Lots of tests... and snow?

Tomorrow morning I will be taking my first Fundamentals II test, unless the snow plans on making my trip to Newport disastrous. It hasn't started yet, but they said it will continue to snow until tomorrow afternoon. The test is going to focus on Grooming and Hygiene, bathing and showering, and dressing. We need to know the area of occupation each takes place in (ADL's) the activity demands and the application of client factors and components (which is lengthy). I've been practicing as much as I can, they take a long time to think about and also to fill out. I'm going to copy an example of one on here just to give you an idea. We'll also need to know how to fill out a SOAP note, which seems easy enough to do, but I'm nervous about it! guuuuh

Here's an example of a SOAP note:
S- "I'm fine today, but my hip is sore."
O- Pt. seen in am for LB dressing training. Pt. listened attentively while therapist demonstrated the use of a reacher to don sweat pants. Pt. locked wc brakes I prior to attempting dressing task. Req. mod. vc to retrieve sweatpants placed on the floor using reacher. Pt. placed R LE into pant leg first then followed with L LE using reacher. Pt. pulled sweatpants over knees to thigh with mod. vc. Provided min vc to prevent pt. from flexing R hip past 90. Pt. observed to wince when transferring from sit-to-stand using FWW with mod A and gait belt. Stand-to-sit transition performed with mod A.
A- Despite R hip pain, pt. was motivated to complete LB dressing training. Pt. demonstrated a beginning ability to utilize a reacher for LB dressing. I at this time is affected by adherence to THP.
P- Will provide written THP for pt. and husband and review in each session. Will review LB dressing techniques with pt. in next 2 tx sessions. Educate pt. on using adaptive eq. to safely retrieve clothing from closet, low dresser, etc. Will instruct pt. on sock and shoe donning using adaptive eq. while following THP.

Activity Analysis Template
_________________________________________________________________________________


Brushing Teeth!

Areas of Occupation - ADL

Activity Demands
Objects and Properties
Tools)
Materials
Equipment
Properties
Space Demands
Size
Arrangement
Surface
Lighting
Noise
Ventilation
Temperature
Possible Locations
Social
Required actions


Steps Required Actions
1 reach for cabinet
2 open cabinet
3 reach for toothpaste
4 open toothpaste
5 reach for toothbrush
6 apply toothpaste onto toothbrush
7 recap toothpaste
8 replace toothpaste
9 insert toothbrush into mouth
10 grip toothbrush with hand and brush teeth in side to side or up and down motion

Cost and Funding Source



Application of Client Factors and Components


Mental Functions
Consciousness Need to be awake in order to properly stand/sit in front of sink
Orientation Normally you would brush your teeth before bed/morning, usually by a sink.
Energy + Drive Functions
· Motivation If your breath smells or your mouth tastes funny you probably would want to brush your teeth to get rid of it.
· Impulse Control The amount of toothpaste you put on your toothbrush, know when enough is enough.
Attention Paying attention to whether you brushed the bottom or top set of teeth.
Memory
· Long-Term Knowing that your toothbrush is used to brush your teeth
· Short-Term Placing toothbrush in proper place
Perception
· Stereognosis Reaching for your toothpaste tube in a drawer filled with other things
· Kinesthesia Flexing and extending your elbow while brushing
· Body Scheme knowing your hand will be in front (proximal) of your face while brushing
· R/L Discrimination Holding your toothbrush with your left hand while you squeeze the toothpaste onto it with your right hand
· Form Constancy Knowing that toothpaste come's in different sized tubes, small travel ones, or large family value ones.
· Visual-Closure Knowing that the rest of your toothbrush is in the toothbrush holder
· Figure Ground Toothpaste is located in front of the soap dish
· Depth Perception Spitting into the sink to rinse mouth
· Spatial Relations Toothpaste belongs on top of the brussles of the toothbrush
· Laterality Using dominent hand to brush your teeth
Using dominent hand to turn on faucet
· Bilateral Integration twisting the cap off of the tube of toothpaste with your left hand while holding it with your right hand



Higher Level Cognitive Functions
· Judgement Brushing your teeth after you eat something instead of before
· Concept Formation Thinking "do I have enough toothpaste to brush my teeth?" before you go to do it
· Sequencing Open cabinet, grab toothpaste, open tube, grab toothbrush, apply toothpaste on toothbrush, begin to brush
· Categorization Keeping your toothbrush, toothpaste, floss together in a little bag
· Problem Solving If you run out of toothpaste, cut the tube with scissors to scrape some more!
· Generalization Brushing teeth in a diff environment, like a kitchen sink instead of a bathroom sink
· Time Management Brush efficiently and accoringly, especially if you want to be on time to class or work
· Calculation N/A
· Decision Making Deciding which toothbrush/toothpaste is yours before you begin
Functions of Language
· Receive Language Directions on certain toothpastes
· Express Self If you have nice clean white teeth you express good hygiene and attractiveness
Sequencing Complex Movement
· Motor Planning Able to reach for toothbrush, open mouth
· Visual-Motor Integration Using mirror to help navigate where you brush
Emotional Functions
· Affect Having a terrible taste in your mouth will want you to brush it out
· Coping Skills If you have little water to use
Experience of Self
and Time
· Body Image You want to present yourself with nice smile and breath when meeting someone new
· Self-Concept Value the fact you don't want cavities so you brush often
· Self Expression Will probably engage in communication more knowing that they have nice breath/smile


Sensory and Pain Functions
Tactile The pressure of the bristles of the toothbrush against your teeth and tongue
Proprioceptive WB left hand on sink while brushing with the other hand
Vestibular Leaning over the sink to spit into it
Visual Picking out which toothbrush is yours by its color
Auditory The swooshing sound in your mouth while brushing, the water running in the sink
Gustatory The minty taste of the toothpaste
Olfactory The smell of mint from the toothpaste
Pain Perception If you brush too hard it could make your gums bleed, for someone who has sensitive gums. Or if you have a cold sore in your mouth you will probably brush more carefully.
Neuromusculoskeletal and Movement Related Functions
Range of Motion In your hand to grip onto brush, flex and extend
Muscle Tone In your hand to be able to grab onto brush and hold onto it while brushing
Strength To twist cap off of toothpaste, to squeeze toothpaste
Endurance To be able to stand/sit upright, to be able to constantly brush back and forth
Postural Control To be able to stand/sit upright at sink
Gross Coordination Flexion of arm/elbow while brushing, being able to manipulate movements in your mouth (keeping it open, act of spitting), the muscles of the face
Fine-Motor Coordination Squeezing toothpaste from tube onto the brustles of the toothbrush, brushing all around the teeth in our mouth
Crossing Midline Opening cabinet to get materials


Application of Contexts


Cultural Depending on ingredients of toothpaste, some culture's may value home-made products as opposed to store bought.
Physical Need to have running water in order to rinse mouth, enough space, and access to materials (toothbrush, toothpaste), maybe a mirror to help coordinate this task.
Social
· Social Conduct N/A
· Interpersonal Skills I guess if someone else is in the bathroom with you and you need to communicate with them to get you a towel to wipe the drool off your face you would need to have some idea how to point to things!(non-verbal example)
· Role Performance If you are a dentist I would hope you had a nice set of clean teeth!
Personal
· Values You value the good ol' $, so you make a promise never to see a dentist again so long as you take care of those teeth everyday
· Interests It interests you the idea of having clean teeth and refreshing breath
Spiritual N/A
Temporal Aspects
· Chronological Appropriate for both kids and adults
· Developmental As soon as those teeth come in you should begin to take care of them, kids, adults and elderly can do it.
· Life Cycle Kids are usually told to brush as often as possible (because of all the candy they consume) Teens usually do it without the vc of an adult (because they don't want to get made fun of by peers) adults normally have a routine and know better (because they certainly don't need another filling, or blind date) and elderly take care of what they have, still brushing, it just may not be their actual teeth!
· Disability Status Depending on disability, one may need some kind of adaptive equipment in order to hold toothbrush in hand, or even just adapting for the environment; if they're in a wc have mirror lowered and angled, along with a pedestil sink.
Virtual N/A




Therapeutic Implications
A. Population - pretty much everyone; some components may not be appropriate for some psychiatric conditions when agitated.
B. Age Appropriateness - degree of interest depends, some not appropriate for kidz
C. Educational Requirements - client should be able to read instructions if assistance is not available
D. Sexual Identification - varies
E. Precautions -
Potential for cuts when shaving and clipping nails
Potential for burns with curling iron and hot water
Potential eye injury with caustic chemicals and tweezers
Flammable and toxic chemicals are used
Potential for injury due to poor safety awareness
Potential for falls due to weakness, debility, etc.
Adhere to WB status precautions in UE and LE
Cardiac precautions- arms raised over head for an extended period of time
F. Contraindications-
Allergies to products
Explosive behaviors, potential for SIB, violence
Diabetic concerns for foot care
Potential respiratory concerns using chemicals, sprays, etc.
G. Prevention -
materials should be set up and w/in reach
client should be well rested, breathing treatments completed, pre-medicated, etc.
Time allotment should reflect daily schedule, appts, ass. avail. etc
Oxygen, BP cuff- nearby
attention to WB status
attention to UE in WB
attention to proper standing, sitting posture, UE and LE position
attention to proper body mechanics


Gradation and Adaptation
Activity Sequence - limit # of steps
Time Allotment - decrease amount of time for completion
Working Position - May begin seated> then graduate to a less dependent posistion
Position of Materials - materials may or may not be set-up for client
Properties of Materials - vary supply bottle size, pre-measure supplies etc.
Interpersonal Contact - degree of supervision by therapist or caregiver
Cueing - grade amount of verbal/tactile cues
Cognitive Environment - limit distractions
Assistive Devices - wc, crutches, chair, cane, dycem grip, bath mitt, walker, adapted mirror, universal cuff, tub bench, reacher
Environmental Modifications - grab bars, hand held shower, pedestal sink

Educational Interventions -
Energy conservation
Joint protection
Mobility training
Skin integrity
Family/caregiver training









And that's just one... wish me luck! (>.<)