NBCOT Exam Trivia Quiz

Answer = D (please refer to Radomski & Latham in the OT for Physical Dysfunction, 6th Ed., pg. 1304)

Answer: a. following a total hip procedure including a total hip replacement the patient is to follow these precautions, no hip flexion beyond 90, no hip rotation, no crossing legs, no adduction and no bending or bringing foot close to hands

Crepeau, E.S., Neistadt, M.E. (1998). Williard and Spackman’s Occupational Therapy Ninth Edition. Baltimore, MD: Lippincott Williams & Wilkins.

These children will also dislike tipping their heads backwards, activities that require you to move in space, and swinging on a swing where their feet won’t touch the ground.

Resource: Too loud Too Bright Too fast Too Tight. What to do if you are sensory defensive in an overstimulating world. Sharon Heller, Ph. D

Rationale: A patient at Rancho Level III has a localized response to stimuli and their response is directly related to the type of stimuli they are receiving. At this point you want to stimulate them as much as possible to get consistent and automatic responses (choice A and B). You also want to keep them positioned and provide ROM since they do not have a lot of active movement (choice C). Choice D is beyond their ability at this point, because they are not even able to follow one-step commands at this level. They are simply responding to stimuli.

Source: Occupational Therapy for Physical Dysfunction, Sixth Edition, Radomski and Latham, p. 1048

Legs ankles should not be crossed, do not bend at the waist, and you should not lie on your side.
Source- http://www.hipsandknees.com/hip/hipprecautions.htm

Rationale: It is not appropriate to tell a patient that they will become fully functional or not be able to regain any function, but it is important to remain realistic with the patient about expectations for therapy.
Source: National Occupational Therapy Certification Exam: Review and Study Guide by Rita P. Fleming-Castaldy

All of the choices would benefit a patient with RA. Community resources can include support groups, the Arthritis Foundation, transportation options, etc.

Resource: Crepeau, E.B., Cohn, E.S., Boyt Schell, B.A., Williard & Spackman's Occupational Therapy, 11th Edition.

Pendleton, H.M. & Schultz-Krohn, W. (2006). Pedretti’s occupational therapy practices skills for physical dysfunction. St. Louis, MO; Mosby Elsevier.
Fleming-Castaldy, R.P. (2009). National Occupational Therapy Certification Exam Review & Study Guide.

Answer: B. This child has tactile defensiveness with water, which is a problem associated with overresponsiveness. Overresponsiveness is also known as hyperresponsivity or sensory defensiveness. She has auditory hyperresponsiveness with loud sounds too, and visual overresponsivity with the movement of the curtains. While answer D (gravitational insecurity) is a type of overresponsiveness, this child does not have any signs of gravitational insecurity.

Reference: Case-Smith & O’Brien, Occupational Therapy for Children, 6th edition, pages 346-347

-exploratory play happens from 0-2 years, symbolic play 2-4 years, creative play 4-7 years and games with rules and directions 7-12 years.

NBCOT Review and study guide, pg 95

Rational: The correct answer is A because stereognosis is the perceptual skill that enables an individual to identify common objects and geometric shapes through tactile perception without the aide of vision. Stereognosis is essential to occupational performance because the ability to see with the hands is critical to many daily activities.
Source:Text book- Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction and the OT Advantage website

Gutman, S.A., & Schonfeld, A.B.(2009) Screening Adult Neurological Populations, 2nd edition. The American Occupational Therapy Association, Inc. (p 4-7)

Rational: Standard precautions include wearing disposable gloves, a face shield and gown when treating a patient in an isolated environment to prevent spreading the disease to other personnel and residents.
Source: http://www.edcp.org/guidelines/mrsa.cfm

To increase (and not just maintain)ROM, the limb must be stretched to the point of maximal stretch, which is just a few degrees beyond the point of mild discomfort- this can be assessed by patients verbal or facial indications. The mild discomfort should not linger after release of stretch (if it does, you may have injured the tissue). The most effective stretch is a slow, controlled movement which allows for the tissues to adjust gradually. The stretch should be held for 15-30 seconds. Quick movements are counterproductive and should be avoided, as connective tissue will resist the movement as a protective mechanism.
Reference:
Occupational Therapy for Physical Dysfunction 6th Edition (Mary Vining Radomski & Catherine A Trombly Latham)

Gutman, S.A., & Schonfeld A.B. (2009). Screening Adult Neurologic Populations, 2nd Edition. The American Occupational Therapy Association; AOTA Press.

Lundy-Ekman, L. (2007). Neuroscience: Fundamentals of rehabilitation. (3rd ed., p. 352). St. Louis: Saunders Elsevier.

Answer: C
-exploratory play happens from 0-2 years, symbolic play 2-4 years, creative play 4-7 years and games with rules and directions 7-12 years.

NBCOT Review and study guide, pg 95

The needle would be held with a two point pinch while being threaded. A glass would be held with a cylindrical grasp and the key being place in a lock would be held with a lateral pinch.

Reference: Johnson, Lorch, and DeAngelis: Occupational Therapy Exam Review Guide. ed 3. FA Davis Company, Philadelphia,2006.

Source: long handled reachers help patients reach for items without breaking their hip precautions. A wheeled walker would be a PT thing! A bedside commode would not be appropriate for someone who is being discharged home and a weighted hairbrush has nothing to do with hip surgery.

Laurie Lundy-Ekman (2007). Neuroscience Fundamental for Rehabilitation 3rd Edition. St. Louis, MO: Saunders-Elsvier. (230).

Answer: B. This child has tactile defensiveness with water, which is a problem associated with overresponsiveness. Overresponsiveness is also known as hyperresponsivity or sensory defensiveness. She has auditory hyperresponsiveness with loud sounds too, and visual overresponsivity with the movement of the curtains. While answer D (gravitational insecurity) is a type of overresponsiveness, this child does not have any signs of gravitational insecurity.

Reference: Case-Smith & O’Brien, Occupational Therapy for Children, 6th edition, pages 346-347

When seated, it is best to be positioned with your knees and hips level to reduce any unnecessary strain on your back.

Significant weight loss is a sign of major depression not schizophrenia
reference: psych notes, author: pedersoen, darlene

Radomski, M. & Trombly Latham, C. (2008). Occupational Therapy for Physical Dysfunction. (6th ed). Baltimore, MD: Lippincott, Williams & Wilkins, Page 1309.

ANSWER: b, ideational apraxia is a conceptual deficit seen as an inability to use real objects appropriately.
Occupational Therapy: Practice skills for physical dysfunction 6th edition, chapter 24

Neurological Rehabilitation, 5th edition. Umphred, D. A.. Mosey, 2007. Pg 537- 551.

Vining-Radomski, M., Trombly-Latham, C. (2008). Occupational therapy for physical dysfunction. Philadelphia, PA: Lippincott Williams & Wilkins. pp 1148.

D is the correct answer. During this stage of recovery, we want to decrease the patient’s agitation by attempting to normalize the environment (A,B) and. providing consistency and predictability that counters their confusion (C). If a patient becomes agitated or restless during an activity, change the activity or move to another environment. Source: Occupational Therapy for Physical Dysfunction.

Rational: Failure to thrive (FTT) is common within the nursing home environment, and it is important that clients demonstrating symptoms of FTT conserve their energy. Nursing personnel and the physician should be notified to modify treatment/medications, and the dietitian should be notified to monitor calorie intake. Client should conserve what energy they have remaining, and physical activities should be discontinued until weight is regained.
Source: www.fpnnoteook.com, presentation/in-service on FTT

Rationale: Since the individual has a severe form of Guillain-Barré, the most important initial approach is to protect weak muscles and prevent contractures. Although ADL performance is important for this patient, protecting muscles and maintaining ROM is most important and light ADL training should follow. After strength improves, balance and strengthening interventions can then be used.

Source(s):

Blesedell Crepeau, E. Cohn, E., Boyt Schell, B. A. (2003). Willard and Spackman's Occupational Therapy. Philadelphia: Lippincott Williams & Wilkins.

Answer: b. it is important to get an orthopedic surgical patient up and moving as soon as the doctors approves it to prevent complications from immobilization and improve healing for the patient

Crepeau, E.S., Neistadt, M.E. (1998). Williard and Spackman’s Occupational Therapy Ninth Edition. Baltimore, MD: Lippincott Williams & Wilkins.

Rationale: The primary treatment goal of the freezing phase is to prevent motion loss. Overstretching the capsule during the freezing phase may enhance the inflammatory process. For more information see chapter 10 in Cynthia Cooper text “Fundamentals of Hand Therapy.”

: a. expression (client's with Broca's aphasia have slowed labored speech with some apraxia also noted, but they have good receptive language skills unless it is too rapid or lengthy.
Pedretti L, Early MB: Occupational therapy: practice skills for physical dysfunction, ed 5, St. Louis, 2001, Mosby. (Found in the Q & A for the Occupational Therapy Board Examination by Patricia Bowyer and Dorthy Bethea, 2007)

the Bay Area Functional Performance Eval. is used as phsychological/cognitive battery. All other responses assess manual dexterity/ fine motor coordination and function.

Pacemakers are a contraindication for any electrical stimulation or diathermy usage.
Source- http://www.biomedofla.com/images/contraindications.htm

“B” is the correct answer (memory is the major factor in Alzheimer’s). “A” consists of the symptoms of schizophrenia, “C” represents dyslexia, and “D” represents the signs/symptoms for Parkinson’s disease.

Source: Lundy-Ekman, L. (2007). Neuroscience: Fundamentals for rehabilitation (3rd ed.). St. Louis: Saunders Elsevier.

Panic Attack and Agoraphobia are NOT codable disorders, the specific disorder in which panic attack or agoraphobia occur are the actual diagnoses so A and D can be ruled out. Because the patient has become increasingly worried about being in places or situations in which she can’t escape when a panic attack occurs and she avoids situations in which she notes panic and anxiety, agoraphobia should be included in the diagnosis, which excludes B as well.

References:
DSM-IV-TR (Panic Disorder Question)
http://www.uptodate.com/patients/content/topic.do?topicKey=~UUVUUsuHJkzvcYr&selectedTitle=1~83&source=search_result (Schizophrenia Question)
http://www.nimh.nih.gov/health/publications/bipolar-disorder/how-does-bipolar-disorder-affect-someone-over-time.shtml (Bipolar Disorder Question)

Answer: a. Contact supervisor to report suspicious elderly abuse and suggest that Adult Protective Services get involved

Rationale: Role of Occupational therapist is required to suspected or observed cases of elder abuse. Since the patient stated the son-in-law was abusing her and their was proof from the broken glasses and the bruises on her forearms and wrists, the OTL/R is required by law to report this case to Adult Protective Services so they can investigate.
Source: National Occupational Therapy Certification Exam Review and Study Guide 5th Edition by Rita P. Fleming-Castaldy (page 122)

Astrocytoma is the most common brain tumor because it originates from astrocytes, which are star-shaped cells that support and nourish neurons. These tumors can occur in different parts of the brain and can vary in grade, with low-grade astrocytomas being less aggressive and high-grade astrocytomas being more aggressive. Glioblastoma and anaplastic are also types of brain tumors, but they are less common compared to astrocytoma.

Cheatum, B.A. & Hammond, A.A. (2000). Physical activity for improving children’s learning and behavior: A guide to sensory motor development. Chicago: Human Kinetics.

ANSWER: A. and B. (but remember, these are only gross screens- standardized versions of these tests are included in the biVABA- brain injury visual assessment battery for adults)
Reference: Pedretti: OT, Practice Skills for Physical Dysfunction- Fifth Edition, page 404

The yoga and stretching program would put the least amount of pressure on the cardio-vascular and pulmonary systems. Also this activity will be monitored by hospital staff rather than personnel who are not familiar with COPD.
Reference: Fleming-Castaldy, R.P. National Occupational Therapy Certification Exam Review and Study Guide; pg 479

REFERENCE: Occupational Therapy Practice Skills for Physical Dysfunction, Fifth Edition, Pg. 362

Reference: Occupational Therapy for Physical Dysfunction, Sixth Edition, p. 731-732

Rationale: You place a pillow under the involved scapula and hip to prevent retraction in these areas. You can place an additional pillow alongside the client’s involved leg to keep the hip from externally rotating if necessary. Do not place a pillow directly behind the knee as this may contribute to DVT or knee flexion contracture.
Source: Willard and Spackman 10th ed. Pg 605

Answer: f. Instruction in & practice the use of AE for lower body dressing and transfer training with tub bench and getting on and off toilet with raised toilet seat

Rationale: Role of Occupational therapist is to adhere to hip precautions after surgical repair of hip fractures. In order for the patient to continue adl independence, instructing the pt with lower body dressing using AE allows the patient to complete the tasks being modified independent. In addition, the patient needs to be able to complete tub transfers safely and use a raised toilet seat while adhering to hip precautions. Strengthening of B UE and/or exercises for affected hip could be an appropriate treatment; however, this is not relevant to hip precautions.
Source: National Occupational Therapy Certification Exam Review and Study Guide 5th Edition by Rita P. Fleming-Castaldy (page 140)

D. Oculomotor control, Visual field and visual acuity are considered to be primary visual skills and serve as the foundation as hierarchy of visual perceptual skills.
Mosby's Q & A Review for the Occupational Therapy Board Examination. Patricia Bowyer EdD OTR/L BCN (Author), Dorothy P. Bethea EdD MPA-OTR-L (Author)

Schuberth, L.M., Amirault, L.M., and Case-Smith, J. (2010). Feeding intervention. In J. Case- Smith & J. Clifford O’Brien (Eds.), Occupational therapy for children (pp. 446-473). Maryland Heights, MO: Mosby Elsevier

Smith-Gavai, H. Occupational Therapy in Acute Care. Page 186.

Following a mild CVA (cerebrovascular accident), executive functioning is commonly affected. Executive functioning refers to the cognitive processes that allow individuals to plan, initiate, and organize their behavior towards achieving goals. Therefore, when evaluating an individual's executive functioning after a mild CVA, the most likely assessment would be initiation and planning. This would involve assessing the individual's ability to initiate tasks, set goals, make plans, and carry them out effectively.

Answer: D Oculomotor control, Visual field and visual acuity are considered to be primary visual skills and serve as the foundation as hierarchy of visual perceptual skills.
Mosby's Q & A Review for the Occupational Therapy Board Examination. Patricia Bowyer EdD OTR/L BCN (Author), Dorothy P. Bethea EdD MPA-OTR-L (Author)

Radomski and Latham, pg. 758

Reference – Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (Sixth Edition), pg 1143, 1146

Rationale: It is the most common visual disturbance associated with stroke.
Source: Occupational Therapy for Physical Dysfunction pg. 1018

Rational: Symptoms of a CVA occurring at the middle cerebral artery include contralateral hemiplegia, contralateral hemianopsia, sensory deficits, and language deficits.
Source: Willard & Spackman’s Occupational Therapy, v. 10

Rationale: According to a “clinical pearl” in Cooper’s book, “Reducing edema is almost always the first priority; do this and the client will gain motion.” A digit that is extremely swollen will not tolerate stretch to be placed upon it the way that a non-swollen digit would. With edema in the way the finger will be stiff and unable to bend. Once the edema is gone the patient will gain the ability to bend and then focusing upon increasing ROM and strength will be appropriate. Also, it is important to use modalities that are appropriate for the client. Using ultrasound on an individual with pins could be detrimental as
the deep heat could increase the temperature of the metal pins and burn internal tissues.
Reference:
Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity (2007)
Edited by Cynthia Cooper

Reference: Weiss, S. (2005). Hand rehabilitation: A quick reference guide and review. St. Louis, MO: Elsevier Mosby.

“A” should be incorporated into sessions to everyone caring for the client so they can in turn provide a possibly medicated client of her hip precautions. Since she has returned to her familiar home environment, she may attempt to return to “normal” too soon, thus forgetting her precautions. “B” is important in home health OT because these items assist clients with navigating their environment independently, safely, and functionally. “C” should be part of a client’s treatment since she still needs to attend follow-up physician’s appointments, even though she no longer drives. “D” is the correct answer because hip precautions do not allow flexion past 90 degrees.

Source: Fleming-Castaldy, R. (2009). National occupational therapy certification exam: Review & study guid (5th ed.). Evanston, IL: TherapyEd.

An individual who had a coronary artery bypass graft 5 days ago would still be in the early stages of recovery. Grooming while standing at the sink would be an appropriate activity because it requires minimal exertion and can be done in a comfortable position. Vacuuming would require more physical effort and may not be suitable at this stage. Showering standing may also be too strenuous, as it involves standing for a longer period of time. Grooming at the edge of the bed may not provide enough support and stability compared to standing at the sink.

Based on the information given, Nathan demonstrates full range of motion (ROM) and is able to withstand minimal resistance during the manual muscle test. The grading system for manual muscle testing ranges from 0 to 5, with 3 indicating "fair" muscle strength. Since Nathan is able to withstand minimal resistance, which suggests a moderate level of muscle strength, the correct answer is 3+ (F+).

Crepeau, E.B., Cohn, E.S., Schell, B.A.B, (2003). Willard & Spackman's Occupational Therapy 10th Ed., Lippincott Williams & Wilkins, PA, p 734-735.

/ Rational: The correct answer is A. Swan neck deformity is when the PIP joint is hyperextended and the DIP joint is in flexion. Boutonniere deformity is when the PIP joint is in flexion and the DIP joint is hyperextended. Mallet deformity is when the DIP joint is flexed/drooping.
Source: Text book from Dr. Flinn’s class- Fundamentals of Hand Therapy by Cynthia Cooper

C: IV Cognitive: Confused-Agitated
a. Confusion
b. Dense PTA
i. Heightened level of activity with decreased information processing abilities
ii. Responding primarily to own internal confusion
iii. Dependent for self care
iv. This is when they wake up
v. Typically no memory of incident
vi. Minimal potential for immediate comprehension
vii. Severely decreased attention span
viii. Can be very challenging
ix. Cry, yell, combative (the cerebral hemisphere is not communicating properly)

Radomski and Latham. (2008). Occupational therapy for physical dysfunction. Sixth Edition. Baltimore, MD. Lippincott, Williams and Wilkins

b, c, and d are all signs that a person has suffered a CVA that is located in the left hemisphere. OT for physical dysfunction page 1009. a, left hemiparesis is a sign that would be present if someone had suffered a CVA of the right hemisphere. OT for physical dysfunction page 1009.

Answer: D. Strengthening occurs more during the restorative phase once pain is improved.

Source: Fundamentals of Hand Therapy, Cynthia Cooper, pg. 290.

ANSWER: c. Impairments of the laryngeal muscles, or the presence of dysphagia is associated with impairments of the cranial nerve root of cranial nerve 11, Accessory Nerve.

Reference: Gutman, S. & Schonfeld, A. (2005) Screening Adult Neurologic Populations. Page 184-185, & 190.

ANSWER: C. Preschoolers from 24-36 mo. Predominately have parallel play skills with emerging associative social play as they begin to play with one another.

Source: Case-Smith, J. (2005). Occupational Therapy for Children, 5th ed. St. Louis, MO: Elsevier, Inc.

ANSWER: C. Free play/running with peers in an open gymnasium will be too overstimulating for a child with these issues. It will be difficult for them to keep their body under control or focus on what is going on. The child will probably become too overstimulated or shut down. Swinging, jumping, and joint compressions/massage are good activities to help provide regulation and body awareness.

18 inches wide, 16 inches deep, and 20 inches high with the hips at 90, the knees at 90 and the ankles at 90.

a, b, and d are all signs or symptoms that may present with a lesion in the cerebellum. Screening the adult neurologic population page 112. c, apraxia is often times seen in a person whom has a lesion in the frontal lobe. Screening the adult neurologic population page 148.

Answer: C
Fleming-Castaldy, Rita. National Occupational Therapy Certification Exam: Review & Study Guide, 5th edition, (2009). Pg. 96-99

Rationale: Mr. Brown has what is known as pusher behavior and because these patients tend to resist hands on attempts to correct their posture, you need to select treatments that manipulate the environment. So reaching for objects toward his R side encourages a weight shift to his stronger side which will bring him more towards midline. It will also be important to use verbal cues.
Source: Occupational Therapy for Physical Dysfunction pg. 1025

Rationale: Children with tactile defensiveness do not seem to mind deep touch as it is calming. Light touch is most aversive. They should always see the source of touch and tend to tolerate actively self-applied stimuli better than when it is done passively by a therapist or someone else.
*Source: Occupational Therapy for Children textbook (By Case-Smith) p. 378

Kitchen items most often used should be placed at a reachable level, between shoulder and waist level. Following hip surgery, patients should not be bending down for things in low cabinets or shelves. Suggesting the use of a high stool when working at the kitchen counter (A) ensures that the patient is following hip precautions and is a good tactic for conserving energy. Removing throw rugs in the home (B) can help a patient to avoid tripping. Using a rolling basket or utility cart (C) to carry items from place to place will prevent the need for multiple trips when working around the house.

Answer: C. A 14 month old should be dipping his spoon in his food and bringing spoonfuls of food to his mouth, with a lot of spilling. A 5-7 month old should be taking cereal or pureed baby food off of a spoon, a 6-8 month old should attempt to hold their own bottle, and a 9-13 month old should finger-feed themselves portions of soft table foods and dry cereal.
Reference: Case-Smith & O’Brien, Occupational Therapy for Children, 6th edition, page 453

Radomski & Latham (2008). Occupational Therapy for Physical Dysfunction. Sixth Edition. Chapter 24: Optimizing Motor Behavior Using the Bobath Approach p. 646

Neurological Rehabilitation, 5th edition. Umphred, D. A.. Mosey, 2007.

ANSWER: a, c, e. Metamorphopsia involves a visual distortion of the physical properties of objects so that objects appear bigger, smaller, or lighter than they really are.
Reference: Gutman, S; Schonfeld, A. Screening Adult Neurologic Populations (2003) p. 61

Answer B, if a patient has TL-spine precautions, they need to wear their TLSO whenever they are out of bed or the head of bed is raised higher than 30 degrees.

To test for radial nerve function, the best way would be to have the patient perform wrist extension. The radial nerve innervates the muscles responsible for wrist extension, so testing the patient's ability to perform this movement would provide a direct assessment of radial nerve function. Gross grasp with a dynomometer, pincer grasp with index and thumb, and thumb opposition are not specific to radial nerve function and would not provide as accurate of an assessment.

Rationale: It is important in the early stages of care that the patient be clear on what might be expected for them before returning home. Strengthening would not be important in the acute care setting given sterna precautions.

Sensory integration begins to occur at conception. It is primarily controlled by the brain. People have a spectrum of different sensory integration levels, it’s not something that either you have or you don’t have.
Source: “Sensory Integration and the Child” by A.Jean Ayers, PhD

bed mobility (hierarchy of mobility skills - bed mobility, mat transfers, bed transfer, toilet & tab transfer)
source: “Occupational Therapy for Physical Dysfunction” M. V. Radomski & C. A. T. Latham p. 819

Rationale: The correct answer is B) to reduce tonicity. By side-lying on the affected side, the client is weight bearing through the hypertonic limb which has been shown to be effective in reducing tone. While answers A,C, and D may all be reasons why a client would be in a side-lying position they are not the primary reasons in this scenario.

Pendleton, H.M., Schultz-Krohn, W. (2006). Pedretti’s Occupational Therapy Practice Skills for Physical Dysfunction (6th edition). St. Louis, MO: Mosby Elsevier.

Reference: Fleming-Castaldy, R.P. (2009). National occupational therapy certification exam: Review and study guide. p.156, Table 5-4.

Lundy-Ekman, L. (2007). Neuroscience: fundamentals for rehabilitation. St Louis, MO: Saunders. pp 494.

Answer: A. True. Children with hypertonia are more likely to retain primitive reflexes. However, delays in the development of postural reactions are a major concern for children with hypotonicity.

Neurological Rehabilitation 5th edition. Umphred, 2007. pg. 399

Answer: c. Remove throw rugs from floors

Rationale: All are interventions to prevent falls. However, the most important factor when assessing ones home would be to remove throw rugs. This is an immediate intervention that could be implemented at that moment.
Source: National Occupational Therapy Certification Exam Review and Study Guide 5th Edition by Rita P. Fleming-Castaldy (page 319)

Rational: Individuals may begin to notice symptoms such as an incoordination or paresthesias of limbs, trunk, or face, as well as an overall fatigue.
Source: Willard & Spackman’s Occupational Therapy, v. 10

Radial Palsy is the most common secondary diagnosis from Humeral fractures. Radial palsy can cause weakness of the extensor muscles of the hand. With weak extensor muscles patients cannot perform full wrist tenodesis which maximizes grip strength.
Cooper, C. Fundamentals of Hand Therapy Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. Page 216 - 219.

Using Nintendo Wii in burn rehabilitation as an adjunct traditional therapy provides several benefits, including recovering from motor deficits, distraction from pain, and increasing motivation. However, it does not directly address fatigue and soreness. While the use of Nintendo Wii may indirectly help in reducing fatigue and soreness by engaging patients in physical activity and promoting movement, it is not specifically targeted towards addressing these symptoms.

The patient's inability to wrinkle his forehead and difficulty closing his eyes completely suggest damage to the facial nerve. The facial nerve controls the muscles of facial expression, including the forehead and eyelids. Damage to this nerve can result from trauma, such as a motor vehicle accident. The other cranial nerves listed (trigeminal, trochlear, and vagus) do not directly control these specific movements and would not likely be responsible for the observed symptoms.

Case-Smith, O'Brien; Occupational Therapy for Children, 2010 pg 453

all other responses are too low, and may result in hypotension, syncope, weakness, dixxyness or nausea.

Reference: Fleming-Castaldy, Rita. National Occupational Therapy Certification Exam: Review & Study Guide, 5th Edition, (2009), pg-636.

Rational: The correct answer is B because active range of motion is crucial. Intervention that increases pain such as passive range of motion should be avoided. Massage reduces the swelling and reintroduces touching of the hand.
Source: Text book- Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction and the OT Advantage website

Electrical stimulation should not be applied directly over or in proximity to active cancer. There are no warnings or contraindications for e-stim related to arthritis (B) or broken bones (D). Answer C is the distracter, as patients with uncontrolled high blood pressure should not receive electrical stimulation, but those on medication to regulate hypertension are safe to receive this treatment.

(Answer: d, completing the visual subtest will remove from the results any influence of physical disability secondary to CP and will allow you to examine her visual perception.)
(Source: Dr. Chisty Nelson class notes, VMI examiners manual)

C is the correct answer. Accomodation is the ability of the eye to adjust focus at different distances while convergence is the ability of the eye to maintain focus as an object moves closer and further away. Saccades are quick eye movements that change fixation from one point to another and allow a person to redirect his or her line of sight. Smooth pursuits are eye movements that maintain continued fixation on a moving target.
Radomski and Latham. (2008). Occupational therapy for physical dysfunction. Sixth Edition. Baltimore, MD. Lippincott, Williams and Wilkins. (pp. 241)