Cores Values of Occupational Therapy

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Cerebral Palsy
A grouping of disorders involving the brain nervous system and affects muscle movement, learning, hearing, seeing and thinking Types of CP include
Spastic (most common) Hemiplegia, Diplegia, Quadriplegia Athetoid Ataxia Mixed

Generally caused by injury or abnormalities in the brain usually due to low oxygen (cause unknown)

CP Symptoms
Can affect one or both sides of the body; just arms or just legs, possibly both Tight muscles and joints Muscle weakness Loss of coordination Inability to walk or issues with gait Nervous system symptoms
Speech/vision/hearing issues, pain, seizures

CP Treatment
Reduce spasticity Improve function and prevent deformities Protect joints Ultimately making the individual as independent as possible

Autism Spectrum Disorders

Neurobiological disorder disrupting social interactions, communication and behavior exact; cause is unknown Symptoms can be observed between 12 and 36 months and vary in terms of severity, onset and development Incurable but helped with intervention Types: Retts, Aspergers, Childhood Disintegrative, Pervasive Developmental

ASD Symptoms
Communication and Social Interactions
Affected both verbally and nonverbally, problems with eye contact, expressing oneself clearly emotionally or verbally, unable to read others emotions, pointing, poor posture Visual perception and processing usually a strong suit Ie: auditory processing, echolalia

Behaviors
Repetitive routines, repeating words and behaviors

Mental Retardation
Diagnosed before the age of 18; most cases no defined cause but can be associated with gene disorders or chromosomal abnormalities
Environmental factors (maternal infections, smoking, poor nutrition)

Includes general intellectual function and lack of skills for daily living Occupational Therapists main concern is with adaptive behavior (conceptual, social, practical skills) Most common cases:
Down Syndrome & fragile X syndrome
Be mindful of hypotonia (poor muscle tone) and seizures relating to Down Syndrome

Schizophrenia
Mental Disorder where the individual experiences difficulties with:
Thinking logically Differentiating real from unreal Behaving in social situations Having normal emotional responses

Cause unknown but may be related to genetic factors

Environmental triggers

Schizophrenic Symptoms
Symptoms may be gradual, can have many all at once or only a few at a time
Difficulties functioning in public whether its with friends, at work or other Anxiety, depression, suicidal thoughts Initial signs: problems with sleeping, concentrating, feeling irritable More intense symptoms: delusions, hallucinations, loose associations

Positive symptoms: Hallucinations, delusions (grandeur and persecution), fixed ideas, ideas of reference, disordered thinking Negative symptoms (deficits): Alogia, anhedonia, avolition, flat affects, reduced movement

Types:
Paranoid- anxious, angry, false beliefs Disorganized- problems with thinking and expressing oneself, childlike behaviors, mute emotional responses Catatonic rigid muscles/posture, negative aggressive demeanor Undifferentiated combination of symptoms from other types Residual continued negative symptoms

Schizophrenia Treatments
Medication Treatment
Educating family members and friends Learning how to alter the environment in ways that support the individual to make up for deficits and increase participation in all areas of life
Life training skills Focus on meaningful values and interests of engagement

Mood Disorders
Disturbances in mood
Cause dependent on disorder but thought to be a mixture of certain factors including genetic, environment, stress factors Often reoccurrent and lifelong

MDD episode lasting for at least 2 weeks

Anhedonia = inability to experience pleasure Waking up early, loss of appetite, depression, psychomotor agitation Catatonia = bizarre motor behavior/immobility

BPD one or more episodes of mania, hypomania, or mixed moods

Flight of ideas, racing thoughts, lack of sleep, unrealistic productivity

Mood Disorder Treatments

Medication paired with treatment for biological, physical and social needs Ots need to acknowledge the many factors influencing the individuals condition and QoL
Support system Economic status Age Roles

Anxiety Disorders
apprehension of danger, and dread accompanied by restlessness, tension, tachycardia and dyspnea unattached to a clearly identifiable stimulus Caused by neurochemical and physical pathways Types:
Combinations of panic with/out agoraphobia, social anxiety, OCD, PTSD (symptoms longer than 1 month andhave significant impairment), generalized anxiety

Anxiety Disorder
Symptoms: Phobias (irrational fears), obsessions/compulsions, panic attacks Treatment
OT should be focused toward the development of or reestablishment of meaningful daily routines Facilitated engagement Assess functioning abilities in all areas to see what will provoke conditions Address diet and exercise, prioritizing activities Be mindful of physical conditions

Dementia
Characterized by cognitive deficits most significantly in the area of memory
Delirium
Caused by fever or medication; rapid onset Anixety, restlessness, sleep disturbance, irritable Apraxia, dysgraphia (inability to write), dysnomic aphrasia ( difficulty naming objects), motor deficits Sundowning Help with nutrition/hydration, providing a safe environment

Dementia
Recent memory is the first thing affected Aphasia (struggles with language), apraxia (loss of skilled purposeful movement), agnosia (Impact on sensory impressions), distrubances in orientation AD no known cause; progressive
Early stage: short term memory significantly impaired and beginning of long term memory; language still intact with problems with word retrieval, saying the wrong word; visuospatial declining; IADLs start to be affected

 Middle Stage: remote memory declines (stuck in the past) and new information is not retained; language is becoming more limited in expression and understanding; visuospatial in continual decline; psychiatric symptoms and behavioral disturbances emerge Late Stage: Loss of new memories; speech limited to one/two words; extreme physical limitations (bed bound), paratonia (involuntary resistance), dysphagia (inability to swallow)

Dementia Treatment
Discussion with family and support groups early on Analysing environment making it suitable for patient

Cerebrovascular Accident
May be caused by lifestyle choices and genetic/personal factors Location of infarct determines what functions are affected Stroke caused by interruption of bloodflow to the brain due to lack of oxygen or nutrients
Ischemic - blockages cause tissue to die Thrombosis blood clot Embolism clot forms elsewhere, breaks off and gets stuck in an artery not large enough for clot to pass Hemorrhagic aneurysm or rupture in blood vessel

TIAs to be differentiated from strokes; temporary blockage, duration is shorter and less permanent effects

Neurological Effects
Impaired sensation Trouble with language Difficulties with muscle control/tone
flaccidity = floppy, spasticity =hyperactive

Loss of memory Restrained personality Vision impairments Emotional instability

Cardiopulmonary Disorders
COPD = Permanent and progressive airflow obstruction that interferes with gas exchange and functional capacity
Dyspnea, fatigue, chronic cough, chest tightness Treatment : client centered approach, active participant in eval and intervention; graded activities to improve cardiopulmonary strength and endurance for ADLs; emphasis on activity; reinforce diaphragmatic breathing (pursed lip breathing)

Pneaumonia = infection (bacterial, viral, mycoplasmal)

Cough, headache, muscle pain, chills Drug therapy/antibiotics

TB = infectious and chronic disease transmitted in the air

Coughing, spitting up blood (Hemoptysis), fever, weight loss, night sweats DOT important, infection control procedures; work simplification and energy conservation

Cardiopulmonary Disease
Coronary Artery Disease
Maintain functions of CV system MI = heart attack, when blood is restricted from entering a section the heart
Cardiac rehabilitation, treatment focused on maximum independence, exercise

CHF = progressive condition with no cure; heart can no longer pump blood Hypertension = blood pressure stays elevated
Lifestyle modifications

Diabetes
Metabolic condition where the regulation of glucose if hindered by the lack of insulin Body ends up using its own fats and lipids as a result of the decreased insulin which hinders intake of nutrients for organs and muscles/tissues
Type 1 autoimmune; sudden rapid onset Type 2 obesity

Hyperglycemia too-little insulin Hypoglycemia too much insulin Diabetic foot trauma causes foot ulcers which can ultimately lead to gangrene Diet and exercise are important ADLs impacted as a result of motor skill impairments

Traumatic Brain Injury

External physical force to the brain that results in disturbances in both physical, mental and emotional functions
Coordination, speaking, reasoning, remembering Mild, Moderate and Severe TBI based on how long patient is unconscious/in a coma Focal and diffuse lesions Multiple stages of recovery over a long period of time; Ranchos Los Amigos Level of Congitive Functioning Scale

TBI
Motor and coordination deficits Disturbances with sight, sense of smell and hearing Headaches, dizziness, fatigue, memory and problem solving difficulties but symptoms generally gradually get better Amnesia and procedural learning should gradually improve Responses and recovery highly individual Goals of therapy are to restore the person to an optimal level of functioning in all areas, and to minimize additional physical or psychosocial disability
Employment is a big contributing facto to an increased QoL

Burns
Largest organ of the body that protects against infection, prevention of loss of body fluid, control of body temperature, functioning as an excretory organ, production of vit D, helping to determine personal identity Temperature and duration of burning two determining factors to level of burn Depth of burn influences survival rates, healing time, treatment and scar formation
Superficial only epidermal layers of skin; redness and pain Partial-thickness burn blisters that will increase in size, usually a deep red waxy color, 7 20 days to heal Full thickness burn penetrates epidermal and dermal layers of skin causing a layer of small possibly multicolored blisters that have ultimately hit nerves; will scar and need skin donor to determine healing

Other systems affects: pulmonary and cardiac

Burns
With open wounds, need to keep them as clean as possible; can be done through debridement, hydrotherapy, can also use allograft to close wound Autograft (sometimes cultured epithelium) transplant of new skin to replace the old Treatment preservation of joint function and maintaining appropriate positioning of affected area
Splints prevent scaring, compression garments, surgery, massage, ointment/injections Help with psychological and social education for individual and family members

Progressive Neurological Disorders

No known cause but may be related to the combination of genetic predisposition, viruses and environmental influences Multiple Sclerosis
Progressive, immunological and neurodegenerative disease Body attacking myelin sheath the surrounds the brain and spinal cord; demyelination of neurons scar tissue Symptoms: optic neuritis, dysesthesia, urinary incontinence, muscle weakness, gross/fine motor incoordination, fatigue, ataxia, dysphagia, dysarthia, and cognitive/emotional disturbances

 Parkinsons Disease
Progressive neurological disorder Deficits in speed and quality of motor movements, postural stability, cognitive and affective expression Symptoms: resting tremor, muscle rigidity, bradykinesia (slowness of all voluntary movement and speech), and postural instability Preclinical, prodromal, symptomatic periods

Amyotrophic Lateral Sclerosis

Fatal, progressive and degenerative motor neuron disease leaving scars on neurons Atrophy of muslces, loss of strength, difficulty speaking and swallowing, loss of emotional control, reducedbody temperature

For all conditions ADLs, IADLs, education, work, play and leisure and social participation will all be areas of concern and focus

Rheumatoid Arthritis
Inflammation of the joints
Stiff, aching, fatigued muscles Chronic, inflammatory, systemic disease Genetic and environmental factors control progression, extent, and patterns (not inherited) Leading cause of disability in the US RA may be progressive for some and not for others and generally affects more than one joint

Systemic Juvenile Rheumatoid Arthritis

May involve stomach pain, anemia, weakness, weight loss, fatigue Late onset and early onset Usually involves large joints

Joint Manisfestations
Hand ie: Swan neck, boutonniere Wrist ie: Carpal tunnel (median nerve compressed, swelling) Elbow ie: tennis elbow Shoulder may be hard to identify initially because swelling will occur under rotator cuff but limitations and pain in movement can be detected during ADLs Hip, knee, ankle, foot RA may result in other conditions such as pulmonary manifestations, nodules, Feltys Syndrome, Cardiac Manifestations, nervous system, eye manifestations Treatment: relief of pain, reduce inflammation, preserve muscle strength and function, maintainence of normal lifestyle, promotion of normal growth/development; not curative! Top-down approach!

Spinal Cord Injury

Brain and spinal cord = CNS
Nerve tissue: Gray matter center, white matter periphery Motor and sensory information paired with spinal nerves
C1- C8 (cervical) carry impulses to and from the head, neck, diaphragm, arms, and hands T1-T2 (thoracic) chest and upper abdominal musculature L1-L5 (lumbar) legs and portion of the foot S1-S5 (sacral) remaining foot, bowel, bladder, sexual functions

Complete: all pathways are interrupted and there is a total loss of muscle control and sensation below level of the injury Incomplete: still room for voluntary movement and sensations below the level of injury

Quadriplegia lost or limited function in all extremeties Tetraplegia loss in the cervical segments Paraplegia loss or limited function in the lower extremeties and trunk Spinal shock Other complications
Respiratory; C4 and above usually need ventilator Hyperreflexia responses of ANS (fight or flight, thermal regulation); T6 or above Decubitus ulcers Hypotension blood pooling in lower extremeties Deep vein thromboses reduced circulation caused by decreased tone Spasticity Heterotopic Ossification Bladder infections

Condition impacts all areas of life and each activity should be analyzed

Orthopaedics
Injury of bones, joints, related structures Generally caused by an accident or disease ie: osteoarthritis (deterioration of cartilage) osteoporosis (low bone density) Fractures: closed, open/compound, greenstick Functional outcomes dependent on age, type of fracture, fracture location, severity, motivation, and health status Therapist be mindful of complex regional pain syndrome Fractures may require open/closed reduction, replacement, braces, immobilizers, etc.; initially try to immobilize and align fracture