OTR Therapeutic Interventions & Techniques 5 — Questions and Answers
Question 1: Which feeding intervention strategy is recommended for a patient with dysphagia and reduced pharyngeal peristalsis?
- Thin liquids to reduce effort during swallowing
- Multiple swallows per bolus and effortful swallow technique (Correct answer)
- Head extension to open the airway during swallowing
- Large bolus sizes to trigger the swallow reflex
Correct answer: Multiple swallows per bolus and effortful swallow technique
The effortful swallow and multiple swallows per bolus increase pharyngeal pressure and help clear residue when peristalsis is weak.
Question 2: A home modification assessment for an older adult focuses on fall prevention. Which change has the STRONGEST evidence for reducing fall risk?
- Installing wall-to-wall carpeting to cushion falls
- Removing hazards (loose rugs, clutter) and installing grab bars in the bathroom (Correct answer)
- Increasing general lighting to very bright levels throughout the home
- Rearranging furniture to create wider pathways only
Correct answer: Removing hazards (loose rugs, clutter) and installing grab bars in the bathroom
Hazard removal combined with targeted grab bar installation in high-risk areas like the bathroom has the strongest evidence for reducing falls at home.
Question 3: When using the Proprioceptive Neuromuscular Facilitation (PNF) hold-relax technique, what occurs during the 'relax' phase?
- The therapist applies maximum resistance to the agonist
- The patient passively allows the limb to be moved into greater range after the isometric contraction (Correct answer)
- The patient actively moves the limb into the new range
- The antagonist muscle is maximally contracted
Correct answer: The patient passively allows the limb to be moved into greater range after the isometric contraction
After an isometric contraction of the tight muscle, autogenic inhibition allows passive movement into increased range during the relax phase.
Question 4: An OTR is treating a patient with burns to the hand. Which positioning principle is MOST important during the acute phase to prevent contracture?
- Positioning in the intrinsic-minus position (MCPs extended, IPs flexed)
- Positioning in the antideformity (intrinsic-plus) position with wrist extension (Correct answer)
- Allowing the patient to rest in a position of comfort
- Positioning in full fist closure to maintain tendon glide
Correct answer: Positioning in the antideformity (intrinsic-plus) position with wrist extension
The antideformity position (wrist extension, MCP flexion, IP extension, thumb abduction) counteracts the pull of scar contracture in hand burns.
Question 5: Which evidence-based practice supports the use of occupation-based interventions over rote exercise in OT?
- Rote exercise produces faster strength gains
- Occupation adds meaning and purpose, which improves motivation, neuroplasticity, and skill transfer (Correct answer)
- Exercise allows more precise monitoring of performance
- Occupation-based tasks are less fatiguing than structured exercise
Correct answer: Occupation adds meaning and purpose, which improves motivation, neuroplasticity, and skill transfer
Meaningful occupation activates motivation circuits and contextual learning, leading to better neuroplasticity and real-world skill transfer than rote exercise.
Question 6: A patient post-CVA has learned to dress independently using a hemi-technique. Which sequence is correct for donning a shirt?
- Unaffected arm first, then affected arm, pull over head
- Affected arm first, then unaffected arm, pull over head (Correct answer)
- Pull shirt over head, then dress unaffected arm, then affected arm
- Either arm first, as sequence does not matter
Correct answer: Affected arm first, then unaffected arm, pull over head
Dressing the affected (weaker) arm first prevents the shirt from pulling on the affected limb and makes it easier to position the garment before adding the unaffected arm.
Question 7: A therapist is using the Canadian Occupational Performance Measure (COPM) with a new patient. At which stage of the therapeutic process is this tool MOST appropriately administered?
- After goal setting is complete to validate the treatment plan
- At initial evaluation to identify the client's priorities and baseline self-rated performance (Correct answer)
- At discharge to measure functional outcomes only
- Mid-treatment to adjust the intervention plan based on progress
Correct answer: At initial evaluation to identify the client's priorities and baseline self-rated performance
The COPM is a client-centered outcome measure used at initial evaluation to identify priority occupational performance issues and establish baseline ratings.
OTR Therapeutic Interventions & Techniques 5
Which feeding intervention strategy is recommended for a patient with dysphagia and reduced pharyngeal peristalsis?