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Results indicate the client has Poor minus (2-/5) functional strength of the dominant
upper extremity. What is the MOST EFFECTIVE method for grading an activity to
improve the clients muscular strength?
A. Increasing the number of repetitions while maintaining the same resistance
B. Decreasing the resistance and increasing the number of repetitions
C. Increasing the amount of time an isometric contraction is held
D. Completing movements through a full arc of motion against gravity
Correct Answer: C
Rationale: This client is very weak as noted in a muscle grade of Poor minus (2-/5). For
clients with this amount of weakness, the most effective method for increasing strength
is to increase the amount of time an isometric contraction is held.
A: This grading method is best for increasing endurance.
B, D: This may be too difficult for a client with Poor minus (2-/5) strength.
Classification: Domain 03 Task 05 Knowledge 04
Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for
Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Page:
127,362 & Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational
Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier
Mosby. Pages 433-434, 471-476
May 25, 2012
OTR Exam Prep Question: A client has moderate hemiplegia, dysarthria and diplopia secondary
to having had a CVA several weeks ago. An OTR and COTA in an outpatient setting are
collaborating to initially evaluate the client using an ecological model. Records indicate the client
is a single parent of an adolescent. The client plans to return to work as a librarian.
MC Question 1: What is the FIRST step the OTR should take when evaluating this client?
A. Assess deficits related to the clients performance skills and patterns.
B. Observe specific client factors during a typical BADL task.
C. Perform a standardized assessment of motor and process skills.
D. Identify the areas of occupation the client wants or needs to do.
Correct Answer: D
Rationale: The practitioner should begin the evaluation process by learning what the
client wants or needs to do. This information can then be used to help determine the type
and focus of the remainder of the evaluation.
A, B, C: These could be included as part of the initial evaluation but only after learning
about the clients wants and needs.
Classification: Domain 01 Task 01 Knowledge 01
Reference: "American Occupational Therapy Association (2008). Occupational Therapy
Practice Framework: Domain & Process (2nd ed.). American Journal of Occupational
Therapy, 62(6), 649.
Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice
Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 38
Correct Answer: A
Rationale: Evidence indicates that repetitive practice of a skill in context will help with
cortical map reorganization for regaining functional use of the affected extremity.
B, C, D: These are not remediation activities.
Classification: Domain 03 Task 01 Knowledge 05
Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational
Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier
Mosby. Pages 793-798, 815, 576 & Gillen G. (2009). Cognitive and Perceptual
Rehabilitation: Optimizing Function. St. Louis, MO: Elsevier Mosby. Pages 38-42
MC Question 4: Which assessment should be included as part of the initial evaluation and can
be administered by the COTA?
A. Functional Independence Measure (FIM)
B. Bay Area Functional Performance Evaluation (BaFPE)
C. Canadian Occupational Performance Measure (COPM)
D. Allen Diagnostic Module (ADM)
Correct Answer: C
Rationale: The ecological model looks at the unique and dynamic relationship between
people, environments, and occupations. The COPM is a client-centered tool that
supports this model by addressing a clients perception of their performance in areas of
occupation and their satisfaction with this performance across 3 key areas: self-care,
productivity and leisure skills. This is a standardized assessment that a service
competent COTA could administer.
A: This tool is designed for collecting information about a client to generate group data
and analyze functional outcomes in inpatient rehabilitation settings.
B, D: These tools are designed primarily for clients who have a psychiatric diagnosis or
cognitive deficit.
Classification: Domain 01 Task 02 Knowledge 01 & Domain 04 Task 02 Knowledge 09
Reference: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational
Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier
Mosby. Pages 38, 813
MC Question #2: Based on the information presented, which deformity BEST describes
the clients finger injury?
A. Boutonniere deformity with joint stiffness
MC Question #3: In addition to considering the use of serial casting, which of the
following splints should the OTR consider when deciding which type of splint would be
MOST BENEFICIAL for the clients middle finger?
A. Dorsally-based static PIP and DIP joint extension gutter splint secured with selfadhering elastic wrap
B. Volar-based static DIP joint gutter splint that permits PIP joint active motion
C. Circumferential neoprene tube splint that extends the entire length of the finger
D. Finger-based dynamic PIP joint extension splint extending from the MCP joint crease
to the DIP joint creaseCorrect Answer: D
Rationale: This splint promotes PIP joint extension while allowing DIP joint flexion.
A, B, C: These splints do not adequately target the structures/joints needed to address
the specific deformity.
Classification: Domain 03 Task 01 Knowledge 09
Reference: Coppard BM, Lohman H. (2008). Introduction to Splinting: A ClinicalReasoning & Problem Solving Approach (3rd ed.). St. Louis, MO: Elsevier Mosby. Pages:
260-264
____________________________________________________________
MC Question #4: How should the OTR respond to the clients concerns about splinting?
A. Listen empathetically and remind the client that wearing the splint is temporary.
B. Advise the client to avoid use of the injured hand to promote the healing process.
C. Encourage full participation in daily tasks by collaborating on ways to modify typical
daily activities.
D. Provide the client with a few assistive devices that require the use of only one hand.
Correct Answer: C
Rationale: The OTR use a client-centered strategy to determine the clients needs and
priorities based on the clients daily activity schedule.
A, B, D: It is most important to gather information about the needs and priorities of the
client prior to providing assistive devices or advice to the client.
Classification: Domain 02 Task 02 Knowledge 02
Reference: "Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for
Physical Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Pages:
424-425
Cooper C. (2007). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment
Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Elsevier
Mosby. Page: 19
_________________________________________________________________
MC Question #5: What type of exercise should be included as part of the clients home
program and would be MOST EFFECTIVE for facilitating lengthening of the oblique
retinacular ligaments and promoting glide of the lateral bands?
A. Active and passive DIP joint flexion with the PIP supported in extension
B. Passive PIP joint extension with the MCP joint supported in extension
C. Active PIP joint flexion with the MCP joint blocked in extension
D. Composite PIP joint and DIP joint passive flexion with the MCP joint supported in
extension
Correct Answer: A
Rationale: Active and passive ROM of the DIP joint with the PIP joint supported in
extension facilitates lengthening of the oblique retinacular ligament which will help to
decrease the hyperextension of the DIP joint.
B, C, D: These exercises do not effectively target the structure impacted by this injury.
Classification: Domain 03 Task 01 Knowledge 04
Reference: Burke S, Higgins J, McClinton M, Saunders R, Valdata L. (2006). Hand and
Upper Extremity Rehabilitation: A Practical Guide (3rd ed.). St. Louis: Elsevier Churchill
Livingstone. Page: 304
OTR Exam Prep Question: A client has moderate hemiplegia, dysarthria and diplopia
secondary to having had a CVA several weeks ago. An OTR and COTA in an outpatient
setting are collaborating to initially evaluate the client using an ecological model.
Records indicate the client is a single parent of an adolescent. The client plans to return
to work as a librarian. - REPEAT
MC Question 1: What is the FIRST step the OTR should take when evaluating this client?
A. Assess deficits related to the clients performance skills and patterns.
B. Observe specific client factors during a typical BADL task.
C. Perform a standardized assessment of motor and process skills.
D. Identify the areas of occupation the client wants or needs to do.
MC Question 2: Which task-oriented approach would be MOST BENEFICIAL to include as
part of the intervention plan for maximizing the clients physical abilities?
A. Augmentative communication
B. Constraint-induced movement therapy
C. Dominance retraining activities
D. Visual attention and scanning exercises
MC Question 3: Which type of activity should be included as part of the INITIAL
intervention to remediate the clients motor impairment?
A. Repetitive practice of an occupational performance skill in context
B. Training on the use of adaptive equipment to support an area of occupation
C. Weight bearing through the affected upper extremity prior to an activity
D. Dominance retraining during a variety of writing and drawing tasks
MC Question 4: Which assessment should be included as part of the initial evaluation
and can be administered by the COTA?
A. Functional Independence Measure (FIM)
B. Bay Area Functional Performance Evaluation (BaFPE)
C. Canadian Occupational Performance Measure (COPM)
D. Allen Diagnostic Module (ADM)
MC Question 1: What is the FIRST step the OTR should take when evaluating this client?
Correct Answer: D
Rationale: The practitioner should begin the evaluation process by learning what the
client wants or needs to do. This information can then be used to help determine the type
and focus of the remainder of the evaluation.
A, B, C: These could be included as part of the initial evaluation but only after learning
about the clients wants and needs.
Classification: Domain 01 Task 01 Knowledge 01
Reference: "American Occupational Therapy Association (2008). Occupational Therapy
Practice Framework: Domain & Process (2nd ed.). American Journal of Occupational
Therapy, 62(6), 649.
Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational Therapy: Practice
Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier Mosby. Page 38
____________________________________________________________
MC Question 2: Which task-oriented approach would be MOST BENEFICIAL to include as
part of the intervention plan for maximizing the clients physical abilities?
Correct Answer: B
Rationale: Constraint-induced movement therapy is a task-oriented approach to motor
control acquisition. This approach focuses on facilitating use of the affected arm during
B) Provide a group task experience with two or three peers of a similar skill level.
C) Allow the patient to find a safe place in the clinic to work alone.
D) Assist the patient to successfully complete key steps with the current task.
Correct Response: B
Classification Code: Domain 03, Task 05, Knowledge 01
Reference: Case-Smith J, OBrien. (2010). Occupational Therapy for Children (6th ed.). St.
Louis, MO: Elsevier Mosby. Page: 38-39, 409-410
Rationale: The OTR should grade the demands of the intervention to accommodate the
patients current ability to deal with social isolation due to a chronic medical condition.
This option allows the patient to participate in a social activity with peers of equal skill
level in order to promote successful task completion.
Incorrect Responses:
A: Engaging the patient in a competitive game does not address current emotional
needs.
C: This option does not support the patients goal of interacting with peers.
D: Assisting the patient to complete key steps does not address the patients need to
socialize with peers.
OTR Prep Question: An inpatient is diagnosed with central cord syndrome. One of the patients
goals is to be independent with ADL when discharged to live at home. Which assessment
represents a biomechanical approach that can be used as part of the evaluation to determine
the patients progress toward this goal?
OTR Prep Question: A client who has a C7 spinal cord injury has been admitted to an inpatient
rehabilitation facility and is beginning OT. One of the clients goals is to be able to prepare
family meals. After identifying the clients typical family mealtime routines and habits, what
should the OTR do NEXT to most effectively promote progress toward the clients goal?
A. Observe the client during a standardized meal preparation task.
B. Assess current physical skills and abilities during a kitchen task.
C. Discuss the lay-out and type of appliances in the clients home kitchen.
D. Provide assistive devices typically used by clients who have quadriplegia.
Correct response: B
Rationale: After identifying the clients typical mealtime habits and routines, the OTR
should conduct a screening by observing the client perform a kitchen task. This will
assist the therapist to generate hypotheses regarding performance deficits.
Reference: Radomski, MV, Trombly-Latham, C (2008). Occupational Therapy for Physical
Dysfunction (6th ed.). Baltimore, MD: Lippincott, Williams and Wilkins. Page: 56
Classification code: Domain 02, Task 03, Knowledge 05
Incorrect responses: A: This stage would occur after generating hypotheses regarding
performance deficits in order to quantify impairments or deficits flagged during a
screening. (OBSERVATION IS FOR SCREENING)
C: This information is typically gathered during the initial interview as part of the process
in identifying the clients typical meal preparation routines and habits.
D: The OTR should collect information about the habits, routines, and environments the
client is used to prior to providing assistive devices.
OTR Prep Question: During which home maintenance tasks would symptoms related to
constructional apraxia be MOST EVIDENT?
A. Washing the interior sides of single pane windows
B. Using a roller brush to paint an interior wall of the home
C. Vacuuming floors in the main living area of the home
D. Following written instructions for installing curtain rods
Classification Code: Domain 01, Task 01, Knowledge 06
Correct response: D
Reference: Reference: Zoltan B. (2007). Vision, Perception, and Cognition: A Manual for
the Evaluation and Treatment of the Adult with Acquired Brain Injury (4th ed.). Thorofare,
NJ: SLACK Inc. Pages 123-128, 184.
Rationale: Individuals who have constructional apraxia have difficulty
constructing/assembling objects; as in following instructions for installing curtain rods.
Incorrect Responses: A, B, C
Rationale: These tasks require motor planning, but they do not require the detailed
attention required to follow instructions for installing the curtain rods.
A 10-year-old child has cerebral palsy with moderate athetosis and age-appropriate cognition.
The child currently requires moderate assistance with BADL. One of the childs goals is to be
more independent with dressing. The OTR plans to use a cognitive approach during a dressing
session with this child. Which method exemplifies this approach?
A.
Employing a top-down approach to encourage the child to problem solve when
difficulties are encountered during the dressing task
B.
Incorporating a bottom-up method to enable the child to learn dressing tasks in a
developmentally appropriate sequence
C.
Allowing the child to select preferred clothing in preparation for learning an ageappropriate dressing task
D.
Adapting the child's clothing and teaching compensatory strategies to use during a
dressing task
OTR Prep Question: During an initial OT interview, a patient denies frequent cocaine use and
cites a recent bonus as proof that work performance is not being negatively affected by
substance use. The patient reports using cocaine only when under a deadline at work or when
having to entertain business clients. The patients account indicates a lack of insight related to
which of the following performance areas?
A. Leisure-time management
B. Current values and interests
C. Interpersonal and coping skills
D. Problem-solving and ethical behavior
Classification code: Domain 01, Task 02, Knowledge 03
Correct response: C
Reference: Cara E, MacRae A (2005). Psychosocial Occupational Therapy: A Clinical
Practice (2nd ed.). Thomson Delmar. Pages: 456-457
Rationale: Based on the patients account, the dependence on cocaine use appears to be
in direct relation to the patients inability to manage stress appropriately. These
performance areas should be addressed by developing an intervention plan that
facilitates effective interpersonal and coping skill acquisition with the goal of promoting
participation in all areas of occupation.
Incorrect responses: A, B, D: Although these areas may need to be addressed during the
occupational therapy intervention, they do not directly relate to the situations described
by the patient in the initial interview.
An OTR is completing a self-care assessment with a resident in a long term care facility.
Nursing staff referred the resident to OT after observing a decline in the residents function
following an exacerbation of COPD one month ago. Medical hx is also significant for residual
cerebellar symptoms secondary to an excision of a brain tumor5 years ago. The client has Fair
Plus (3+/5) functional strength of bilateral upper extremities. During the assessment, the OTR
asks the resident to pick up your shirt from the night stand. When reaching for the shirt, the
resident has to stabilize the arm to prevent reaching beyond or short of the shirt. When
documenting the session what term should the OTR use to BEST describe the residents
action?
A. Decreased motor planning
B. Generalized weakness
C. Dysmetria
D. Dysdiadochokinesia
Incorrect:
A:The resident has the ability to plan the motor components needed for picking up shirt
B:Clients functional strength is adequate to pick up shirt w/o resulting in these
movements
D:Dysdiadochokinesia is the ability to perform rapidly alternating movements. These
movements are not required for picking up a shirt
Rationale: Dysmetria is a common-side effect of cerebellar dysfunction. It is
characterized as overshooting or undershooting an intended target
Classification: Domain 02 Task 01 Knowledge 03
Active Motion
Passive Motion
Extension Flexion
Extension Flexion
(in degrees)
(in degrees)
MCP Joint
0-90
0-90
PIP Joint
-50-90
0-95
DIP Joint
+30-40
+30-50
Long Finger
OTR Exam Prep Question: An OTR is teaching joint protection strategies to a client recently
diagnosed with rheumatoid arthritis. The client enjoys cooking large family meals but pain in the
MCP joints and wrist are interfering with the ability to cut meats and vegetables. In addition to
recommending the use of an adapted cutting board, which type of knife would be beneficial for
the client to use?
A. Serrated knife with finger contoured handle
B. Universal cuff attachment for standard slicing knife
C. Wheel configured knife with non-slip padded grip
OTR Exam Prep Question: A client had a repair of the median nerve on the dominant
upper extremity after sustaining a work-related laceration of the wrist 6 weeks ago. The
client has been undergoing rehabilitation and resumed light work as a warehouse
stocker several days ago. During a follow-up appointment, the OTR observes several
blisters on the clients index finger. What INITIAL action should the OTR take based on
this observation?
A. Advise the client to file an incident report with the employer
B. Teach the client protective sensory re-education strategies
C. Contact the case manager to modify the clients job tasks
D. Recommend strategies for minimizing the use of the index finger
Correct Answer: B
Rationale: It is important for the client to learn visual compensation techniques to
reduce secondary injury or trauma due to the loss of sensation.
Incorrect Rationale: A: The clients blisters may not be due to a work-related injury.
C, D: The client should continue with daily routines using visual compensation and other
protective sensory re-education techniques.
Classification Code: Domain 03 Task 05 Knowledge 05
References: Pendleton HM, Schultz-Krohn W (eds). (2006). Pedrettis Occupational
Therapy: Practice Skills for Physical Dysfunction (6th ed.). St. Louis, MO: Elsevier
Mosby. Page 848 Cooper C. (2007). Fundamentals of Hand Therapy: Clinical
Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity.
St. Louis, MO: Elsevier Mosby. Page 242-243