Occupational therapy programs tables of content
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- Bu səhifədəki naviqasiya:
- IX ORTHOTICS/ADAPTIVE EQUIPMENT
- SENSORY AWARENESS EVALUATION AND FLOW SHEET PROCEDURES
- GUSTATORY/ORAL MOTOR STIMULATION
- STIMULUS RESPONSE FLOW CHART PROCEDURES
- STIMULUS/RESPONSE FLOW CHART Scoring + response
- Generalized Nonfunctional Motor Response to Stimulus
- Nonverbal Attempt to Communicate
- Reference Ranchos Los Amigo Cognitive Functioning Scale
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VIII PREFEEDING Present Status of Food and Liquid Intake: Nasogastric Tube Gastric Tube Oral Gastric Tube Intravenous Semisolid Solid Liquid Oral Intake: None Assisted Supervised (Self) Independent Present Respiratory Status: Tracheostomy Endotracheal Tube Oxygen Congestion Needs Suctioning Normal History of Ascription: Yes/No____________________________________________________________________ Tracheostomy: Yes/No Size_______________________ Type________________________________________ Cuff: Physician’s orders require: inflated/partially inflated/deflated Cough: Volitional: present/absent Strength:_________________________________________________________ Gag: Intact/Diminished/Absent____________________________________________________________________ Other Impairments: (tonic bite, tongue thrust, agitation, impulsivity, etc.)____________________________________ _____________________________________________________________________________________________
SENSORY AWARENESS EVALUATION AND FLOW SHEET PROCEDURES Fill in the patient’s name and history number. Remember to date the evaluation. During presentation of all stimuli, tell the patient what you are doing and what response you expect. The patient’s response to stimulation may be quite prolonged or prevented altogether because CNS processing occurs more slowly after a traumatic brain injury. Wait for a response to the stimulation and repeat the stimulation if necessary. Allow 15 to 30 seconds between presentations of stimuli so as not to overstimulate the patient and allow sufficient time for a response. Each stimulus should be presented alternately to both sides of the body. Score all patients’ responses to stimulation according to the key provided on the flow sheet. TACTILE STIMULATION If the patient responds appropriately to painful stimuli, i.e., withdrawal or facial grimace, discontinue the pain stimulus (from that session and thereafter) and note the response. Touch: Touch the patient lightly on the hand and shoulder. Repeat with a firm touch once you have assessed the patient’s response to light touch. Stiff brush: Rub a stiff brush over the right and left shoulders, and observe for response. Chest rub: Rub the sternum with knuckles at the nipple line. Icing: Apply icing (icing of the A-size sensory fibers to activate a reflex reciprocal action of the superficial phasic or mobilization muscles) by quick strokes of an ice cube along the forearm and upper arm to evoke a withdrawal response. Pinprick: Prick the forearm and upper arm with a safety pin. Pressure to nail bed: Apply pressure to the patient’s nail bed at the cuticle level with the thumb and forefinger. Vibration: Apply vibration to muscle or tendon. Vibration is reciprocally inhibitory when it is applied to the weaker antagonist of the spastic muscle. Application of the vibrator to the tendon is more effective than application to the muscle belly, although a similar response can be obtained if the vibrator is applied to the belly and the amplitude is high. Caution: The vibration of a muscle or tendon should last at least 30 seconds but not more than 1 or 2 minutes because heat and friction produced by the vibrator may cause the patient discomfort. Life support and monitoring lines: Observe the patient’s response to the life-support system. Note whether he or she attempts to pull on tubes or becomes agitated or shows any response to the sounds of the monitors or alarms. AUDITORY STIMULATION Radio/television: Observe the patient’s response to these sounds: i.e., withdraws: turns head appropriately; shows changes in vital signs in response to familiar music, favorite shows, and the like. (During therapy sessions, unless used as treatment, radios, TV’s or other noises should be eliminated as much as possible so that voice commands for motor responses or the selected auditory stimuli are the most prevalent auditory input to the patient.) Voice: Place the patient’s head in midline or stand opposite to the side that the patient’s head is turned toward. Call the patient by the name with which he or she is most familiar. Use a normal but firm voice.\ Bell: Place the patient’s head in midline or stand opposite to the side that the patient’s head is turned toward. Ring bell 12 inches away from the patient’s ear (if the head is turned to the right, ring in the left ear, and vice versa). Familiar voice: Play a tape recording of the voice of a familiar family member or friends, or observe the patient’s response to these individuals’ voice while they are present. “Familiar voices” can be pet sounds on tape. OLFACTORY STIMULATION 1. Place a cotton ball saturated with the appropriate concentration of odor under the patient’s nostrils (a bottle of the odorant may used also). Be careful to avoid touching the patient’s face with the cotton ball, as this might cause an aversive protective response to the light touch. Allow the odorant to remain long enough to stimulate but not so long as to cause adaptation (about 10 seconds). Be alert to possible changes in level of consciousness, muscle tone, facial expression, verbalization, postural reflexes, feeding patterns, and affective state. If the patient’s initial response to banana/vanilla is reflexive sucking, it is considered an adaptive response. If the patient does not progress, the continued reflexive sucking is no longer considered adaptive. VISUAL STIMULATION Shiny object moving horizontally; Use colored blocks or keys, but keep keys from jingling, if they do, note in comments. Penlight: Use a small flashlight in a darkened room to observe for eye tracking. Fast-moving object toward face: Use your hand. Stationary object in visual field: Use colored blocks. Pictures of familiar people: Use large prints if possible with only one to three people in a picture to encourage focusing on the familiarity of an individual. GUSTATORY/ORAL MOTOR STIMULATION The taste buts are located on the tongue, palate, oropharynx, mucosa of the lips and cheeks, and the floor of the mouth. Before using peppermint or popsicle, obtain the physician’s approval. Toothettes may be dipped in various tastes: make a note in comments section of this is done. The basic categories of taste and the location of greatest acurity are as follows: Sweet: anterior dorsal tongue Bitter: posterior margin and tongue tip Salt: anterior tongue margin Sour: lateral tongue edges INSERT DEPARTMENT OF OCCUPATIONAL THERAPY REPORT SENSORY AWARENESS AND FLOW SHEET HERE. STIMULUS RESPONSE FLOW CHART PROCEDURES Fill in the patient’s name and history number. Remember to date the evaluation. During presentation of all stimuli, tell the patient what you are doing and what response you expect. The patient’s response to stimulation may be quite prolonged or prevented altogether because CNS processing occurs more slowly after a traumatic brain injury. Wait for a response to the stimulation and repeat the stimulation if necessary. Allow 15 to 30 seconds between presentations of stimuli so as not to overstimulate the patient and allow sufficient time for a response. Scoring: Assign a plus (+) when the patient gives the listed response (1 to 6) to the stimulus (a to e). Assign a minus (-) when the stimulus is applied or the command is given, but the patient does not give the listed response. Generalized nonfunctional motor response to stimulus: The patient responds to a stimulus in a manner that is not purposeful or functions, such as an increase in tone or a withdrawal response. Auditory only: Apply an auditory stimulus (call the patient’ name, ring a bell, clap, turn on radio, make a loud noise). Tactile only: Apply any tactile stimulus (use shaking, patting, different textures, a brush, ice, vibration). Auditory and tactile: Apply an auditory stimulus (call the patient’ name, ring a bell, clap, turn on radio, make a loud noise) and tactile stimulus (use shaking, patting, vibrating). Pain: Apply a painful stimulus, such as deep sternal pressure or apply pressure to the patient’s nail bed at the cuticle level with the thumb and forefinger. Opens eyes to stimulus: The patient responds to a stimulus by opening eyes. Turns to stimulus: The patient responds by turning head toward the direction of the stimulus. Visual only: Apply a visual stimulus (brightly colored objects, balloons, blocks, therapist). Auditory only: Refer to above descriptions. Tactile only: Refer to above descriptions. Auditory and tactile: Refer to above descriptions. Nonverbal attempt to communicate: The patient responds in a nonverbal manner indicating likes and dislikes, answers questions, or attempts to communicate with the environment. Facial expression: The patient grimaces in response to pain, stretching (PROM), ice, loud noises, or unpleasant stimuli or smiles in response to pleasant stimuli such as light stroking, music, or a familiar voice. Shakes head yes/no: Self-explanatory. Motor response: The patient responds with the appropriate motor response to a given command. Follows one-step commands One muscle group: The patient is able to follow simple one-step commands involving only one muscle group (squeeze hand, wiggle toes, open hand, blink eyes, shrug shoulders, open mouth). Two or more muscle groups: The patient is able to follow simple one-step commands involving two or more muscle groups (touch head, reach for knees, touch nose, touch shoulder, raise arm, reach for glass, grab other hand). Follow two-step commands One muscle group: The patient is able to follow a command with the complexity of two steps, with each step requiring a response from only one muscle group (squeeze hand and blink eyes, wiggle toes and open mouth, open hand and blink eyes, reach for glass and put it on table). Two or more muscle groups: The patient is able to follow two-step commands, with each step involving a response from two or more muscle groups (touch head and reach for knees, touch shoulder and grab other hand). Verbal response Appears to “mouth” words: The patient appears to form words with mouth although does not verbalize. Yes/no verbalization: Self-explanatory. Other: The patient is able to verbalize words to communicate.
+ response - no response Patient’s Name_____________________________________________________ UH#_________________________________ DATE COMMENTS/DATE
Reference Ranchos Los Amigo Cognitive Functioning Scale No response - Patient appears to be in a deep sleep and is completely unresponsive to any stimuli. Generalized response - patient reacts inconsistently and non-purposefully to stimuli in a nonspecific manner. Responses are limited and often the same regardless of stimulus presented. Responses may be physiologic changes, gross body movements, and/or vocalization. Localized responses - Patient reacts specifically but inconsistently to stimuli. Responses are directly related to the type of stimulus presented. May follow simple commands in an inconsistent, delayed manner, such as closing eyes or squeezing hand. Confused/agitated - Patient is in heightened state of activity. Behavior is bizarre and nonpurposeful relative to immediate environment. Does not discriminate among persons or objects; is unable to cooperate directly with treatment efforts. Verbalizations frequently are incoherent and/or inappropriate to the environment: confabulation may be present. Gross attention to environment is very brief: selective attention is often nonexistent. Patient lacks short-term and long-term recall. Confused/inappropriate - Patient is able to respond to simple commands fairly consistently. However, with increase complexity of commands or lack of any external structure, responses are nonpurposeful, random, or fragmented. Demonstrates gross attention to the environment but is highly distractible and lacks ability to focus attention on a specific task. With structure, may be able to converse on a social automatic level for short periods of time. Verbalization is often inappropriate and confabulatory. Memory is severely impaired; often shows inappropriate use of objects; may perform previously learned tasks with structure but is unable to learn new information. Confused/appropriate - Patient shows goal-directed behavior but is dependent on external input or direction. Follows simple directions consistently and shows carry-over for relearned problems but appropriate to the situation; past memories show more depth and detail than recent memory. Yüklə 3,55 Mb. Dostları ilə paylaş:
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