Day 1 notes

Stressed out
Handout downloaded
 Neuron cognitive disorders
o Deficits and set of symptoms that include dementia, not a diagnosis
o Global losses
o Impaired thought and social functions
o Many causes
o Depression can sometimes look like dementia
o Dementia ultimately leads to death
 Levels I’d ncd
o Mild is like mci and iadls
o Major is when it interferes with adls and iadls
 Trends
o Age is a risk factor
o Under diagnosed
o Under reported
o On the rise
 Conditions that cause ncd
o AD
o Vascular dementia
 Caused by strokes
o Lewy body
 Usually don’t have memory impairment
 Usually younger
 Robin Williams had it
 Behavioral and sleep disturbances
o Mixed
o Fronto temporal
 45-60 years old
 Behavior, language; not so much memory
 Effects of ncd
o Abstract thinking impaired
o Judgment
o Language
o Attention
o Planning, choosing actions and orders, reasoning
 Thinking of cause and effect
o Behavioral and physiatrist problems are typically more difficult for the caregiver
 BPSD
 Key area for us to help
o Comorbid effects: UTI causes confusion and they can’t articulate that
 Family caregivers
o It can make them feel useful, but it is usually burdensome and causes anxiety
o Health effects of chronic stress
 Stress
 o Stress theory
o Identity change theory
 Caregivers have to accept this new role and adapt that the role of the person
they’re caring for is changing
 Keeps them from asking for help
o Role captivity “I’m doing this because I don’t have a choice”
o Dementia care is more stressful
o Sense of self efficacy is gone
 Mediating stress
 Risks of unmanaged stress
o More chronic conditions
o Mental and emotional health is impacted
o Ncd can go on for years
 Lack of knowledge
o Caregivers do not have the knowledge of current strategies
 We no longer do reality orientation
o Often don’t receive training
 Medication management
 Family relationships
o Someone has to pick up when demented person loses roles
o Are family members collaborating or just observing
 Range of care provided
 Competing occupations
o Caregivers might be managing two households
o Distance from receiver
o Things that keep us well tend to go out the door
 Lack of self efficacy***
o They don’t know what to do
o Neuropsychiatric symptoms increase over time of disease
 Benefits of caregiver interventions
o Is there a fit between demands of caregiving and the capabilities of caregivers
o Personal mastery allows a physiologic response to handle stress
 Evidence
o Actively involve the caregiver in identifying concerns
 Evidence based caregiver training
o OT interventions
 Savvy caregiver
 Skills 2 care
 Better wats for better days TAP
 COPE
 RCI REACH
 Rosalyn Carter Institute
o Good resource
 Use evidence in OT
o Sytematics review sept 2017
 Caregiver assessment
o Evidence based formal assessments available on handout
 o She recommends Next Step in Care
o Caregiver and person with dementire a are a dyad
 Caregiver priorities
o Find out what is most difficult for them
 Tailor to the dyad needs
o Make sure they understand our abilities
 Consider readiness for info
o Trans theoretical model
 OT Intervention
o We might just have to educate them on the disease process
o Refer to resources and support
o Problem solving
o Communication skills
o Behavior strategies
o Self appraisal
o AOTA came out with practice guidelines for those with dementia and caregivers
 Teach about dementia
o Strategies for caregiving role
 Connecting to help and support
o They need to know where to go in the future when we are not available
o Help them understand realistic community supports
o Family Caregiver Support Programs
o Alzheimer’s Association
 Not just AD
 All dementias
o Eldercare.gov
 Stress management
o Assess what triggers stress
 Problem solving
o Skills they can use ongoing when we are not there
o They always have to make new decisions
 The Problem Solving Process
o Evaluate is the key step
o Use graphic to show caregivers
 Communication skills
o Validate the care receiver and meet them where they are at
o Ex: telling someone that husband is off fishing instead of saying they are dead
o Go to the emotion
o Redirection and distract when someone is upset
o Reassure them that you are here and that it’s going to be ok
o Simplify the choices you give them. More choices are more confusing
o Speak slowly
o Be more directive and keep sentences simple
 Everything needs to be on a need to know basis.
 Teach caregivers
o Care receiver to be contented involved in an activity that matches the persons abilities
o Simplify the environment
  Declutter
 Less confusing environment leads to less agitation

Nbcot
 Student characteristics
o Demonstrate flexible thinking
 Most useful prep resources
o Commercial courses
o Exam prep textbooks
o Test prep materials by nbcot
 Pass rate
o 98% for OTR of new grads pass
 Facebook group
 Strategies
o Go to nbcot website to see how the exam works
o Know where gaps of knowledge are
o Plan a schedule to study
o Break it into small chunks
o Create a strategy for questions you don’t know
o Maybe drive to test center day before to know where it is
 How to do it
o Create study checklists to know what you need to study
o Create summary notes and flash cards
o Leitner system
 Spaced retrieval
o OT Miri has good things to look over
o Try mapping to link things together
o Exam materials are not the same as the real thing
 Often harder than actual exam
o Maybe start studying during second level2
 A lot of materials to use
o AOTA PDFs and online test questions
o TherapyEd and USB with practice tests
o YouTube videos
o Pocket prep app
 Things o consider
o Be aware of your state Lisle sing process before you schedule your exam
o Don’t obsess too much on details (ex different Allen’s cognitive levels)
o They give you enough info
o Remember high pass rate
o One guy studied 4-8 hours a day for 4 weeks and passed
 Save some money, you don’t need to buy everything
 Therapy ed was his main tool
 Made quizlet and read it
 AOTA study materials
 Practice tests and PDFs for weaker areas
 OT Miri!!!
  Nbcot practice tests very similar to real thing
 Do more timed practice tests
 Practice tests in noisy environment or bring ear plugs
o Confirm that with testing center to see if you can bring it

Pediatric primary care

 Doctors do not use standardized screenings for well children
 16-18% of children have disabilities
o Less than a third are referred to intervention before kindergarten
 Follow up through by caregivers is part of the reason why children who are referred to early
intervention do not get therapy
 Waiting lists are a problem as well
 Families need guidance regarding the importance of EI services
o Therefore there is a need to screenings in a primary care setting
 We can see what is causing the barriers to occupational performance
o Behavior, development, cognition, etc
o We also have a role in parent education
 Early steps project to screen and give parents handouts if their child is at risk
Level 2 fieldwork
 Look at the performance evaluation before you go so you can know what the expectations are
o Go over it with CI
 A 2 at midterm is okay; indicates you’re needing more practice
o 4 is above entry level performance
 See if your site has specific objective which identifies what that looks like in that setting
o Talk to them about what they expect if they don’t
o Find a student manual; if there isn’t one for your site, you can find them on AOTA and
see if it’s acceptable
 Find out site policy on illness, vacation time, etc. and best contact information
 Convey your learning style to your fieldwork educator and strategies that help you integrate
that information
 Mutual purpose
o In any relationship, the mutual purpose is the goal you both have
o In fieldwork, the same goal is to become a competent practitioner
 Resources
o In PowerPoint
o Take Utah student manual as a reference when going to fieldwork;sample level two
student schedules
 Knowing expectations
o If they don’t have a student manual, considering helping them create one
o You might have assignments from school as well as from the facility
o Weekly meeting form is a way to evaluate your skill week by week
 If they do not have a set time, ask if there is a way you can meet
 Consider student filling it out as well as educator and compare
 Sometimes educators only provide feedback if there’s something to change
 Receiving feedback
o Assess your own orientation to feedback
 What is your general baseline emotions
  How far is your swing of emotions
 How quickly can you pull yourself back to baseline
o Use the feedback to relate it back to your ultimate goals
 What do you need to change to meet that mutual purpose
o Transformative learning model
o Crucial conversations book
o FEAT tool is used to structure feedback to fieldwork educator
Chronic pain
Ranchos los amigos
 Ask the client what kind of pain they are in
 Non physical and psychosocial involvement
o Emotional, financial, self image, side effects of meds
o Avoidance so they will not experience pain
 Impact on occupational performance
 Negative neuroplasticity
o Bombardment of sensory information
o Pain is amplification
 Depression and anxiety are huge
 Lifestyle redesign
 Self analysis
o They may forget what they were like before chronic pain
 If you find the right occupation for the person, pain will decrease and quality of life will increase
 The flow experience
o You’re so immersed in occupations and you forget everything else
o You enter a place of flow
o Work outside of the house was shown to be the most healing
 Assessments
o COPM
o Observation
o Self efficacy questionnaire
 They may not know a lot about their current condition, so we help them figure it out
 Motivational interviewing

Sensation
 Sensory stim is the foundation for infant development
o Especially touch!!!
o Tactile is the most sensitive, develops first in utero
o Vestibular system helps with motor control
 Sensory integration
o Giving mean to what they’re experiencing
o Adaptive responses are when the baby responds to situations
o Number one priority when born is survival
o They want to trust before they explore
 Fourth trimester
o Important to nurture these months as if the baby was still inside the mother
o First three months of life outside the womb
 o Really important for emotional development. Want them to feel confident and secure
within themselves
 Sensory nourishment
o 80% of brain growth happens in first two years
o Sucking
o Shushing
 White noise to imitate the womb
o Positions
 Football hold, tossing in the air
o Vibration
 Deep
o Rocking
 Skin to skin
 Very important through first years
 Swaddling
o Really wrap them tight
o Reduces SIDS
o Basis for soothing
o Improved neuromuscular function
o Cry less
o Sleep better
 Give handouts provided directly to parents
o Might want to double swaddle for more proprioceptive feedback
 Rocking
o Stims vestibular, proprioceptive, tactile, visual, auditory
o Natural baby tranquilizer
o Simulates womb when mother walked
o Calm, digestion, circulation benefits
 Skin to skin
o Have to educate on this.
o Not enough education to new parents
o Releases feel good hormones of mom
 Attachment
o Healthy touch is so important for brain development
o Recommended sixty minutes per day
o Touch helps stimulate growth hormone
 Feeding skin to skin
o Can bottle feed or breast feed
o If a mother is having difficulty producing milk, you can educate on skin to skin
 Carrying and baby wearing
o Get all the input from this
o It is essential
o Eastern societies that wear their babies tend to reach milestones quicker
 Calming reflex
o Swaddled
o Sucking
o Sushing
 o Sidelying
o Swaying
o Dr Harvey Karp
 Happiest baby on the block
 Babies will tell you if they don’t like what you’re doing
o Positive attachment
 They feel more comfortable to explore because of that attachment
 Carrying culture
o Can help with post pardum depression
o Released feel good hormones
o Sling is good from infancy to toddler
 Better for first few months of life
o Baby wearing international
 Refer parent to one of their classes or check out their website
 Importance of touch
o Tactile is most sensitive
 Benefits of massage
o Getting their bodies to feel what healthy touch looks like
o Helps reduce toxins
o Release hypothalamus input
 Regulates emotion and stress
o It’s the two of you so it increases attention
o I love you massage good for digestion
 Lighter pressure on belly for first month or so
o Stay away from Johnson and Johnson products
 Tummy time
o Prone to play
o Back to sleep
o Wearing your baby is tummy time too
 Sensory deprivation
o Only a third of body stimulated in supine
o Touch is import imperative than nutrition
 Monkey study
o Beware of baby carriers
 Look at substitutions for carriers and swings on handout
 Many diagnoses have difficulty with sensory processing as infants
 Sensory nourishment
o Don’t be afraid to get right into baby’s face a shush them
 It’s constant white noise
 Attach a weighted beanie baby to pacifier to stimulate sucking as well as
bringing hands to midline
o Put baby to sleep in a swing or rock n play or mama roo
 Mama roo has more movements than a swing
o If your baby is on tubes, maybe wear the baby during dish washing or watching tv
o Alert state prior to feeding
 What can we do
o Educate parents
 o Don’t intervene if child is being held by parent; let them have that time
o Doulas are great after birth
 See if there is a financially feasible way to get one for patients
Mental health and occupational balance in stroke
 How do we define mental health
o We assume based on appearance what their mental health status is
 WHO
o Mental functions in OTPF is limited to emotions
o We need to consider what other professions define mental health
 Health
o WHO defines it as well being in all facets
o Clinical divisions don’t consider mental health needs to be addressed in all settings
o We assume other people will tackle this issue
 Separation of health and illness
o Physical and mental health are separate from illness
 Post stroke mental health disorders
o Depression
 One third of all stroke survivors
o Anxiety
 One in six
 Sub threshold of a disorder
o Emotional liability
 Pathology
o Lesion in the brain
o Pathways shift
 Reorganized brain which is indicative of mental health disorders
o Sometimes changes are not always negative
 Ex=depression vanish
o It’s a cycle
 Occupations influence cycle and cycle influence occupations
 Mental health effects
o Occupational engagement
 Functional impairment is influenced by MH disorders
 They don’t see the point in engaging therapy
 Daily routine changed
 Self efficacy decreased
o Cognitive
 Stress acts a persistent load which affects how you perform in occupations
 People with depression have smaller hippocampus which affects memory
o Physiological
 Increase BP
 INCREASES risk of stroke
 70% of people after stroke have sexual functioning decrease
o Motor
 If person does not have motivation to make motor changes, it feeds into cycle
 They are afraid of falling, they might feel less comfortable standing and walker
 Physical functioning doesn’t get better
  Self fulfilling prophecy
o Spirituality
 Negative spirituality can decrease coping mechanisms
o Social support
 People with depression have lower perceived support
 Fear influences social relationships
o Technology
 Improve it because it helps you engage in occupations, but it can also make
them think it will change their perceptions of the stroke survivor
 Contributes to ideas of lost identity
 Physical environment
 Green space
o Anything outdoors or plant life increases mental health
o Noise
o Pollution influences post stroke mortality
o Removing barriers improve overall mental health
 Mental health cycles
o If it’s good, it keeps balance for individual
 Assessments
o HADS
 Good for in and out of hospitals
o Neurological QOL
 Designed specifically for neuro patients******
 Interventions
o Occupation based practice
o Set achievable goals to give a sense of competency
o Get family and friends involved
o Advocate for patients
 Mental health is in everything we do
 Interventions for stroke survivors with depression (look at PowerPoint for details)
o Therapeutic exercise program
o Dense cranial electroaccupuncture stim
o Brief psychosocial behavioral intervention
o Upper extremity aerobic exercise
o Motivational interviewing
 Within our scope of practice to do this
o Transitional care program
NBCOT
 Register for a myNBCOT account
o Need this to apply and track status of application
 Connect with NBCOT for hints on studying
o Practice questions on Facebook
 Nbcot.org
o Everything you need to know is on the site
 Read the exam handbook
o Outlines the exam application process
o Info about the exam
 o Includes FAQs
 Code of conduct
o Act with integrity during the testing process
 Survey results on how to prepare for the exam
o 3,000 students surveyed
o 2017
o 21% said 6 weeks of preparation
 17% said 5
o 44% said 5 days per week
 24% said 6
o 27% said 4 hours per day
 20% said 5
o All of these students were successful
 Exam outline
o Domains and task components and knowledge components
 NBCOT aspire
o Use entry level self assessment
o Identifies your personal strengths and weaknesses
o Use it more than once to track your knowledge
o Use for continuous self reflection
o It is your perception of what you know
 Illustrated guide to entry level process
o Helps you understand entry level practice
o Task
 Knowledge statement
 Scenario
 Application to practice
o Available through myNBCOT account
 Preparing
o Unique to you
 Aspire
o Flashcards
o Knowledge match games
o Study guides
 E book or hard copy
 Exam items and answer key and rationale
o Practice tests
 Content and time management
 Mirror the format and flow of the actual examination
 Get a scaled score just like the actual exam
 Application process
o Read exam handbook
o Update myNBCOT profile if necessary
o Research the process to obtain a license
o Complete the exam application
o Submit an official final transcript or academic credentials verification form
 Tracking your exam application thro ugh myNBCOT account
  Follow the instructions in the ATT letter
o Allows you to schedule and take the certification exam
o Your ATT letter is active for 90 days to take the exam
o It’s given electronically so give it to a legit email
 Scoring calendar
o They give you days when they are gonna score the exam
o You have to take it at least two days before the scoring date if you want to have it by
that date
 Schedule with pro metric
o Contact them
o Instructions within ATT letter
 The day of the exam
o Take a tutorial before you start an exam
o 4 hours for the exam, and they give you a chance to breathe
 Clinical simulation test items
o 3 of these
o Average time spent on multiple choice questions is 1 minute
 Exam results
o Available on score day
o But can happen any time of day
o Alert by email or Facebook/Twitter
 Digital badges
o Promote. Share and confirm
o Put on emails, linked in, etc.
 Pro quest database
o Given access to evidence based resource once you pass your exam
 Navigator
o Once you get your certification, you can have access to free tools to continue your
education
 Lot of new tools to use coming up this fall

NICU
 Role of OT in NICU
o Promote health and wellness through development of occupations
o Recognize medical needs and vulnerabilities of acutely ill or premature infants
 Barriers for infant participation
o Provide best fit between infant and environment
 Barriers to parent occupations
o Parenting interrupted
o Can’t bond well with infant
o Might have to travel to see baby
o General separation
 Cannot see them if parent is sick
o Grief and loss
 Parents may have unrealistic expectations
 Baby’s vitals can stabilize using kangaroo hold
 Resting hand splints can be used to promote typical development
  Advocate for parents goals to blend with the safety of the child
o Other medical professionals may limit the contact a parent has with a baby
 Non nutritive stimulation
o Putting milk on a pacifier or something just to stimulate
 Parent education
o Ex: telling parents that a child cannot feed due to high respiratory rate
o Slow controlled feeding to facilitate that co-occupation
 Window of three or four months
o If they do not bottle or breast feed by then they will lose that skill
 We get to be a part of these first meaningful co-occupations
 Oral stim
o Breast milk on toothette
 Developmental interventions
o Promoting developmental interactions
 Holding baby at shoulder and leaning back for tummy time
 Teaching them how to interact with baby
o Recognizing baby cues
o Talking to baby
 Providing age appropriate developmental stimulation as tolerated by the baby
 Support development of age appropriate postures, muscle tone, and reflexes
 Prevent deformity through therapeutic positioning and splinting when needed
 Promote neurobehavioral organization through modified sensory input
 Promote efficient oral feeding
 Skills needed
o 24 months pediatric experience
o Medical knowledge
The weekly calendar planning activity: analysis for those with acquired brain injury
 WCPA
o Generic, C-IADL task
o Available to use across many populations
o 3 levels of complexity
o Level two most frequently used
o Put the appointments into weekly schedule
o Many different versions for different ages
 Requires executive functioning abilities
o Working memory
 Looking away from paragraph to write the appointment down
o Inhibition
 Breaking the rules
o Cognitive flexibility
o Planning
o Organization
o Self monitoring
 Skills
o Managing interruptions
o Keep track of all information
o Inhibit distractors or competition
 o Etc.
 Challenges across levels
o Sat and Sunday reversed
o Calendar ends before one of the appointments
o Time slots at 6 pm change to 30 min
o Etc.
 Prior to administering
o Administer to two or three healthy people before
 Key areas
o Performance
o Strategy use
o Self monitoring and awareness
 Summarize
o Performance
o Strategy use
 Frequency, type, efficiency, awareness of strategy, etc.
o Awareness
 Self corrections, ability to identify challenges, etc.
 Interpretation
o Avoid over interpretation of accuracy score
o Look at pattern of scores simultaneously
 And observations and responses to after task interview
 Implications for treatment
o Functional cognitive activity set
o Interventions correspond to your incorrect performance patterns used during test
o Set up activities where same error pattern emerge and see if they can find ways to
compensate and use the cognitive demands required of it
New practitioner Panel
 When transitioning to a new setting that was not your level II setting
o talk to supervisor about it
o shadow beforehand or ask to shadow while on fieldwork
o look through old study material
o use mentors and peers from class to help during practice
 general tips
o don’t sacrifice ethics for productivity
o try to find a place that has mentorship
 negotiating salary
o always negotiate
o don’t sell yourself short
o you may have this salary years down the line, so it’s worth it
 you are worth the expertise!
o Ask about loan repayment, PTO, vacation, CEU, etc.
 They might just give it to you if you ask!
o Look at salaries across the board to know what the job is worth