493
Chapter 18 ■ Driving and Community Mobility
for adaptation to vehicles so that physical limitations do not prevent a return to driving, but understanding the driver-vehicle interaction is complex, and the appropriate level of expertise is needed to prescribe, fit to the vehicle, and to train. Young adults with life-long disabilities such as muscular dystrophy or cerebral palsy generally will require specialized evaluation, equipment, and training by a DRS to be able to drive. These clients may need adapted driver’s education, may drive with joystick and computerized controls, and may have very specific and individualized options designed for them. Some disabili- ties, unfortunately, will preclude ever driving in a safe and controlled manner, and the OTA can address alternative transportation options.
Adult Physical Conditions Intervention Strategies for Occupational Therapy Assistants, 2nd Edition Amy J. Mahle, MHA, COTA/L, ROH Amber L. Ward, MS, OTR/L, BCPR, ATP/SMS, FAOTA The comprehensive resource for class, clinical, and practice ... now in full color! A blend of theory and foundational knowledge with practical applications to OTA interventions and client-centered practice helps students develop the critical-thinking and clinical-reasoning skills they need to become professional, creative, and competent practitioners. § NEW & UPDATED! Chapters incorporate language from the 4th Edition of the Occupational Therapy Practice Framework and align with the latest ACOTE standards § NEW & UPDATED! Full-color photographs reflect real clients and therapists in diverse settings § NEW CHAPTERS! Occupational Justice for Diverse and Marginalized Populations, Motor Control and Neurotherapeutic Approaches, Sexual Activity and Intimacy, and The Influence of Aging on Occupational Performance § “Evidence-Based Practice” features recent research relevant to topics in each chapter § “Putting It All Together: Sample Treatment and Documentation” uses evaluation, treatment, and documentation based on one relevant case from each diagnosis chapter to connect learning in the classroom and the lab to real-world, skilled client-centered care § “Technology & Trends” highlights interesting, new, and relevant technology or treatment trends § Real-life “Case Studies” with questions develop critical-thinking and problem-solving skills § "Review Questions" at the end of each chapter assess progress, knowledge, and critical thinking HHHHH New Holy Grail for Occupational Therapy! “This is the most comprehensive occupational therapy textbook I have ever seen! It is refreshing how up to date all of the information is compared to any other textbook I've had on the subject.” —Hogan, Online Reviewer FIGURE 18-7. Manual wheelchair going into an accessible van. Another option can be a vehicle that is modified to carry a wheelchair inside it during transport. This is generally a minivan or full-sized van that has been modified with a raised roof and/or lowered floor for increased headroom, so clients can enter the van sitting in their mobility device. Either a ramp will fold out of the back or side, or a lift will raise and lower to allow this (Figs. 18-6 and 18-7). Once inside, the client can transfer to the driver’s or passenger’s seat (preferable), or stay in the wheelchair (if it is designed/ tested for this purpose) (Fig. 18-8). Either way, the wheel- chair must be secured, and the person must be secured as well, not only by the wheelchair seat belt, but a safety shoulder harness and belt in the vehicle. An important resource to share with clients is the National Mobility Equipment Dealers Association’s (NMEDA’s) Quality Assur- ance Program (QAP) at www.nmeda.com. With QAP, the client will have access to trained staff and certified techni- cians that meet all federal and industry safety regulations for specialized vehicle conversions designed to meet the client’s unique needs. Routinely, DRSs work closely with
ADULT CONDITIONS & INTERVENTIONS
1,264 pages | 670 illustrations Hard cover | 2022 $136.95 (US) ISBN-13: 978-1-7196-4435-8
VEHICLE OPTIONS
For the client who uses a wheelchair, especially a power wheelchair, transportation can be an issue. Complex power wheelchairs can weigh over 400 pounds and do not disas- semble to go into a vehicle. Even a small scooter, when disassembled for transport, can have the heaviest part at 35 pounds, which may be unreasonable for a caregiver to manage. Lifts can be added externally on the hitch or inter- nally to a vehicle to allow these important mobility devices to be taken to destinations with access, thus providing the client with more flexibility in mobility than with a cane or walker (Fig. 18-6). If the mobility device is carried exter- nally, the weight of the device on the frame of the car must be considered. Hitch lifts can have a ramp that folds out to load the mobility device or a battery-operated, height adjustable platform. Loading, unloading, and carrying the device in the rain and weather is a consideration as well as transferring the potentially dependent client into a vehicle seat. A small trailer may allow a smaller vehicle to carry the weight of a heavier chair, and a grill cover or wheel- chair cover tied down over the chair can be used to keep off the rain and dirt.
Instructor § eBook § Test Bank § Instructor’s Guide § Image Bank § PowerPoint Lecture § Videos § Critical-Thinking
Case Study PowerPoint
325
Chapter 13 ■ Muscle Strength
maintain the forearm in the position to keep pills or coins in the palm of the hand. Weak supination and pronation make meal prep especially challenging with stirring, cut- ting, and other tasks. Wrist Flexion Client sits with arm supported on a flat surface, forearm supinated, and wrist between a neutral position and full flex- ion. The OT practitioner stabilizes the anterior aspect of the distal forearm while the client holds the test position, which is midway between neutral and full wrist flexion. The practi- tioner applies resistance on the palm of the hand in the direction of wrist extension saying, “hold, don’t let me move you.” For a gravity-minimized position, the client sits with forearm in neutral position (halfway between supination and pronation) and moves the wrist in the direction of flex- ion. Resistance is not necessary in this position (Fig. 13-16). FIGURE 18-8. OT practitioner providing cues to client with thoracic SCI on loading wheelchair into his vehicle during final OT session before discharge. Wrist Extension Client sits with arm supported on a flat surface, forearm pro- nated, and wrist between a neutral and extended position. The OT practitioner stabilizes the anterior aspect of the distal forearm while the client holds the test position, which is the
FIGURE 13-14. Functional supination manual muscle testing. Test position is client in slight pronation with practitioner’s hands holding/stabilizing to provide resistance and to avoid compensation. Practitioner’s hands may need to be placed slightly differently from the picture to achieve this outcome. FIGURE 18-6. Loading a power wheelchair into the back of a van with a power lift system.
FADavis.com
2
4435_Ch18_475-500.indd 493
22/12/21 3:17 PM
Powered by FlippingBook