and lower parts? a. Frontal b. Sagittal c. Horizontal d. Rotational ANS: C
The horizontal or transverse plane divides the body into upper and lower parts. 7. Which tissue covers and protects the body surface, lines body cavities, and consists of densely
arranged cells on the outer layer of the body? a. Nervous b. Muscle c. Connective d. Epithelial ANS: D
The epidermis is the thin outer layer that is composed of epithelial cells. Epithelial tissue or thin skin also lines the internal organs. 8. What elbow movement is shown when a child straightens his arm out to reach a toy (starting
from his hand being near his shoulder and moving it straight out in front of him)? a. Flexion b. Extension c. Rotation d. Abduction ANS: B
Extension is the straightening of a joint, which increases the angle of the joint.
9. What is the term used to describe the primary muscle that shortens, producing movement
around a joint? a. Antagonist b. Skeletal c. Co-contraction d. Agonist ANS: D
The agonist is the prime mover muscle that shortens, producing movement at a joint. 10. Which circuit allows transport and exchange between the heart and lungs? a. Pulmonary b. Systemic c. Coronary d. All are correct. ANS: A
The pulmonary circuit allows transport and exchange between the heart and lungs. Oxygen-poor blood is pumped from the right atrium to the right ventricle into the left and right pulmonary arteries going to the capillary beds at the alveoli of the lungs. Carbon dioxide diffuses out of the cardiovascular system and oxygen diffuses in. The pulmonary veins return the oxygen-rich blood to the left atrium of the heart. 11. Which statement describes the autonomic nervous system? a. It consists of the brain and spinal cord. b. It consists of a network of peripheral nerves. c. It consists of the “fight-or-flight” and “rest-and-digest” nerves. d. It controls movement oTnE lyS . TBANKSELLER.COM ANS: C
The autonomic nervous system consists of the sympathetic (flight-or-fight) and parasympathetic (rest-and-digest) nervous systems. 12. What is the purpose of the endocrine system? a. Breaks down waste products. b. Secretes hormones that travel to target cells. c. Transports hormones to the body. d. Fights diseases and disorders. ANS: B
The endocrine system is responsible for digestive, metabolic, and hormonal functions. Unlike the nervous system, the endocrine system does not necessarily communicate rapidly with other organ systems. The endocrine system contains glands that secrete hormones, which travel to target cells. 13. How many thoracic vertebrae are there? a. 1 b. 5 c. 7 d. 12 ANS: D
To remember the number of vertebra in the first three regions of the vertebral column, know that breakfast is at seven in the morning, lunch is at noon, and dinner is at five in the afternoon. This translates into 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. The vertebrae of the sacrum and coccyx are fused, and the number of vertebrae can be variable. 14. When standing in anatomic position, where are the hands in relation to the shoulder? a. Anterior b. Distal c. Posterior d. Proximal ANS: B
Distal means “farther away from the body.” The shoulder is proximal to the hand, and the hand is distal to the elbow. 15. What is homeostasis? a. Balancing water and electrolytes b. Maintaining a steady heart rate and blood pressure c. Maintaining a stable internal body temperature d. Creating an external barrier to microbes ANS: C
Homeostasis is thermoregulation (relatively stable internal body temperature) and osmoregulation (balance among water and electrolytes).
Chapter 12: Neuroscience for the Pediatric Practitioner Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which one is not considered part of the human nervous system? a. Autonomic b. Central c. Peripheral d. Motor ANS: D
The human nervous system can be divided into three parts: the central nervous system, the peripheral nervous system, and the autonomic nervous system. 2. What type of damage is characterized by hyperactive deep tendon reflexes, spastic paralysis or
weakness as in cerebral palsy, hydrocephalus, or shaken baby syndrome? a. Autonomic nervous system b. Central nervous system c. Motor system d. Peripheral nervous system ANS: B
Central nervous system damage results in upper motor neuron pathology which is characterized by hyperactive deep tendon reflexes and spastic paralysis or weakness. Pediatric examples include cerebral palsy, developmental dyspraxia, hydrocephalus, shaken baby syndrome and other reasonTs E foSr TtrB auAmNaK tiS cE brL aiL nEinRju.rC ieO s,Mand spina bifida. 3. Which statement reflects the dynamic and ever-changing nature of the brain? a. Cell migration b. Neuroplasticity c. Physiology d. Proliferation ANS: B
Neuroplasticity is a term used to describe the dynamic and ever-changing nature of the brain. The brain is use dependent, meaning that the way you use it is reflected in its structural and functional architecture. 4. Which statement reflects what occurs in therapy in regard to neurons? a. Brain neurons do not change over time. b. Damaged neurons can be repaired. c. Destroyed neurons are replaced with new ones. d. Neurons gain new synapses. ANS: C
While the neurons that have been destroyed cannot be replaced with new ones, the functions that the damaged neurons had can be relearned through the development of new synapses. Synaptogenesis, the ability to gain new synapses, is a function that stays with us throughout our lives.
5. How does a child with neurological damage (i.e., cerebral palsy) learn to do things with his
peers? a. Repetition of task b. Passive movement c. Active repetition d. All are correct. ANS: C
When the brain of a child is damaged, such as from cerebral palsy, surrounding healthy neurons can take on the functions of the damaged neurons. One factor that will enhance this plasticity is repetition of the task that is being learned. Neurons are most stimulated when a child repeats active voluntary movements. 6. What deficits is a child with frontal lobe damage most likely to present? a. Memory and emotions b. Personality, judgment, and motor control c. Touch, pressure, and tactile discrimination d. Visual and auditory perception ANS: B
The frontal lobe houses personality, judgment, insight, and motor control. 7. What deficits is a child with parietal lobe damage most likely to present? a. Memory and emotions b. Personality, judgment, and motor control c. Touch, pressure, and tactile discrimination d. Visual and auditory peT rcE epStiToB n ANKSELLER.COM ANS: C
The parietal lobe’s primary function is to make sense out of the sensations coming from the body that relate to touch, pressure, tactile discrimination, and conscious proprioception. 8. What deficits is a child with occipital/temporal lobe damage most likely to present? a. Memory and emotions b. Personality, judgment, and motor control c. Touch, pressure, and tactile discrimination d. Visual and auditory perception ANS: D
The occipital lobe receives and makes sense from what one is seeing and the temporal lobe from what one is hearing. 9. What is the pattern of cortical representation in the motor homunculus for fine motor skills as
compared to the area for gross motor skills? a. Equal amount of cortical representation b. Greater amount of cortical representation c. Smaller amount of cortical representation d. This has not been calculated. ANS: B
Areas in the motor homunculus responsible for fine motor skills, for example, your thumbs or tongue, have more cortical representation than areas for gross motor skills. This pattern is because fine motor activities take a smaller innervation ratio of neurons to motor units, thus requiring more gray matter for the complexity of the movement. 10. A child showed prolonged eye movement after being spun around 10 times. Which statement
best describes this response? a. Absent nystagmus illustrating impaired cranial nerve II b. Dysfunctional vestibular system illustrating hypertonia c. Oculomotor deficit illustrating hypoactive vestibular system d. Prolonged nystagmus illustrating hyperactive vestibular system ANS: D
Oculomotor difficulties can result from damage to cranial nerve III, IV, or VI, the oculomotor, trochlear, and abducens, respectively. These cranial nerves control eye movements and reactions of the pupils in response to light. A major input into these cranial nerves comes from the vestibular system. This input allows the eyes to stay fixed on an object when the head is moving in rotation. Your eyes will turn opposite to the direction of the rotary movement of the head. Occupational therapists can use this relationship to evaluate the intactness of the vestibular system by spinning a child and looking for the oculomotor reaction. Nystagmus, that involuntary back and forth, rhythmic movement of the eyes, is a normal reaction to rotation. Children who show little or no nystagmus may have a hypoactive vestibular system, and children who show excessive movement may have a hyperactive vestibular system. 11. How many lumbar vertebrae are there? a. 1 b. 8 c. 5 d. 12 ANS: C
There are 31 pairs of spinal segments, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. 12. Which ascending pathway is responsible for enabling a child to feel objects within his or her
hand (without using vision)? a. Dorsal column medial lemniscus (DCML) b. Lateral corticospinal pathway c. Lateral spinothalamic tract d. Vestibulospinal ANS: A
One of the primary ascending pathways is the dorsal column medial lemniscus (DCML). This pathway carries touch, vibration, tactile discrimination, and stereognosis, which is the ability to identify objects placed in the hand using only tactile clues. Without this pathway being intact, a client may have poorer motor control since the sensory information is inadequate. Think of trying to pick up small pegs while wearing a pair of gloves. 13. A child who shows difficulty controlling the speed and accuracy of his or her movements and
shows inaccurate reach and grasp is showing difficulty with what area of the brain? a. Brainstem
b. Cerebellum c. Cerebrum d. Peripheral nervous system ANS: B
When the motor cortex initiates a movement, for example, to pick up a pencil and write one’s name in a small box on a form, the cerebellum plays a critical role in the successful execution of this task. It helps some motor units to relax while others contract, making the movement smooth. The cerebellum helps control the speed of the movement and makes adjustments so one can write in the correct space with the correct size print for the space. It monitors the position of the body and therefore plays a huge role in keeping one balanced in the position or postures needed for walking, running, sitting, etc. It also has an important role in learning the complex sequences necessary for completing a motor task, and it is especially critical when the motor task requires speed and dexterity. 14. What region has the primary function of increasing the surface area for the neuron? a. Axon b. Cell body c. Dendrite d. Golgi ANS: C
The three regions of the neuron include the cell body (soma), dendrites, and an axon. The soma contains the nucleus and the organelles and has large attachments that branch repeatedly from it, known as the dendrites. The principle function of the dendrites is to increase the surface area for the neuron to receive most of its synaptic connections. 15. Which receptor is responsiT blEeSfoTrBpA roN viKdS inE gL coLnEtiR nu.oC usOiM nformation on midrange position
sense? a. Alpha motor neuron b. Extrafusal muscle fibers c. Golgi tendon d. Muscle spindle ANS: D
Accurate interpretation of movement starts with receptors such as the muscle spindles, Golgi tendon organs, and several of the tactile mechanoreceptors. By far, the most used receptor for position sense, especially in midranges of the joint, is the muscle spindle. As a muscle contracts, one needs continuous information on the length, tension, and speed of the contraction. Every striated muscle contains numerous of these spindle-shaped receptors that lie parallel with the main contractile element of a muscle, the extrafusal muscle fibers. Muscle spindles have tendons that merge with the tendons or fascia of the muscle that surround the spindles.
Chapter 13: Pediatric Health Conditions Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Carolyn is a 5-year-old with a cardiac disorder. She has trouble playing with her peers at day
care. Which client factors (associated with cardiac disorders) may be interfering with her play? a. Decreased range of motion (ROM) b. Increased muscle tone c. Inability to process sensory information d. Poor strength and endurance ANS: D
Children with congenital heart defects allocate more energy for basic physiologic function leaving less energy available for developmental tasks. A referral of children with cardiac disorders to the pediatric occupational therapy (OT) practitioner is typically based on secondary deficits associated with the child’s primary diagnosis. Oral-motor and feeding issues or sensory processing problems may necessitate a referral to a pediatric occupational therapist. 2. Mira is a 10-year-old with juvenile rheumatoid arthritis (JRA). She has trouble completing her
work at school. Which client factors (associated with JRA) may be interfering with her educational work? a. Decreased ROM b. Increased muscle tone c. Inability to process sensory information d. Poor strength and endurance ANS: A
Children with JRA experience exacerbations and remissions of symptoms. During exacerbations, or flare-ups, symptoms worsen, and the joints become hot and painful; joint damage can occur. During remissions, or pain-free periods, children with JRA may resume typical activities. Joint protection techniques and energy conservation techniques are encouraged at all times so that these strategies become a habit. However, these children may have functional limitations due to contractures and deformities. The OT practitioner helps educate these children on how to protect their joints, compensate for decreased ROM during exacerbations, and complete activities with less stress on the joints (joint protection or energy conservation techniques). Furthermore, the OT practitioner provides these children with stretching and movement activities to maintain the functioning of the joints and prevent contractures. The OT practitioner may prescribe adaptive equipment or technology to help these children engage in everyday activities. 3. Which disorder is not considered a pulmonary disorder? a. Asthma b. Cystic fibrosis c. Chronic obstructive pulmonary disease d. Cerebrovascular accident (CVA) ANS: D
Pulmonary disorders are conditions that involve the lungs and one’s ability to breathe. The most common pulmonary diseases affecting children are asthma and cystic fibrosis. Children with pulmonary diagnoses are referred for OT when they experience problems that interfere with activities of daily living (ADLs), instrumental ADLs (IADLs), sleep and rest, education, play, and social participation. CVA is a neurological condition. 4. Karen, the Certified Occupational Therapy Assistant (COTA), is concerned that Tom fell off
the balance beam while in OT. He complained of pain, and Karen noticed some swelling and tenderness on his ankle. What is the most likely diagnosis for this injury? a. Contusion b. Crush injury c. Dislocation d. Sprain ANS: D
A sprain is a traumatic injury to the tendons, muscles, or ligaments around a joint and is characterized by pain, swelling, and discoloration. Sprains can occur when children or adolescents lose their balance and consequently use a protective response that makes the wrist and ankle the most vulnerable joints for injury. Sprains are most frequently seen in the ankles and wrists. Most do not require emergency medical attention or OT intervention. 5. Which statement most closely reflects the OT intervention for a child who has a traumatic
brain injury (TBI)? a. Intervention is aimed at maintaining skills. b. Intervention is short and focuses on motor impairments. c. Intervention targets motor, cognitive, and emotional changes. d. Intervention targets senTsE orS y TpB roA ceNsK sinSgEsLkL illE s.R.COM ANS: C
Children and adolescents with TBIs are referred for OT because of their inability to function in the areas of occupation (ADLs, IADLs, education, work, play, and social participation). The trauma to the brain typically results in motor, cognitive, and emotional changes. Motor deficits may include abnormal muscle tone (changes in the resting state of a muscle typically resulting in increased muscle tone), hemiplegia (involvement of the arm and leg on one side of the body), and quadriplegia (involvement of both arms and legs). As the swelling of the brain begins to heal, some of the deficits may improve. Children and adolescents with TBI may need to relearn motor patterns. They may have musculoskeletal concerns secondary to tone problems and may require orthoses of the extremities to maintain and improve the ROM. OT practitioners work with children and adolescents who have sustained TBIs to help them relearn movements. OT practitioners address cognitive changes such as difficulty with attention and concentration, loss of memory, word-finding problems, and poor abstract thinking and reasoning. These children and adolescents may experience perceptual deficits that include lack of awareness of their surroundings and poor sequencing and timing skills. They may experience emotional changes such as lability (moods ranging from happy to tearful or angry), inappropriateness (e.g., cursing, touching, and disrobing), and personality changes. Children and adolescents with TBI may demonstrate a “flat” affect, showing little or no emotion. Often, aggressiveness, impulsivity, and irritability occur during recovery.
6. Theodore is a 2-year-old boy who avoids playing with others. He does not ask his mother for
help, screams to have his needs met, prefers to sit alone, and flaps his hands in front of his face. He loves to spin the wheels on toy cars and to swing. Which developmental disorder do these behaviors describe? a. Asperger syndrome b. Attention deficit hyperactivity disorder c. Autism d. Rett syndrome ANS: C
The most recent Diagnostic and Statistical Manual (Fifth edition; DSM-V) defines autism by the presence of four diagnostic criteria as follows: 1. Persistent deficits in social communication and social interaction across multiple domains. 2. Restricted, repetitive patterns of behavior, interests, or activities. This may include stereotyped motor activities, insistence on sameness, fixed routines and ritualized patterns, highly restricted, fixated interests, and/or altered sensitivity and reactivity to sensory input. 3. Symptoms presenting early in life (apparent by 12 to 24 months but manifest earlier). 4. Symptoms causing significant impairment in social and/or occupational functioning. 7. Gina is a 14-month-old infant who seemed to be developing normally, but she lately has
started to have seizures and is no longer walking. She wrings her hands constantly. Which developmental disorder do these behaviors describe? a. Developmental coordination disorder (DCD) b. Attention deficit hyperactivity disorder c. Autism spectrum disorT deEr STBANKSELLER.COM d. Rett syndrome ANS: D
Rett syndrome is a progressive neurologic disorder that occurs only in girls. It is a genetic disorder with mutation of the X chromosome. The infant or toddler seems to be developing normally until 6 to 18 months of age, at which time regression in all skills is observed. Microencephaly, seizures, abnormal muscle tone, intellectual disability, loss of purposeful hand use, and stereotypical patterns of behavior (especially hand wringing) emerge. Adolescents with Rett syndrome are generally nonambulatory and do not have functional hand use. 8. Kendra, a 7-year-old girl, shows some hand flapping behaviors and some difficulty with
expressing herself. She speaks slowly and does not seek out her peers. Although Kendra can perform her self-help skills and receives good grades in school, the teacher notices that Kendra is “by herself” frequently. Which developmental disorder do these behaviors describe? a. Developmental Coordination disorder b. Attention deficit hyperactivity disorder c. Autism spectrum disorder d. Rett syndrome ANS: C
The most recent Diagnostic and Statistical Manual (Fifth edition; DSM-V) defines autism by the presence of four diagnostic criteria as follows:
1.
Persistent deficits in social communication and social interaction across multiple domains. 2. Restricted, repetitive patterns of behavior, interests, or activities. This may include stereotyped motor activities, insistence on sameness, fixed routines and ritualized patterns, highly restricted, fixated interests, and/or altered sensitivity and reactivity to sensory input. 3. Symptoms presenting early in life (apparent by 12 to 24 months but manifest earlier) 4. Symptoms causing significant impairment in social and/or occupational functioning. 9. Martin is a 10-year-old boy with DCD who has difficulty writing and tying his shoes. He is
falling behind in school. He falls and bumps into things frequently and performs poorly in sports. Which statement is true concerning DCD? a. Martin probably has associated cognitive problems. b. Martin will need classroom modifications. c. Martin will show high self-esteem. d. Martin will outgrow it. ANS: B
DCD encompasses a wide range of characteristics, but an essential feature is that the child’s motor coordination is markedly below his or her chronologic age and intellectual ability and significantly interferes with ADLs. If intellectual disability is present, the motor difficulties must be in excess of those usually associated with the level of severity of intellectual disability. These children also often exhibit low self-esteem, show frustration, and begin to expect failure. Many professionals suggest that these children will outgrow their coordination deficits, but evidence indicates that children who have DCD continue to have difficulty in adolescence and adulthood. 10. Bob, a 5-year-old boy, is unable to dress himself and cannot write his name or count to 10.
Bob has a longish face with a high forehead and prominent jaw; he has lax joints and stands with flat feet. Which genetic disorder is suspected? a. Cri du chat syndrome b. Down syndrome c. Fragile X syndrome d. Prader-Willi syndrome ANS: C
Fragile X syndrome affects boys more often than girls because it is an X-linked genetic disorder. Children present with limited cognitive development, abnormal skull, joints, and feet structures. They exhibit typical structural features, including elongated faces, prominent jaws and foreheads, hypermobile or lax joints, and flat feet. Children with fragile X syndrome may be intellectually delayed and often present with autistic-like behaviors. OT practitioners often work with children with fragile X on sensory processing difficulties, social participation, ADLs, and IADLs. 11. Sean injured himself on the stove, resulting in a second-degree burn. Which statement
describes the involvement? a. Bone involved b. Epidermis and portions of the dermis involved c. Muscle involved d. Tissue minimally damaged
ANS: B
Second-degree burns are partial thickness burns and involve the epidermis and portions of the dermis. Although second-degree burns will heal, the process can be painful, and scarring may be a result. 12. Why is it important for a COTA to understand the problems commonly associated with a
specific diagnosis? a. To know what to expect when seeing the child for the first time b. To prepare for the initial evaluation c. To be a more valuable member of the treatment team d. All are correct. ANS: D
COTAs work with team members to help children and their families. Being knowledgeable about problems commonly associated with diagnoses helps them know what to expect, prepare for data collection and intervention, and provides more feedback to the treatment team. 13. What must the OT practitioner never do when a child is having a seizure? a. Turn the child’s head to the side in case she or he vomits. b. Put a finger in the child’s mouth. c. Remove dangerous objects around her or him. d. Put something soft under her or his head. ANS: B
If a child has a seizure, the OT practitioner may need to ensure that the child is in a comfortable setting with no dangerous objects nearby. The child can be placed on his or her side on the floor. The OT pTrE acS tiT tioBnA erNsKhS ouEldLnLeE veRr.pC laO ceMan object in the child’s mouth during a seizure. 14. What are common signs of arthrogryposis? a. Absence of muscle tissue and stiffness of all or most of the extremity joints b. Arthritis, spinal stiffness, and visual problems c. Developmental delays resulting from intellectual disabilities d. All are correct. ANS: A
Arthrogryposis can range from mild to severe, depending on the number of joints involved and the amount of muscle tissue missing. In the classic form of arthrogryposis, all the joints of the extremities are stiff, but the spine is not affected. In addition to contractures, muscles are often thin, weak, or missing. Arm posture in children with arthrogryposis often includes internal rotation, elbow extension with limited flexion, and flexed wrists with ulnar deviation. Contractures in the lower extremities are noted with typical posture including hip abduction and external rotation, knee extension or knee flexion contractures, and foot deformities. Arm and leg muscles are small, with webbed skin covering some or all the joints. Infants are born with significant contractures that improve with aggressive ROM exercises during infancy. In typical cases, all the joints of the arms and legs are fixed in one position, partly due to muscle imbalance or lack of muscle development during gestation. 15. What do boys with Duchenne muscular dystrophy (DMD) commonly develop? a. Arthritis
b. Osteoporosis c. Scoliosis d. Seizures ANS: C
Scoliosis can develop in children with DMD because of muscle weakness, especially during growth spurts. Proper wheelchair positioning and support are important to prevent scoliosis.
Chapter 14: Mental Health Disorders Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Stanley, a 10-year-old boy, shows a continual pattern of behaviors in which he picks fights
with other children, breaks classroom rules, and skips school. Stanley was recently caught shoplifting from a local store. Which disorder fits this pattern of behavior? a. Attention deficit disorder b. Conduct disorder c. Oppositional defiant disorder d. Major depressive disorder ANS: B
Conduct disorder is characterized by long-standing behaviors that violate the rights of others and the rules of society. The following behaviors characterize conduct disorder in children and adolescents: • Physical aggression toward other people or animals • Participation in mugging, purse snatching, shoplifting, or burglary • Destruction of other people’s property (e.g., setting fires) • Breaking of rules (e.g., running away from home or skipping school) • Impaired school performance, especially verbal and reading skills • Suspensions from school for behavioral problems Boys with conduct disorder are likely to be involved in behaviors such as vandalism, stealing, and fighting, whereas girls with the disorder tend to be sexually permissive (e.g., prostitution) and engage in manipulativT eE beShT avBioArN s sKuS chEaLsLlyEinRg.oCrOruMnning away. Other problems associated with conduct disorder are abuse of addictive substances, reckless behavior, and temper outbursts. Children diagnosed with conduct disorder exhibit a lack concern for others, and they show no feelings of guilt or remorse. 2. Ruben, a 9-year-old boy, becomes easily annoyed and angry over seemingly everything. He
states that he hates his family. His parents are concerned that Ruben argues and blames his brother for his mistakes. Which disorder fits this pattern? a. Attention deficit disorder b. Conduct disorder c. Oppositional defiant disorder (ODD) d. Major depressive disorder ANS: C
The primary symptoms of ODD are negative, hostile, and defiant behaviors that are uncharacteristic of typical children. Children and early adolescents with ODD display outbursts of temper, argue, defy adults, and are especially hostile to authority figures. These children seem to be angry all the time and resent rules; they become easily annoyed and readily blame others for their mistakes. Behaviors that might be observed are frequent temper tantrums; mean, hateful talking; revenge-seeking behaviors; and deliberately annoying others. These behaviors differ in duration and intensity from the occasional “difficult” periods some children and adolescents may experience.
3. Mary needs extra time for her writing assignments, and she needs a tutor in math to help her
sequence properly. The occupational therapy (OT) practitioner works with her on writing and sequencing once a week and provides suggestions to the child, teacher, and parent. What type of learning disorder does this depict? a. Mild b. Moderate c. None d. Severe ANS: A
The levels of severity of learning disorders can be described as: • Mild: Child experiences some difficulties learning skills in one or two academic areas but is able to compensate and function well with accommodations, special education services, resource support, and/or related services. • Moderate: Child demonstrates marked difficulty learning skills in one or more of the core academic areas such that the student is not likely to succeed without intensive support through special education and related services outside of the general education classroom and with small group specialized direct instruction. • Severe: Child shows severe difficulty learning skills in several academic areas requiring ongoing and intensive individualized and specialized instruction in a special education self-contained classroom setting with related services specific to the child’s needs. 4. Susan, a 12-year-old girl, refuses to go to her new school. She is irritable and angry, and she
complains of headaches every morning. Susan perspires and feels restless each morning. She is unable to sleep because she worries about the next day at school. What do these symptoms represent? a. Normal reactions to new situations b. Phobic anxiety disorder c. Separation anxiety d. Generalized anxiety disorder ANS: D
Generalized anxiety disorder (GAD) is diagnosed in 0.9% of the adolescent population in the United States and is more prevalent in girls than boys. Symptoms include excessive anxiety and worrying (e.g., about future events, school performance, family health, and world events) on most days without a specific trigger event or social situation. Children with GAD cannot control their fear of situations and activities, and these fears manifest as irritability, tiredness, inability to relax (i.e., feeling on edge), restlessness, apprehension, negative self-image, difficulty concentrating, and disrupted sleep. The physical symptoms described previously can also occur with other anxiety or mood disorders (e.g., panic attacks, phobias, or dysthymia). Not surprisingly, these children will have difficulty in school, social situations, and all areas of occupational performance. 5. Gerald, a 5-year-old kindergartner, is reluctant to go to sleep without his parents nearby. He
clings to his parents each morning when being dropped off at school and spends the first 30 minutes in tears, even after the second month of school. What do these symptoms represent? a. Normal reactions to new situations b. Phobic anxiety disorder c. Separation anxiety
d. Generalized anxiety disorder ANS: C
Separation anxiety disorder is characterized by extreme anxiety when anticipating separation from or separating from home or a parent. It is a disorder experienced by about 4% of children. Children and adolescents with this disorder may experience extreme distress traveling away from home or may refuse to go to school or visit or sleep over at a friend’s home. The diagnostic criteria include repeated nightmares involving the theme of separation, reluctance or refusal to sleep without a significant person nearby, and persistent worrying about separation or harm to major attachment figures (e.g., mother or father). Separation or the anticipation of separation may trigger physical (somatic) symptoms that include headaches, dizziness, palpitation, stomachache, nausea, and vomiting. Typically there are exacerbations and remissions with this disorder. Children with separation anxiety disorder exhibit delayed social development, refusal to attend school, and anxiety while at school, all of which result in poor academic performance. Separation anxiety disorder will usually resolve or decrease in severity with time, but it may also be a precursor to other conditions such as panic disorder. 6. Which statement is true concerning suicide in adolescents? a. Bringing up suicide may encourage the adolescent to act on it. b. An adolescent expressing suicidal thoughts will probably not act on them. c. Adolescents who are preoccupied with death require professional counseling. d. Suicide is very uncommon in teens. ANS: C
OT practitioners need to be able to assess suicide risk, since it is the third leading cause of death among 15- to 19-year-olds and the fourth leading cause of death among the 10- to 14-year-old age group. A cThE ildSoTrBaA doNleKsS ceEnL t eLxE prRe. ssC inO gMsuicidal thoughts or exhibiting a preoccupation with death should receive professional psychiatric help immediately and be monitored closely. The OT practitioner should immediately report signs of self-mutilating behavior or suicidal ideation to the parents and/or to a supervisor or other appropriate team member (e.g., nurse, psychologist, or mental health counselor) and document this on the child’s chart. Supervision and a safe environment (e.g., no access to medications and supervision of use of tools) is the best protocol when working with children who are depressed. 7. Which of the following represent positive symptoms of schizophrenia in children or
adolescents? a. Disorganized thought and apathy b. Hallucinations and delusions c. Lethargy and blunted affect d. Poor concentration and attention ANS: B
Schizophrenia and other psychotic disorders are characterized by abnormalities in one or more domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized motor behavior, and/or negative symptoms such as decreased emotional expression. Symptoms include: • Delusions: Fixed beliefs that do not change irrespective of conflicting evidence. Delusions may be persecutory, referential, grandiose, erotomanic, and nihilistic or somatic.
•
Hallucinations: Vivid and clear perceptions of experiences without an external stimulus. • Disorganized speech: Speech that involves switching topics or answering unrelated questions. • Disorganized motor behavior: Behavior manifests itself in a variety of ways from unpredictable agitation to silliness. Brief psychotic disorder is a sudden onset (within 2 weeks) of positive psychotic symptoms. Schizophrenia with a childhood or adolescent onset typically involves avolition or reduced drive to actively engage in daily occupations. 8. Which statement is not true concerning children with conduct disorder? a. They have an apparent lack of feelings of guilt or remorse about hurting others. b. Academic performance is affected in most cases. c. They have good self-esteem. d. Those who do not receive treatment may develop antisocial personality disorder as
adults. ANS: C
Boys with conduct disorder are likely to be involved in behaviors such as vandalism, stealing, and fighting, whereas girls with the disorder tend to be sexually permissive (e.g., prostitution) and engage in manipulative behaviors such as lying or running away. Other problems associated with conduct disorder are abuse of addictive substances, reckless behavior, and temper outbursts. Children diagnosed with conduct disorder exhibit a lack concern for others, and they show no feelings of guilt or remorse. However, despite this image of toughness, they often have poor self-esteem and experience anxiety, depression, and suicidal thoughts. Children with conduct disorder are at high risk for poor outcomes, including dropping out of LiL school, unemployment, anT dE enSgT agBinAgNiK nS crE im naEl R be.hCavOiM ors and substance abuse. If left untreated, many will develop antisocial personality disorder as adults (i.e., in approximately 40% of cases, childhood-onset conduct disorder develops into antisocial personality disorder). Antisocial personality disorder is associated with serious crimes, including rape, physical assault, and homicide. 9. What is the name of a life-threatening disorder characterized by a body weight 15% below
average, an intense fear of gaining weight, and a perception of being or feeling fat even though looking emaciated? a. Anorexia bulimia b. Anorexia nervosa (AN) c. Bulimia nervosa d. Failure to thrive ANS: B
AN typically develops in early adolescence (around 13 years of age). However, AN can present in younger children or older adolescents and adults. It is characterized by an intense fear of being overweight, although most often weight for age and height is well below the average. The condition is characterized by active pursuit of thinness, inability to realistically perceive the risks of weight, and self-denial of weight loss. When confronted by parents or concerned friends, adolescents with AN deny or minimize the severity of the problem and resist treatment efforts. They have a distorted body image and see themselves as overweight in all or some body parts regardless of how thin or emaciated they are.
10. Which of the following is an appropriate OT intervention for conduct disorder? a. Assist the child in channeling energy into appropriate activities. b. Clearly define acceptable behaviors. c. Reinforce appropriate behaviors. d. All are appropriate interventions. ANS: D
It is important to praise or recognize a child when he or she is working on or exhibiting desired behaviors. This recognition should be clear and should label the behavior of the child, for example, “Well done, you are working quietly on the task.” This is better than saying “Nice work!” This strategy helps the child feel validated and shapes his or her behavior. The Cognitive Orientation to Occupational Performance (CO-OP) model provides a framework for involving the child in developing a plan. This model advocates that practitioners help children identify goals (Goal), plan how they will work on it (Plan), carry out the plan (Do), and evaluate their progress (Check). This model is effective for addressing learning issues. 11. Which of the following statements is true about Tourette’s disorder? a. Tics increase during activities that require a lot of concentration. b. Coprolalia is the vocal tic of repeating others’ words. c. The disorder improves in adolescence and adulthood. d. Tics increase during sleep. ANS: C
The typical onset of Tourette’s syndrome is between 6 and 7 years of age, and Tourette’s syndrome is more prevalent in boys than girls. Tourette’s syndrome is viewed as a genetic disorder involving repetitive involuntary motor and vocal tics. The tics may occur many times a day and must occur consT isE teS ntT lyBfA orN1KySeE arLoL rE mR or.eCbO efM ore the age of 18 for a diagnosis of the syndrome. Related comorbidity occurs with attention-deficit hyperactivity disorder, behavioral problems, specific learning disabilities, or obsessive-compulsive disorder. Although Tourette’s syndrome is typically a chronic disorder, some children experience improvement during adolescence and early adulthood. 12. Which of the following is true about youth suicide and risk signals? a. Suicide attempts are seldom repeated. b. Sudden improvement in mood may be a danger signal. c. Youths who talk about suicide rarely kill themselves. d. There is no treatment for depression in teens. ANS: B
A child or adolescent who has recently started therapy with antidepressants can have an increased risk of suicide. The therapeutic response to a widely used antidepressant medication (e.g., a selective serotonin reuptake inhibitor such as Prozac or Zoloft) usually takes 2 to 3 weeks before a marked improvement in mood occurs. However, ironically, the gradual improvement in energy and mood due to the medication may actually push the child or adolescent who is still depressed to act on his or her suicidal thoughts. Therefore, the OT practitioner should be suspicious of sudden elation or energy in a child or adolescent diagnosed with depression. This sudden unexplained improvement is known as a “flight into health” and can signify that the decision to end one’s life has been made. Other warning signs of impending suicide include getting organized, subtle good-bye gestures, and giving away personal items.
13. Which statement is not a criterion for substance dependence? a. The individual does not realize that the use is excessive. b. Much time is spent in obtaining, using, and recovering from the substance. c. Withdrawal symptoms occur with attempts to reduce or stop using the substance. d. Responsibilities are neglected. ANS: A
Children and adolescents may abuse substances such as alcohol, amphetamines (uppers), cannabis (marijuana), hallucinogens (e.g., ecstasy and other club drugs, such as GHB and LSD), opioids (e.g., heroin, cocaine), phencyclidines (e.g., PCP, angel dust), sedatives, hypnotics, anxiolytics (e.g., Valium, Librium), steroids, and inhalants (e.g., nitrous oxide, acetone). Young people with substance dependence and abuse disorders can spend much of their time acquiring, using, and recovering from the substance. As their dependence on and need for a drug grow, adolescents may become involved in illegal activities that place them at further risk of harm (e.g., prostitution or selling drugs). Using and acquiring drugs has significant health risks, and children and adolescents entering treatment programs for substance dependence or abuse often have poor physical health and sometimes contract life-threatening conditions such as human immunodeficiency virus infection or hepatitis from sharing needles. A strong association exists between alcohol use and suicide. 14. Which tier targets mental health intervention for all children in the school system? a. Tier 1 b. Tier 2 c. Tier 3 d. Tier 4 ANS: A
Tier 1: Universal, whole population mental health promotion. At this level, services emphasize promoting positive health, mental health literacy, social emotional learning, and coping with challenges with all children and youth. 15. Which of the following is not a major goal or outcome of Every Moment Counts? a. Providing mental health services free of cost to all children b. Building capacity of OT practitioners, school personnel, and families c. Developing, implementing, and evaluating model programs d. Dissemination using a variety of strategies ANS: A
All the other goals are part of Every Moment Counts programming.
Chapter 15: Childhood and Adolescent Obesity Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. What is the category for a body mass index (BMI) value that falls in the 96th percentile? a. Healthy weight b. Overweight c. Obese d. Morbidly obese ANS: C
Underweight: Less than 5th percentile. Healthy weight: 5th percentile to less than 85th percentile. Overweight: 85th percentile to less than 95th percentile. Obese: Equal to or greater than the 95th percentile. 2. What is the BMI based on? a. Height, weight, age, and gender b. Height, age, and grade c. Height, weight, and body fat d. Height, body fat measures, and grade ANS: A
BMI [(weight in pounds/Height in inches) 703] is a reliable method used to measure body fat. It correlates highly with direct measures of body weight (e.g., underwater weighing-displacement). After a child’s BMI is calculated, the score is plotted on the BMI for age growth chart for sex to obtain the child’s percentile ranking. This ranking rates the child relative to children of the same age and sex. 3. Which factor is not associated with childhood obesity? a. Quality of diet b. Level of physical activity c. Family history of obesity d. Living in a ranch house ANS: D
Factors associated with childhood and adolescent obesity. These include: • biological/physiological factors. • genetic disorders, medical conditions. • hormonal or endocrine disorders (e.g., hypothyroidism, diabetes). • diet. • limited physical activity and sedentary lifestyle. • personal contexts: family, friends, and peer networks. • family stressors. • parent education, ethnicity, and socioeconomic status. • parents’ limit setting concerning food choices. • family physical activity patterns, interests, and leisure activities.
• • •
• 4.
family preference for sedentary activity patterns. factors associated with health (e.g., medications, chronic health conditions, asthma that restricts participation in physical activity). environment: unsafe urban settings (e.g., playgrounds with poorly maintained equipment or used as meeting places for adults engaging in criminal activities, under-resourced schools, high-density communities with limited access to fresh produce and healthy food choices, limited community resources for participating in physical activities). access to affordable health care services across the life span (e.g., prenatal and postnatal care, early childhood screening).
Which statement reflects the trend in physical activity as children get older? Participation in activity declines across childhood and into adolescence. Adolescents are more physically active than preschool children. Puberty slows down the need for physical activity. Sedentary activities replace active activities as a person ages.
a. b. c. d.
ANS: A
The Centers for Disease Control Youth Media Campaign Longitudinal Study found that 61.5% of children between the ages of 9 and 13 years did not participate in any organized physical activity in non-school hours, and 22.3% did not participate in any free-time activity. 5. What is the problem with sedentary activities (e.g., playing computer games) in relation to
obesity? a. They require a low expenditure of energy. b. They displace high-energy activities. c. They place visual strain TE onStT heBeAyN esK. SELLER.COM d. Children eat while they play. ANS: B
The problem is not that sedentary activities require a low expenditure of energy. Rather, sedentary activities may displace high-physical-energy activities, and children who engage in sedentary activities end up with a lower metabolic rate than their physically active peers do. 6. Which is not a factor associated with obesity in children? a. Foods are used as a reward. b. There is a lack of effective intervention. c. Children are offered limited education on healthy nutrition. d. Children are unmotivated to change. ANS: D
Family and peer relationships, attitudes, education, ethnicity, and behaviors, school/community environments, and societal attitudes are the socioeconomic, cultural, and physical factors that influence activity patterns, eating behaviors, and attitudes toward food, physical activity, leisure choices, and personal weight (e.g., body image). Therefore, they can contribute positively or negatively to a child’s and adolescent’s weight. For example, environmental factors may support and encourage a healthy active lifestyle, while others can be barriers to positive behavioral change. A 2-year study of households that restricted certain foods, especially when it involved a mother’s dietary restriction, found that the weights of the children in these households increased. An explanation for this finding may be that when these children managed to get access to the restricted foods, they ate more of them. In contrast, the availability of healthy foods (e.g., fruits and vegetables) in the home and the healthy eating patterns modeled by parents (and grandparents) positively influence food preferences and eating behaviors that will persist when children begin to make their own choices about the foods they will eat. 7. What can an occupational therapy (OT) practitioner do to engage the family in establishing
health habits? a. Make complex suggestions that require major life changes. b. Engage the whole family in simple habit changes. c. Keep things private and encourage the family not to seek support from others. d. Make the family members feel guilty about their poor health habits. ANS: B
Since family context significantly affects eating and exercise patterns, it is important to establish healthy eating and exercise habits early, before parental control over diet diminishes during adolescence. Adolescents are more likely to purchase foods outside the home. These foods are often foods of coTnE veSnT ieB ncAeN , hKigShEiL nL suEgR ar. sC anOdMfats, and of questionable nutritional value. If paired with an increase in sedentary activity level (e.g., homework, fewer physical extracurricular activities) the change in diet can lead to weight gain in adolescents. Adolescence brings challenges associated with weight, diet, and exercise. It is the peak time for dysfunctional eating patterns and psychopathology. At the same time, peer and the media are influential forces in relation to behaviors and attitudes concerning weight, body image, and choices about exercise and use of discretionary time. 8. What percentage of children or adolescents who are overweight report being teased compared
with 15% of those of average weight? a. 100% b. 45% c. 15% d. 0% ANS: B
1 out of 3 Americans between 2 and 19 years old who are overweight or obese are vulnerable to weight-based bullying. They are subject to teasing, discrimination, and social exclusion. For example, in one study, 45% of children with weight issues reported being teased, compared with 15% of children with normal weights. 9. Into what category do children with Down syndrome who develop obesity fall? a. Obesity due to genetic or metabolic disorders b. Obesity due to developmental or congenital disorders
c. Obesity as a primary disorder d. Obesity due to chronic health disorder ANS: B
Excessive weight gain is further complicated by medical and congenital disorders such as diabetes, thyroid imbalance, and Down syndrome or Prader Willi syndrome. 10. Which intervention approach helps children identify their thinking and behaviors that may be
interfering with making healthy food choices and participating in physical activity? a. Social learning theory b. Health education c. Behavioral modification d. Cognitive-behavioral therapy ANS: D
A cognitive behavioral approach helps them identify their dysfunctional thinking and behaviors that may be interfering with making healthy lifestyle choices or exercising and the relationship between thoughts, feelings, and events and excessive eating (see Chapter 14). It is necessary that the children’s cognitive abilities are adequate for insight that will enable them to comprehend the relationships among their thoughts, feelings, and behaviors. 11. Which strategy is not recommended for managing and preventing obesity in children and
adolescents? a. Set many short-term, achievable goals at a time. b. Address issues of health rather than weight. c. Encourage the child to have regular sleeping hours. d. Do not completely deny child occasional sweets or soda. ANS: A
Box 15-5 Managing and Preventing Obesity • Set goals that are obtainable, simple, and easy to measure. • Set one short achievable goal at a time. • Make goals very concrete so the child sees progress. For example, provide child with a pedometer to measure distance walked. Have simple short-term goals such as walk to best friend’s house or walk to the nearest store. • Develop goals with child or adolescent. Have child set own reward system. • Keep goals positive. For example, walk to the end of the street every other day rather than do not watch TV on Tuesdays. • Involve friends and family in goals. • Minimize the number of breads, sweets, and soda and replace with healthy choices such as fruit, vegetables, and water at home. • Do not completely deny child occasional sweets or soda. Otherwise, he or she may crave them and eat more when they are available to him or her. • Address issues of health rather than weight. • Focus on the child’s volition (interests, motivation, and desires) to engage in a variety of activities. • Build on existing physical and healthy routines and habits. • Consistently repeat new behaviors until they become part of the child’s everyday behaviors.
• •
Encourage child to get regular sleeping hours. Involve child in chores that require physical effort (e.g., sweeping, taking out garbage, raking, running errands). Sample goals: • Mark will eat a vegetable at each meal. • Diane will play outside with her family or friends for 1 hour each day. • Jose and his family will drink water instead of soda during the weekend. • Rochelle will try Frisbee and tee ball (two new activities) at least three times. • Sajay will help his parent prepare a low-fat, low-carbohydrate meal (once a week). 12. What is the recommended physical activity level for children? a. Vigorous activity for 1 hour daily b. Moderate activity for 30 minutes daily c. Quiet activity all day long d. Outdoor play for at least 20 minutes daily ANS: A
Box 15-6 Recommendations for Physical Activity for All Children at Their Ability Levels • Perform daily vigorous physical activity for at least 1 hour. • Engage in play and activities that involve physical activity in a variety of settings: home, school, and community. • Participate in physical activity with parents; parents can set an example and encourage physical activity as part of everyday life. • Explore a variety of activities and choose an activity of interest. • Participate in enjoyT abElS e,TfuBnA , aNnKdSmEoL tiL vaEtiR ng.aCcO tiM vities that promote long-term activity. • Participate in activities with peers, siblings, and parents. • Try new activities. 13. What is not considered a core value to a program to prevent childhood obesity? a. Social participation b. Health education c. Moderate to high physical activity d. Including only obese children ANS: D
To promote follow-through, many programs involve team models and educating teachers and parents. Other programmatic goals include promoting sports and extracurricular activities, encouraging hobbies, and involving families and friends in a more active lifestyle. Importantly, programs emphasize setting realistic goals as key to successful outcomes. The outcomes are not measured solely by the amount of weight loss, but generally include child, adolescent, family or school satisfaction, increased knowledge of nutrition and exercise, improvement in healthy eating habits, increased levels of physical activity, and increased participation in social activities. Figure 15-6 provides examples of low-cost, noncompetitive activities that children and their families may enjoy as part of an intervention plan. 14. According to Kielhofner, what is one way to target childhood obesity? a. Through volition—engage children in activities they will sustain over time. b. Change the environment so that children are not allowed sweets or fats.
c. Through habits—engage children in 2 hours of physical training each day. d. Through performance—encourage children to work out more intensely each day. ANS: A
Kielhofner suggested that engaging children in volitionally oriented activities helps them sustain activity over time, which makes a difference in their overall health. 15. Poor body image in girls has been shown to predict which of the following? a. Poor grades and immaturity b. Sexual promiscuity and poor grades c. Depression and binge eating d. Delayed motor skills and poor abstract reasoning ANS: C
Dissatisfaction with physical appearance is significantly associated with obesity, namely, poor body image, as well as psychosocial problems. Poor body image in girls has been shown to predict poor psychological function, depression, and binge eating. Furthermore, lower levels of participation in physical activities are associated with poor psychological functioning.
Chapter 16: Intellectual Disabilities Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Who is qualified to do intelligence quotient (IQ) testing? a. Certified occupational therapy assistant b. Registered occupational therapist c. Psychologist d. Special education teacher ANS: C
IQ tests such as the revised Wechsler Intelligence Scale, Stanford-Binet Intelligence Scale, McCarthy Scales of Children’s Ability, and Bayley Scales of Infant Development are administered by a qualified psychologist. 2. What must be included for a child to be diagnosed with an intellectual disability? a. Below-average intellectual functioning b. Motor delays c. Deficit in two or more skill areas d. Below-average intellectual functioning and deficit in two or more skill areas ANS: D
The following criteria suggest the diagnosis of intellectual disability: • Deficits in intellectual function (e.g., abstract thinking, problem solving, and academic learning) as confirmed by clinical assessment and individualized, standardized testing. • Deficits in adaptiveTbEeS haTvB ioA rN wK hiS chErLeL quEirRe.oC ngOoM ing support to be successful in daily life across multiple environments as confirmed by clinical assessment. The level of severity of an ID defined by adaptive functioning is a more reliable indicator of intensity of support as than intelligence quotient (IQ) measures. • Onset of intellectual and adaptive deficits occurs during the developmental period. 3. Which factors are considered when diagnosing a child with intellectual disability? a. Parental intelligence b. Body height and weight c. Culture and language d. Socioeconomic status ANS: C
The diagnosis of intellectual disability involves consideration of the child’s cultural, linguistic, behavioral, sensory, motor, and communication abilities and how those abilities may influence intelligence testing. Professionals consider the child’s age, strengths, and weaknesses, along with the limitations in intelligence when examining how these factors influence adaptive functioning. 4. Smith is 36 months old, but his score on a performance assessment placed him at 24 months.
What is his estimated IQ? a. 50 b. 67 c. 100
d. 115 ANS: B
It is possible to estimate IQ in younger children by dividing mental age by chronological age and multiplying by 100. For example, 24 months (mental age) 36 months (chronological age) 100 = 67. The child in this example has an IQ of 67. (Note: This is considered an estimate.) 5. Which statement reflects the influence of alcohol and drugs during pregnancy? a. Teratogens during prenatal periods can be dangerous to brain growth. b. Anoxia may result in bleeding around the baby’s brain. c. Postnatal infections may cause permanent brain damage. d. Toxins cause particular problems when ingested. ANS: A
A teratogen is any physical or chemical substance that may cause physical or developmental complications in the fetus. Teratogens can include prescription medications, lead, alcohol, or illegal drugs consumed by the mother; maternal infections; and other toxins. The effects of teratogens on the fetus range from congenital anomalies (defects) to intellectual disability. The type of agent, the amount of exposure, and the point at which exposure occurs during embryonic and fetal development play important roles in the outcome. Exposure to teratogens during the first 12 weeks of pregnancy can have the most dangerous consequences because it is during this time that the fetal brain, spinal cord, most internal organs, and limbs develop. 6. In which category of intellectual disability does a child’s IQ test result of 60 place him or her? a. Mild b. Moderate c. Severe d. Profound ANS: A
Individuals with mild intellectual disability have IQ scores of 50 to 69 and may be further classified as “educable.” 7. Joey is 18 years old and intellectually disabled. He completed the seventh grade and is going
to start vocational training in the fall. In which category of intellectual disability does Joey fit? a. Mild b. Moderate c. Severe d. Profound ANS: A
Individuals with mild intellectual disability have IQ scores of 50 to 69 and may be further classified as “educable.” Children in this category may not seem significantly different from others until they attempt to attain higher levels of cognitive skills and perform tasks that require significant abstract thinking. These children can develop social and communication skills and usually master academic skills from Grade 3 to Grade 7; however, it takes them longer than average to attain them. They are able to achieve the following academic skills: • Reading at the Grade 6 to 7 level • Writing simple letters or lists, such as a grocery list
• •
Performing simple mathematical functions such as multiplication and division Using the computer and the Internet to perform simple research or to communicate with others As adults, their social, vocational, and self-help skills are usually sufficient to allow them to partially or completely support themselves financially through employment. Therefore, they can live independently or in a minimally supervised setting in the community. 8. Julie is 19 years old and able to accomplish habitual self-care skills, such as feeding. She has
been able to participate in some vocational training with supervision. She lives in a group home that provides extensive supervision. In which intellectual disability category would Julie fit? a. Mild b. Moderate c. Severe d. Profound ANS: C
Individuals with severe intellectual disability have an IQ score between 20 and 35 and therefore require support in all areas of occupational performance on a regular basis. Functional independence depends greatly on their associated physical limitations. Habitual basic self-care skills such as feeding and hygiene tasks may be learned because of the recurring nature of these activities. Children with severe intellectual disability have difficulty generalizing skills and perform best with routine and consistency. 9. Paul is 10 years old and has noticeable developmental delays. He has been in special
education classes and has completed the second grade. Although he can complete most of his activities of daily living (ATDELSs)T, B heAdNoK esSnEeL edLsEuR pe.rvCiO sioMn. In which intellectual disability category does Paul fit? a. Mild b. Moderate c. Severe d. Profound ANS: B
Individuals with moderate intellectual disability have IQ scores of 36 to 49; they may also be considered “trainable.” These children need support regularly and are likely to have deficits in academic, communicative, and social skills. With special education, individuals who have moderate intellectual disability are usually able to attain the skills of a Grade 1 or Grade 2 student. 10. Danny is 14 years old. He requires extensive help for all ADLs. He is able to communicate his
wants and needs by answering yes/no questions. Which intellectual disability category applies to Danny? a. Mild b. Moderate c. Severe d. Profound ANS: D
An IQ score of less than 20 classifies individuals as having profound intellectual disability. Because of the numerous physical disabilities that may accompany profound intellectual disability, these individuals often have difficulty progressing developmentally and require constant support to engage in every aspects of daily routines. Depending on the extent of their physical limitations, individuals with profound intellectual disability may learn to communicate and perform basic or routine self-care activities such as hygiene and grooming tasks. Extensive assistance is required for all other ADL skills, and continuous support is needed in living arrangements. Maintenance of the physical skills required for everyday occupations assists in preserving the overall health of the child. Occupational therapy practitioners working with children who have profound intellectual disability concentrate on basic skills required for occupations. For example, the goals of therapy may include such tasks as the following: • Smile on approach. • Indicate food preference. • Feed oneself with a spoon. • Make visual contact. • Allow caregiver to bathe them. • Allow caregiver to touch them. • Cooperate with dressing or self-care 11. Which of the following conditions is considered a trisomy disorder? a. Anoxia b. Down syndrome c. Fragile X syndrome d. Meningitis ANS: B
Two common examples of genetic conditions associated with intellectual disability are Trisomy 21 and fragile X syndrome. Trisomy 21 (also known as Down syndrome) is a condition in which individuals have three copies of chromosome 21 instead of a pair. Individuals with fragile X syndrome have an abnormal or “fragile” X chromosome that contains a weak area. 12. What term refers to the cause of intellectual disability occurring before a child is born? a. Acquired b. Perinatal c. Postnatal d. Prenatal ANS: D
Prenatal causes occur before birth, perinatal causes occur at birth, and postnatal causes occur from birth to 3 years of age. 13. Which IQ scores are within normal limits? a. 0 to 100 b. 50 to 70 c. 80 to 90 d. 85 to 115 ANS: D
Scores between 85 and 115 are considered within normal limits (average IQ). 14. Which statement is true regarding children with intellectual disabilities? a. Those with similar IQs will function alike. b. There are individual differences between children with the same IQs. c. There is little variation between classifications. d. They will always fully depend on a caregiver. ANS: B
Intervention is not aimed at improving intelligence (it is not possible to reverse the condition); instead, it is aimed at helping the child or adolescent develop performance patterns, including habits, roles, and rituals used in the process of engaging in meaningful activities. Each client should be assessed in terms of his or her strengths and weaknesses. OT practitioners focus on the occupations that the child or adolescent hopes to perform as goals. 15. What is the first step when using a behavioral modification approach with a child? a. Identify behaviors that interfere with learning, socialization, or engagement in
occupations. b. Make modifications to the behavior plan as needed. c. Implement the plan with teachers and parents. d. Collect data on each behavior and determine why it is occurring. ANS: A
First, data are collected to identify the behavior(s) that needs to be changed. Then practitioners collect data on the “A,” antecedent behavior(s), which refers to the events and behaviors that occur prior to target behavior.
Chapter 17: Cerebral Palsy Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Stacey has increased muscle tone affecting only the lower half of her body. What type of
cerebral palsy describes this pattern? a. Diplegia b. Hemiplegia c. Monoplegia d. Quadriplegia ANS: A
Cerebral palsy can be defined by the location of the lesion in the central nervous system and by distribution of abnormal muscle tone in the trunk and extremities. Involvement of one extremity is commonly referred to as monoplegia, upper and lower extremities on one side of the body as hemiplegia, both lower extremities as diplegia or paraplegia, all limbs as quadriplegia, and all limbs and head/neck as tetraplegia. 2. What component is not essential for the acquisition of motor skills? a. Inborn reflexive movement patterns b. Opportunities to practice and repeat movements c. Following an exact sequence of motor skills d. Feedback regarding the effectiveness of our actions ANS: C
LaLrdER According to the systems aTpE prSoT acB hA , fN eeKdS foErw ac.tiC onOsMrequire that posture be highly variable and subject to being affected by all the factors motivating the person to choose to catch the balls. No one right way to execute movement exists; rather, movement is strongly influenced by many variables. According to this approach, in contrast to reflex-hierarchical models, motor development follows a step-like progression, starting with primitive reflexes and progressing to voluntary movement control through the higher brain centers. The research of systems theorists has shown that motor activity is most often initiated by the interaction of sensory, perceptual, environmental, and other factors leading to task-focused, goal-directed movement. One other concept from systems model research has important therapeutic implications for the treatment of children with cerebral palsy or other neurologic disorders. Postural control and movement are at their greatest levels of efficiency, flexibility, and adaptability after randomized practice and repetition. Infants attempt to roll, crawl, stand, and walk over several hundred attempts with varied success and failure. Each attempt provides necessary feedback that will feedforward to more skilled motor responses and the eventual mastery of the motor skill. 3. What are children with cerebral palsy whose muscles appear very weak and soft and who have
trouble sitting up independently exhibiting? a. Cocontraction b. Hypertonia c. Fixation d. Hypotonia
ANS: D
Decreased muscle tone, which is defined as hypotonia, can make a child appear relaxed and even floppy. Increased muscle tone, which is defined as hypertonia, can make a child appear stiff or rigid. In some cases, a child may initially appear hypotonic, but the muscle tone may change to hypertonia after several months of life and the influence of movement against gravity. 4. Stan has a type of cerebral palsy in which balance and fine motor functions such as
coordination are impaired. What type of cerebral palsy is this? a. Ataxia b. Choreoathetosis c. Hypotonia d. Spasticity ANS: A
The third type of cerebral palsy, ataxia, has less effect on muscle tone, but greatly impacts balance and coordination. Children who have ataxia may show shifts in muscle tone, but to a lesser degree than those with dyskinesias. Distribution of related muscle control issues is typically quadriplegic. 5. What is the term for the degree of contractility and elasticity in muscle tissue? a. Resistance b. Cocontraction c. Coactivation d. Muscle tone ANS: C
The qualities of contractiliT tyEaS ndTeBlaAsN ticKitSyEaL reLnE ecRe. ssC arOyMfor the muscle’s accurate response to changes in stimuli experienced during movement, an event referred to as coactivation. Muscle tone allows muscles to adapt readily to changing sensory stimuli during functional activities. 6. Which statement is not emphasized in the dynamic motor control systems theories? a. Movement will improve through use of controlled sensory input only. b. Movement will improve through use of sensory input and practice. c. Movement will improve if the individual is able to use feedforward when planning
movements. d. Movement will improve when an individual has to move in many different types of situations. ANS: A
Systems models purport that posture and movement must be flexible and adaptable so that a person can perform a wide range of daily activities, whereas reflex-hierarchical models state that the control of posture and movement is the outcome or product of a process. Dynamic systems models postulate that posture is anticipatory to the initiation of movement. Postural adjustments precede movements; they prepare the body to counterbalance the weight shifts that are caused by the movement activity. In this way, less balance disturbance occurs. Dynamic systems theorists also suggest that control of movement occurs due to the interactions of many body systems working cooperatively to achieve a desired movement goal.
7. Why do occupational therapy practitioners use positioning and handling techniques for
children with cerebral palsy? a. Maintain postural alignment. b. Facilitate improved movement patterns. c. Facilitate performance of activities of daily living. d. All are correct. ANS: D
Positioning and handling methods are especially important for the child with cerebral palsy who is unable to move independently. These methods also help the child work toward the achievement of performance-area goals such as increased independence in dressing, feeding, playing, and doing schoolwork. Practitioners can also select and recommend specific types of positioning equipment, such as chairs, supine or prone standers, and sidelyers, which support the child during functional activities with the best possible postural alignment, control, and stability. Handling techniques such as slow rocking, slow stroking, imposed rotational movement patterns, and bouncing are used to enhance the child’s muscle tone, activity level, and ability for independent movement. 8. What is one of the problems seen most frequently in children with cerebral palsy? a. Early integration of the primitive reflexes b. Absent or impaired righting and equilibrium responses c. Wide ranges of movement patterns d. Excessive muscle strength ANS: B
Children with cerebral palsy may continue to rely on automatic movement patterns because they are unable to direct their muscles to move successfully in more typical motor patterns. SpElL The atypical patterns used T toEpSlaTyB , oArNcK om etL eE fuR nc.tiCoO naMl activities may become repetitive and fixed. The repetition of the atypical movement patterns prevents children with cerebral palsy from gaining independent voluntary control of their own movements and can lead to diminished strength and musculoskeletal problems. The combination of impaired muscle coactivation and the use of reflexively controlled postures may lead to future contractures in muscles, tendons, and ligamentous tissues, causing the tissues to become permanently shortened. Bone deformities and alterations of typical posture or spinal and joint alignment may also occur. With guidance from the occupational therapist, occupational therapy assistants can help the children by using techniques to develop postural control, righting and equilibrium reactions, and controlled movement against gravity. 9. What is the best way to describe muscle tone that is associated with atypical postural
alignment and limited joint range of motion? a. Flaccid b. Hypotonic c. Hypertonic d. Weak ANS: C
Increased muscle tone, which is defined as hypertonia, can make a child appear stiff or rigid. A child with cerebral palsy may have a primary impairment such as hypertonia and a muscle imbalance across a joint. This abnormal muscle tone may cause poor alignment across a joint, further muscle weakness, and eventually a contracture in the joint. The resulting muscle contractures, poor body alignment, and poor ability to initiate movement would be considered secondary impairments. 10. Frank is unable to extend his hand quickly enough to prevent him from falling. With what
reaction is he having difficulty? a. Equilibrium b. Protective c. Righting d. Static balance ANS: B
When righting and equilibrium reactions are not enough to regain an upright posture quickly and safely, individuals use another reflexive reaction called the protective extension reaction. When people fall, they frequently use this reaction, automatically reaching outward from their bodies to catch themselves or break the fall. A protective response requires the motor ability to quickly bring an extremity (i.e., arm or leg) out from the body to prevent a fall and requires strength to support the body’s weight momentarily while bracing. 11. Charlie is a 10-month-old with cerebral palsy who has difficulty sitting. With what is he
having difficulty? a. Equilibrium b. Protective c. Righting d. Static balance ANS: D
The functions that aid individuals in maintaining or regaining posture are righting reactions and equilibrium reactions often referred to concomitantly as balance reactions. These functions can be thought of as static or dynamic. When people are sitting and not engaged in any activity, they are using static balance. 12. George is unable to sit in a regular chair because when he writes, he falls off the edge as soon
as his hand moves past midline. With what is he having difficulty? a. Equilibrium b. Protective c. Righting d. Static balance ANS: C
Righting reactions are the foundation for all balance responses and help maintain upright postures against gravity during times when the center of gravity is moving off the body’s base of support. Righting reactions help sense that the head is out of alignment with the body and produce a motor response to realign the head with the body. This requires the ability to bring the head and trunk back into “normal” skeletal alignment by using only the necessary muscle groups. 13. 10-year-old Matt falls when he tries to get on his bicycle. With what is he having difficulty?
a. b. c. d.
Equilibrium Protective Righting Equilibrium and righting
ANS: D
The functions that aid individuals in maintaining or regaining posture are righting reactions and equilibrium reactions often referred to concomitantly as balance reactions. These functions can be thought of as static or dynamic. 14. What type of intervention is based on the theory of learned nonuse and requires children try to
use the affected hand? a. Complementary and alternative medicine b. Constraint-induced movement therapy (CIMT) c. Kinesio taping d. Orthoses and casting ANS: B
CIMT is an evidenced-based intervention approach to address functional implications and learned nonuse or developmental disregard of the impaired upper extremity in children with hemiplegia. 15. What is the role of orthoses for children who have cerebral palsy? a. Improve range of motion b. Improve overall function c. Decrease muscle tone d. Decrease pain ANS: B
Often orthoses are worn by children with cerebral palsy to improve overall function. Orthoses are designed to meet specific objectives identified by the child or the parents. In many instances, orthoses can compensate for functional deficits in hand grasping toys or pointing in order to get toys, holding eating utensils, holding writing implements, or accessing computing devices.
Chapter 18: Positioning and Handling: A Neurodevelopmental Approach Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. The Certified Occupational Therapy Assistant (COTA) observes a 6-year-old child with
cerebral palsy and high muscle tone always using a W-sitting position. What does this observation suggest about the child? a. He is developing normally. b. He is using a compensatory position to establish stability. c. He is using a position considered normal for an older child. d. He is using a compensatory position to establish mobility. ANS: B
Children with poor trunk stability may favor a W-sitting position, since the lower extremities are positioned to provide a wide base of support. W-sitting does not require trunk strength or stability and thus makes it easier for children to manipulate objects and play on the floor. However, W-sitting may lead to orthopedic problems, including increased risk of hip dislocation, joint deformities, and the aggravation of muscle tightness. W-sitting does not allow for rotation, weight shifting, or the opportunity to cross midline. Therefore, occupational therapy (OT) practitioners discourage W-sitting by promoting other sitting positions that engage children’s postural system and encourage the use of trunk muscles. Alternatives to W-sitting include tailor-sitting; long-sitting; side-sitting; or sitting on the OT practitioner’s lap, on a bench, or on a ball. 2. Which position benefits a cThE ilS dT wB ithAN inK crS eaEsL edLtE ruRn. kC mO uM scle extensor tone while standing in a
Freedom stander? a. Neutrally positioned b. Slightly tilted backward c. Slightly tilted forward d. Tilted back into supine position ANS: C
Children with increased trunk muscle extensor tone may benefit from having the stander tilted slightly forward to decrease the muscle tone so that they can maintain the head at midline. Freedom standers, standing boxes, and parapodiums provide external support to children who have limited trunk control and stability. These positioning devices allow children to stand upright and use their arms and hands to play, feed, write, or read. 3. The COTA positions her palm on the child’s abdomen and back in an effort to help the child
move from upright sitting to quadruped. What is the term used for what the practitioner is doing? a. Handling b. Intervention c. Positioning d. Weight bearing ANS: A
OT practitioners use positioning and handling techniques to help children engage to their fullest extent in daily occupations. In addition, OT practitioners use handling techniques to promote improved motor control during the performance of daily tasks and activities. As such, handling involves continual evaluation of children’s responses to the practitioner’s input (i.e., cues and touching) as it relates to the desired motor movement. This is a dynamic process and therefore requires the practitioner to be aware of how he or she is influencing children’s motor and emotional responses. 4. Arthur is a 4-year-old with Down syndrome who is beginning to work on bilateral midline
hand skills. His low muscle tone causes him to fatigue quickly when working against gravity. What is a good positioning choice to help Arthur’s fine motor play? a. Long-sitting on the floor b. Placement in a supine stander, reclined 30 to 40 degrees c. Seated in a chair with good support to the trunk d. Sitting independently on a bench ANS: C
One of the first principles of positioning is to assure that children have the capacity to align head, trunk, and pelvis with extremities approaching midline. The ability to maintain proper body alignment is important for developing postural stability and allows children to participate in daily occupations. Symmetrical positioning, with head, neck, trunk, and pelvis aligned, allows children to move their arms and legs efficiently, bring the hands to midline to play with objects, couple the visual system with hand use, and engage the upper and lower body together. 5. Yuki is a 9-year-old with spastic quadriplegia. Yuki’s parents would like her to be able to
participate in their weekly T faEmSilT yBgA am WEhR at.isCtO heMmost important point to consider NeKtSimEeL. L when developing a positioning plan for Yuki? a. Yuki has her head upright. b. Yuki can participate from her wheelchair. c. Yuki can easily move her wheelchair if she wants to leave the room. d. Yuki is safely secured with a lap belt. ANS: A
Neck extension below a 45-degree angle is recommended, as this prevents the head movement from triggering hyperextension throughout the body. 6. Anitra is a 2-year-old with low muscle tone, flat emotions, and frequent lethargy. The COTA
who treats her has difficulty gaining Anitra’s attention when trying to engage her in movement activities. What handling technique can facilitate increased tone, alertness, and activity level? a. Slowly rocking with her positioned sideways in an adult-sized rocking chair b. Wrapping her with a light flannel blanket c. Tickling her feet d. Positioning her on the lap and bouncing her up and down ANS: D
In the presence of hypotonicity, practitioners use facilitation techniques to increase muscle tone to a more normal level (Table 18-2). Indicators for Use of Inhibition and Facilitation Techniques INHIBITION
Child Indicators: Hypertonicity Active primitive reflexes Excessive activity and motion Behavioral excitation Excessive sensitivity or reactivity to handling and touch Strategies: Sustained pressure to tendon Slow stroking of spine while child is in prone position Rotational movement (trunk and hip rotation) Slow rocking or rolling Heavy joint compression Sustained weight bearing Slow holding movements Wrapping, swaddling Calm music, warm colors, soft noises, dim lights, warm temperatures FACILITATION Child Indicators: Hypotonicity Inactive primitive reflexes, lack of balance reactions Excessive relaxation, semiconscious state Behavioral nonresponsiveness, flat affect Decreased reactivity to handling and touch Strategies: Light moving touch Tapping, sweep tapping, and alternate tapping to activate contraction Fast vestibular input Heavy joint compression Active weight shifting Quick, variable movements Upbeat music, cool colors, louder noises, bright lights, and cool temperatures 7. Tyrell is an 8-year-old with spastic quadriplegia cerebral palsy who has made great gains in
head control and use of his arms and hands while positioned prone on a wedge. The COTA decides to have Tyrell try to use his skills at a more advanced level. Which activity is most likely to integrate his success with prone posture? a. Self-feeding while seated on a bolster chair b. Initiating forward movement while prone on a scooter board c. Reading a story while prone on a wedge d. Swimming with his classmates at school ANS: B
The prone position, in which a child is positioned on his or her tummy, facilitates neck and trunk extension and thus helps the child build muscle strength and stability in the neck, upper back, shoulders, arms, and hands. Once a child develops strength, he or she can better stabilize and control upper arm movements. Once the child has established stability in prone, he is ready to progress to movement in prone. 8. What is considered the optimal sitting position for children with cerebral palsy (spastic
quadriplegia)?
a. b. c. d.
Chair reclined for comfort Hips extended back into chair Knees extended into long sitting Hips flexed forward
ANS: D
Therapists frequently evaluate children’s sitting posture and provide interventions to facilitate the correct alignment in upright sitting to encourage children to participate in chosen occupations (Box 18-2). Basic Sitting Position OT practitioners help to develop sitting options for children using the following guidelines: • Hips and knees are flexed to 90 degrees. • Back rests against chair back. • The trunk is vertical. • The body is symmetrical. • The head is aligned with the trunk, at midline, and flexed slightly forward. • All three back curves (cervical [neck], thoracic [middle], and lumbar [lower]) are present and in good alignment. A small, rolled-up towel or a lumbar roll can be used to help maintain the normal curves in the back. • Both feet are positioned flat on the floor or supported on a raised surface in neutral. • The tabletop or lapboard is positioned at elbow height. Elbows are flexed at 90-degree positions on armrests, if available. 9.
Which statement correctly describes positioning? a. Children should assume a variety of positions. b. The ideal functional position is sitting. c. Positioning does not imTpE roSvT eB soAcN iaK l iSnE teL raL ctE ioRn. s. COM d. Only children younger than 1 year sit on the floor. ANS: A
In the case of typically developing children, assuming and maintaining a variety of positions leads to the development of more mature movement and overall motor control. Children naturally gain improved motor planning and coordination as they develop postural control in each new developmental position. 10. Which description is not a purpose of positioning? a. Improves functioning b. Eliminates skin breakdown c. Limits the child’s movement d. Enhances socialization ANS: C
Positioning refers to a child’s ability to maintain postural control while participating in daily activities. For example, a therapist may help a child sit in an adapted chair that provides additional support at the trunk so that he or she can write more efficiently and effectively in school. The principles of positioning children include the following: • Provide the child with a variety of positioning options throughout the day. • Consider positions that enhance function in specific activities. • Avoid positions that restrict the child’s ability to move purposefully.
• • • •
Provide positions that are comfortable for the child. Consider safety when determining optimal positions (e.g., do not leave a child unattended in a positioning device). Ensure proper skeletal alignment and body symmetry during positioning of the child. Recommend positioning equipment that provides external trunk stability to facilitate movement.
11. What is the first event that must happen for a child to move? a. Flexion b. Extension c. Rotation d. Weight shift ANS: D
All movement requires an initial weight shift. The term weight shift refers to the change in the center of mass which allows one to move a body part. 12. What does prone position facilitate in infants? a. Hand strength and neck and trunk extension b. Elbow extension and neck flexion c. Trunk flexion, leg strength, and abdominal strength d. Trunk extension and leg and hand strength ANS: A
The prone position, in which a child is positioned on his or her tummy, facilitates neck and trunk extension and thus helps the child build muscle strength and stability in the neck, upper back, shoulders, arms, and hands. Once a child develops strength, he or she is able to better stabilize and control upper arm movements and muscle control. Prone position leads to higher-level motor skills such as prone-on-elbows, prone-on-extended-elbows, and quadruped positions. 13. What are the reactions called that bring the body back to midline position and the head into
vertical position (e.g., when an infant is tilted to the side and brings his head back to the middle)? a. Equilibrium b. Protective extension c. Righting d. Balance ANS: C
Righting reactions support midline postures and are those reactions that bring the head back into alignment with the body. 14. What statement most closely describes the principle of neurodevelopmental treatment (NDT)? a. Through repetition of movement, children develop improved neural pathways to
help them move. b. Repetition of movement improves muscle tone so that the child can sustain correct
movements. c. Repetition of movement increases range of motion and muscle strength. d. Sensory feedback provided by handling techniques motivates the child to move.
ANS: A
The following list provides a summary of NDT principles that guide intervention: • The goal of NDT intervention is to improve overall function in daily tasks by increased active use of the trunk and involved extremities. • Intervention should be individualized and focused on functional outcomes. • OT practitioner may attempt to normalize muscle tone before and during functional movement. • OT practitioner should analyze musculoskeletal limitations interfering with movement and function. • OT practitioner should facilitate normal movement patterns, including both passive and active movements that are meaningful to children. • Treatment should emphasize quality of movement (e.g., accuracy, quickness, adaptability, and fluency) and reproducibility of movement. • Experience is a driving force for children. New activities build on previous sensorimotor experiences (typical and atypical). • Target postural control and movement by using key points of control. Proximal points of control (e.g., hips, trunk, and pelvis) provide more support to children, while distal points of control (e.g., head, hands, and feet) require children to perform more of the movement. • Engage children in “typical” movement and repetition using new movement patterns, which develops new neural pathways. • Children’s motivation and active problem solving should be considered when developing therapy goals and treatment activities.
Chapter 19: Activities of Daily Living and Sleep/Rest Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. What term is used to describe a parent calming his or her child or two siblings working to
clean their room? a. Family-centered care b. Co-occupation c. Multidisciplinary d. Behavior modification ANS: B
The term co-occupation refers to occupations shared by at least two individuals. A naturally occurring co-occupation involves a parent calming his or her child. In this case, the child is responding to the parent (social participation), and the parent is engaging in the caregiving role. 2. The occupational therapy (OT) practitioner decides to help Molly feed herself by working on
strengthening Molly’s upper extremity functioning. What type of approach is this? a. Remediation b. Adaptation c. Compensatory d. Strength based ANS: A
Remediation techniques inT clE udSeTuBpA peNr K exStrEeL mL ityER th. erC apOeM utic exercises (range of motion and strengthening) and therapeutic activities to increase active participation and independence. 3. What is the practitioner doing by moving the objects higher so that the child has to reach
above his head to get them? a. Remediating b. Adapting c. Compensating d. Grading ANS: D
Grading the location of bath supplies on shelves by altering the shelf height or the placement of supplies on the shelves will provide the child with reaching opportunities prior to entering the bath tub or shower area. 4. What technique is the OT using by providing the child with a shower chair, nonslip map, and
safety bars when showering? a. Remediation b. Adaption c. Compensatory d. Grading ANS: C
Compensatory strategies that may be beneficial to children include assistive devices and adaptive equipment such as pediatric-sized reachers, button hooks, leg raisers, sock-aids, loops for clothing, shirts and pants without tags, socks without seams, and Velcro fasteners. 5. What is required for a successful bowel and bladder management program? a. Volition, intention, and intake neurologic system b. Scheduling, planning, and follow through c. Consistency, timing, and luck d. Cognitive ability, visual-perceptual skills, and sensory awareness ANS: A
Bowel and bladder management encompasses both the voluntary control of bowel and bladder movements and the utilization of alternative methods, including the use of equipment, to support bladder control. In order to optimally manage bowel and bladder functions, which include processes of both volition and intention, an intact neurologic system is essential. 6. Which of the following is a remediation strategy that would help a child with motor planning
deficit dress? a. Let the child make mistakes and figure it out for herself. b. Use a strategy of practice, repetition, and simple directions. c. Provide the child with clothes that require no buttons, zipper, or snaps. d. Talk to the child and remind her how to dress. ANS: B
Remediation strategies include helping children who exhibit motor and praxis skill deficits through practice with repetition and variation, as described in the section on motor control/motor learning. 7. Suck-swallow-breathe synchrony is not necessary for which of the following? a. Eating without gasping b. Smiling and frowning c. Sleeping without drooling d. Talking and singing ANS: B
Suck-swallow-breathe synchrony typically emerges as the first self-regulatory activity during the prenatal period. Infants work on further developing the suck-swallow-breathe synchrony, often finding pleasure in drinking from a bottle and/or breast-feeding. 8. Useful techniques to help special children develop sleep patterns do not include which one of
the following? a. Allowing children to go to bed when they wish b. Establishing a sleep routine with family c. Having family ignoring the behaviors d. This is not the domain of OT. ANS: B
Sleep/rest is defined as “a period of inactivity in which one may or may not suspend consciousness.” Sleep is an occupation and sleep disturbances have serious impact on the quality of an entire family’s life. Young children may experience sleep disturbances for a variety of reasons (e.g., anxiety, hunger, nutrition, illness, medication, habits). OT practitioners consult with children and families after carefully evaluating sleep patterns and routines. Behavioral interventions may help change inconvenient sleep patterns. OT practitioners understand that understanding the factors contributing to the sleep disruptions is essential when developing a plan. Sensory diets may be helpful in regulating a child’s sleep-wake cycle. 9. The occupational therapy assistant suggests that the school install a gate at the top of the stairs
so the child can be safe. What type of effort is this? a. Reasonable accommodation b. Least restrictive learning environment c. Prevention d. Compensation ANS: C
Finally, prevention efforts may be aimed at eliminating potential barriers to occupational performance in the area of functional mobility. A simple prevention effort for a child who is gaining functional mobility but lacks adequate safety awareness includes environmental manipulation in the form of a gate to block off access to stairs or other dangers. 10. An adolescent with limited judgment and cognitive skills makes a sexual comment to the
Certified Occupational Therapy Assistant (COTA). The proper responses do not include which of the following? a. Asking the adolescent T abEoS utTsB exAuN alKaS ctE ivLitL y ER.COM b. Asking the adolescent to use words that are more polite c. Reporting the incident to the registered OT d. Reporting the incident to the adolescent’s counselor ANS: A
In some cases, the role of the COTA may be to work with the adolescent to establish and encourage the appropriate context for sexual activity. 11. The activities of obtaining and using supplies and washing, drying, combing, and trimming
one’s hair fall in what category? a. Grooming b. Personal device care c. Personal hygiene or grooming d. Toileting hygiene ANS: C
Personal hygiene and grooming is defined as “obtaining and using supplies; removing body hair (e.g., using razor, tweezers, lotion); applying and removing cosmetics; washing, drying, combing, styling, brushing, and trimming hair; caring for nails (hands and feet); caring for skin, ears, eyes, and nose; applying deodorant; cleaning mouth; brushing and flossing teeth; and removing, cleaning, and reinserting dental orthotics and prosthetics.” 12. What can an OT practitioner do to encourage sleep and rest patterns in children? a. Design a sensory diet.
b. Dictate a sleep schedule. c. Nothing can be done; this is not an OT issue. d. Prescribe herbal supplements. ANS: A
Sensory diets may be helpful in regulating a child’s sleep-wake cycle. 13. Which strategy to help with dressing is not appropriate for a child with sensory processing
issues? a. Allow the child to pick his clothing. b. Cut out tags completely. c. Use detergent with a strong fragrance. d. Wash new clothing before the child wears it. ANS: C
Wash new clothes in familiar detergent before having the child wear them. Use detergent with mild or no fragrance. 14. Which technique is not used to promote swallowing in children? a. Position the child in a semireclined position. b. Provide a calm setting. c. Use vibration and quick stroking about lip. d. Work quickly with the child. ANS: D
Work slowly with the child. Some children may have a delayed swallow. 15. According to the AmericanTA edLiaLtrEicRs,.wChOatMsuggestion is not recommended for EcSaTdeBmAyNoKf SPE
infant sleep safety? a. Use pacifier at naptime and bedtime. b. Swaddle baby. c. Soft sleep surface d. Place infant on back. ANS: C
Infants should have a firm sleep surface. A crib, bassinet, portable crib, or play yard needs to meet the safety standards of the Consumer Product Safety Commission (CPSC).
Chapter 20: Instrumental Activities of Daily Living Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which of the following is not considered an instrumental activity of daily living (IADL)? a. Care of pets b. Community mobility c. Eating and feeding d. Shopping ANS: C
IADLs are defined by the American Occupational Therapy Association (AOTA) as “activities to support daily life within the home and community that often require more complex interactions than those used in ADLs.” More specifically, IADLs involve care of others, care of pets, child rearing, communication management, community mobility, financial management, health management and maintenance, home establishment, meal preparation and clean-up, religious observance, safety and emergency maintenance, and shopping. 2. At what age do children begin to exhibit prosocial behaviors? a. 6 months b. 12 months c. 18 months d. 24 months ANS: A
Parents have described theT irEchSiT ldB reAnNaK s ySoEuL ngLaEsR6.mCoOnM ths old demonstrating prosocial behaviors or helping behaviors related to activities such as picking up toys, throwing away trash, or other basic household chores (Hammond, Al-Jbouri, Edwards, & Feltham, 2017). 3. Which of the following is not considered a part of self-determination? a. Decision making b. Problem-solving c. Self-efficacy d. Physical ability ANS: D
Self-determination is defined as “volitional actions that enable one to act as the primary causal agent in one’s life and to maintain or improve quality of life” (Wehmeyer, 2005, p. 117). Components of self-determination include choice making, decision making, problem-solving, goal-setting and attainment, self-regulation, self-advocacy, self-efficacy, self-awareness, and self-knowledge (Wehmeyer & Field, 2007). 4. Which statement is not true regarding self-determination? a. Individuals who demonstrate strong self-determination behaviors have an internal
locus of control or a belief that one has control over his or her own life. b. Self-determination skills can be learned and demonstrated by children of all ages. c. Self-determination skills can be learned and demonstrated by children of all ability
levels. d. Self-determination is not as important as youth transition into adulthood.
ANS: D
Individuals who demonstrate strong self-determination behaviors have an internal locus of control or a belief that one has control over his or her own life. Self-determination skills can be learned and demonstrated by children of all ages (Erwin et al., 2016) and ability levels (Algozzine, Browder, Karvonen, Test, & Wood, 2001; Wood, Fowler, Uphold, & Test, 2005) and are increasingly important as youth transition to adulthood. It is important that self-determination interventions are provided to children of all ages (Stang, Carter, Lane, & Pierson, 2009). 5. John is a 15-year-old boy who wants to take public transportation to meet up with his friends.
Which skill is he showing by requesting a reduced fare due to his disability? a. Self-determination b. Self-efficacy c. Self-advocacy d. Self-esteem ANS: C
Several IADLs may require self-advocacy skills, especially for individuals with disabilities. For example, youth with disabilities may need to advocate for their health needs when working with a personal care attendant, medical personnel, or school staff. Children and youth with disabilities may need to exercise self-advocacy skills to access supports and benefits related to IADL performance, such as reduced fare public transit or communication accommodations. 6. Which of the following is not an Instrumental Activity of Daily Living (IADL)? a. Care of pets b. Community mobility c. Shopping d. Dressing ANS: D
IADLs for children and youth include care of others, care of pets, child rearing, communication management, driving and community mobility, financial management, health management and maintenance, home management, meal preparation and cleanup, religious and spiritual activities and expression, shopping, and safety and emergency procedures (AOTA, 2014). Dressing is an Activity of Daily Living (ADL). 7. Which statement is supported by research on self-determination skills of children? a. There is a positive relationship between self-determination and independent
community living. b. Self-determination must be learned before 3 years of age. c. There is no correlation between self-determination and employment for children
with mild intellectual and/or learning disabilities. d. There is no correlation between self-determination and positive adult outcomes. ANS: A
Several research studies found that self-determination skills correlate with positive adult outcomes (Shogren, Wehmeyer, Palmer, Rifenbark, & Little, 2015; Wehmeyer & Schwartz, 1997; Wehmeyer & Palmer, 2003). There is a positive relationship between self-determination and independent community living. In fact, youth with mild intellectual and/or learning disabilities who have higher self-determination were employed at greater rates, earned higher wages, and were more involved in the community at 1 and 3 years out of school than similar youth with low self-determination (Wehmeyer & Palmer, 2003; Wehmeyer & Schwartz, 1997). 8. How is a child’s IADL performance influenced by cultural context? a. It may affect the age at which they are granted freedom to engage in IADLs. b. There is no influence of culture on IADL performance. c. Children are more influenced by school than parents. d. Children whose parents work are influenced by culture, whereas others are not. ANS: A
Cultural context includes the customs, beliefs, activity patterns, behavioral standards, and expectations accepted by the society in which the child is a member (AOTA, 2014). The age at which children are granted the freedom to engage in IADLs varies on the basis of cultural norms (Lancy, 2016). For example, children of parents who both work long hours may need to be more independent with laundry and meal preparation than children who have one parent who is home most of the day. Adolescents from a culture that values parent–child relationships were found to be more likely to comply with parental chore expectations than adolescents from cultures that placed a higher value on autonomy (Tamm, Kasearu, Tulviste, Trommsdorff, & Saralieva, 2017). Culture has a strong influence on the IADLs that children and youth are exposed to within their home and the support and encouragement they will receive to participate in IAT DELS s.TBANKSELLER.COM 9. Which statement is true regarding the frequency of engaging in household chores for
adolescents? a. There is decrease in engagement of chores from childhood to adolescence. b. As children get older, they spent more time dusting, vacuuming or taking out garbage. c. Girls spend less time than boys engaged in household tasks regardless of age. d. The amount of time mothers spent working outside of the home predicted a decrease in time adolescents spent in household tasks. ANS: B
The frequency of engaging in household chores typically increases from childhood to adolescence (Lam, Greene, & McHale, 2016). A 7-year longitudinal investigation of over 200 families with two or more children found differences in the amount of time children spent in household tasks varied not only in relationship to age but also in gender differences. As children got older, they spent more time engaged in tasks such as dusting, vacuuming, or taking out the garbage. Boys spent less time than girls engaged in household tasks regardless of age. The amount of time mothers spent working outside of the home predicted an increase in time spent in household tasks by girls but not boys (Lam et al., 2016). In summary, age and functional abilities contribute to the extent of participation and performance of household management tasks for children and youth (Dunn & Gardner, 2013). 10. Which of the following tasks is considered home management?
a. b. c. d.
Picking up one’s toys Washing one’s hands Eating a snack Putting on one’s coat
ANS: A
Home management includes a variety of tasks that can be seen across the age range from toddlers or young children picking up toys or placing clothes in a hamper to far more complex tasks of a teenager doing laundry or assisting family moving out of a house to an apartment. 11. Which of the following statements best defines financial literacy? a. The ability to buy those things one wants b. Skills such as basic money concepts, borrowing, investing and protecting resources c. Skill in understanding concepts of money, adding and subtracting d. Balancing one’s checkbook ANS: B
The definition of financial literacy includes a variety of skills such as basic money concepts (knowledge of currency values to personal accounting), borrowing, investing, and protecting resources (Huston, 2010). 12. Which statement is true regarding research on care of pets and teens? a. Teens who owned pets reported higher levels of self-esteem compared with peers
without pets. b. Teens who owned a pet reported fewer friends compared with non-pet owners. c. There is no difference in self-esteem between teens who own a pet and who do not own a pet. d. Teens with ASD did noTtE bS enTeB fitAfN roKmShEaL viL ngER a. peCt.OM ANS: A
Teens who owned pets reported higher levels of self-esteem compared with peers without pets (Black, 2012). An investigation of close to 300 teens living in rural New Mexico found that teens who owned a pet reported significantly less loneliness compared with nonpet owners (Geerdts, 2015). Teens with ASDs benefitted from both pet ownership and the direct responsibility to care for the pet (Ward, Arola, Bohnert, & Lieb, 2017). An investigation of 73 teens with ASD found that pet ownership and care of the pet enhanced social interaction, and these teens had fewer depressive symptoms when compared with teens with ASD who did not have pets. Parents of children diagnosed with ASD reported several benefits associated with having a dog (Carlisle, 2014). 13. The COTA engages a teen in a relaxation activity before beginning intervention to address
financial management. What is this called? a. Occupation b. Activity analysis c. Physical agent modality d. Preparatory methods ANS: D
Preparatory methods are used as part of an intervention session to ready a client for occupational performance. These tasks may also be used as part of home exercise programs as part of necessary, skilled occupational therapy services. Preparatory methods include “modalities, devices, and techniques to prepare the client for occupational performance” (AOTA, 2014, p. S29). In order to prepare for an activity, a practitioner may involve a child in range of motion stretches, ultrasound, physical agent modalities, splinting, or wound care. Preparatory methods may involve relaxation techniques or changes in the environment to allow the child to feel comfortable. 14. In which setting does the COTA focus strategies for addressing IADLS on the family’s
everyday activities and routines? a. Early intervention b. Schools c. Community d. Hospital inpatient ANS: A
• •
Interventions are incorporated into the family’s everyday activities and routines. Children may require assistance to fully complete the task.
15. Which strategy is an example of how a COTA might address a child’s IADLs in a hospital
inpatient setting? a. Shopping with family members b. Wiping desks and chalkboard c. Putting away toiletries in desk d. Participating in local parade ANS: C
• If the hospital has a simulated living environment, practice meal preparation, cleanup, and household tasks (e.g., putting away items, cleaning up) • Putting away and organizing items such as clothing and grooming materials in the hospital room • Care of pets (e.g., caring for therapy dogs visiting hospital) • Reporting emergency contact numbers and procedures for safety • Discussing and practicing strategies for nutrition, health routines, and medication management in preparation for discharge home
Chapter 21: Play and Playfulness Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which trait is not a characteristic of play? a. Active involvement of the player b. Child-centered activity c. Extrinsically motivated d. Spontaneous ANS: C
The characteristics of play (i.e., intrinsic motivation, internal control, and suspension of reality) need to be present when play is used as a tool to improve a child’s skills. These characteristics occur within the framework of a play setting. 2. Which of the following best describes the role of the OT practitioner in promoting play in
children with special needs? a. Boss and facilitator b. Coach and boss c. Model and boss d. Model and facilitator ANS: D
OT practitioners acting as play facilitators pay careful attention to a child’s interests, elaborate on his or her verbalizations, and model play behaviors. If an activity is not challenging to a child but he or she is enjoyTinEgSitT, B thA eN OK TSpE raL ctL itE ioR ne.rCmOaM y decide to continue the activity before increasing the level of the skill required. OT practitioners must be careful to avoid “teaching” play. They model play, cultivate the skills needed for play, and set up the environment to facilitate play. OT practitioners must ensure that play is enjoyable. Increasing the skills required for play is important and beneficial to the child. 3. You are treating a 12-month-old girl for delayed fine motor skills. During the intervention
session, you pick out toys that encourage hand use. Your goal is for her to use a neat pincer grasp to pick up the small toys. Which statement best describes the role of play in the treatment of this child? a. Play is the goal of the session. b. Play is the method of intervention to work on gross motor skills. c. Play is the method of intervention to work on hand skills. d. Play is being used to divert the child’s attention. ANS: C
Play is often used as a tool to increase skill development. OT intervention is designed around play activities that will increase skills such as strength, motor planning, problem solving, grasping, and handwriting, which are necessary for the child to function. 4. Which objective best reflects playfulness as the goal of the therapy session? a. Sara will participate in a turn-taking game with playmate for 5 minutes within 4
weeks. b. Sara will demonstrate increased fine motor skills as evidenced by her ability to
dress and undress a Barbie doll during play. c. Sara will follow one-step verbal direction during the play session. d. Sara will show pleasure in activity as evidenced by completing her homework
without getting out of her seat. ANS: A
The OT practitioner emphasizes the child’s approach to activities and the way the child plays when play itself is the goal of therapy. When play is viewed as a goal of therapy rather than merely a tool of intervention, the OT practitioner notes the way Angie engages in play, not just her using her right hand to manipulate a toy. A short-term objective to increase Angie’s play might be for her to spontaneously initiate play with a peer at least three times during an adult-supervised play session. Box 20-2 contains sample objectives when play is the goal of OT intervention. 5. Which standardized assessment provides practitioners with an age-equivalent score of play
skills? a. Knox Preschool Play Scale b. Test of Playfulness (ToP) c. Takata’s Play History d. Transdisciplinary Play-Based Assessment ANS: A
The Knox Preschool Play Scale is reliable in measuring play skills in children with multiple disabilities. It provides a play age for each domain and total play age. 6. Which statement is true about the role of spontaneity in OT sessions? a. OT practitioners should provide structure so that spontaneity is limited in a
treatment session. b. Children do not want flexibility and spontaneity. They enjoy it when the therapist
tells them what to do. c. Spontaneity indicates the OT practitioner has not planned the session well. d. Spontaneity is an essential feature of play and should be fostered in the
intervention session. ANS: D
OT practitioners must maintain the quality of play. A child who has the skills needed for play but does not engage in spontaneous and intrinsically motivated activity is at risk. That child may show deficits in play that will carry over to the school, home, and community. 7. Which statement reflects the description of play as the occupation of the child? a. OT practitioners examine the role of play and expectations of the child. b. OT practitioners are interested in the individual abilities and disabilities regarding
particular tasks. c. OT practitioners are interested in the psychological, not physical, aspects of play. d. OT practitioners are interested in improving motor skills for the occupation of
play. ANS: A
When play is viewed as a goal of therapy rather than merely a tool of intervention, the OT practitioner notes the way the child engages in play, not just if the child is performing a set skill.
8. Mike and Scott are wrestling in the water. Mike flips Scott, who goes under water. Scott gets
up laughing and pushes Mike. In which type of play are they engaged? a. Symbolic b. Games with rules c. Sensorimotor d. Rough and tumble ANS: D
Many children enjoy roughhousing. Gentle roughhousing can provide sensory input to them and is often therapeutic and fun. 9. Which rule is the most important to ensure safety in a therapy session? a. Cover electrical outlets. b. Cut all hanging cords. c. Inspect toys and equipment regularly. d. Always watch children. ANS: D
OT practitioners should provide enough rules for children to feel secure and safe without imposing so many that they do not feel free to play. 10. Which characteristic of an OT practitioner promotes play in children? a. Be serious. b. Keep activities the same from session to session. c. Insist that children use toys only in standard ways. d. Try out silly things and have fun. ANS: D
OT practitioners may have to act silly, make mistakes, and even act as a peer to encourage a child to play. 11. Which activity is most suitable to use in OT intervention to help 3-year-olds share? a. Lecture on sharing. b. Have only one toy available. c. Take toys away from the children. d. Play catch in a small group. ANS: D
Sharing is naturally encouraged by playing catch (as children share the ball). 12. Terry, the Certified Occupational Therapy Assistant (COTA), plays “Simon Says” with Julie
and asks her to raise her hands high above her head and to the sides. On which motor goal is she working? a. Increasing endurance b. Increasing upper extremity strength c. Increasing range of motion in the upper extremities d. Increasing fine motor skills ANS: C
The COTA is asking the child to move her arms throughout the range.
13. The OT practitioner played a dress-up game in therapy to work on the child’s goal to put on a
shirt independently. What does this session illustrate? a. Play as the goal b. Play as the tool c. Backward chaining d. Playfulness as the goal ANS: B
Play is often used as a tool to increase skill development. OT is designed around play activities that will increase skills such as strength, motor planning, problem solving, grasping, and handwriting, which are necessary for the child to function. The practitioner is using play to work on dressing. 14. Which objective addresses playfulness as the intended outcome? a. The child will share toys with another child at least twice during a 15-minute play
session. b. The child will put on and button a shirt independently. c. The child will ride a bike at least 20 yards in a straight line without falling. d. The child will reach above his head five times during play. ANS: A
Sharing is an aspect of playfulness as it refers to one’s approach or attitude toward play. The other objectives emphasize motor outcomes. 15. Which characteristic does not promote play and playfulness in children? a. Positive reinforcement b. Patience c. Rigidity with rules d. Sense of humor ANS: C
Play is a fun, spontaneous, internally motivated, and self-directed activity that is free from rigid rules. Playfulness is defined as an individual’s disposition to play. OT practitioners typically use play as a tool to improve a child’s skills and as a goal for therapy.
Chapter 22: School: Handwriting Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Kayla, a 7-year-old first grader, is having trouble in school because her teacher says she does
not try to write well. The Certified Occupational Therapy Assistant (COTA) observed that Kayla had trouble with letter identification, especially when the letters were smaller than those on her desk. What type of visual perceptual skill does this describe? a. Figure ground b. Form constancy c. Visual closure d. Visual memory ANS: B
Form constancy: The ability to realize and recognize that forms, letters, and numbers are the same or are constant whether they are moved, turned, or changed to a different size. This means that a square is always a square no matter what size or color. 2. The COTA, Marvin, is working with 3-year-old Harvey on his prewriting skills. Which skill
would be the easiest for Harvey to accomplish? a. Copy a square. b. Imitate a straight line. c. Spontaneously scribble. d. Draw a face. ANS: C
12 months: Stirring spoon. 14 months: Scribbling—1 scribble 1 inch long. 23 to 24 months: Imitating vertical line 2 inches long. 27 to 28 months: Imitating horizontal line 2 inches long. 33 to 34 months: Copying circle—end points within half inch of each other. 39 to 40 months: Copying cross—intersecting lines within 20 degrees of perpendicular. 41 to 42 months: Tracing line—deviates 2 times. 3. Which pencil grip is considered the most mature? a. Crossed-thumb grasp b. Dynamic tripod c. Palmar grasp d. Static tripod ANS: B
The most mature grasps are the dynamic tripod and lateral tripod grasps. 4. The occupational therapy (OT) practitioner provided Trey with a variety of drawing activities
that were fun and promoted hand skill. These activities were slightly challenging for Trey, based on his current level of functioning. What frame of reference was the practitioner using? a. Biomechanical b. Developmental c. Educational d. Sensory
ANS: B
Development occurs through the learning, experiencing, and acquisition of the skills. The rate of development and the progression of skills vary in children but usually follow sequential patterns. 5. What is the term for when the child moves something from the palm of the hand to the tips of
the fingers? a. Shift b. Rotation c. Translation d. Flexion ANS: C
Translation: Working items to or from the palm of the hand to or from the tips of the fingers without dropping the items (e.g., moving coins from the palm of the hand to the tips of the thumb and index finger to place coins into the slot of a vending machine). 6. Raysor has difficulty writing. He hesitates when trying to continuously form letters. He does
not understand where to begin writing on his paper. He sometimes begins at the bottom of the letter and sometimes at the top, despite frequent repetitions of the letter. What type of problem does Raysor show? a. Poor midline crossing b. Poor motor planning c. Poor visual acuity d. Tactile defensiveness ANS: B
Children with poor organizTaE tioSnTalBsA kiNllK sS mE ayLuLsE eR le. tteCrO sM of varying sizes and wrongly mix uppercase (capital) and lowercase (small) letters in words. Some organizational problems are related to poor visual processing, while others are related to poor motor planning or attention. Children with poor handwriting skills may have deficits in motor planning (i.e., figuring out how to move their bodies and then actually doing it) or motor memory (i.e., remembering the motor patterns and being able to repeat them). 7. Brigit is an 8-year-old girl who presses hard on the paper and frequently smears her letters and
rips the paper. What do you expect to observe with her grasp pattern? a. Dynamic tripod grasp b. Grasp by the eraser c. Loose grasp d. Tight grasp ANS: D
Tight grasps may limit the variety of movements and make smooth, fluid motions difficult. Writers using tight grasps often press hard on the paper, which results in the formation of dark, sometimes smeared, letters. 8. Which sitting position is most helpful for writing? a. Feet on floor, desk resting on lap b. Feet off floor, desk under armpits c. Feet on floor, desk slightly above elbow d. Feet off floor, desk slightly above elbow
ANS: C
The best sitting position for a child is sitting with the hips and knees at 90 degrees, feet flat on the floor, and the ankles at 90 degrees. The desk should be at a height of two inches above the flexed elbow. 9. Which of the following is not considered a performance skill that may affect handwriting
performance? a. Muscle tone b. Sensory processing c. Endurance d. School desk ANS: D
The performance skills that may affect handwriting performance include muscle tone, strength, endurance, posture, integrity of structures, visual perception, and sensory processing. In addition to evaluating the underlying factors that may affect handwriting. A child’s school desk is part of the physical context. 10. Tiffany is a 10-year-old girl who got in trouble in class for talking during free writing time.
When confronted, she told the teacher that she did not intentionally speak out loud, but it made the writing easier. What kind of learner is Tiffany? a. Auditory b. Visual c. Kinesthetic or tactile d. Perceptual ANS: A
Children who learn through auditory means write better if they hear or verbalize the letters or words while putting them on paper. These children may talk to themselves while writing, saying the letters and verbally describing the letter formation as they write. Using fun “sayings” for letter formations are also helpful in learning how to stroke a letter. For example, when writing the capital letter “B,” the OT practitioner would say: “Big line down. Frog jump up. Now, little curve, and another little curve.” 11. What type of learner benefits from role playing and feeling the letters? a. Auditory b. Visual c. Kinesthetic or tactile d. Perceptual ANS: C
Some children are tactile or kinesthetic learners; that is, they need to physically feel and act out the task to remember the sequence. These children learn or perform a task better when they can stand while writing or when given the opportunity to move the body through the act. Using proprioceptive input—such as practicing and feeling the letter formation in the air with or without hand-over-hand assistance for additional tactile sensation of the letter shape— supports their learning. They frequently respond well to physical rewards such as a pat on the back or being sent on errands to the school office. 12. Which classroom strategy is most helpful to a child with handwriting difficulties?
a. b. c. d.
Allow the child to spend recess time writing homework assignments. Do not require the child to write at all. Provide a written list of homework assignments. Require the child to write in neat, full paragraphs.
ANS: C
Providing written list of homework assignments allows the child to get the classroom work done at home and does not penalize him/her for writing. Other strategies include: • A written list of homework assignments and a checklist of each book or folder that needs to go home can be provided to the child. • Delegate a packing buddy to help the child pack up at the end of the day to make sure that all of the necessary papers and books are put in the bag. • Allow the child more time to complete written assignments, or use an outline format for him or her. • Grade and emphasize the content of assignments of written expression with a grade for the mechanics of writing. 13. Which observation indicates a child has poorly developed hand arches? a. Strong grip strength b. High muscle tone c. No creases seen in the palm d. Hand can form a bowl ANS: C
Children with poorly developed hand arches have flat, underdeveloped, weak hands. The lack of hand arching interferes with the strength and coordination. When the arches are well developed, the hand is ableTtE oS foTrm ow nL thE eR pa.lm , aMnd distinct creases are seen in the BAaNbK SlEiL CO palm. Children with poorly developed arches may compensate by holding the pencil tightly against the palm, showing no web space. 14. What are the benefits of keyboarding? a. It improves legibility and reduces spelling errors. b. It requires less memorization and little bilateral coordination. c. It strengthens upper extremity strength and timing. d. It reduces eye strain and improves visual skills. ANS: A
The keyboard would improve legibility and reduce spelling errors in written assignments. Most school districts have computer keyboarding skills included in their curriculum; OT practitioners should review what is recommended. 15. How does using raised-lined paper help children in their handwriting? a. Provides visual cue to stay within the lines b. Provides tactile sensation cue to stop c. Allows child to write larger d. Keeps child’s hand stabilized ANS: B
The tactile system plays a key role in writing. This important skill requires the ability to feel the pencil and manipulate it without the aid of vision.
Chapter 23: Therapeutic Media: Activity with Purpose Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. You are working with Ben, a 5-year-old child, who has tremors in his hands, poor balance,
and poor endurance and who leans forward while walking. He tells you he likes trucks. Which activity would you choose to work on increasing his endurance? a. Pick up heavy blocks. b. Read truck books. c. Push toy trucks around the clinic. d. Walk around the yard briskly. ANS: C
Body movement games such as pushing toy trucks work on endurance. 2. Why did you choose the activity in question 1? a. It is purposeful. b. It has meaning for the client. c. It works on endurance skills. d. All the reasons are correct for choosing the activity. ANS: D
Occupational therapy (OT) practitioners use clinical reasoning skills when choosing therapeutic media for clients. Specifically, therapeutic activities are meaningful and motivating while addressing the client’s goals. When selecting media, the OT practitioner considers the client’s intereTsE tsS , tT heBrA apNyKgS oaElsL, L clE ieR nt.fC acOtoMrs, performance skills, and performance patterns. They consider the context(s) and activity demands of the activity (refer to the Occupational Therapy Practice Framework (OTPF), 3rd edition for further definition of these terms). Practitioners also evaluate how therapeutic media can be graded or adapted to address the needs of individual clients. The authors provide an overview of the reasoning necessary to select media for intervention. 3. According to the OTPF, which factor is considered an occupational performance context? a. Activity demands b. Habits c. Motor d. Personal ANS: D
Contexts include cultural, personal, temporal, and virtual factors. The term environment refers to the physical and social conditions that surround the client. OT practitioners consider the clients’ contexts when selecting intervention activities. 4. According to the OTPF, what are you addressing by taking into consideration that Suzy is a
3-year-old child? a. Activity demands b. Habits c. Client factors d. Context
ANS: D
Context refers to a variety of interrelated conditions that are within and surrounding the client. Personal characteristics of the client include age, gender, socioeconomic status, and educational status. 5. Georgette had difficulty holding a spoon, so you build up the handle. What term describes
providing her the spoon with a built-up handle for the cooking activity? a. Activity analysis b. Adapting the activity c. Grading the activity d. Occupation ANS: B
Adapting refers to changing how the activity is performed. 6. Grace is a 9-year-old girl who is unable to raise her right arm over her head and complains of
pain. According to these observations, with what area is she having difficulty? a. Endurance b. Muscle tone c. Range of motion (ROM) d. Strength ANS: C
Physical requirements (i.e., neuromusculoskeletal and movement-related functions, muscle function, movement functions) are needed to complete activity or use media (e.g., ROM, strength, bilateral integration). ROM refers to moving the extremity through the full movement. 7. Which statement best describes making the activity of carving a pumpkin more challenging
for a group of teenagers? a. Allow them to work in pairs. b. Allow them to light the candles. c. Have them use an extremely dull knife. d. Provide samples of intricate stencils for them to trace and cut. ANS: D
Grading activities involves making things more or less difficult for clients. Requiring more details increases the activity demands. 8. You are trying to increase the social skills of a group of adolescents. Which adaptations to a
sponge-painting activity would best meet this goal? a. Allow them to work in groups of three. b. Limit talking and encourage independent work. c. Provide them with simple directions and a time limit. d. Seat them in desks positioned in a row. ANS: A
Working in groups promotes social skills. 9. What term describes examining the features, characteristics, and qualities of activities? a. Activity analysis
b. Occupational analysis c. Role history d. Task analysis ANS: A
Activity and occupational demand refers to the objects and their properties, space demands, social demands, sequence and timing, required actions and skills, and required underlying body functions and body structures. Analysis of activity demands helps the OT practitioner select appropriate activities and media. 10. Tim, a Certified Occupational Therapy Assistant (COTA), is working to promote Kevin’s
poor grip strength and postural control. Kevin is unable to stand for extended periods. What aspects is Tim targeting? a. Activity demands b. Client factors c. Context d. Performance patterns ANS: B
The COTA analyzes activities in terms of client factors to design interventions to meet the client’s goals. Client factors refer to values, beliefs, and spirituality; body functions; and body structures. Strength and postural control are considered body functions. 11. What is it called when Harry, a COTA, shows 7-year-old Raymond a way to put on his coat
using only one hand? a. Adapting activity b. Analyzing activity c. Grading activity d. Evaluating activity ANS: A
Adapting refers to changing how the activity is performed. 12. Mary is 8 years old and has difficulty stirring a heavy cookie mixture. What is it called when
the COTA adds more milk to make the mixture easier to stir? a. Adapting activity b. Analyzing activity c. Grading activity d. Evaluating activity ANS: C
Grading refers to changing the degree of difficulty of the activity whereas adapting refers to changing how the activity is performed. In this scenario the COTA made the activity easier but did not change how it was done. 13. Which activity is most suitable for a group of 15- to 17-year-old girls? a. Blowing bubbles b. Playing with Barbie dolls c. Scrapbooking d. A 20-piece puzzle ANS: C
Scrapbooking is age appropriate for adolescent girls. The other activities are best for younger ages. 14. Which activity would be most suitable for a group of 3-year-old boys and girls? a. Blowing bubbles b. Playing with Barbie dolls c. Scrapbooking d. A 20-piece puzzle ANS: A
Young boys and girls enjoy blowing bubbles. In some cultures, young boys will not want to play with Barbie dolls. Scrapbooking and a 20-piece puzzle are too difficult for 3-year-olds. 15. The OT practitioner noticed the client had a small cut and provided a glove to protect his hand
during woodworking. This shows the practitioner was taking into account what client factor? a. Skin-related structures b. Sense of self c. Cardiovascular system d. Eye-hand coordination ANS: A
Body structures refer to the anatomical parts of the body. The OT practitioner evaluating handwriting abilities explores the structures of the hand when deciding upon intervention strategies. For example, children may have hand deformities requiring compensatory activity or adaptive equipment. The practitioner may have to provide stability to assist a child in writing. Skin-related structures are considered a client factor under body structures.
Chapter 24: Motor Control and Motor Learning Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. What term is used to describe the intrinsic processes that go hand in hand with children
experiencing and participating in meaningful activities that lead to long-lasting changes in motor performance? a. Bilateral motor control b. In-hand manipulation c. Implement usage d. Motor learning ANS: D
Motor learning refers to the intrinsic processes that go hand in hand with children experiencing and participating in meaningful activities that lead to long-lasting changes in motor performance. 2. What type of practice includes having a child placing coins in a slot, resting briefly, and
repeating the same activity again? a. Blocked b. Distributed c. Transfer of learning d. Variable ANS: A
An example of blocked praTcE ticSeTinBcA luNdK esShEavLiL ngEaRc.hC ilO dM put pegs in a pegboard or placing coins in a slot, resting briefly, and then doing the same activity again. 3. Alison quickly repositions her body to catch a ball. Of what is this an example? a. Adaptation b. Blocked practice c. Feedback d. Feedforward ANS: D
Feedforward is that intangible abstract representation of sensation that gives us the awareness of what the movement pattern will feel like before we begin to move. Feedforward refers to the adjustments in anticipation of the movement required. For example, a child may position himself to catch a ball by predicting where he thinks the ball will go. 4. Glen is a 5-year-old boy who is unable to pick up cereal and small toys. The certified
occupational therapy assistant (COTA) engages Glen in a game to pull objects out of Play-Doh and poke his finger in the Play-Doh to make holes. On what skills do these activities work? a. Balance and range of motion b. Endurance and trunk strength c. Strength and in-hand manipulation d. Timing and sequencing
ANS: C
Children and youth with motor deficits may experience decreased strength, which negatively impacts the ability to engage and perform occupations. For example, an OT practitioner using distributed practice to develop a child’s fine motor skills for handwriting and play designs an interesting session using a “Fall” theme. The session begins with the child tearing small pieces of paper (working on neat pincer grasp), then gluing the pieces on paper (in hand manipulation) and ending with coloring around the picture (tripod grasp). 5. What type of practice is most effective for transfer of learning? a. Blocked b. Distributive c. Variable d. Repetitive ANS: C
Variable practice (also referred to as random practice) incorporates the practicing of many different skills, with periods of rest. This type of practice is helpful for fine tuning of skills and most helpful in the transfer of learning as well. Further, they indicate that better movement quality is attained in whole-task practice and repetition. The child completes a variety of movements with natural breaks. 6. What would be the first step when working with a 6-year-old child with poor coordination and
timing for handwriting? a. Games involving running and moving b. Using fingers to grasp object c. Scooping, using thumb and index finger d. Picking up object, usinT gE tiS pT ofBiA ndNeK xS fiE ngLeL r aEnRd.thCuO mMb ANS: A
Coordination and timing deficits may be addressed by beginning with gross movements and progressing to more precise movements. OT practitioners focus coordination intervention by starting with postural control or stability. This may be achieved through intervention or positioning or adaptive equipment. The practitioner provides the child with opportunities to practice coordination by designing activities that require the child to repeat motions and progressively become more accurate. For example, the practitioner may begin by providing a large target area and gradually lessen the target area (to facilitate more precision). Timing may be promoted by including music, rhythmic songs, or counting activities into the intervention sessions. 7. The COTA working with 6-year-old Dylan plays a game of crumpling sheets of paper into
balls and throwing them. What is the goal of this activity? a. Basketball mastery b. Finger individuation c. Hand strengthening d. Range of motion ANS: C
Crumpling sheets of paper helps develop hand strength. 8. To improve upper extremity control needed for writing, the practitioner gives the child a large
piece of paper taped to the wall and finger paints. What has the practitioner altered?
a. b. c. d.
Attention to details Degrees of freedom Practice expectations Mental rehearsal
ANS: B
All of these movements refer to the degrees of freedom in which the shoulder can move. All of this mobility may impede a child’s ability to control the joint. For fine motor tasks, for example, the child must be able to control the very mobile shoulder joint, as well as the elbow, wrist, and hand joints. In order to increase control, the degrees of freedom can be limited by holding or stabilizing the joint. For example, to improve upper extremity control needed for writing, the degrees of freedom of the upper extremity can be limited by giving the child a large piece of paper taped to the wall and providing finger paints. The child can hold the distal joints of the hand, wrist, and elbow, while performing a “prewriting” task utilizing primarily the shoulder joint. This activity can be made more challenging by providing a large paintbrush and then smaller paintbrushes and a smaller piece of paper. 9. Which concept is least central to motor control theory? a. Meaningful activities b. Natural contexts c. Promote problem solving d. Teach components ANS: D
Meaningful activities are the foundation of OT practice and have been found to increase a child’s motor performance. OT practitioners carefully design meaningful interventions to maximize the child’s involvement, volition, and engagement. Children will repeat activities that they find meaningful. T OE TSpT raB ctA itN ioK neSrsEuLsL eE mR ea.nC inOgM ful activities that closely mimic occupations of childhood as both the goal of intervention and the means to achieve the goals. Engaging a child in meaningful activity in a natural context is the most effective strategy, because it allows the child to adapt, problem solve, and respond appropriately and accordingly within the natural context. OT practitioners providing intervention to a child within their natural context are urged to allow the child to make mistakes, problem solve, and self-correct to create motor solutions. 10. Which statement is not a guideline for applying the concept of transfer of learning? a. There is no benefit to practicing the skill in real-life situations. b. Skills need to be presented in a logical progression. c. Foundational skills should be practiced before complex skills. d. Similar skills are more likely to transfer. ANS: A
Practicing skills in real-life situations reinforces the child’s ability to perform activities more naturally, effectively, and automatically in his or her natural context and promotes transfer of learning to a variety of environments. The best ways to ensure transfer of learning include allowing the child to practice the actual task in natural context; perform a variety of skills with random or variable rest periods. 11. Which statement is correct concerning feedback and motor skill learning? a. Direct the child to critical cues before demonstrating the skill. b. Talk to the child throughout the entire process while demonstrating the skill.
c. Do not provide demonstrations; allow the child to work through the skill. d. Demonstrate throughout. ANS: A
Demonstrations are best if they are given to the child before practicing the skill and in the early stages of skill acquisition. Before demonstrating the skill, the child’s attention should be directed toward critical cues. 12. Which statement is true concerning how knowledge of performance (KP) facilitates motor
learning? a. KP should be given 100% of the time. b. KP should be provided the next day. c. Prescriptive KP is more helpful than descriptive KP in the early stages of learning. d. KP error information is not helpful. ANS: C
KP refers to providing information about the nature or characteristic of the movement used to perform the task. The OT practitioner provides information about how the task is performed. KP answers questions such as “What did the individual actually do?” or “How did she move to carry out the task?” KP helps children understand how they could adjust or change movements for more accuracy or success. 13. Karen provides her client, Bill, with 1-minute rests between 5-minute of repetitive skill
practice. What kind of practice is this? a. Continual b. Distributed c. Blocked d. Variable ANS: C
Blocked practice is practice in which the child has longer practice time than rest. It also refers to practicing a similar skill and then getting a break. In blocked practice the child practices one skill with short break and returns to that skill. 14. Which statement is true concerning part practice? a. Part practice may be preferable with complex skills. b. Part practice is always preferred over whole practice. c. Part practice is best when the sequence varies. d. The learner should not receive assistance with part practice. ANS: A
Part practice may be preferable when the skill is more complex. 15. Which statement is not true concerning using mental practice to develop motor skills? a. Mental practice should be relatively short, not prolonged. b. Mental practice can help the person prepare to perform a task. c. Mental practice combined with physical practice works best. d. Mental practice replaces physical practice. ANS: D
Mental Practice
• • • • •
Mental practice helps to facilitate acquisition of new skills as well as the relearning of old skills. Mental practice helps the person prepare to perform a task. Mental practice combined with physical practice works best. For mental practice to be effective, the individual should have some basic imagery ability. Mental practice should be relatively short, not prolonged.
Chapter 25: Integration and Occupation/Sensory Processing Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which statement most closely represents the role of the Certified Occupational Therapy
Assistant (COTA) in sensory integration (SI) intervention? a. The COTA may not use SI intervention techniques. b. The COTA may use an SI approach under supervision. c. The COTA may only perform formal SI evaluations. d. The COTA may not treat children with SI dysfunction. ANS: B
When an appropriately SI-trained and experienced pediatric occupational therapist is available only on a limited basis (or not at all), the COTA can contribute effectively to promoting sensory processing with practical intervention strategies. 2. What is sensory processing? a. The process of receiving, detecting, and making sense of input from the
environment b. Planning, designing, and executing movements c. Discriminating between different textures within the environment d. A fear of height, movement, or textures so that the child is unable to make an
adaptive response ANS: A
EL ChOicMh the brain receives, detects, and The term sensory processinTgErS efTerBsAtoNtK heSm eaLnE s bRy.w integrates incoming sensory information for use in producing adaptive responses to one’s environment. 3. What is thought to be the cause of SI dysfunction? a. Blindness or deafness b. Traumatic brain injury c. Central nervous system (CNS) processing dysfunction d. Genetic abnormality ANS: C
Children who have sensory integrative dysfunction have a cluster of symptoms that are believed to reflect dysfunction in CNS processing of sensory input, rather than a primary sensory deficit such as hearing or visual impairment. 4. Multiple choice questions 4 through 6 are based on this case study. Stewart is a 9-year-old boy
who is having difficulty in school. Stewart shows an aversion to being touched and is uncomfortable with movement. He has poor penmanship, is unable to keep up with his friends on the playground, and shows poor self-esteem. Stewart has low muscle tone, a positive asymmetric tonic neck reflex in standing positions, difficulty tracking objects, and associative reactions. He has poor shoulder cocontraction and endurance. He wants to play soccer at recess with the other kids.
The occupational therapy (OT) practitioner who is treating Stewart begins the session by playing swinging games in the net and inner tube swings. Together, they design an obstacle course, and Stewart hits balls with his head and runs around the course. Stewart jumps on a miniature trampoline and tries to make baskets. Stewart ends the session by participating in a finger-painting activity. What type of treatment approach does this describe? a. Motor control b. Sensory diet c. Sensory integration d. Sensory modulation ANS: C
The central principle of this intervention approach is the provision of controlled sensory input, through activities presented by the therapist, to elicit adaptive responses from the child, thereby bringing about more efficient brain organization (Fig. 25-7). This latter result becomes observable in the increased organization of behavior, movement, and affective expression that is seen in the child. These diverse and multilevel responses are elicited within a rich environment that provides multiple, variable types of sensory experiences with the guidance of a skilled occupational therapist (Fig. 25-10). 5. A student observes the session. She decides to instruct Stewart on the techniques of playing
soccer. She provides Stewart with verbal and demonstrative instructions on the skills needed for soccer. They go outside and play a game of soccer. According to OT theory, what is true of this session? a. Stewart will benefit from this carefully planned session. b. Practicing a skill is not a principle used by occupational therapists. c. The student has not fully analyzed the occupations of the child. d. This is a typical sensorT yE inSteTgB raA tiN veKsS esEsL ioL n.ER.COM ANS: A
The practitioner may use other approaches (motor control/motor learning) if they deem necessary. 6. Which activity would best work on Stewart’s poor shoulder cocontraction and endurance? a. Walking on a balance beam b. Spinning in a net c. Playing “Simon Says” d. Wheelbarrow walking ANS: D
Observation of the endurance level as well as frustration tolerance, problem solving, and creativity is critical to guiding the intervention session. The OT practitioner adjusts the bar as necessary, raising or lowering it for challenges accordingly. Wheelbarrow walking involves cocontraction and endurance. The other activities may not challenge the child as needed. 7. Henry, a 9-year-old boy, complains of how his new school clothes feel, hates noises in the car,
and is easily irritated at school by all the movement of his classmates. Henry becomes car sick easily. He is a very picky eater, stating that he does not like the smell and taste of many foods. Which type of deficit do these findings represent? a. Bilateral integration dysfunction b. Developmental dyspraxia c. Postural-ocular dysfunction
d. Sensory modulation disorder ANS: D
Sensory modulation and discrimination disorders can be found in one or more sensory systems in any affected individual, namely vestibular, somatosensory, visual, auditory, and olfactory/gustatory. Henry is showing discrimination and sensory defensive behaviors (e.g., tactile, auditory, vestibular). 8. Charlie, a 10-year-old boy, is unable to ride a bicycle. He has poor balance and low muscle
tone throughout and does not cross midline. His teacher reports that he sits slouched in his seat and has difficulty reading across the page. Charlie has difficulty copying words from the board. Which type of deficit do these findings represent? a. Bilateral integration dysfunction b. Developmental dyspraxia c. Sensory modulation disorder d. Postural-ocular disorder ANS: D
Postural-ocular disorder: Other related concerns frequently noted include poor protective, righting, and equilibrium responses during functional movement or clinical assessment and immature gait patterns such as the use of a wide base, with lateral weight shifting of the lower extremities. To compensate for low extensor muscle tone in the upper body, shoulder girdle positioning may be marked by scapular retraction, scapular elevation, and high-guard arm posturing. These postural patterns are typical in normal toddler and early preschool development but usually give way to mature postural organization, smooth bilateral-reciprocal movements, and normal lateral dominance during the period between the ages of 4 and 6 years. 9. Tracy is a 5-year-old girl who is unable to get on a tricycle. She tries, but even after directions
and demonstrations, ends up backward or sideward on the seat and is unable to understand how she should be positioned. Which term most closely describes Tracy’s difficulties? a. Cognition b. Constructional praxis c. Developmental dyspraxia d. Sensory modulation ANS: C
Developmental dyspraxia: Children with this disorder represent some degree of motor planning difficulty, which is part of the diagnosis of severe developmental delay and is consistent with their development across the board. (a) The first and most fundamental process is the ability to register and organize tactile, proprioceptive, vestibular, and visual input in order to assemble accurate internal cognitive maps of the body and the environment with which the body typically interacts. (b) The second process, which is based on these constructions, requires the ability to conceptualize internal images of purposeful actions, termed ideation in the neuropsychological and rehabilitation literature. (c) The third process is the planning of sequences of movements within the demands of the task and environmental context, including the ability to program anticipatory actions within the next few seconds. 10. Which statement describes the principles of sensory integration intervention? a. Provide controlled sensory input to elicit an adaptive response. b. Practice motor movements to repeat patterns.
c. Desensitize the child so she or he can tolerate input. d. Provide fun and exciting activities to promote playfulness. ANS: A
The central principle of this intervention approach is the provision of controlled sensory input, through activities presented by the therapist, to elicit adaptive responses from the child, thereby bringing about more efficient brain organization. 11. Which statement best describes the focus of sensory processing intervention? a. Desensitization of sensory input for tolerance b. Improved balance and equilibrium c. Organization of multiple sources of sensory input d. Organization of tactile input for fine motor skills ANS: C
The focus of sensory processing intervention is aimed toward the organization of multiple sources of sensory input. The focus is also on the lower brain processing of vestibular input integrated with proprioceptive and visual inputs, making it important to identify the target sensory system(s). Ayres proposed that the vestibular system was a major integrator of other senses and had a significant influence on overall modulation. Pumping a bolster swing to move forward and backward while making postural adjustments in sitting not only provides vestibular input, but also integrates proprioception in the neck, trunk, and eyes. This integration of sensations paves the way for postural integration as well as conjugate eye movements that are necessary for fine and visuo-motor activities. 12. Why does the COTA provide a new activity on the swing during the treatment session using a
sensory integration approach? a. To facilitate attention tT oE neSwTsBeA nsNaK tioSnE s LLER.COM b. To prevent the COTA from becoming bored c. To assure the child that the COTA is in charge d. To reduce the structure of the session ANS: A
The introduction of new toys, sounds, smells, and even movement on a swing provides novelty to the interaction and elicits vigilance to new incoming sensations. Employing novelty does not necessarily mean changing the equipment (the toy) or, in the case of a writing activity, the size, shape, and color of the pen or the smell of the ink or the sound that the pen makes with pressure. Infusing activities with controlled novelty is similar to the way in which novelty is effective in managing sensory modulation disorder; only this time it is infused with opportunities to refocus on the variety of the qualities and characteristics of sensations. Additionally, novel activities should be approached with a variety of materials but not at the expense of needed continuation as expressed or observed. 13. During a sensory integration session, Ryan, a 10-year-old boy, suddenly becomes quiet,
forgets the object to the swinging game he is playing, and stops playing. What do these behaviors suggest? a. Ryan is processing vestibular input accurately. b. Ryan has attention deficit disorder. c. Ryan is showing signs of sensory shutdown behaviors. d. Ryan needs more sensory stimulation.
ANS: C
While engaging in the activities, introduce changes in the sequence and other components of the activity to detect signs of sensory overload or shutdown behaviors such as purposeless running around, losing track of the end goal of an activity, a glassy-eyed expression, or simply suddenly becoming quiet, retreating to a corner, or even seemingly falling asleep. Introducing the changes can result in sustained interest and maintained vigilance, thereby influencing attention and purposeful interaction with the environment. 14. Charlene, the COTA, talks with 11-year-old Bob about strategies that may help him in the
classroom and at home. Why does Charlene choose to do this? a. Bob can become an active participant in problem solving. b. Charlene does not have to document the strategies. c. Bob’s parents are not involved in the therapy. d. Charlene should not be discussing strategies with a child. ANS: A
Different strategies may be designed not only for direct treatment with the child but also for implementation in the classroom by teachers and in the home by family and caregivers. TRUE/FALSE 1. COTAs can become certified in the administration and interpretation of the Sensory
Integration and Praxis Tests (SIPT). ANS: F
Because of its complexity, only certain licensed rehabilitation professionals with a baccalaureate or graduate dTeE grSeT eB wA hoNhKaS veEuLnLdE erR go.nCeOdM ocumented rigorous training may administer the Sensory Integration and Praxis Test (SIPT). To become more familiar with the various components of SI evaluation, pediatric OTAs should have a qualified SIPT examiner administer this instrument to them and engage in a reflective discussion of their experiences. This will provide valuable insights about both the process of SI and its assessment.
Chapter 26: Applying the Model of Human Occupation to Pediatric Practice Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. A child’s pattern and organization around different occupations is called a. volition. b. performance capacity. c. habituation. d. environmental factors. ANS: C
Habituation is the internalized readiness to engage in consistent patterns of behavior during certain times of day and days of the week, as determined by one’s habits and roles. Habits and roles help children organize their lives and make participation in everyday occupations easier. 2. What idea can be used to help a therapist understand how children experience their
participation in occupations? a. Performance capacity b. Personal causation c. Occupational forms d. Volitional process ANS: D
The volitional process is how children experience their participation in occupations. The volitional process includes four steps: anticipation, making choices, experience, and interpretation. A child’s inT teE reS stT s,BvA alN ueKsS , aEnL dL peErR so.nC alOcM ausation influence each step of this volitional process. 3. The Model of Human Occupation (MOHO) uses what term to define the common and typical
way of doing specific occupations? a. Habituation b. Occupational forms c. Performance capacity d. Roles ANS: B
Occupational forms, or tasks, are these conventional sequences of actions that are oriented to a specific purpose and understood by and recognizable to members of a shared culture. 4. During a treatment session, a therapist provides the guidelines for choice and performance of
tasks by allowing a child to choose from a set of alternative activities that addresses the same area of concern. This type of therapeutic strategy is a. structure. b. encouragement. c. coaching. d. giving feedback. ANS: A
Using the strategy of “structure” to modify the social environment and occupational task helps create a therapeutic environment in which the child is most likely to be successful. 5. What is the subconcept of volition that describes a child who uses internalized convictions
and some sense of obligation to determine the choice of activity engagement? a. Interests b. Personal causation c. Values d. Self-efficacy ANS: C
Volition is comprised of values, interests, and personal causation. Values are those things that a child finds important and meaningful and are influenced by a child’s culture and context. Values result from internalized convictions and are associated with a sense of obligation. 6. A child is engaged in a play group at his local place of worship. When using MOHO as a
guide to practice, this sort of activity is an environmental factor. This is an example of a. occupational form. b. spaces. c. objects. d. social group. ANS: D
The MOHO concepts that help us think of the environmental factors that directly influence participation are spaces, objects, social groups, and occupational tasks. Social groups are collections of people who come together for a variety of formal and informal purposes. Social groups include play groups, classrooms, worship communities, internet social networking groups, families, and a neiT ghEbS orThB ooAdN . KSELLER.COM 7. According to MOHO, which subsystem should be objectively measured and is typically
measured using other frames of reference? a. Performance capacity b. Volition c. Habituation d. Environment ANS: A
Performance capacity is the third and final MOHO concept addressing client personal factors. Performance capacity is a child’s ability to do things as supported by the status of his/her physical and mental components as well as his/her subjective experience of living within his/her body. Occupational therapy (OT) practitioners use other theories to measure, classify, and describe the status of physical and mental components of a child. Therefore, MOHO acknowledges the importance of a child’s physical and mental components but relies on OT practitioner’s utilization of other frames of reference (biomechanical, sensory integration) to evaluate and explain those components. 8. A child does not like the way he feels when he slides. He has done similar activities in the
past and did not like them. He now avoids any activity that requires sliding or movement that is similar. The step on the volitional process that is being affected is the child’s a. interpretation. b. experience.
c. anticipation. d. making choices. ANS: C
How the volitional process is influenced by a child’s interests, values, and personal causation. 9. The subjective experience a child has in being in her own body is called a. lived body. b. personal causation. c. volitional process. d. occupational task. ANS: A
A child’s own experience of using and living in his or her body is the subjective aspect of performance capacity, also referred to as the “lived body” experience. 10. What is the MOHO concept that is influenced by a child’s interests and beliefs about her
ability to perform an occupation? a. Habituation b. Performance capacity c. Volition d. Environment ANS: C
Volition, or a child’s motivation for occupations, is influenced by those activities the child finds most enjoyable (interests), the child’s beliefs about what is important (values), and the child’s beliefs about his or her ability to effectively perform occupations (personal causation). In combination, these threeTaEsS peTcB tsAoN f vKoSliE tioLnLcEreRa. teCaOuM nique pattern of thoughts and feelings that influence how a child anticipates, chooses, experiences, and interprets what he or she does. 11. A classroom that is arranged to allow a child using a walker to move about freely is an
example of what under the MOHO concept area of environment? a. Objects b. Spaces c. Occupational tasks d. Social group ANS: B
Spaces are physical places, or contexts, that are arranged in ways that influence what children do within those spaces. 12. A therapist begins intervention with a child who does not like any of the activities that the
therapists selects for him to do. Each treatment session, the child walks to a corner, crosses his arms, and will not do anything that the therapist has planned. The therapist asks the child’s mother what he likes to do. On finding out the child likes elephants, the therapist incorporates them into the activities in the treatment session. The therapist allows the child to select from two activities, both of which the child has been mildly successful in completing. Which step in the volitional process is the therapist trying to impact through this change of approach to intervention? a. Making choices
b. Anticipation c. Experience d. Interpretation ANS: A
Children are more likely to choose a certain activity if they think it is fun; if they think it is meaningful; and if they believe they can successfully engage in and complete the activity. 13. When a child identifies a set of related actions and attitudes that define a familiar status, this is
what within the conceptual area of habituation? a. Habits b. Social groups c. Personal causation d. Roles ANS: D
When a child identifies as a son or daughter, brother or sister, student, soccer player, band member, or worker, he or she is internalizing a role. 14. A therapist engages in a give-and-take interaction with a child, his parents, and consultants
from other disciplines working with the child to gain an agreement about something that the child should do. The goal of this type of therapeutic strategy is to a. validate. b. advise. c. negotiate. d. identify. ANS: C
Negotiate: Engage in give-and-take with the child, his or her parents, and other professionals to achieve a common perspective or agreement about something that the child will or should do in the future. 15. What is the term for things that a child is happy to do, finds happiness in doing, and usually is
able to do successfully? a. Occupational forms b. Occupational objects c. Interests d. Values ANS: C
Interests are things that a child finds enjoyable and satisfying to do. Usually children are interested in activities in which they are most likely to be successful and engage without possibility of failure, pain, or difficulty.
Chapter 27: Assistive Technology Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Which statement is true concerning assistive technology (AT)? a. AT refers to aids and devices that help rehabilitate an individual. b. AT helps a person to be more functional. c. AT is always commercially manufactured. d. AT helps persons with only certain diagnoses. ANS: B
Congress described four major benefits of assistive technology (AT) for individuals with disabilities: 1. Greater control over their individual lives, 2. Increased participation in their daily lives, 3. More widespread interaction with nondisabled individuals, and 4. The capacity to benefit from opportunities that most people frequently take for granted. 2. 2. From where would someone seek AT funding for an 8-year-old to perform successfully in
school? a. Medicare b. Vocational rehabilitation program c. Individuals with Disabilities Act (IDEA) d. Birth to three program ANS: C
In 1975, Congress enacted a major piece of legislation, also patterned after civil rights law, this time protecting the rights of children with disabilities. The Education for All Handicapped Children Act, P.L. 94-142, later became known as the Individuals with Disabilities Act, or IDEA. In this legislation, handicapped children were acknowledged as people with “certain inalienable rights.” 3. What do built-up controls for a toy or activity represent? a. No-technology solution b. Low-technology solution c. High-technology solution d. Bad solution ANS: B
Low technology is easy to obtain, easy to use, and of relatively low cost. 4. Which statement is true of direct selection? a. Direct selection is faster than indirect selection. b. Direct selection is cognitively more complex than indirect selection. c. Direct selection may be accomplished without physical contact. d. Direct selection may involve scanning or encoding. ANS: A
One form of access is referred to as direct selection. Direct selection is a straightforward method for making a choice or selection. Physically, direct selection is considered more difficult than indirect selection because it requires more refined, controlled movements. However, because all of the elements in the selection set are equally available and do not need to be scanned, direct selection is considered the faster form of device control. Direct selection is also considered less cognitively complex than indirect selection because it is more intuitive. For these reasons, direct selection forms of device control are considered a better option than indirect forms of control. 5. What should the Certified Occupational Therapy Assistant (COTA) consider when selecting
assistive switches? a. Use whatever switch is available. b. Match switch characteristics to the user’s specific needs. c. Move the switch around as much as possible to find the best spot. d. Make access challenging for the individual. ANS: B
Like so many aspects of rehabilitation, AT assessment is a team endeavor. Although COTAs do not conduct evaluations, it is critical to understand the process of evaluation so that the clinical information that is shared with the occupational therapist is valuable in adjusting AT goals and intervention procedures for individual users. Numerous approaches to decision making for assistive technology exist. The one discussed here is adapted from a model rooted in the field of human factor. 6. Which of the following adjectives does not accurately describe low technology? a. Inexpensive b. Inaccessible c. Accessible d. Simple ANS: B
Low technology is easy to obtain, easy to use, and of relatively low cost. In contrast, high technology is more difficult to obtain, requires greater skill to use, and is frequently more costly. We consider these factors when weighing options for individual users. For example, if we are working with an individual who we know to be “technophobic,” then we would probably want to keep our AT options toward the low-technology end. At the same time, we do not want to make AT decisions simply based on the fact that someone enjoys and is comfortable with technology. This author’s motto is simple: Never buy a Jaguar when a Volkswagen will do! To be safe, we should always make sure that our decisions about technology are based on the goals and abilities of the client. 7. Which of the following is an example of a low-technology device? a. Pencil grip b. Environmental control unit (ECU) c. Powered wheelchair d. Laptop computer ANS: A
Low technology is easy to obtain, easy to use, and of relatively low cost. 8. Which of the following is an example of an adapted input device for computer access?
a. b. c. d.
Braille embosser Enlarged print Speech synthesizer Switch
ANS: D
See Table 27-2 Control Sequence for Environmental Control Systems. 9. Which of the following is the most important aspect that affects the functional use of a
personal high-technology augmentative communication device? a. Implementing b. Planning c. Pricing d. Selecting ANS: B
Careful planning and training are required for children to become competent users of Alternative Augmentative Communications (AAC) systems. The goal of AT is to reinforce and facilitate any attempt at communication, since what a child has to say is more important than how he or she says it! 10. What is an ECU? a. Environmental care unit b. Environmental control unit c. External communication unit d. Educational communication unit ANS: B
Environmental control units (ECU) are systems that allow an individual to control his or her environment. 11. Which of the following is not considered a low-technology mobility aid? a. Wheelchair b. Scooter c. Cane d. Walker ANS: A
Low technology is easy to obtain, easy to use, and of relatively low cost. In contrast, high technology is more difficult to obtain, requires greater skill to use, and is frequently more costly. 12. Which of the following is not a disadvantage of a power wheelchair? a. Weight b. Portability c. Maintenance d. Speed ANS: D
However, the student’s family is committed to emphasizing the use of a walker and so does not want to consider a power wheelchair. Since the caregivers do not share the goal of powered mobility, it may not be wise to pursue that goal at this time. Speed is one of the advantages of a powered wheelchair. However, they weigh more, are less portable, and must be maintained. 13. What was the team trying to identify when they observed the child playing to determine what
voluntary movement he had before placing the switch on his arm? a. Indirect selection b. Direct selection c. Access d. Control site ANS: D
For example, you and I “access” the computer via a keyboard and/or mouse. Initially, we work as a team on the identification of a particular “control site” or location on the body that can be used to operate a device. Potential sites for controlling aids or devices include hands and fingers, arms, the head, eyes, legs, or feet. Ultimately, the site and movement chosen should represent the fastest, most energy efficient, and most reliable. Following the identification of a control site, the team begins the task of determining the most appropriate form of access for a given user. 14. What type of selection is it when the child moves the joystick to the right so the cursor goes to
the right? a. Direct selection b. Encoding c. Indirect selection d. Scanning ANS: A
Using your hands to operate the joystick on a computer game console is another example of direct selection; when you want to go left, you move the joystick to the left with no intermediate steps involved. 15. The child observes all the letters pass by on the computer screen and presses a button when
the letter he wants passes by. What type of selection is this? a. Direct selection b. Encoding c. Scanning d. Physical selection ANS: C
Alternatively, he or she might use a single switch connected to a directional panel, scanning through the options (i.e., left, right, back, forward). Scanning is one form of indirect selection; another is referred to as encoding. With encoding, the user relies on multiple signals together to specify response.
Chapter 28: Orthoses, Orthotic Fabrication, and Elastic Therapeutic Taping for the Pediatric Population Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. What is the reason to fabricate an orthosis for a deformity? a. To immobilize the injury to prevent further damage b. To allow the client to move the extremity without pain c. To cover any external signs of the injury d. To attempt to realign the deformity ANS: A
An orthosis might support and protect an extremity after injury; provide corrective positioning of a joint with a deformity; assist a weak or injured muscle in active motion; and/or increase functional performance of the extremity. 2. What type of protocol is provided with orthosis? a. Occupational b. Cleaning c. Repair and maintenance d. Wearing ANS: D
The wearing protocol defines the specific schedule of orthotic use and must be carefully explained to the child and family members for maximum benefit of the orthosis. The wearing protocol may vary from chT ilE dS toTcB hiAldNbKaS seEdLoL nE eaRc. hC inO dM ividual’s needs and condition. 3. How do dynamic orthoses assist an individual with movement? a. They assist movement in all planes. b. They assist movement in only one plane. c. They use outriggers and various moving parts. d. They generally prevent movement. ANS: C
Dynamic orthoses have components that allow movement. They include elastic elements or coils and springs in the orthotic design. These additions are known as outriggers. Dynamic orthoses may be used to aid in function and/or to improve motion at joints with limitations. 4. Which factor is not considered when fabricating an orthosis for a child? a. Swelling b. Compliance c. Sensory factors d. Time before lunch ANS: D
The purpose of the orthosis varies from individual to individual. An orthosis might support and protect an extremity after injury; provide corrective positioning of a joint with a deformity; assist a weak or injured muscle in active motion; and/or increase functional performance of the extremity.
5. What must the OT practitioner consider when fabricating an orthosis? a. Gross motor development b. Development of grasp patterns c. Hand use d. All are correct e. None are correct ANS: D
It is critical to appreciate the normal developmental progress of the child’s hand to appreciate which activity level suits each child. Orthotic intervention must try to accommodate this development. When fabricating orthoses for children with congenital hand differences, the OT practitioner looks at the child’s development and current functioning, determines the purpose of the orthosis, and considers the context in which the child will use the orthosis. 6. Which skill represents appropriate hand use for a 5-month-old child? a. Hand crosses the midline while supine. b. Active forearm supination while prone. c. Two-handed approach to objects with a unilateral grasp. d. Roll from supine to prone. ANS: C
See Table 28-2: Normal Hand Development. 7. Which statement is not a goal of orthotic fabrication? a. Alleviate pain b. Enhance function c. Prevent deformity d. Shorten soft tissue structures ANS: D
Box 28-1: Goals of Orthotic Fabrication. 8. You are treating Maggie, a 14-year-old girl who was injured playing soccer. Maggie wears an
orthosis but is noncompliant when donning it. You stress the importance of wearing the orthosis. What is the best reason you can give Maggie to encourage her to wear the orthosis? a. It prevents the tendons and ligaments from shortening. b. It decreases the potential contracture formation. c. It prevents the progression of deformity. d. All are good reasons. ANS: D
The orthosis provided usually will support and immobilize the healing structures and protect them from sudden movements. During the fibroplasia phase, the wounds are still healing but the edema is decreasing. The child may begin to move the limb for active exercise and functional activities. The orthosis must continue to support the limb but may require modifications due to decreased edema and better positioning. 9. Which statement shows the responsibility of the certified occupational therapy assistant
during the splint fabrication process? a. Writing down the sequence of when to don or doff the orthosis
b. Teaching the child how to properly don or doff the orthosis c. Instructing parents, teachers, and others involved in donning and doffing the
orthosis d. All are correct. ANS: D
The certified OT assistant (COTA) may contribute to the evaluation process and assist in fabricating the orthosis or may fabricate the orthosis, depending on his or her skill level, setting of care, and reimbursement/funding sources. Medicare does not permit OTAs to fabricate orthoses independently. 10. What is the purpose of a wrist immobilization orthosis with universal cuff? a. It stabilizes the forearm. b. It allows the child to hold things. c. It rests the arm. d. It provides support to the wrist and elbow. ANS: B
A wrist immobilization orthosis can be fabricated to help a child hold an object (e.g., spoon). For example, a wrist immobilization orthosis was fabricated for Rosa to help her hold the spoon (see Fig. 28.2). This orthosis provides Rosa with the wrist support she needs to position her wrist in extension, increase hand control and be successful in this important ADLs. The OT practitioner uses the principle that external stability may increase mobility. 11. Which type of orthosis is used to apply adjustable static force? a. Static orthosis b. Dynamic orthosis c. Static progressive orthoTsE isSTBANKSELLER.COM d. Resting hand orthosis ANS: C
Static progressive orthoses have components that provide a static pull on a stiff joint or on a contracture of the skin to increase passive motion and tissue length. They also have outrigger attachments. Static progressive orthoses are nonfunctional and are used to gain passive motion when joints are stiff and tissue has shortened. 12. Which statement does not reflect the purpose of a static orthosis? a. Decreases contractures by maximizing range of motion (ROM) b. Provides stability to unstable joint c. Improves joint alignment d. Promotes movement to aid in healing process ANS: D
Static progressive orthoses have components that provide a static pull on a stiff joint or on a contracture of the skin to increase passive motion. They also have outrigger attachments. Static progressive orthoses are nonfunctional and are used to gain passive motion when joints are stiff and tissue has shortened. 13. Which statement is not a function of Kinesio tape? a. Supports muscle b. Improves ROM
c. Stabilizes fractures d. Reduces pain and inflammation ANS: C
Elastic therapeutic taping, also known as Kinesiological taping and/or Kinesio taping, is an intervention that occupational therapy (OT) practitioners utilize to support weak and/or injured muscles or body tissues. Appropriate taping may enable children and adolescents to participate more freely in their daily routines at home, in school, and in the community. 14. What is the primary goal of Kinesio taping? a. To help the body in self-healing b. To provide stability to muscles c. To correct misaligned joints d. To normalize muscle tone ANS: A
The primary goal of elastic therapeutic taping is to aid the body in self-healing. The use of elastic therapeutic tape is thought to activate the neurologic and circulatory systems by mimicking human kinesiology and normal muscle activity. 15. What is not considered an outcome of Kinesio taping? a. Control edema b. Facilitate or inhibit movement c. Immobilize joints d. Provide support ANS: C
The literature describes thrT eeEdSiT ffeBrA enNt K mSetEhL odLsEoR r t.ecChOnM iques of applying tape to an individual’s body to either facilitate or inhibit movement, provide support, help control edema, and alleviate pain.
Chapter 29: Animal-Assisted Therapy Solomon: Pediatric Skills for Occupational Therapy Assistants, 5th Edition MULTIPLE CHOICE 1. Of what is hippotherapy an example? a. Animal-assisted therapy b. Therapy for zoo animals c. Physical therapy d. Water therapy ANS: A
When animals work within the therapeutic milieu, the activities are known as animal-assisted therapy. Animal-assisted therapy refers to a licensed, degreed health care or human service provider with continuing education and expertise in the area of AAT, and includes an animal in the formal intervention plan. The plan is specific to each clients predetermined goals and will have measurable outcomes (AAII, 2020; American Hippotherapy Association [AHA], n.d.). 2. “Henry will ride a horse for 10 minutes on trails” is an example of what? a. Occupation of childhood b. Means to improve balance c. Physical therapy d. Recreational therapy ANS: A
Riding a horse is an occupT atE ioS n.TBANKSELLER.COM 3. Jack, a Bernese mountain dog, has been trained to pull Carrie as she sits in her wheelchair.
Jack is also able to bring Carrie items and carry her backpack. What type of dog is Jack? a. Guide dog b. Hearing dog c. Pet dog d. Service dog ANS: D
Service animals are typically trained dogs; however, miniature horses can also be trained to help those with physical disabilities with everyday tasks, such as retrieving dropped objects, opening doors, or turning on lights. Service dogs can also be trained to alert individuals with life-threatening conditions, such as diabetes or epilepsy, that medical intervention is needed. Service animals (dogs or miniature horses) are legally defined in the Americans with Disabilities Act (ADA, 1990). According to ADA, the three types of service dogs are guide dogs, hearing dogs, and medical alert dogs (Box 29.2); US Department of Justice, 2015). 4. Which factor is most important for the occupational therapy (OT) practitioner to consider
when using an animal as an occupation for children? a. Family and child’s pets b. Parental income and educational level c. Practitioner’s comfort with animals d. Transportability of pet
ANS: A
A personal pet lives with an individual or family and is a part of that individual’s or family’s life. An institutional pet resides in a facility or institution such as a skilled nursing facility. When using care for the animal as the occupational goal, practitioners must consider the family and child’s pets. 5. Which statement is not true regarding emotional support animals? a. They provide comfort by their presence. b. They are afforded the same privileges and access to public spaces as service
animals. c. They may be allowed in housing that otherwise does not allow pets. d. They can help individuals with anxiety. ANS: B
Some dogs or other animals may be designated as emotional support animals. These animals are not trained for a specific task but provide comfort just by their presence (US Department of Justice, 2015). Emotional support animals can be very calming for individuals with anxiety, autism, or posttraumatic stress disorder. Emotional support animals are not afforded the same privileges and access to public spaces as service animals; however, the Air Carrier Access Act allows an emotional support animal to accompany an individual on an airplane (US Department of Transportation, 2018) and may be allowed in housing that otherwise does not allow pets (US Department of Justice, 2015). 6. What is the role of the OT practitioner during a hippotherapy session? a. Help the child successfully ride the horse. b. Improve the child’s communication skills. c. Improve the child’s poT st E urS eT anBdAbNalKanScEe.LLER.COM d. Teach the child to ride properly. ANS: A
Hippotherapy, a special form of equine-assisted therapy, uses the dynamic three-dimensional movement of the horse to achieve specific therapeutic goals. In the United States, hippotherapy is always provided by an OT practitioner, physical therapist (PT), or speech-language pathologist. The OT practitioner helps the child successfully ride to work on therapeutic goals. 7. Mary is an 8-year-old girl with ASD. As part of her OT sessions, she is engaged in caring for
a sheep as part of a 4-H club. She goes to meetings, discusses her animal, and talks to other children who also have sheep. She especially likes the shows at the local fairs. Which occupation(s) does this address? a. IADL b. ADL c. Social participation d. A and C ANS: A
Care of pets is an IADL. Mary is learning to care for her pet as well as engage in social participation. Animals may be used as a modality to improve social participation. A child may show his or her pet to friends, meet other children with the same type of pet, or join clubs that discuss the care of animals (e.g., a 4-H club, riding organization, fair). These groups help children learn about and gain interest in their animals and develop a sense of belonging. OT practitioners can help children with special needs participate in these groups by helping them adapt or compensate as needed. 8. George enjoys lifting the bowl of water and feeding his dog every day. The certified
occupational therapy assistant (COTA) incorporates this activity into George’s morning sessions to improve George’s upper extremity strength. How is she using this activity? a. Diversion b. Hippotherapy c. Modality d. Occupation ANS: C
She is using the animal activities to improve his strength. This is OT using the animal as the modality to work on strength. Animals can be used in therapy as a modality (i.e., the animal is the tool to improve the skill) 9. George is unable to lift the heavy bowl. The COTA provides him with a lighter-weight bowl
so that he can feed the dog on his own. How has the OT practitioner used the activity? a. Animal-assisted therapy b. Diversion c. Modality d. Occupation ANS: D
Animals can be used in therapy as a modality (i.e., the animal is the tool to improve the skill) or as the goal itself (i.e., caring for the animal is the occupation that the person is trying to master). 10. The COTA designed an hippotherapy activity of asking a child to direct the horse to go
around a cone. What client factor is the OT practitioner best targeting with this activity? a. Hand-eye coordination b. Gross motor skills c. Tactile discrimination d. Balance ANS: A
Hand-eye coordination: Learning to turn a horse around a cone requires hand-eye coordination. 11. Karli, a 7-year-old girl, lives on a farm, where she is responsible for feeding the chickens,
dogs, and cats. Karli is currently in the hospital after a burn accident. Which activity will Karli most likely enjoy and help her grasp with her burned right hand? a. Caring for the hospital fish and cats. b. Reading about life on the farm. c. Watching videos about farm life. d. Walking on the treadmill in the OT clinic.
ANS: A
Fish that are popular as home and classroom pets include goldfish, beta fish, and kissing fish. Animal-assisted activities involving fish might include increasing occupational performance through caring for them. Caring for the fish can work on her hand skills. 12. What is the role of animals in OT practice? a. Animals should not be allowed in the clinic. b. Animals may help clients reach their goals. c. Pet care is considered a social work goal. d. OT practitioners must be trained to care for animals. ANS: B
Animals allow OT practitioners to address a variety of therapeutic goals. Therapy animals can help children engage with peers, develop self-esteem, and help a child have fun. They can help children work on a variety of goals.