Ot - Role of Ot in Pulmonary Rehab

CONTINUING EDUCATION
for Occupational Therapists

THE ROLE OF OCCUPATIONAL THERAPY
IN PULMONARY REHABILITATION
PDH Academy Course #OT-1604 | 3 CE HOURS
This course is offered for 0.3 CEUs (Intermediate level; Category 2 – Occupational Therapy
Process: Evaluation; Category 2 – Occupational Therapy Process: Intervention; Category 2 –
Occupational Therapy Process: Outcomes).
The assignment of AOTA CEUs does not imply endorsement of specific course content, products,
or clinical procedures by AOTA.
Course Abstract
This course provides an overview of Occupational Therapy’s role in pulmonary rehabilitation,
with attention to diagnoses, terminology and procedures, and process. It concludes with case
studies.
Target audience: Occupational Therapists, Occupational Therapy Assistants (no prerequisites).
NOTE: Links provided within the course material are for informational purposes only. No endorsement of
processes or products is intended or implied.
Learning Objectives
By the end of this course, learners will be able to:
❏ Differentiate between primary pulmonary diagnoses
❏ Identify terminology and procedures pertaining to pulmonary rehabilitation
❏ Recognize roles of occupational therapy in pulmonary rehabilitation
❏ Recall elements of three pulmonary rehabilitation-focused case studies
OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 1

INTRODUCTION
Timed Topic Outline
According to the Center for Disease
I. Primary Pulmonary Diagnoses (30 minutes)
Control (CDC), 15% of adults in the
Chronic Obstructive Pulmonary Disease (COPD), Pneumonia (PNA),
United States live with a diagnosis
Interstitial Lung Disease (ILD), Acute Respiratory Distress Syndrome (ARDS)
of chronic lung disease such as
II. Common Respiratory Terminology and Procedures (15 minutes) asthma or chronic obstructive
III. Role of Occupational Therapy in Pulmonary Rehabilitation (45 minutes) pulmonary disease (COPD).1 While
Overview, Settings, Process, Common Questions approximately 10% of those adults
report mild symptoms, more than
IV. Case Studies (75 minutes)
a third report persistent moderate
V. Conclusion, Additional Resources, References, and Exam (15 minutes) to severe symptoms that greatly
impact quality of life.2 Each year
Delivery & Instructional Method more than 614,000 inpatient
admissions are attributed to chronic
Distance Learning – Independent. Correspondence/internet text-based self-study,
and unspecified bronchitis.1
including a provider-graded multiple choice final exam. To earn continuing education
Additionally, chronic lung
credit for this course, you must achieve a passing score of 80% on the final exam.
disease greatly increases the risk
of developing pneumonia with
Registration & Cancellation critical episodes accounting for
Visit www.pdhtherapy.com to register for online courses and/or request approximately 1.1 million inpatient
correspondence courses. admissions per year.3 Critical
As PDH Academy offers self-study courses only, provider cancellations due to illness or acute lung injury, such
inclement weather, instructor no-shows, and/or insufficient enrollment are not as acute respiratory distress disease
concerns. In the unlikely event that a self-study course is temporarily unavailable, (ARDS) commonly associated
already-enrolled participants will be notified by email. A notification will also be with sepsis, trauma, and severe
posted on the relevant pages of our website. pulmonary infections, account
for approximately 15-18% of all
Customers who cancel orders within five business days of the order date receive ventilated patients in inpatient
a full refund. Cancellations can be made by phone at (888)564-9098 or email at care.4 Lung disease has now become
support@pdhacademy.com. the third highest cause of mortality
in the U.S.A.1
Accessibility and/or Special Needs Concerns? Common symptoms associated with
Contact Customer Service by phone at (888)564-9098 or email at support@ chronic lung disease such as COPD
pdhacademy.com. include increased shortness of
breath, deconditioning with general
loss of muscle mass and strength
Course Author Bio & Disclosure impacting activity tolerance, as
Midge (Annamaria) Hobbs, OTR/L, originally from the UK, graduated with an MA well as anxiety and depression.
in Occupational Therapy from Tufts University, Boston MA in 2005. She spent Persistent symptoms can greatly
the following ten years working in long-term acute care gaining experience as a reduce function leading to a
clinician, educator, and manager. In 2010, Midge was selected for the inaugural gradual loss of independence and
cohort of AOTA’s Emerging Leaders Development Program (ELDP). Since then she a downward spiral in confidence
has continued to amplify AOTA’s leadership initiatives by serving the Emerging based on the understanding that
Leaders Development Committee (ELDC) as Chairperson and as a member of quality of life has been permanently
AOTA’s Volunteer Leadership Development Committee (VLDC). She is currently compromised.5,6 Interdisciplinary
the Editor of AOTA’s A Mindful Path to Leadership, a new online self-paced rehabilitation is generally designed
leadership development course, and she co-authored Module 3: Mentoring and to alleviate and/or manage
Leadership with current AOTA president, Amy Lamb. symptoms, increase strength and
Midge is currently employed as a consultant for internship development in the endurance in order to optimize
adolescent residential psychiatric programs at Sheppard Pratt Hospital in Baltimore function, and maximize quality of
MD, an adjunct professor at the MGH Institute of Health Professions in Boston, life.7
and a clinician at local rehab and assisted living facilities. Midge is also enrolled Occupational Therapy (OT)
at Thomas Jefferson University for her post-professional OTD with a specialty in can be a key member of the
teaching in the digital age. In her limited spare time she watches English soccer interdisciplinary team with its focus
and eats a lot of popcorn. on providing client-centered care
DISCLOSURES: Financial – Midge (Annamaria) Hobbs received a stipend as the to maximize individual functional
author of this course. Nonfinancial – No relevant nonfinancial relationship exists. capacity through education,
the improvement of activity
2 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

tolerance, and psychosocial support. While many indicated by an increase in mucus production and a
occupational therapists may not choose to specialize thickening and narrowing of the airway walls. Chronic
in pulmonary rehabilitation, many therapists working bronchitis is diagnosed when increased inflammation
in physical medicine settings will encounter adults persists over time and it is characterized by a chronic
with limitations associated with lung disease, and it is productive cough.13
important to understand OT’s role and be prepared to
Clinical Picture:
provide appropriate services.8
An increase in mucus production and narrowing
of the airways significantly impacts gas exchange
PRIMARY PULMONARY DIAGNOSES and may exhaust respiratory muscles and lead to
an accumulation of carbon dioxide as well as an
Chronic Obstructive Pulmonary Disease (COPD) increased risk of hypoventilation. Dyspnea with
Description: minor exertion is the most common symptom
associated with COPD, along with a persistent cough,
COPD is not a single disease but rather an umbrella expiratory wheezing, and fatigue.8 However, symptoms
term used to describe progressive lung diseases of COPD typically do not manifest until significant
that include emphysema and chronic bronchitis. lung damage has already occurred. A diagnosis may
While COPD is considered preventable, it is also a be confirmed through a pulmonary function test
progressive, life-threatening disorder in which the (PFT), a chest X-ray, CT scan, or an arterial blood gas
lungs are irreparably damaged making it difficult to analysis (ABG). Management of the disease focuses
breathe. Multiple factors may contribute to its onset on lifestyle changes, including smoking cessation,
and progression, including smoking, exposure to and prescribed medication such as bronchodilators
environmental pollutants, and a history of asthma. that relax the muscles around the airways and relieve
Prolonged exposure to toxic agents over time may coughing and dyspnea.14
result in increased mucous production (chronic
bronchitis) and tissue breakdown (emphysema).9 For more severe symptoms, inhaled corticosteroids
COPD is characterized by irreversible airflow may be prescribed to reduce airway inflammation and
obstruction causing dyspnea (shortness of breath) and minimize the risk of worsening symptoms known
limited reserve lung capacity with an increased risk of as an exacerbation. However, even with appropriate
developing hypoxemia. 10 lifestyle changes and symptom management,
individuals with COPD may experience exacerbations
Worldwide, 64 million people live with COPD with commonly triggered by increased exposure to irritants
an estimated 3 million deaths attributed to the disease or a respiratory infection. Immediate medical care
each year. According to the World Health Organization is indicated for an acute exacerbation to minimize
(WHO), 80% of deaths are a result of long-term the risk of lung failure. For persistently moderate
smoking, which explains why COPD typically affects symptoms or an acute exacerbation, a short course of
older adults who may have had a longstanding history oral steroids may be indicated. Typically, long-term use
of tobacco use.9 Additionally, more women than men of oral steroids is avoided due to the significant side-
are now being diagnosed with the disease as a result effects associated with prolonged use. These include
of increased tobacco use over the past 30 years.9,11 In diabetes, weight gain, osteoporosis, and an increased
2010, the cost of hospital admissions attributed to risk of infection. In cases of moderate to severe COPD,
COPD exacerbations was estimated at $32.1 billion doctors may also prescribe supplemental oxygen.15
dollars annually and is projected to reach $49 billion
by 2020.12
Pneumonia (PNA)
Pathophysiology:
Description:
Upon inhalation, air is moved down through the
trachea which then branches into two bronchi leading Pneumonia is an acute infection affecting one or both
into the lungs. The bronchi then branch into smaller lungs that is classified by origin, location, and type
bronchioles, which end in clusters of air sacs known or pathogen. It may be caused by bacteria, a virus, or
as alveoli that are comprised of tiny blood vessels fungi.16 Influenza is one of the most common causes
or capillaries. Gas exchange occurs when inspired of viral pneumonia, while Streptococcus pneumonia
air moves from the lungs to the bloodstream via the is the most common cause of bacterial pneumonia.
walls of the alveoli and carbon dioxide simultaneously Aspiration pneumonia is the result of inhaling foreign
moves from the blood into the capillaries of the lungs material, such as gastric contents, into the lungs.17 It
to be exhaled. A diagnosis of emphysema is indicated can be further classified as hospital-acquired (HAP),
when the walls of the alveoli become damaged due to community-acquired (CAP), or ventilator-acquired
long-term exposure to toxic agents and the capillaries pneumonia (VAP). Symptoms may range from mild
decrease their elasticity impacting gas exchange. to life-threatening depending upon etiology, age,
Bronchitis is inflammation of the bronchioles and baseline health concerns. While it can affect all

age groups, PNA tends to be more serious for infants treatments to support recovery. In severe cases,
and young children, older adults over the age of 65, complications include respiratory failure that may
and individuals with co-morbidities such as COPD or lead to acute respiratory distress syndrome (ARDS), or
those with compromised immune systems. According the development of sepsis - systemic inflammation
to the CDC, pneumonia is the leading cause of of the body that may lead to organ failure. Both are
hospitalizations for adults and children in the United life-threatening scenarios that may require the use of a
States. Worldwide, it is the leading cause of death in mechanical ventilator to support breathing.20
children under 5 years of age. In the United States,
approximately 53,000 adult deaths are attributed to
PNA each year.18 Interstitial Lung Disease (ILD)
Pathophysiology: Description:
The infecting organism can be inhaled, spread directly Rather than referring to one specific disease, interstitial
from another site, or carried via the bloodstream, and lung disease is a group of disorders that share a similar
impacts the lower respiratory tract. Once colonized, clinical profile. The chief characteristic is scarring of
infection may develop. Viral pneumonia creates the pulmonary interstitium, which includes the walls
interstitial inflammation, first affecting the bronchial of the alveoli and the microscopic spaces around the
mucous glands before spreading to the alveoli, which blood vessels. Scarring causes progressive lung stiffness
fill with fluid and purulent material (pus). Bacterial impacting the ability to breathe.21 Disorders associated
pneumonia triggers an inflammation of the alveoli with ILD may be of known or unknown etiology.22
causing low ventilation that congests the capillaries. It has not been possible to accurately estimate the
In turn, alveoli fill with fluid and purulent material. prevalence of ILD given the diverse number of
In aspiration pneumonia, particles of inhaled associated diseases and variation in etiology.23
foreign material may obstruct airways and trigger an ILD associated with exposure to toxic agents:
inflammatory response. Regardless of pathway, gas The most common toxic agents associated with
exchange is restricted making breathing difficult.16 occupational exposure include asbestos, commonly
Clinical Picture: found among electricians, auto mechanics, and pipe
fitters; silica, commonly attributed to mining and
While the clinical picture may vary depending foundry work; and coal dust, associated with mining
upon the type of pneumonia, the most common and granite workers. Additionally, prolonged exposure
symptoms include dyspnea, a cough, fever, shaking to therapeutic radiation in the management of cancer
chills, fatigue, substernal discomfort, and myalgia. is also a known contributor to the development of
While the prognosis is good for those with healthy acute inflammation that can cause lung scarring
lungs, immediate medical attention is indicated when over time. Individuals exposed to birds or molds
there is a persistent fever above 102 F, a lasting cough may also develop inflammation and hypersensitivity
with excess sputum, or chest pain.16 It is particularly pneumonitis. 22,23
important for those in high risk groups to seek
immediate medical attention. For example, pneumonia ILD associated with systemic disease: ILD is a
can quickly escalate to life-threatening status in those common complication of a number of connective
individuals with chronic heart failure, underlying lung tissue diseases, including rheumatoid arthritis,
disease, or suppressed immune systems, such as those scleroderma, and systemic lupus erythematosus.
receiving chemotherapy.3 Sarcoidosis, a multi-system inflammatory disease, is
the most common ILD in the United States affecting
Diagnosis is made via a chest X-ray to confirm more women than men and individuals over the age of
infiltrates, a sputum specimen, blood cultures, and 20.22,24
a white blood count to differentiate the type of
organism present and whether the infection is viral or ILD of unknown etiology: Despite evaluation
bacterial in origin. Pulse oximetry may also indicate efforts to determine origin, underlying systemic
oxygen saturation levels in the blood.19 Treatment disease association, or genetic predisposition, many
for pneumonia is primarily focused on managing individuals with ILD belong in the idiopathic
the infection and preventing complications. In interstitial pneumonia (IIP) category. The most
many cases, individuals with community-acquired common IIP is idiopathic pulmonary fibrosis, a
pneumonia (CAP) may be treated at home, although crippling disorder with minimal treatment options
symptoms may persist for up to a month. Typically, most commonly affecting individuals over the age of
treatment includes antibiotics for bacterial pneumonia 60. It has a poor prognosis due to rapid progressive
or an anti-viral medication for viral pneumonia, scarring.22,25
antipyretics to reduce fever, rest, and increased fluid
Pathophysiology:
intake. In more serious cases, hospitalization may be
indicated and the individual may receive supplemental The pulmonary interstitium is a collection of tissue
oxygen, intravenous (IV) fluids, and breathing within the lungs that includes the space between

the alveoli and adjacent blood vessels, and is directly Pathophysiology:
involved in supporting the process of gas exchange. Lung injury associated with ARDS is commonly
Typically, the body is able to repair tissue that is described as having three distinct but overlapping
damaged, but if inflammation persists over time, phases. The initial inflammatory phase may last for
the interstitial tissue develops scarring (fibrosis) a week after onset followed by a proliferation phase
that eventually replaces normal lung tissue. As the characterized by tissue damage and narrowing of air
tissue and walls of the alveoli thicken, gas exchange space with a subsequent fibrotic phase. The degree of
is impaired. While medications may slow down the fibrotic changes in the lungs is commonly a predictor
disease process, scarring is typically irreversible.22 of outcomes.31 The consequences of lung injury
Clinical Picture: typically include significantly impaired gas exchange
resulting in hypoxemia, decreased compliance whereby
Regardless of etiology and type, the primary clinical the fluid filled lungs become stiff and unable to stretch
signs and symptoms of ILD are similar. These include and expand, and increased arterial pressure that may
dyspnea and a non-productive cough. Additional lead to right ventricular failure. Most deaths associated
symptoms, such as increased sputum production, with ARDS are attributed to sepsis and multi-organ
hemoptysis associated with microscopic hemorrhages, failure versus primary respiratory dysfunction.32
and wheezing, as well as non respiratory related
Clinical Picture:
symptoms, such as myalgia and joint pain may help
to further classify the disease.22 A thorough physical Signs and symptoms vary in severity depending on
examination and history is imperative to determining the cause and the presence of underlying heart or lung
an accurate diagnosis.26 Upon auscultation, many disease; however, the most common early symptoms
individuals with ILD will have bilateral respiratory include significant dyspnea, increased respiration rate,
crackles with inhalation indicating excess fluid in the low blood pressure, extreme fatigue, and confusion.33
lungs. Imaging, pulmonary function tests (PFT), and a Diagnosis is usually determined via a complete
lung tissue analysis are commonly ordered by doctors physical exam and diagnostic testing. These include
in order to make a definitive diagnosis. For example, an arterial blood gas test (ABG), a chest X-ray to assess
a computerized tomography (CT) scan may reveal the fluid levels in the lungs, a chest CT scan to look for
extent of the fibrosis, while an incentive spirometry signs of pneumonia or tumors, a complete blood count
test will indicate lung capacity. Given that lung (CBC) and sputum culture to help clarify the cause of
scarring is irreversible, treatment is typically associated the infection.34
with disease management.27 For example, minimizing ARDS is a life-threatening condition and treatment is
exposure to any known toxic agents, providing most commonly conducted in an intensive care unit
supplemental oxygen to assist breathing, and (ICU) with the primary aim of improving oxygen
prescribing anti-inflammatory or immunosuppressing levels and treating the underlying cause. Supplemental
medications. In some cases, a lung transplant may be oxygen may be initially provided via a nasal cannula
considered, although mortality risk is high.22 or face mask but if breathing is significantly difficult,
non-invasive positive pressure ventilation (NIPPV)
may be trialed. For example, continuous positive
Acute Respiratory Distress Syndrome (ARDS) airway pressure (CPAP) may improve oxygenation
Description: thereby minimizing the need for more invasive
mechanical ventilation procedures. However, the need
Acute respiratory distress syndrome (ARDS) is defined for intubation or the placement of a tracheostomy are
as an acute life-threatening inflammatory reaction common considerations if the airway needs protection
to illness or trauma affecting approximately 200,000 in an unconscious patient or where there is facial
people each year in the United States.28 In many cases, or neck trauma, if there is significant hypoxemia
ARDS is a complication of severe pneumonia, sepsis, or an increase in secretions, or if there is a need to
or major trauma with severity greatly influenced by control hypercapnia.35 The ventilator is designed to
age, comorbidities, and alcohol consumption. Onset provide adequate oxygen, remove carbon dioxide, and
typically occurs within 24 hours to three days of the support the process of breathing when respiration is
initial illness or trauma. The inflammatory response compromised, and it is adjusted to the needs of the
causes injury to the lungs and fluid to build up in the individual patient. For example, providing low tidal
alveoli compromising gas exchange, making breathing ventilation may minimize airway pressure and avoid
difficult, and increasing the risk of respiratory failure.29 over distention of the alveoli, while the use of positive
Up to 40% of ARDS cases are fatal with research end expiratory pressure (PEEP) may maximize alveoli
suggesting more men than women are affected, involvement. Additional treatment focuses on fluid
although the cause is commonly a predictor of survival management and minimizing further complications
rates. For example, typically healthy young patients such as malnutrition, blood clots, pneumothorax,
with trauma-related ARDS have a better survival rate and pneumonia. Medications may include vasodilators
than older individuals who develop ARDS as a result of in order to improve gas exchange, as well as anti-
sepsis.30 inflammatories.31,36

Once medically stable, a systematic ventilator weaning noted for unpleasant side effects including stomach
process may begin with short regular breathing trials issues and insomnia. Additionally, anticholinergic
to assess the individual’s spontaneous efforts.37 If bronchodilators are used to treat patients with
successful, the patient will trial pressure support emphysema and chronic bronchitis. They are typically
ventilation (PSV) whereby the individual initiates inhaled and not recommended in asthma.41
every breath with ventilator support. The ultimate Bronchoscopy: An endoscopic procedure to visually
goal of weaning is for the patient to tolerate unassisted
examine the airway in order to assess abnormalities
breathing.38 Due to the severity of ARDS, recovery from
that may be affecting ventilation. Abnormalities may
the condition may be protracted and it is commonly
include foreign bodies, bleeding, or inflammation. The
associated with residual physical and cognitive
bronchoscope may be inserted into the airway via nose
challenges requiring additional pulmonary rehab or
or mouth, or in some cases, a tracheostomy, and there
support for depression.39
are two types of procedures. A flexible bronchoscopy
uses a long, thin tube, is performed without general
COMMON RESPIRATORY anesthesia, and allows for minor biopsies. A rigid
bronchoscopy uses a hollow metal tube and is
TERMINOLOGY AND PROCEDURES performed under general anesthesic, most commonly
Arterial blood gas (ABG): A test to provide valuable when the risk for bleeding is higher or larger biopsies
information about the acidity (pH) and the partial are required.42
pressures of specific gases such as oxygen (PaO2) and Carbon dioxide (CO2): A colorless and odorless
carbon dioxide (PaCO2) in the blood. It is used to naturally occurring waste gas that is produced by
determine how well a patient’s lungs are able to move
all aerobic organisms in the process of respiration.
oxygen into the blood and remove carbon dioxide
If gas exchange is impaired and the body cannot
from the blood, and is typically performed via a
appropriately remove CO2, respiratory acidosis may
puncture in the radial artery at the wrist or in the
occur, which is considered a medical emergency. Signs
femoral artery at the groin. It is commonly used in
and symptoms of respiratory acidosis include increased
critically ill patients who are in respiratory failure or
fatigue or drowsiness, shortness of breath, headache,
who have deteriorated quickly due to sepsis or multi-
and confusion. In cases of respiratory alkalosis where
organ failure.
there is too little CO2 in the bloodstream, symptoms
The normal range for pH is 7.35-7.45. A decrease in may include prolonged muscle spasms or twitching,
pH suggests respiratory acidosis, which is a medical numbness, and nausea. If untreated, symptoms may
emergency caused by hypoventilation that increases escalate rapidly and include dizziness and difficulty
the CO2 in the blood. An increase in pH suggests breathing leading to shock or coma.45
respiratory alkalosis due to an abnormally low level Continuous Positive Airway Pressure (CPAP):
of CO2, often caused by rapid deep breathing that can The most common non-surgical intervention for
be a result of pneumonia, lung disease, or asthma.
obstructive sleep apnea (OSA). A CPAP machine is a
Partial pressure of PaO2 measures the pressure of the O2
small bedside device that delivers a continuous flow of
dissolved in the blood and how well it moves from the
air via a nasal or facial mask that is worn over the nose
airspace of the lungs into the blood. Partial pressure of
and mouth. OSA is a disorder that causes the airway
PaCO2 measures the pressure of CO2 dissolved in the
to collapse or become blocked while the individual
blood and how well it is excreted from the body.40
is sleeping leading to episodes of shallow breathing
Bilevel Positive Airway Pressure (BiPAP): Please see or interruptions in breathing. Consequently, oxygen
Non-invasive positive pressure ventilation (NIPPV). reaching the lungs is limited and gas exchange is
impaired. Continuous pressure from a CPAP machine
Bronchodilator: A medication used to relax the
maintains an open airway and prevents it from
bronchial muscles causing the airways to dilate and
collapsing or becoming blocked, thereby improving gas
improve ventilation. It is commonly used in cases of
exchange. To assess appropriateness for CPAP, a sleep
asthma where narrowing of the bronchial tubes causes
study is typically required in order to measure oxygen
wheezing and difficulty breathing. Bronchodilators
levels during the night. CPAP may also be indicated
are categorized depending on need and come in many
in individuals who have both OSA and COPD as an
forms. For example, the medication may be breathed in
additional means of maintaining healthy oxygen levels
via spray or mist, taken orally, or given intravenously.
in the bloodstream.45,46
The most common form of bronchodilator is the
beta-adrenergic agonist, which stimulates the Corticosteroids: Synthetic drugs that closely resemble
bronchial muscles to relax. It is most commonly cortisol, a hormone that is produced naturally in the
inhaled so that it can work rapidly. Theophylline adrenal glands. Corticosteroids are often referred to by
bronchodilators are typically taken orally or given the shortened term “steroids” and are used to reduce
intravenously, and their effect can last 12-24 hours. the production of chemicals that cause inflammation
Theophylline bronchodilators are not considered as particularly when inflammation threatens to damage
strong as the beta-adrenergic agonists and have been critical body organs.43

Decannulation: The removal of a tracheostomy tube Incentive spirometry (IS): Spirometry is method
when an individual no longer requires mechanical of measuring an individual’s volume of inhalation
ventilation to support breathing or the airway is and exhalation. The technique is commonly used to
deemed safe. The opening in the neck is covered with diagnose conditions such as asthma or COPD, and may
a sterile dressing and taped to inhibit air leakage. The also be used to monitor the effectiveness of treatment
hole typically heals over a period of days to a week.44 for chronic respiratory conditions. Additionally, it is
often used to improve respiratory health following
Dyspnea: Shortness of breath or difficulty breathing,
surgery or an acute illness such as pneumonia when
commonly an indicator of airway, lung, or heart
breathing may be difficult. Individuals blow into the
dysfunction. The most common respiratory diseases
mouthpiece of the device and are encouraged to exhale
associated with dyspnea include asthma, pneumonia,
normally before inhaling slowly. An indicator within
and COPD. Red flags of particular concern include
the chamber of the device will rise upon inhalation
dyspnea at rest, chest pain, wheezing, palpitations,
providing an observable measure of volume that may
and crackles (suggestive of left sided heart failure or
be recorded to assess progress. The goal is to take
interstitial lung disease). An appropriate history and
long, deep breaths to expand the lungs that may help
physical is required to determine severity, cause, and
increase O2 levels as well as improve an individual’s
treatment.45
ability to clear mucus.22
Foley catheter: A flexible tube that is inserted into
Interstitium: A lace-like network of supportive
the urethra and into the bladder to drain urine. It
tissue that extends throughout both lungs. Chronic
has a small balloon at the bladder end, which can be
inflammation of the interstitium changes the lungs’
inflated and retained as an indwelling catheter. Urine
ability to function well impacting gas exchange.22
is typically collected via a bag outside of the body
that will require regular emptying. A Foley catheter Infiltrates: Fluid filled air space or presence of
is recommended by doctors when an individual inflammation in the lungs, commonly indicating
cannot control his or her bladder, including those infection, including PNA.20
experiencing critical illness. 46
Mechanical ventilation: A life support system used to
Gas exchange: The primary role of respiration or gas assist or control respiration. A mechanical ventilator
exchange is to deliver oxygen from the lungs to the is also commonly called a respirator or breathing
bloodstream. The process occurs via simple diffusion machine, and is used in cases of severe illness or injury
and takes place in the alveoli in the lungs and the when an individual is unable to breathe independently
surrounding capillaries. As oxygen moves from the or there is significantly impaired gas exchange
alveoli to the blood, carbon dioxide is transferred seriously impacting the levels of O2 or CO2 in the
from the blood in the capillaries to the alveoli and is blood. In many cases, a ventilator is used as a short-
breathed out via the lungs.47 term measure to medically stabilize a patient who is
critically ill and is commonly used in an intensive care
Hypercapnia: Abnormal increase of carbon dioxide
unit (ICU). However, it is also found in long-term care
(CO2) in the blood.45
facilities if the patient is considered medically stable
Hypoventilation: Abnormally slow rate of breathing or if being cared for at home. While a ventilator can
that results in an increased amount of carbon dioxide be life-saving it also comes with risks, and healthcare
(CO2) in the blood.45 providers typically attempt to wean individuals from
the machine as soon as possible.
Hypoxemia: Abnormally low levels of oxygen (O2)
in the blood indicative of breathing or circulatory The ventilator is connected to the patient either via a
disorders. A normal range is considered 95-100% and means of intubation, whereby an endotracheal tube
in many cases, below 90% is considered low. Without is placed into the mouth or nose, or a tube is inserted
sufficient O2, the brain, liver, and other organs may via a tracheostomy, where a surgical incision is made
be damaged. Symptoms of inadequate O2 include directly into the trachea. The tracheostomy or “trach
shortness of breath, headache, fatigue, and confusion, tube” is considered more secure than the endotracheal
and may be the result of asthma, COPD, interstitial tube. The ventilator conducts oxygen into the lungs
lung disease, pneumonia, pulmonary fibrosis, sleep with the rate and flow set according to the needs
apnea, pneumothorax, or ARDS.48 of the patient. For example, it may provide full
respiratory support or partial assistance. Patients may
Hypoxia: Hypoxemia (low O2 in the blood) may cause
require temporary sedation while on the ventilator,
hypoxia, which is an abnormally low level of O2 in
particularly during the early stages of critical care, in
the body’s tissues and cells. Most common symptoms
order to minimize resistance against the machine’s
include changes in skin color (most often a blue
flow or to avoid pulling at the ventilator lines or the
hue), confusion, shortness of breath, sweating, and
trach tube.
wheezing. Like hypoxemia, it is a medical emergency
requiring immediate assistance, most commonly The potential for infection, including the development
provided via supplemental O2.46 of pneumonia, increases with ventilator use due to the

risk of bacteria accessing the lungs via the endotracheal and elimination of CO2. In the case of an acute COPD
or tracheostomy tube. Additional risks associated with exacerbation, the option to use NIPPV may minimize
ventilator use include pneumothorax (lung collapse), the risk of more invasive procedures.52, 53
which may occur if the lung is weak. The pressure of
Oxygen (O2): A vital, life-sustaining odorless gas
the ventilator may also cause damage to the lungs over
time and it is important to find the appropriate level of that represents 21% of air. It plays a vital role in gas
oxygen required per individual. The ventilator weaning exchange. The exchange takes place in the alveoli in
process involves safely decreasing the amount of the lungs and the surrounding capillaries. A normal
support that the patient receives so that the individual peripheral capillary oxygen saturation (SpO2) range is
begins to take on greater responsibility for respiratory between 95-100%. While 90-95% is considered low it
effort. is not necessarily indicative of a health issue. Without
adequate O2, the brain, liver, and other vital organs can
Whether intubated via an endotracheal tube or be damaged. The brain is extremely sensitive to lack
attached to the ventilator via a tracheostomy, patients of O2 and cells can begin dying within minutes with
cannot speak or eat and typically receive nutrition via significant implications including brain damage or
a nasogastric tube (NGT) or a percutaneous endoscopic death.45
gastrostromy (PEG) tube. During the weaning process,
patients may be provided with a Passy-Muir® valve or Passy-Muir® valve: Please see Mechanical ventilation.
trach cap, both of which enable the individual to speak Pleural effusion: An increase in fluid accumulation
despite retaining the trach tube. The most common in the space between the pleura, the thin membrane
type of Passy-Muir valve® is a small plastic device that that lines the surface of the lungs. A pleural effusion
is placed over the hub of the trach tube to redirect air may be indicative of a number of conditions, including
flow through the vocal folds enabling communication, congestive heart failure and cancer. It is also a common
improving swallowing and secretion management.51 indication of pneumonia as a result of inflammation.
Nasal cannula (NC): Lightweight tube that splits Symptoms may include shortness of breath, chest pain,
into prongs and is used to deliver supplemental O2 and/or a cough. A pleural effusion is typically detected
via the nostrils. A standard nasal cannula delivers an via imaging, such a chest X-ray. 54
inspiratory O2 fraction (FiO2) of 24-40% and supply
Pneumothorax: An accumulation of air, gas, or blood
rates ranging between 1-5L. 50
in the pleural space may cause the lung to collapse
Nebulizer: A device used to convert a medication in or partially collapse causing chest pain and difficulty
liquid form into a mist or fine spray which can then be breathing. It is most commonly a result of underlying
inhaled. It is most commonly provided via an inhaler, lung disease, trauma, or a medical procedure, such
but can also come in the form of a portable compressor as a bronchoscopy, where air is introduced into the
unit. They are particularly effective in delivering pleural space. Pressure from mechanical ventilators
asthma medications.51 can also damage the lungs leading to a pneumothorax.
Diagnosis is via chest x-ray and treatment involves
Non-invasive positive pressure ventilation (NIPPV):
A process of delivering ventilation without the need for using a catheter inserted into the area to facilitate
invasive procedures like intubation or a tracheosotomy. drainage.55
Bilevel Positive Airway Pressure (BiPAP) and Positive end expiratory pressure (PEEP): A common
Continuous Positive Airway Pressure (CPAP) are technique used in ventilator support to assist the
the most common non-invasive ventilation therapies process of breathing by increasing the air pressure in
and were originally intended to treat people with the lungs and air passages near the end of expiration so
obstructive sleep apnea (OSA) but are now considered that an increased amount of air remains in the lungs
important options in treating other respiratory following expiration.51
disorders. Both deliver pressurized air from a small
bedside device via a tube to a nasal or facial mask Pulmonary function test (PFT): A means of measuring
that is worn over the nose and mouth. Both forms of breathing to assess how well the lungs are functioning;
NIPPV can improve ventilation and can be particularly includes an assessment of lung volume and how
beneficial for those suffering from chronic lung disease. well gas exchange is being performed. It is typically
The difference between the two NIPPV therapies is that used to determine the cause of shortness of breath,
CPAP delivers a single pre-set air pressure to maintain diagnose diseases such as asthma or bronchitis,
open airways, while BiPAP delivers two levels of check lung function prior to surgery, or measure the
pressure: one that corresponds with the inhale and one progress of treatment. Measurements are made via a
with the exhale. BiPAP is the more common method spirometer, which is a mouthpiece connected to a tube
used for people with a diagnosis of COPD because and recording device. The volume of air inhaled and
it targets the dysfunctional ventilation patterns exhaled, as well as the duration of the breath cycle, are
associated with the disease. The custom settings can recorded and analyzed. Lung volume measurements
alleviate the work of breathing at night and improve indicate the elasticity of the lungs and strength of the
ventilation leading to more efficient gas exchange respiratory muscles. Flow rates indicate the degree of

airway narrowing or obstruction.56 Occupational Therapists (OT) and Occupational
Therapy Assistants (OTA) consider both intrinsic
Pulse oximetry: A non-invasive means of measuring
and extrinsic factors in determining interventions,
oxygen saturation levels in the blood. A pulse oximeter
including psychosocial, cultural, physical, and
is a small device that is usually attached to a fingertip,
environmental issues, and use occupation as a means
but can also be used on a toe or an ear. Light passes
to promote health and wellness.62
from the device through the blood in the finger and
the device calculates the information to provide a OT/OTAs are trained in the areas of prevention,
percentage reading.57 life-style modification, and physical and
psychosocial rehabilitation.63 Therapists work from
Pursed-lip breathing: A simple technique used to
the understanding that many factors influence
slow the rate of breathing by prolonging exhalation
participation and performance, and that clients have
in order to manage shortness of breath. It improves
values, life experience, and skills that are invaluable
breathing patterns, keeps the airway open for longer,
in developing meaningful short and long-term
and facilitates relaxation. Clients are encouraged to
goals. OT/OTAs understand that including the client
breathe in slowly and normally through the nose for
and caregivers in the decision-making process care
a count of two before exhaling through pursed-lips
is empowering and that client-centered practice
while counting to four. A common phrase associated
fosters greater collaboration and participation in the
with the technique is, “Smell the coffee, blow out the
therapeutic process.64
candles.” 58
Additionally, interprofessional collaborative practice
Sepsis: A potentially life-threatening condition
is integral to providing safe, quality, accessible, and
associated with the body over-responding to infection
client-centered care. Successful interprofessional
causing damage to multiple organ systems. It is most
practice includes four competencies: understanding
common in older adults or those with compromised
one’s role and those of other professions to assess
immune systems, and requires immediate and
and address the needs of clients and populations
emergency medical care. Treatment typically includes
served; maintaining a climate of mutual respect based
antibiotics and IV fluids.59 on shared values and ethical principles; providing
Tracheostomy: An emergency procedure whereby responsible and timely communication with clients,
a small incision in the trachea is made to access caregivers, communities, and other healthcare
the airway when It isratuory hoscopy, where air providers; and applying relationship-building values
eumothorax. ung disease, trauma, or during a medical to maintain healthy team roles in order to plan and
procedure, such as bronchoscopy, where air ventilator deliver effective client-centered health care.65
support is critical to a patient’s survival or long- Occupational Therapy plays a distinct role in
term ventilator support is indicated. Tube selection interprofessional practice and in the provision of
is important and considerations for size include client-centered care while addressing respiratory
minimizing airflow resistance to reduce the work disease across the continuum of care from acute care to
of breathing and the ability to facilitate suctioning inpatient rehab to home care.
bronchoscope use, as well as ventilator weaning.60
Typical Settings Associated with Occupational

ROLE OF OCCUPATIONAL THERAPY Therapy and Pulmonary Rehabilitation
IN PULMONARY REHABILITATION Acute Care Hospitals: Individuals are typically
admitted to acute care hospitals with significant or
life-threatening health concerns requiring immediate
Overview of Occupational Therapy Philosophy
medical diagnosis and/or intervention, as well as
Occupational Therapy practice, education, research, 24-hour physician and nursing care. An intensive
and advocacy is founded on the premise that care unit (ICU) is indicated for those individuals who
individuals, communities, and populations of all require advanced medical support, which may include
age groups have the right to engage in meaningful acute respiratory distress syndrome (ARDS), respiratory
occupations throughout the lifespan. It is understood arrest, threatened airway, and significantly low oxygen
that participation in occupation can be a conduit to saturations causing hypoxemia and risk of brain injury.
change and a means to foster health and well-being. Respiratory support may be provided via non-invasive
“Health enables people to pursue the tasks of everyday positive pressure ventilation (NIPPV), mechanical
living that provide them with life meaning that is ventilation, or supplemental oxygen.
necessary for their well-being.” 61
OT/OTAs are increasingly assuming a more active
Occupation is defined as any purposeful and role in acute care settings with an emphasis on early
meaningful activity that enables participation in mobilization, monitoring of vitals with activity,
society and supports the ability to live life to its fullest. client and caregiver education, restoring function,

and performing evaluations to assist with the Home Care, Including Independent and Assisted
coordination of care and to determine appropriate Living Facilities (ILF and ALF): Upon discharge from
discharge recommendations. OT/OTAs work within either acute care, inpatient rehab, or long-term acute
an interprofessional team that may include members care settings, clients may benefit from continued OT
from medicine, nursing, respiratory therapy, case services to maximize functional independence within
management, physical therapy, speech and language the context of their own homes. Therapists often
pathology, social work, and spiritual care. continue to provide ADL and IADL re-training, as well
as safety and energy-conservation education while
Long-term Acute Care (LTAC): In some cases,
supporting caregivers during this transitional period.
individuals require ongoing medical care while
beginning rehabilitation. In these instances, The most common pulmonary conditions addressed
individuals may have experienced a prolonged and/or in home care or independent/assisted living facilities
complex hospital course or may remain significantly are asthma, COPD, and pneumonia related. However,
impaired requiring 24-hour care. In these cases, a long- OT/OTAs may also assist clients with more significant
term acute care facility may be indicated as a bridge pulmonary impairments, including individuals with a
between acute care and rehabilitation or home. diagnosis of interstitial lung disease or those recovering
from acute respiratory distress syndrome (ARDS) and
As successful critical care intervention increases and prolonged hospitalization.
mortality rates decline, the number of individuals
surviving but experiencing long-lasting complications Occupational therapy works within an
is on the rise. These include chronically impaired interprofessional team that may include members
pulmonary function, neuromuscular weakness, from medicine, nursing, physical therapy, speech and
and cognitive impairments, as well as anxiety and language pathology, as well as independent/assisted
depression. It is important for all members of the living staff.
interprofessional team to understand these additional
Outpatient Pulmonary Rehab: Typically, OTs have a
complications while addressing the more common
limited role in outpatient pulmonary rehab programs
impairments associated with respiratory disorders.66
but clinicians may work within an interdisciplinary
Common pulmonary conditions encountered in team to address the needs of clients with chronic
long-term acute care include COPD exacerbations, pulmonary conditions. OT/OTAs typically assess an
pneumonia (PNA), interstitial lung disease (ILD), individual’s ability to perform meaningful ADLs and
and acute respiratory distress syndrome (ARDS). IADLs in a satisfactory manner, develop individualized
Occupational therapy provides evaluations and treatment plans, and collaborate with the client and
develops client-centered short- and long-term goals caregivers to establish goals and provide education to
that may address ADL and IADL re-training, as well as manage conditions at home and in the community.
education that includes safety, energy-conservation
strategies, and cognitive impairments. Therapists
are also involved in caregiver training and discharge
OT Process – From Evaluation to Discharge
planning. OT/OTAs work within an interprofessional Evaluation Process:
team that may include members from medicine,
nursing, respiratory and/or pulmonary therapy, case An OT evaluation is indicated when there are concerns
management, physical therapy, speech and language regarding an individual’s functional ability to perform
pathology, social work, and spiritual care. the activities that are meaningful and necessary
to live life to its fullest. In order to understand an
Inpatient Rehab and Skilled Nursing Facilities individual’s performance strengths and limitations,
(SNF): Given the number of admissions to acute care an OT will use his/her clinical reasoning skills to
facilities that are associated with chronic pulmonary perform an evaluation that may include a synthesis of
conditions, such as COPD exacerbations, as well formal standardized assessment tools, medical data,
as health crises that are acute in nature, such as informal observation and interview techniques, as
pneumonia, individuals are often referred to inpatient well as interprofessional communication. In addition
rehabilitation facilities. The primary focus of OT in to performance skills impacting motor, cognitive
short-term rehab is to promote strength, endurance, processing, and/or social interaction, client factors
and mobility within the context of ADL and IADL and performance patterns, such as values and beliefs
re-training, and provide client/caregiver education, and roles and routines, as well as environmental and
including energy conservation strategies, in order to contextual factors are also considered in OT’s holistic
manage conditions at home and in the community approach to care.
upon discharge.
By synthesizing all pertinent data, the OT is able to
OT/OTAs work within an interprofessional team that develop an occupational profile that will guide the
may include members from medicine, nursing, case plan of care. This includes collaborating with the client
management, physical therapy, speech and language and/or caregiver to determine his or her priorities
pathology, social work, and spiritual care. regarding outcomes in order to develop objective

and measurable goals that are meaningful and client- 5 = independent face/hair/teeth/shaving
centered. Once the goals have been established, (implements provided)
interventions may be determined to execute the plan

Dressing
of care.59,60

0 = dependent

OT Evaluations and Screening Tools that May be
used in Pulmonary Rehabilitation 5 = needs help but can do about half unaided
ADLs 10 = independent (including buttons, zips,
laces, etc.)
F
unctional Independence Measure (FIM®): A system
of measuring dysfunction appropriate for varied Transfers (bed to/from chair)
settings including sub-acute and rehabilitation
0 = unable, no sitting balance
facilities, long-term care hospitals, and skilled
nursing facilities. It determines the degree of 5 = major help (one of two people, physical)
assistance required for an individual to perform 10 = minor help (verbal or physical)
his or her ADLs and is typically completed upon

15 = independent 63
admission and discharge. The tool assesses 18 areas
of ADLs, including 13 motor and 5 cognitive items. ADLs/IADLs
Performance areas are rated on a 7-point scale
ranging from total assistance to independence. Canadian Occupational Performance Measure (COPM):
Every facility has its own processes in place for An evidence-based, client-centered outcome tool
administering the FIM®; however, OTs will most designed to reflect an individual’s satisfaction with
commonly address the performance areas of eating, ADL and/or IADL performance. It is primarily
grooming, bathing, upper body dressing, lower body administered by OTs and can be used across the
dressing, toileting, toilet transfer, shower transfer, lifespan with all clients, regardless of diagnosis
problem-solving and memory.67 or setting. The COPM enables individuals to self-
assess performance, prioritize areas to address,
FIM® levels: and collaborate with their therapist to identify
7 = Independence (timely, safely) goals. Administration is conducted via a semi-
structured interview format and is recommended
6 = M
odified independence (device, increased
at the beginning of services and periodically
time)
thereafter to monitor progress towards outcomes.
5 = Supervision (cuing, prompting) The tool has five key steps: The client is asked to
4 = M
inimal assistance (performs 75% or more identify performance areas that are challenging,
of task) rate the importance of each identified area using a
10-point scale, and then select up to 5 of the most
3 = M
oderate assistance (performs
important problems to address through therapy.
approximately 50-74% of task)
The client is then asked to self-assess their own
2 = M
aximal assistance (performs level of performance and satisfaction with each of
approximately 25-49% of task) the identified problem areas. The therapist then
1 = T
otal assistance (performs less than 25% of calculates an average score, typically between 1-10.
task) A low score indicates poor performance and lower
satisfaction with a higher score indicative of good
0 = A
ctivity does not occur (only used upon performance and a higher level of satisfaction.69
admission)62
Safety/Fall Risk:
B
arthel Index (BI): A 10 item ordinal scale used to
measure ADL performance that is most commonly
Missouri Alliance for Home Care (MAHC-10): A
used in inpatient rehabilitation, skilled nursing standardized multi-factor screening tool used to
facilities, and home care. Each of the 10 items determine fall risk that may be used with all home
describes performance in feeding, bathing, care clients, including those who are bed-bound and
grooming, dressing, bowel control, bladder control, those with significant mobility impairments. Scoring
toileting, chair transfer, ambulation, and stair is based on clinical judgment with one point
climbing. Each performance item has a designated designated for each core element scoring a “yes.”
score. A higher total score is associated with the Screening components include age (above 65),
increased likelihood of an individual successfully three or more co-existing documented diagnoses,
and safely living at home independently.68 prior history of falls, presence of incontinence,
visual impairment, decreased functional mobility,
BI sample performance items and rating scale: environmental hazards, poly-pharmacy, pain

Grooming affecting function, and cognitive impairment.70
0 = needs help with personal care

Work Activities: 10 = Shortness of breath so severe you need to
stop67
F
unctional Capacity Evaluation (FCE): A combination
of interview, tests, and observations typically Cognition:
completed over the course of 4-6 hours and
The Montreal Cognitive Assessment (MoCA): A
designed to assess an individual’s functional
brief screening tool designed to detect mild
ability to perform specific tasks associated with
cognitive impairment (MCI). The 30-point test
employment. It is typically conducted as a means to
has been validated for 55-85 year olds and takes
determine an individual’s ability to return to work
approximately 10 minutes to administer. The tool
or participate in voluntary activities after illness
assesses multiple cognitive areas including attention,
or injury, assess an individual’s appropriateness
concentration, working memory, language,
for vocational rehabilitation services, or when an
visuospatial and executive function.74
individual is applying for Social Security Disability
benefits. The process allows OTs to analyze the MoCA sample test items:
activity components required to perform the specific
• Visuospatial: Draw clock (ten past eleven)
tasks associated with a typical work day. Therapists
will review the individual’s medical history and • Memory: Read list of words, subject must
current health status, and compare performance repeat them. Do two trials, even if first trial is
factors and skills to the demands of the task. The unsuccessful. Do a recall after 5 minutes.
components of the FCE will depend upon the
• Attention: Read list of letters. The subject
individual’s needs, but may include an interview
must tap with his hand at each letter A. No
and musculoskeletal screen. Areas of function tested
points if > 2 errors
may include material-handling such as lifting,
positional-tolerance such as sitting or reaching, and • Abstraction: Similarity between e.g. banana –
object-handling such as in-hand manipulation or orange = fruit68
fine motor control. Pain and cognitive demands
The Mini Mental State Examination (MMSE): A
are also commonly assessed in order to fully assess
30-point questionnaire designed to measure
performance and identify recommendations. An
cognitive impairment, most commonly used as a
FCE is typically paid for by workers’ compensation
screen for dementia but can be used to estimate
insurance plans, individual insurance plans, federal,
cognitive impairment associated with illness or
state, and/or local agencies, employers, or managed
injury. The tool typically takes approximately 5-10
care plans.71, 72
minutes to administer and assesses cognitive areas
Exercise/Activity Intensity: such as attention, recall, language, repetition,
orientation, calculation, and ability to follow

Borg Rating of Perceived Exertion Scale (RPE): A self-
directions. One point is given to each correct
assessment tool used by individuals to measure his
response with a score equaling or greater than 24
or her perceived intensity of an exercise or activity.
points out of 30 indicating normal cognition. A
Individuals are asked to estimate the degree of
score of 19-23 indicates mild cognitive impairment,
exertion required during an activity using a 0-10
a score of 10-18 suggests moderate impairment, with
scale where 0 equals no perceived exertion and 10
a score equal or below 9 points indicative of severe
indicates maximal exertion.
cognitive deficits.75
Modified Borg Scale for Perceived Dyspnea (RPD): A
MMSE sample questions:
modified scale designed to assess an individual’s
shortness of breath associated with exercise or • What is the year? Season? Date? Day?
activity. An RPD score can be compared over time to Month? (Maximum score = 5)
assess activity tolerance and pacing needs.73
• The examiner names three unrelated objects
RPD examples: clearly and slowly, then asks the patient
to name all three of them. The patient’s
0 = Nothing at all
response is used for scoring. The examiner
2 = Mild shortness of breath repeats them until the patient learns all of
them, if possible. (Maximum score = 3)
3 = Moderate shortness of breath or breathing
difficulty • “I would like you to count backward from
100 by sevens.” (93, 86, 79, 72, 65…)
4 = Somewhat severe
Alternative: “Spell WORLD backwards.” (D-L-
7 = Severe shortness of breath or very hard R-O-W). (Maximum score = 5)
breathing
• “Repeat the the phrase: “No ifs, ands, or
9 = Extremely severe buts.” (Maximum score = 1)

• “Make up and write a sentence about significantly improve functional outcomes.77
anything.” (This sentence must contain a
A
ctivities of daily living (ADL) re-training: Clients
noun and a verb.) (Maximum score = 1)69
experiencing respiratory disorders commonly find
Short Portable Mental Status Questionnaire test their ability to perform basic ADLs compromised
(SPMSQ): A short 10-item standardized assessment by dyspnea and decreased activity tolerance. OT/
tool designed to detect intellectual impairment, OTAs provide interventions to address tasks that
particularly in the elderly. Incorrect responses are typically performed on a daily basis and are
are tallied to provide an indication of cognitive considered essential to an individual’s ability to live
impairment. For example, 0-2 errors indicate life to its fullest. ADLs include bathing/showering,
normal mental functioning, 3-4 errors indicate mild grooming, dressing/undressing, toileting including
cognitive impairment, 5-7 errors suggest moderate hygiene, eating, sexual activity, and the ability to
impairment, and 8 or more errors are associated perform functional mobility.61 In caring for clients
with severe deficits.76 with respiratory disorders, energy conservation
techniques are commonly embedded into ADL
SPMSQ sample questions: re-training. For example, the OT/OTA may provide
• What is the date, month, and year? recommendations to modify tasks, such as adjusting
body mechanics to minimize the work of breathing,
• What is the name of this place? or may suggest altering the environment to reduce
• How old are you? extraneous effort and decrease activity demand.
Therapists will also educate the client or caregiver
• What year were you born? regarding the use of adaptive equipment (AE) to
• Who is the current president? maximize functional independence, such a long-
handled shoe or sock aide, or the use of durable
• Who was the president before that?69 medical equipment (DME), such as a tub seat for
Intervention Process: seated showers. The ability to complete ADL tasks
safely is also a consideration and appropriate
Once the initial evaluation process is complete and education is provided to both client and caregiver.
objective, measurable goals have been determined,
OTs develop an individualized treatment plan tailored I nstrumental activities of daily living (IADL) re-training:
to meet individual needs that also incorporate IADLs include activities that support daily life and
anticipated outcomes and methods. Discharge and enable an individual to successfully live life to its
long-term needs are also considered, along with fullest and interact with his/her environment and
recommendations to other professionals if needed. The community. Examples of IADLs include home
plan of care typically includes meaningful occupation- management, shopping, meal preparation, driving
based interventions such as skill training and and community mobility, pet care, financial
education, but may also include preparatory methods management, medication management, care of
to facilitate performance. The client’s response to others, leisure tasks, employment, education, rest/
therapy is monitored throughout the process and sleep, and social participation.61 The OT/OTA may
modified as needed.60 provide recommendations to modify tasks or alter
the environment to reduce extraneous effort and

OT Interventions and Education that May be decrease activity demand. Energy conservation
used in Pulmonary Rehabilitation techniques are commonly embedded into IADL
re-training. Examples of recommendations include
Early mobilization: A process of passive, active, and
making larger meals to freeze, letting dishes air
progressive movement during critical illness to
dry, grouping task items together to minimize
counter the effects of sedation and immobility that
unnecessary searches, sliding rather than carrying
may lead to neurocognitive deficits and physical
items, shopping with someone who can carry
debilitation. It may be performed by any member
grocery bags, or using grocery home delivery
of the interdisciplinary team, including OTs. Early
services.
mobilization typically occurs in acute care settings,
particularly in the ICU with critically ill patients, A
ctivity tolerance and energy conservation techniques:
but may also be relevant in long-term acute care or Fatigue, shortness of breath, and limited endurance
sub-acute settings when the client has experienced are common factors that may limit performance
a prolonged or complex hospital course after and participation. OT/OTAs address strategies to
critical illness and remains significantly debilitated. modify tasks, and make recommendations regarding
Evidence indicates that limited mobility is a the use of assisted devices (AD), and/or adaptive
significant contributor to long-term health issues equipment (AE) to reduce effort associated with the
including muscle weakness, delirium and cognitive performance of daily routines in order to minimize
impairments, and joint shortening. Research fatigue, shortness of breath, and work of breathing.
suggests that safe and appropriate early mobility can Energy conservation education emphasizes

prioritizing, planning, and organizing tasks. This the potential need for equipment, home modifications,
may include simple strategies such as eliminating or further services.61
unnecessary steps, sitting versus standing if possible,

Additional OT Considerations for Safe Discharge
setting up task equipment in advance to minimize
Planning
extraneous effort, and using lightweight tools or
utensils. Additionally, clients are encouraged to self- S afety / home O2 management: OT/OTAs address home
assess dyspnea, pace themselves through activities, safety training that may include recommendations
and take rest breaks prior to experiencing fatigue. for environmental modifications, such as grab bar
installation, the removal of scatter rugs, and the
Ventilation strategies / breathing techniques: OT/
improvement of lighting. Education also focuses on
OTAs provide education that includes strategies to
fall prevention training and emergency responses,
regulate breathing with activity, self-assess dyspnea
safe O2 tank use and O2 cord management training,
with exertion, and independently apply appropriate
as well as caregiver education to support a safe
techniques to minimize work of breathing as well
as perform recovery breathing, if applicable. The transition.
most common technique employed to minimize Health / wellness at home and in the community:
shortness of breath is pursed-lip breathing. Education includes medication management
Strategies are commonly embedded into ADL/IADL training, exploration of healthy leisure pursuits
tasks and mobility.78 for the home and/or the community to promote
Stress management / relaxation strategies: Stress lifestyle balance, information regarding community
and anxiety are common by-products of resources, such as fitness groups, diet and nutritional
respiratory disorders. Providing education to help education, and smoking cessation, as well as
individuals manage their shortness of breath caregiver education to support a safe transition.
is an important step in lessening anxiety and Common Pulmonary-Related Questions that Clients
promoting participation in the treatment program. may Ask in the Course of OT Services:
Interventions include strategies to help clients
prioritize activities and create a balanced lifestyle, I have COPD, can I still use my fireplace at home?
increase awareness of body and mind interaction to You should minimize pollutants in your home and this
manage breathing, increase confidence to manage includes smoke from open fires, vapors from cooking,
stressors and perform daily activities with more aerosol spray products, strong perfumes, and tobacco
confidence, and provide education on a variety of smoke. It is advisable not to burn wood or kerosene
relaxation methods. These include guided imagery, in your home unless this is the only means of heating
progressive muscle relaxation, pursed-lip breathing your environment.
technique, and diaphragmatic breathing.79, 80
I use O2, can I still cook?
Therapeutic exercise programs / upper extremity function:
Prolonged hospitalization and chronic respiratory You can continue to cook but use common sense.
conditions frequently impact muscle strength, and Don’t cook on an open flame and be careful that
in turn, may limit participation and/or performance your O2 tubing does not come into contact with hot
in functional activities. Clients with a diagnosis burners or hot pans/pots – essentially, anything that
of COPD, for example, often experience pain in could cause your tubing to melt. Additionally, electrical
the neck and/or shoulder region associated with appliances that get hot or may spark should be kept
overuse of accessory muscles, while individuals away from the O2 tank. Oxygen does not burn but
who have experienced critical illness may present anything flammable will do so more readily in an O2-
with significant muscle weakness. Providing rich environment.
education for body mechanics, stretching, and an Why should I quit smoking?
appropriate exercise program can be invaluable to
the process of improving aerobic capacity, reducing Research has shown that people who quit smoking
O2 requirements, minimizing pain, and increasing reduce the risk of developing or exacerbating lung
performance in functional tasks.75 disease, and increase their chances of living longer.
Discharge Planning: Can I use O2 when I shower to relieve my shortness of
breath?
While each discipline involved in an individual’s care
will contribute specific information according to their Yes, if your medical provider has prescribed O2 for
professional expertise, discharge planning is typically home use it is advisable to keep your O2 on while
an interdisciplinary effort ensure safe transitions. taking a shower as this can be a demanding activity for
OT provides a distinct perspective on the client’s some.
functional status, including the individual’s ability
How do I get around my home while using O2?
to safely perform ADLs, IADLs, and mobility, with
recommendations for the continuum of care including Your home O2 supplier will assist you in setting up the

container and establishing how much cord you will including increased shortness of breath, fatigue, an
need to be able to freely and safely move around your elevated temperature, persistent headache, and a
home, as well as do the activities you need to do. productive cough. Upon admission, the patient had
a temp of 100.5 F, significant dyspnea, and an O2 sat
How heavy are portable O2 tanks?
of 84% on 2L. Her lungs were noted for diminished
Tanks vary in size and weight, but most commonly bases and an expiratory wheeze throughout, and her
weigh between 6-15 pounds, and can be carried on the labs indicated increased CO2. Her husband reported
shoulder via a strap or transported by other means, a significant increase in his wife’s work of breathing
such as a rollator basket. and that she had been unable to participate in her
normal routine, including ADLs. Her past medical
I use O2, what should I do if I want to leave my home?
history includes a 40-year tobacco history (she quit
Small, portable tanks should be available from your 3 years ago), hypertension, anxiety, and depression
supplier. Make sure you are aware of the tank’s capacity after the death of her adult son 3 years ago in a motor
in relation to your O2 needs, so that you can calculate vehicle accident. She was diagnosed with community
the number of hours available to you. acquired PNA (CAP) and admitted to acute care for
the third time in twelve months. Her hospital course
Can I still drive or travel while using O2?
was unremarkable and she was treated with Bilevel
Yes, but use common sense. Make sure you have Positive Airway Pressure (BiPAP), antibiotics,
enough O2 with you to last your trip and make sure the prednisone, and nebulizers. She continued to require
tank is stable while driving so that it will not tip or fall. increased supplemental O2 between 4-5L to maintain
You may also travel via public transportation using a an O2 saturation above 92%. Once stable, the patient
portable tank. was transferred to a short-term rehabilitation facility
for continued medical management and rehab efforts.
Can I fly using O2?
Reason for OT Referral:
Airlines are not required by the Americans with
Disabilities Act (ADA) to provide O2 service on flights, Mrs. M. has decreased endurance and is functioning
so policies and procedures vary between carriers and below her baseline. She continues to have shortness
some may not permit the use of supplemental O2. of breath with minimal activity and is requiring an
Therefore, it is important to communicate directly increase in O2 from her baseline. The initial plan is for
with your carrier before you fly and notify them of her to return home and resume her normal routine.
your O2 needs. Federal regulations do not permit She is being referred to OT for an evaluation in order
the transportation of personal O2 canisters aboard to assess her current status, develop a plan of care, and
but passengers can often purchase canisters from provide appropriate interventions and education to
the airlines for use during the flight. You will need support a safe discharge home and minimize future
to provide a doctor’s letter to verify your needs. hospitalizations.
Additionally, it is important to arrange O2 supplies for
layovers and for your arrival at your final destination. OT Initial Assessment:
Anticipate providing the local carrier with flight The evaluation to ascertain Mrs. M.’s background and
information, as well as local contact information. current functional status is conducted in her room via
What should I do if I run out of O2? informal interview, observation, and the Functional
Independence Measure (FIM). Mrs. M. is greeted resting
Much depends on how much O2 you are using, which on her bed in a hospital gown. The head of the bed is
is typically prescribed by your medical provider. It’s in an elevated position and she is watching TV. She is
important to contact your O2 supplier immediately if on 4L O2 via nasal cannula and appears comfortable.
you do run out so that they can refill the container. She reports being anxious about the evaluation as she
Your breathing may become uncomfortable, so gets tired very quickly but she agrees to participate as
minimize your activities to reduce the demand on your tolerated.
lungs while you wait. If you are concerned, go to the
emergency room. She is married and lives with her husband in a 2 level
home with 3 stairs to enter and a rail on the right side.
She is on disability and her husband works part-time,
CASE STUDY #1 mostly afternoon/evening shifts. Prior to admission,
the patient was independent (I) with mobility without
COPD Exacerbation (Short-term Rehab Setting) an assistive device, and functioning at a moderate
independent (Mod I) level for bathing and dressing,
History of Presenting Information (HPI):
although she reports that her husband has needed to
Mrs. M. is a 63-year-old woman with a past medical help more recently, particularly her lower body bathing
history significant for moderate COPD on 2L O2 at (LBB) and dressing (LBD). She typically removes her
baseline who presented to the emergency room as O2 for showers and reports feeling very short of breath
a result of an exacerbation of symptoms x 1 week, and tired afterwards. The patient’s bedroom and

bathroom are on the second floor. She typically uses OT Problem List:
a tub/shower combination with a tub seat, hand-held
• Limited activity tolerance impacting mobility and
shower hose, and a grab rail, but she also uses the half-
participation in ADLs/IADLs
bath downstairs during the day to minimize the use
of stairs. She has no other medical devices and uses a • Limited knowledge of O2 use, energy-conservation
regular bed. education, and effective pacing strategies
Her husband does the grocery shopping and heavier • Increased anxiety with shortness of breath
household chores, and the patient tries to do all the impacting ability to manage breathing and apply
meal prep and laundry although has required more appropriate pursed-lip breathing techniques
assistance from her husband in recent weeks. The
patient states that she likes to keep a nice home and do • Increased signs of depression associated with a
housework, especially vacuuming, but this is getting decline in function and potential caregiver burden
harder due to her respiratory status. She does not like • Limited knowledge of available adaptive
to be idle because it gives her too much time to think equipment (AE) to assist with ADLs
and she gets sad about her son’s death. She has a strong
faith but is not part of a specific church community. • Limited knowledge of community-based resources
She has persistently deferred seeing a psychiatrist for • Exposure to second hand smoke due to her
her depression despite her primary care physician’s husband’s ongoing tobacco use in the home
recommendation. She enjoys playing games on her
iPad, watching TV, and going to Foxwoods casino, OT Plan of Care (POC):
although this hasn’t been possible this past year due to Anticipated length of stay: 2 weeks
her medical status and frequent hospitalizations. Her
husband is very supportive but continues to smoke in Duration and frequency of OT sessions: Approximately
the house. 60 minutes per day, 5-6 x per week.
During the initial OT interview, Mrs. M. appeared OT Goals (Anticipated timeframe – 2 weeks):
to be comfortable at rest and only mildly short of
• Patient will complete all steps of toileting
breath while talking with a respiration rate (RR) of
routine with modified independence (Mod I) and
18 and an O2 sat of 93% on 4L. She appeared weak
appropriate application of pursed-lip breathing
getting to the edge of the bed and when attempting
technique
to stand, but was able to slowly transfer to a bedside
chair with close supervision (CLS) and a rolling walker. • Patient will complete shower routine with Mod I
However, Mrs. M. became increasingly short of breath sitting/standing as tolerated with appropriate use
while ambulating 15 feet to the bathroom and her of adaptive equipment (AE) and application of
O2 decreased to 87%. She became anxious and was pursed-lip breathing technique
instructed to perform seated pursed-lip breathing. She
benefitted from a visual demonstration and verbal cues • Patient will complete dressing routine sitting/
for 2 minutes in order to maintain consistency with standing as tolerated with Mod I, appropriate use
the technique and her O2 level increased to 93%. Her of AE, and application of pursed-lip breathing
supplemental O2 was increased to 5L with activity and technique
Mrs. M. was able to participate in toileting and seated • Patient will complete safe tub transfer with Mod I
sponge-bathing and dressing tasks, but only stood as and appropriate use of durable medical equipment
needed. She required increased time with all ADL tasks
and benefitted from moderate assistance (Mod A) for • Patient will complete simple meal prep or laundry
both LBB and LBD due to shortness of breath with folding task with Mod I, appropriate energy
increased activity demand. Her O2 saturations were conservation strategies, and application of pursed-
monitored throughout the evaluation process using lip breathing technique
a pulse oximeter, and ranged between 88-91%. She • Patient will purchase adaptive equipment to
needed frequent cueing to apply pursed-lip breathing maximize functional independence with ADLs
technique and minimize her shortness of breath due to upon discharge home
impaired gas exchange. A basic cognitive screen using
the Mini Mental State Examination (MMSE) indicated • Patient will explore relaxation strategies and
that Mrs. M. was alert and oriented x 3, able to follow independently use an appropriate technique to
multi-step directions, and both short- and long-term minimize anxiety with increased shortness of
memory was intact. She verbalized anxiety about her breath
increased shortness of breath and current need for
• Patient will participate in disease management and
more oxygen. She also expressed concern and feelings
lifestyle balance strategies
of depression about her frequent hospitalizations
this year and how much her health is affecting her • Patient and husband will be provided with
husband’s life. community resources regarding smoking cessation

•P
atient will tolerate 15 minutes daily upper Mrs. M. was encouraged to plan her activities in
extremity (UE) exercise in order to increase general advance in order to decrease the need for extraneous
activity tolerance and performance in ADLs/IADLs mobility. She was also encouraged to pace herself
throughout the task rather than rush, sit for tasks if
Interprofessional Communication:
possible, and apply appropriate breathing techniques
Physical Therapy (PT): Discussed Mrs. M.’s OT plan to minimize shortness of breath. She was instructed
of care and goals in order to develop a coordinated, on how to include pursed-lip breathing technique
collaborative effort with PT to build strength, activity throughout her daily activities, and given energy
tolerance, and functional mobility. Participated in conservation strategies to perform her tasks more
daily communication to provide updates, reinforce efficiently and with less fatigue. Discussion about the
consistent educational material, and coordinate efforts benefits of adaptive equipment (AE) was embedded
to minimize schedule conflicts. into her ADL routine and she was encouraged to
trial recommendations for a reacher, a long-handled
Nursing: Discussed Mrs. M.’s ADL goals and provided shoe-horn, a sock aide, and a long-handled sponge.
rationale for allowing her to practice her newly After practicing, Mrs. M. decided to purchase all
acquired energy conservation skills during all tasks recommended items as she noticed less shortness
so that she could improve her functional status and of breath when she minimized the need to bend
perform her bathing, dressing, and toileting tasks at frequently to reach her feet during her ADLs. Mrs. M.
a Mod I level by discharge. Both nursing and nursing was also instructed on the importance of using her
assistants were encouraged to cue Mrs. M. to self- O2 for all activities, including showering, as this was
pace, apply pursed-lip breathing, and use adaptive a particularly demanding physical activity for her.
equipment (AE) as needed. While initially hesitant, she understood the rationale,
Pulmonary Rehab: Discussed Mrs. M.’s OT plan of and after several trials realized she was significantly
care and determined pulmonary rehab’s schedule for less short of breath and fatigued. Once she had
nebulizer treatments in order to coordinate efforts and mastered her daily ADL routine more efficiently and
minimize schedule conflicts. independently, she more confidently participated
in meaningful IADL activities. Energy conservation
Social Work: With Mrs. M.’s permission, a referral was and work simplification strategies were included in
made to Social Work services. Discussed the need for beverage and meal prep activities, as well as light
smoking cessation material, community resources, and housekeeping allowing Mrs. M. to perform tasks
support due to her husband’s ongoing tobacco use. more efficiently and confidently without significant
MD: Discussed evaluation results and requested O2 shortness of breath.
parameters prior to initiating services. Provided Providing both Mrs. M. and her husband with
ongoing updates throughout Mrs. M.’s stay regarding education to help manage COPD was important to
her functional status, O2 needs with activity, shortness ensure less frequent hospitalizations. The impact of
of breath and response to breathing strategies, as well second hand smoke on compromised lungs from
as her progress towards long-term goals. Also discussed Mr. M.’s continued tobacco use was explained. He
Mrs. M.’s report of depression following the death of was unable to commit to stopping but he agreed to
her son and potential need to see psychiatry. review the smoking cessation literature provided
Spiritual Care: With permission from Mrs. M. a referral and stop smoking inside the house. The early signs
was made to Spiritual Care services with particular and symptoms of a COPD exacerbation or the
concern regarding her continued grieving over the loss development of PNA were also discussed and Mrs.
of her son three years ago. M. was encouraged to seek medical assistance as
soon as possible rather than wait for symptoms to
Case Manager: Ongoing communication throughout worsen. Both Mrs. M. and her husband verbalized
Mrs. M.’s stay regarding her OT plan of care, goals, understanding of the rationale for early action.
and recommendations for a safe discharge home with
Mrs. M. was also provided with an UE exercise program
continued OT services.
to improve her general endurance. She was provided
Interventions: with a handout and after several sessions with visual
and verbal cues, she was able to manage the routine
Mrs. M.’s treatment plan consisted of increasing her
independently and apply appropriate breathing
functional mobility and activity tolerance through both
strategies. Mrs. M. verbalized her understanding of
ADLs and IADLs in order to maximize her functional
the importance of maintaining general endurance and
independence and minimize the potential for caregiver
agreed to continue the exercise routine after discharge.
burden. It was of primary importance to include
She also agreed to trying a local outpatient pulmonary
education for disease management, energy conservation
rehab program once she had successfully transitioned
skills, ventilation strategies, and adaptive equipment
home and was able to manage community outings.
use via all tasks so that she could better manage her
condition and prepare for a safe discharge home.

Mrs. M. also expressed an interest in exploring Barthel Index (BI) to assess ADL status, the Short
relaxation strategies to address some of her anxiety Portable Mental Status Questionnaire (SPMSQ) to assess
associated with her breathing limitations. She was cognition, and the Missouri Alliance for Home Care
introduced to diaphragmatic breathing and progressive test (MAHC-10) to assess fall risk. It was conducted
muscle relaxation strategies but stated a preference in Mr. and Mrs. E.’s home at the independently
for guided imagery/meditation via pre-recorded CDs living facility; a single level studio apartment with a
that she was able to trial during her stay in rehab. kitchenette/diner and separate bedroom and bathroom
She agreed to purchase and download several on her with a shower stall. Mrs. E. was present throughout
smartphone to use at home. the evaluation but only contributed when addressed
directly. Mr. E. was greeted in his pajamas and dressing
Discharge:
gown sitting in a recliner on room air with his legs
Mrs. M. met all her long-term goals by the anticipated elevated. He was pale and reported fatigue despite just
date and was discharged home at a Mod I level of waking up but did not exhibit any signs of respiratory
function for all her ADLs and simple IADLs. She distress. He was agreeable to the evaluation.
agreed to OT services upon discharge to ensure a safe
This is a second marriage for Mr. and Mrs. E. who
transition home, apply her new strategies in her own
both lost spouses to cancer. They have been married
environment, and continue to build activity tolerance
for 20 years but have only lived at the independent
via higher level IADLs so that she could perform these
living facility for 7 months and still feel like they
meaningful tasks to a satisfactory level.
are acclimating to the change. Prior to his recent
hospitalization, Mr. E. was modified independent
(Mod I) with mobility using a 4-wheeled rollator both
CASE STUDY #2 in the apartment and the community. He was able to
complete his toileting and grooming independently
PNA (Home Care Setting)
but had assistance from his wife for shower transfers
History of presenting information (HPI): and dressing. He uses a shower stall with a seat and a
grab rail and although he reports that he was capable
Mr. E. is an 81-year-old male with a past medical
of bathing unassisted he states that he prefers to
history significant for hypertension, Parkinson’s disease
have someone present for showers, particularly when
(well managed), and chronic back pain who is hard of
doing the transfer. He also reports that he is capable
hearing and lives in an independent living facility with
of dressing unassisted but it is easier to let his wife
his wife who has mild dementia. Three weeks ago he
help don his socks and shoes. He uses a regular bed
was transferred to the hospital due to the sudden onset
and has a grab rail next to the toilet, but otherwise
of a fever with chills and malaise, as well as a harsh,
uses no other adaptive equipment. Mr. E. takes all his
productive cough. Upon admission, his sputum was
meals in the dining room on the first floor, which is
noted to be yellow, he had difficulty breathing with
accessed via an elevator approximately 150 feet from
a respiration rate of 28, a pulse of 120, a temperature
the apartment. He shared that being able to socialize
of 101.2, and his O2 saturation was 86% on room air.
with other residents during meals and participating
His white blood count (WBC) was elevated and a chest
in other social events are very important to him. He
X-ray revealed a right middle lobe pleural effusion
particularly enjoys movie nights and the monthly
consistent with PNA. Due to his advanced age and
themed happy hour. He is concerned that he may be
weakened condition, Mr. E. was admitted and treated
too weak to continue this aspect of community living.
with antibiotics and supplemental oxygen. Once
His wife likes to stay busy and performs all beverage
stable he was transferred to a skilled nursing facility
or snack preparation as needed. Neither husband or
for continued medical management and rehab efforts
wife drive any more but they like to participate in the
where he received OT services 5 x per week for 10 days
facility’s van trips to the grocery store or other outings
until ready for discharge home.
to local restaurants. The couple’s adult sons help with
Reason for OT Referral: transportation to medical appointments. They have
housekeeping services 1 x per week and a member of
While Mr. E. made good progress in therapy and was
staff monitors medications. Mr. E. likes watching the
considered medically stable for a safe discharge home,
Red Sox and reading the newspaper.
his OT at the rehab facility recognized that he was not
at his baseline and recommended home care services in During the initial OT interview, Mr. E. appeared to
order to continue addressing his strength, endurance, be comfortable at rest with no significant shortness
and mobility in an effort to return him to a satisfactory of breath while speaking. He was able to stand to
level of function. his rollator without need of assistance, but reported
that his legs still felt weak. He completed the MAHC
OT Initial Assessment:
test with a score suggesting that he is at risk for falls,
The initial evaluation to ascertain Mr. E.’s background although he has no prior history. Mr. E. was able to
and current functional status is conducted via informal ambulate approximately 25 feet to the bathroom
interview, observation, mobility assessment, the and complete his toileting routine unassisted before

washing his hands and face standing at the sink, • Limited knowledge of fall prevention techniques
although he required increased time to complete each
• Limited knowledge of PNA, including relevant
step. He subsequently requested a further 5 minute
signs and symptoms
seated rest break due to fatigue before performing a
shower stall transfer where he benefitted from contact OT Plan of Care (POC):
guard assistance (CGA) to maintain adequate balance
Anticipated length of OT services: 6 weeks
while stepping over the lip of the stall and reaching
for the grab rail. He required an additional 2 minutes Duration and frequency of OT sessions: Approximately
to sit on the shower seat and rest prior to transferring 45-60 minutes, 2 x per week.
out of the stall and ambulating back to his recliner.
OT Short-term Goals (Anticipated timeframe
He reported moderate fatigue and mild increase in
– 3 weeks):
shortness of breath with exertion, which he stated
was very frustrating. In completing a dressing routine, • Patient will complete safe shower stall transfer
he was able to independently don an undershirt and with Supervision (S) and verbal cues to
button down shirt but required increased time for appropriately use durable medical equipment
buttoning, reporting that his hands felt weak and (DME)
clumsy since being hospitalized. He required moderate
• Patient will complete shower routine with
assistance (Mod A) to complete his LBD tasks sitting/
Supervision (S) sitting/standing as tolerated with
standing as tolerated. He was able to feed his feet
appropriate use of adaptive equipment (AE) and
through both pant legs before standing to hike, button, verbal cues for energy conservation strategies
and buckle his belt, but he did exhibit increased including ventilation techniques as needed
shortness of breath bending forward and reported
that it felt like a lot of effort. He requested assistance • Patient will complete dressing routine sitting/
to don his socks and shoes. Using the Barthel Index standing as tolerated with Supervision (S) and
in addition to observation, it was evident that Mr. E.’s verbal cues for appropriate energy conservation
main deficits were in the areas of bathing and dressing strategies, ventilation techniques, and use of AE as
and that endurance was a limiting factor. In recording needed
vitals pre and post activity, Mr. E’s RR remained in • Patient will tolerate 15 minutes continuous
the 18-20 range, his HR approximately 90-96, and his standing to complete shaving routine sink-
O2 sat was between 90-94% on room air. Mr. E. also side with Supervision (S) and verbal cues for
participated in the SPMSQ test with 4 errors that scored appropriate energy conservation strategies,
him in the mild intellectual impairment range with including ventilation techniques as needed
short-term memory deficits suggesting potential for
new learning but that he may require increased time • Patient will complete a simple beverage/snack
and repetition. Throughout the evaluation process, he prep with Supervision (S) and verbal cues for
was able to sustain attention to task and follow 1-2 step appropriate energy conservation strategies
directions. Mr. E. expressed that his limitations were including ventilation techniques as needed
depressing him and that he was concerned about his • Patient will participate in disease management
wife feeling burdened in caring for him. His medical education in order to monitor signs and symptoms
record stated chronic back pain, but Mr. E. stated that of acute respiratory distress requiring immediate
this was not a limiting factor. He requested that he medical attention
continue using Tylenol and a heating pad as needed.
He deferred alternative pain management options. • Patient will participate in fall prevention
education in order to maximize safety
OT Problem List:
• Patient will tolerate 10 minutes daily upper
• Limited activity tolerance impacting mobility and extremity (UE) exercise in order to increase general
participation in ADLs/IADLs activity tolerance and performance in ADLs/IADLs
• Limited knowledge of energy-conservation • Patient will tolerate 10 minutes daily fine motor
education, effective pacing strategies, and exercises in order to increase dexterity and
ventilation techniques impacting performance in performance in ADLs/IADLs
ADLs and participation in IADLs
OT Long-term Goals (Anticipated timeframe
• Limited knowledge of available adaptive – 6 weeks):
equipment to assist with ADLs
• Patient will complete safe shower stall transfer
• Increased signs of depression associated with a with Supervision (S) and appropriate use of
decline in function and potential caregiver burden durable medical equipment (DME)
• Limited strength, including hand strength and fine • Patient will independently (I) complete shower
motor control, impacting ADL performance routine sitting/standing as tolerated with

appropriate use of adaptive equipment (AE) independence with use of adaptive equipment and
and energy conservation strategies including energy conservation strategies.
ventilation techniques as needed
Independent Living Facility Resident Programs Coordinator:
• Patient will independently (I) complete dressing Discussed evaluation results and deficits impacting
routine sitting/standing as tolerated with participation in social/community activities, including
appropriate application of energy conservation options to incorporate energy conservation strategies
strategies, ventilation techniques, and use of AE as and encourage participation.
needed
Interventions:
• Patient will tolerate 15 minutes continuous
Mr. E.’s treatment plan consisted of increasing his
standing to independently (I) complete shaving
activity tolerance and functional mobility through
routine sink-side with appropriate application
both ADLs and IADLs in order to maximize his
of energy conservation strategies, including
functional independence and minimize the potential
ventilation techniques as needed
for depression associated with loss of function or
• Patient will independently (I) complete a simple caregiver burden. It was of primary importance to
beverage/snack prep with appropriate energy include education for disease management, energy
conservation strategies including ventilation conservation skills, ventilation strategies, and adaptive
techniques as needed equipment use via all tasks so that he could better
manage his condition and return to a satisfactory
• Patient will participate in disease management
baseline level of function.
education and be able to verbalize strategies to
monitor signs and symptoms of acute respiratory Mr. E. was encouraged to plan his activities in advance
distress requiring immediate medical attention in order to decrease the need for extraneous mobility
while he was still building up his activity tolerance. He
• Patient will participate in fall prevention
was encouraged to include both ADLs and community
education in order to maximize safety
leisure activities into his daily schedule in order to plan
• Patient will tolerate 15-20 minutes daily upper for tasks, include adequate rest breaks, and create a
extremity (UE) exercise in order to increase general balance of necessary and meaningful occupations. He
activity tolerance and performance in ADLs/IADLs was also encouraged to pace himself through all tasks,
sit when possible, and apply appropriate breathing
• Patient will tolerate 15-20 minutes daily fine
techniques if he experienced shortness of breath.
motor exercises in order to increase dexterity and
Mr. E. was instructed on how to include pursed-lip
performance in ADLs/IADLs
breathing technique and given energy conservation
Interprofessional Communication: strategies to perform tasks more efficiently and with
less fatigue. Discussion about the benefits of adaptive
Primary Care Physician (PCP): Discussed evaluation equipment was embedded into his ADL routine and
results and rationale with request for continued OT he was encouraged to trial recommendations for
services 2 x pw for 6 weeks. PCP agreed with plan of a reacher, a long-handled shoe-horn, a sock aide,
care and provided verbal order. and a long-handled sponge. After practicing, Mr. E.
Physical Therapy (PT): Discussed Mr. E.’s OT plan of noticed less shortness of breath when minimizing the
care and goals in order to develop a coordinated, need to bend frequently to reach his feet during his
collaborative effort with PT to build strength, activity bathing and dressing tasks. He decided to purchase all
tolerance, and maximize functional mobility and recommended items except the shoe-horn because his
safety. Participated in frequent communication to son purchased easy to don slip-on shoes. Once Mr. E.
provide updates, reinforce consistent educational had mastered his daily ADL routine more efficiently
material, and coordinate efforts to minimize schedule and independently, he was more confidently able to
conflicts. participate in meaningful IADL activities, including
retrieving drinks or snacks from the apartment’s
Nursing: Discussed Mr. E.’s evaluation results including kitchenette, selecting clothes from the closet or dresser,
deficits, goals, and rationale for OT services. Discussed and warming a heating pad in the microwave when
potential risk for falls, depression, and caregiver his back was sore. Energy conservation and work
burden. Participated in frequent communication to simplification strategies were included allowing Mr. E.
provide updates, reinforce consistent educational to perform IADL tasks more efficiently and confidently
materials, and monitor for signs and symptoms of without significant fatigue or shortness of breath.
depression or caregiver burden.
Providing Mr. E. with education to self-monitor
Independent Living Facility Aides: Discussed evaluation for signs and symptoms of respiratory distress was
results including Mr. E’s goals to return to baseline important to minimize the risk of PNA and further
level of function for ADLs. Discussed OT plan of hospitalizations in the future. Mr. E. was encouraged to
care and recommendations to maximize functional seek medical assistance as soon as possible rather than

wait for symptoms to worsen or rely on community requiring a tracheostomy for continued mechanical
staff to notice changes. He was also educated regarding ventilation and a nasogastric tube (NGT) placement to
fall prevention strategies and safety recommendations support his nutritional needs. His medical work up was
were made, including use of a cable organizer and indicative of ARDS secondary to sepsis. While in the
adequate lighting at night. ICU, he experienced prolonged sedation to minimize
the work of his respiratory muscles and his hospital
Mr. E. was also provided with an UE exercise program
course was further complicated by a pneumothorax,
to improve his overall endurance. He was issued a
edema, an episode of hospital acquired PNA (HAP),
handout and a light resistance theraband and after
and acute renal failure. After 3 weeks he was deemed
several sessions with visual and verbal cues, he was
stabilize enough to slowly wean from the ventilator.
able to manage the routine independently and
However, he remained significantly debilitated and
apply appropriate breathing strategies as needed.
his respiratory function remained compromised.
He verbalized his understanding of the importance
Following a bronchoscopy, his pulmonologist
of exercise in maintaining general endurance and
decided to maintain the tracheostomy at this time
although stated that he disliked exercising he agreed
with supplemental O2 via a nasal cannula in case of
to continue the routine. His wife verbalized that she complications and the need for re-intubation while he
did enjoy exercise and her inclusion in the training transitioned to a long-term acute care facility.
increased Mr. E.’s compliance. Given his general dislike
for exercises, he was provided with a list of activities Reason for OT Referral:
to help him increase his hand strength and fine motor
Although considered stable, Mr. C. was transferred
control. These included opening/closing containers,
to a long-term acute care hospital (LTACH) as he was
picking up/placing coins, using the TV remote or cell
functioning well below his baseline with significantly
phone, turning newspaper pages, buttoning shirts, decreased strength, endurance, and mobility, and
playing cards, and writing. he still required medical management. He continues
Discharge: to have a trach tube in place and uses a Passy-Muir
valve® to communicate, but experiences shortness
For the first week, Mr. E. used a wheelchair to go of breath with minimal activity and still requires
down to the dining room for meals or community 6L O2 via a nasal cannula to maintain adequate O2
events, but as his strength and endurance increased saturations. The NGT remains in place but he has
he was able to safely ambulate independently with begun feeding trials with Speech Language Pathology
his rollator and initiate seated rest breaks as needed. (SLP). He is currently requiring assistance for all his
He met all his long-term goals by the anticipated date ADLs and continues to have a Foley catheter in place.
and was discharged from OT services at a Supervision The plan is for Mr. C. to return home to participate
level for shower stall transfers, and an Independent in his normal routine as able with family support as
level of function for bathing, dressing, and simple needed. His ultimate long-term goal is to return to full-
IADLs. He agreed to join his wife in the community’s time work once he has successfully transitioned home.
exercise group to maintain his strength and endurance, He is being referred to OT for an evaluation in order
and he was motivated to participate in the monthly to assess his current status, develop a plan of care, and
health tasks at the facility to learn more about disease provide appropriate interventions and education to
management and take more responsibility for his own support a safe discharge.
health and well-being.
OT Initial Assessment:
The evaluation to ascertain Mr. C.’s background and
CASE STUDY #3 current functional status is conducted in his room via
ARDS (Long-term Acute Care Setting) informal interview, observation, and the Functional
Independence Measure (FIM). Mr. C. is greeted resting
History of Presenting Information (HPI): in bed with his eyes closed and the TV off. He is
wearing a hospital gown and the head of the bed is in
Mr. C. is a 51-year-old male with a past medical history
an elevated position. A Passy-Muir valve® is capping
significant for hypertension and hyperlipidemia
his trach tube and he is on 6L O2 via nasal cannula.
who presented to the ER with worsening shortness
He opens his eyes upon greeting and readily agrees to
of breath x 2 days, sudden fever, a productive cough
the evaluation stating that he is sick of hospitals and
with green sputum, and altered mental status (per his
willing to do anything to get home.
wife). Upon admission he was hypoxic with an O2
saturation of 64% on room air, BP 101/54, RR of 24, He is married and lives with his wife of 22 years in a 2
and HR of 111. BiPAP was attempted unsuccessfully level home with 2 stairs enter but no rail. He has two
requiring intubation and he was transferred to the children living at home, a boy aged 11 and a girl aged
intensive care unit (ICU) but failed to respond to 16. They also have a family dog. Mr. C. works full-time
conventional treatment. He remained in critical in construction as a supervisor and his wife works
condition and his breathing continued to deteriorate part-time as a dental hygienist, although she is willing

to take some leave in order to support his transition breathing technique to minimize his shortness of
home. Prior to admission, the patient was independent breath. A basic cognitive screen indicated that Mr.
(I) for mobility and all ADLs and IADLs. He reports C. was alert and oriented x 3 when provided with
that he works long hours and no longer has time for options for the name of the facility and location. He
exercise or leisure activities. His only hobby now is was able to follow simple 1-2 step directions, but his
watching sports on TV and occasionally walking the short-term memory was impaired. His ability to sustain
family dog if no else is available. The patient’s bedroom attention declined as he fatigued. Additionally, as his
and bathroom are on the second floor. He uses a tub/ performance declined, he verbalized more feelings of
shower combination for standing level bathing and he frustration and depression about his slow recovery
has no adaptive equipment. and ongoing reliance on supplemental oxygen. He
The patient’s wife does most of the grocery shopping, also expressed concern about the effect his prolonged
meal prep and household tasks, but Mr. C. reports that hospitalization is having on his family and whether his
he tries to help out with the heavier chores as needed cognitive status would impact his return to work.
and he does all of the yard work, including mowing OT Problem List:
the lawn. He reports feeling very frustrated about his
prolonged hospitalization and somewhat depressed • Limited core strength and activity tolerance
about his loss of function and identified roles, but he impacting functional mobility and participation in
refers to the experience as a “wake up call.” He states all ADLs
that he still gets nightmares from his time in the ICU • Prolonged use of a Foley catheter impacting
and is motivated to live a more balanced life with less bladder control and toileting routine
stress upon discharge. He also reports that his thinking
is still “fuzzy from the ICU” and he has a hard time • Limited knowledge of energy-conservation
concentrating for any length of time. He hopes that education, effective pacing strategies, and
he will regain both his cognitive skills and function ventilation techniques impacting performance in
by participating in therapy as his long term goal is to functional mobility and ADLs
return to work. • Limited knowledge of O2 cord management with
During the initial OT interview, Mr. C. appeared mobility impacting safety
to be comfortable at rest and only mildly short of
• Limited knowledge of available adaptive
breath while talking with a respiration rate (RR) of
equipment to assist with ADLs
18 and an O2 sat of 94% on 6L. He appeared weak
getting to the edge of the bed and required minimal • Increased signs of acute stress disorder associated
assistance (Min A) to complete appropriate sitting with prolonged sedation and time in the ICU
balance. Once in midline, he was able to support
• Increased signs of depression associated with a
himself with close supervision but visibly fatigued
significant decline in function, loss of role, and
and used his upper extremities to provide additional
potential caregiver burden
support. When standing and transferring to a bedside
chair he also required Min A and a rolling walker. Mr. • Limited bilateral UE strength, including hand
C. was notably fatigued with increased shortness of strength and fine motor control, impacting ADL
breath with minimal activity demand and stated that performance
he was looking forward to getting back into bed. He
was educated about the value of early mobilization • Decreased attention, ability to concentrate, and
and the importance of sitting out of bed more problem-solving skills impacting potential for new
often to build endurance and he agreed with the learning
recommendation. He ambulated approximately 10 OT Plan of Care (POC):
feet into the bathroom with Min A and the rolling
walker in order to complete a toilet transfer but his Anticipated length of stay: 4 weeks
O2 decreased to 88% and he required 3-4 minutes Duration and frequency of OT sessions: Approximately
to recover before standing again. He was instructed 30-45 minutes, 5-6 x per week.
to perform seated pursed-lip breathing to maximize
recovery and decrease his work of breathing, and his OT Short-term Goals (Anticipated timeframe – 2 weeks):
O2 level increased to 92%. With increased time and • Patient will complete all steps of toileting routine
pacing cues, Mr. C. was able to participate in a sponge- with close supervision (CLS) and adaptive device
bathing routine sitting/standing as tolerated, and (AD) as needed via bedside commode
benefitted from moderate assistance (Mod A) for both
LBB and LBD due to shortness of breath with increased • Patient will complete sponge-bathing routine sink-
activity demand and reaching. His O2 saturations were side with CLS sitting/standing as tolerated with
monitored throughout the evaluation process using appropriate use of adaptive equipment (AE) and
an oximeter, and ranged between 87-92%. He needed application of pursed-lip breathing technique as
frequent rest breaks and cueing to apply pursed-lip needed

•P
atient will complete dressing routine sitting/ Interprofessional Communication:
standing as tolerated with CLS, appropriate use
Physical Therapy (PT): Discussed Mr. C.’s OT plan of
of AE, and application of pursed-lip breathing
care and goals in order to develop a coordinated,
technique as needed
collaborative effort with PT to build strength, activity
•P
atient will tolerate 10 minutes continuous tolerance, and functional mobility. Participated in
standing with CLS while performing sink-side daily communication to provide updates, reinforce
grooming tasks in order to increase standing consistent educational material, and coordinate efforts
balance/tolerance to minimize schedule conflicts.
•P
atient will complete safe tub transfer with contact Speech-Language Pathology: Discussed evaluation and
guard assistance (CGA) and appropriate use of plan of care in terms of limitations impacting self-
durable medical equipment feeding with recommendations and goals to improve
function. Discussed SLP’s plan of care in order to
•P
atient will tolerate standing level beverage prep
develop a coordinated and collaborative effort.
with CLS, assistive device, and appropriate energy
conservation strategies MD: Discussed evaluation results and requested O2
parameters prior to initiating services. Discussed
•P
atient will participate in 30-minute leisure
timeline for removal of NGT and Foley catheter, as
activity via Wii sports in order to increase standing
well as O2 weaning process and decannulation of the
balance/tolerance
trach tube. Provided ongoing updates throughout Mr.
•P
atient will tolerate 15 minutes daily upper C.’s stay regarding his functional status, O2 needs with
extremity (UE) exercise in order to increase general activity and response to breathing strategies, as well as
activity tolerance and performance in ADLs/IADLs his progress towards long-term goals. Also discussed
referral to psychiatry due to Mr. C’s report of ongoing
OT Long-term Goals (Anticipated timeframe
nightmares and feelings of depression associated with
– 4 weeks):
prolonged sedation and extended hospitalization.
•P
atient will complete all steps of toileting routine
Nursing: Discussed Mr. C.’s ADL goals and provided
in bathroom with modified independence (Mod
rationale for allowing him to participate in all steps
I) and appropriate application of pursed-lip
of routine sink-side when able. Encouraged inclusion
breathing technique as needed
of energy conservation skills and use of adaptive
•P
atient will complete shower routine with Mod I equipment/durable medical equipment during all tasks
sitting/standing as tolerated with appropriate use so that he could improve his functional status and
of adaptive equipment and application of pursed- perform his bathing, dressing, and toileting tasks at a
lip breathing technique as needed Mod I level by discharge.
•P
atient will complete dressing routine sitting/ Respiratory Therapy: Discussed respiratory plan of
standing as tolerated with Mod I, appropriate use care to continue weaning process in anticipation of
of adaptive equipment, and application of pursed- eventual decannulation. Provided ongoing updates
lip breathing technique as needed throughout Mr. C.’s stay regarding his shortness of
breath and O2 needs with functional activity, and his
•P
atient will complete safe tub transfer with Mod I
response to breathing strategies.
and appropriate use of durable medical equipment
Pulmonary Therapy: Discussed Mr. C.’s OT plan of
•P
atient will complete simple meal/beverage prep
care and determined pulmonary rehab’s schedule for
with Mod I and appropriate energy conservation
medication and/or therapy in order to coordinate
strategies
efforts and minimize schedule conflicts.
•P
atient will purchase adaptive equipment/durable
Case Manager: Ongoing communication throughout
medical equipment to maximize functional
Mr. C.’s stay regarding his OT plan of care, goals, and
independence with ADLs upon discharge home
recommendations for a safe discharge home with
•P
atient will explore healthy leisure activities and continued OT services.
stress management techniques in order to establish
Psychiatry: Discussed Mr. C’s report of ongoing
lifestyle balance upon discharge
nightmares and feelings of depression associated with
•P
atient and family will participate in disease prolonged sedation and hospitalization, including
management education the impact on cognition and function. Discussed
adjunctive strategies to minimize anxiety and
•P
atient will tolerate 30 minutes daily upper
depression.
extremity (UE) exercise in order to increase general
activity tolerance and performance in ADLs/IADLs

Interventions: equipment as needed in the interim. After two weeks
of therapy, he was able to demonstrate increased
Mr. C.’s treatment plan consisted of increasing his
activity tolerance but still only stood as tolerated. He
functional mobility and activity tolerance through
also improved his functional reach but still benefitted
both ADLs and IADLs in order to maximize his
from using the adaptive equipment to complete his
functional independence and minimize the potential
LBB and LBD tasks as bending continued to increase
for caregiver burden upon discharge. It was of primary
his work of breathing, which he found uncomfortable.
importance to also address his cognitive status,
While undergoing the O2 weaning process, Mr. C.
including his attention to task, ability to follow multi-
was also instructed on the importance of using O2
step directions, and problem-solving skills through
for all demanding activities while he continued to
both familiar routine tasks and more challenging
build up his strength and endurance. This included
scenarios. His education also included energy
using O2 while showering as this was a particularly
conservation skills, ventilation strategies, adaptive
equipment use, and O2 cord safety via all tasks so that demanding physical activity for him. By discharge, he
he could begin to see progress towards independence, was still performing his ADL routine sitting/standing
minimize his need for assistance, and prepare for a safe as tolerated but no longer required the adaptive
discharge home. equipment to reach his lower extremities. He initially
required assistance to complete a safe tub transfer
With the removal of the Foley catheter on day 2, Mr. but progressed to a Mod I level, still using a grab
C. experienced frequent episodes of urinary urgency rail and tub seat to maximize safety and functional
and two episodes of incontinence. He found these independence. He decided to purchase a tub seat and
experiences very embarrassing and he verbalized have a grab rail installed for discharge but decided
frustration with his ongoing need to have assistance against purchasing any further adaptive equipment.
to get to the bathroom. It was recommended that he
use a urinal and a bedside commode as a short-term Once Mr. C. had mastered his daily ADL routine more
measure in order to promote bladder control and efficiently with CLS to monitor his respiratory status
help him to feel more independent. As his endurance and provide cues as needed, he more confidently
improved and O2 cord management was implemented, participated in meaningful IADL activities. Energy
he was able to safely ambulate with supervision and a conservation and work simplification strategies
rolling walker to the bathroom. He slowly progressed were included in both simple beverage and meal
to performing all toileting tasks at a Mod I level. prep activities allowing Mr. C. to perform tasks
more efficiently and confidently without significant
With the removal of the NGT and an upgraded diet by shortness of breath. Additionally, all IADL tasks were
SLP, Mr. C. was encouraged to take all meals sitting out graded as needed to increase Mr. C.’s ability to follow
of bed to increase his sitting tolerance and ventilation multi-step directions and facilitate problem-solving
capacity. He initially struggled to maintain a consistent skills.
out of bed routine due to fatigue and tired easily
while self-feeding but was able to slowly increase his Mr. C. was agreeable to stress management education
endurance for out of bed activities. and the exploration of strategies to create a more
balanced lifestyle upon discharge. He agreed to trial
He was initially encouraged to participate in all aspects leisure options, and regularly participated in Wii golf
of sponge-bathing tasks sitting at the edge of the bed and bowling during his hospitalization, which helped
or in his chair with a short-term goal of completing him to increase his standing balance and tolerance
all his bathing routine sink-side until he was able to while also engaging in a fun leisure activity that he
tolerate a shower. A routine was established and the could continue with his family upon discharge. Mr.
plan of care discussed with nursing staff, including C. also agreed that he could also walk the dog on a
nursing aides, to minimize bed level ADLs. He was daily basis and explore options to get involved in his
encouraged to pace himself throughout his ADL children’s extracurricular sports activities.
routine, sit for tasks if possible, and apply appropriate
breathing techniques to minimize shortness of breath. Mr. C. was also provided with an UE exercise program
He was instructed on how to include pursed-lip to improve his general strength and endurance.
breathing technique throughout his daily routine, and He was initially frustrated by his debilitation and
given energy conservation strategies to perform his reluctant to perform exercises with “easy” weights
tasks more efficiently and with less fatigue. Discussion but he was encouraged to use them until he was able
about the benefits of adaptive and durable medical to tolerate more advanced options. He was provided
equipment was embedded into his ADL routine and with a handout and was able to manage the routine
he was encouraged to trial recommendations for a independently with good application of breathing
reacher, a long-handled shoe-horn, a sock aide, and a strategies. By discharge, Mr. C. had progressed to using
long-handled sponge, along with a tub seat and grab “heavy” resistance bands and 8lb hand weights. Mr.
rails for showers. After practicing, Mr. C. decided to C. verbalized his understanding of the importance of
defer purchase until closer to discharge in the hope maintaining general endurance and agreed to continue
that he would not need them. He agreed to use the the exercise routine after discharge, using heavier

weights as tolerated. He also agreed to explore local The Missouri Alliance for Home Care Fall Risk
gyms once he had successfully transitioned home and Assessment Test (MAHC-10):
was able to manage community outings. http://www.homecaremissouri.
Discharge: org/projects/falls/documents/
Oct2012FINALValidatedFallriskassessmenttool.pdf
Mr. C. was decannulated after 2 weeks, weaned from
supplemental O2 after 3 weeks, and met his long- Stress management and relaxation techniques:
term therapy goals by the anticipated date. He was http://www.caot.ca/default.asp?pageid=1327
discharged home at a Mod I level of function for all
his ADLs and simple IADLs. He agreed to OT services REFERENCES
upon discharge to ensure a safe transition home and 1. enter for Disease Control and Prevention
C
to continue building activity tolerance via higher (CDC). (n.d.). Chronic obstructive pulmonary disease
level IADLs so that he could eventually return to his (COPD) includes: Chronic bronchitis and emphysema.
prior functional status and complete his recovery by Retrieved from http://www.cdc.gov/nchs/fastats/
returning to work full-time. copd.htm
2. orhay, J. L., NGUYEN DANG, D., Van
C
CONCLUSION Cauwenberge, H., & Louis, R. (2014). Pulmonary
rehabilitation and COPD: providing patients
In response to the growing number of individuals a good environment for optimizing therapy.
living with chronic pulmonary conditions as well International journal of chronic obstructive pulmonary
as those recovering from acute respiratory illness or disease, 9, 27-39.
injury, OT/OTAs are becoming increasingly involved
in care across the continuum. In addition to physical 3. enter for Disease Control and Prevention (CDC).
C
and psychosocial rehabilitation, OT/OTAs are educated (n.d.). Pneumonia. Retrieved from http://www.cdc.
in the areas of disease prevention and/or management gov/nchs/fastats/pneumonia.htm
and lifestyle modification that give the profession a
distinct role within the interprofessional team. Using a 4. dobi, K. F., Childs, E. D., & Touijer, K. A. R. I.
U
collaborative and client-centered approach, therapists M. (2003). Acute respiratory distress syndrome.
are able to rely on their clinical reasoning training to American family physician, 67(2), 315-322.
holistically address the needs of clients experiencing 5. S ewell, L., Singh, S. J., Williams, J. E., Collier,
pulmonary dysfunction in order to develop individual R., & Morgan, M. D. (2005). Can Individualized
treatment plans and promote health and wellbeing at Rehabilitation Improve Functional Independence
home and in the community. in Elderly Patients With COPD?. CHEST Journal,
128(3), 1194-1200.
RESOURCES 6. han, S.C.C. (2004). Chronic Obstructive

C
Pulmonary Disease and Engagement in
Functional Independence Measure (FIM®) Occupation. The American Journal of Occupational
http://www.udsmr.org/WebModules/FIM/Fim_About. Therapy, 58(4), 408-415.
aspx
7. S tewart, D. G., Drake, D. F., Robertson, C.,
Barthel Index (BI) Marwitz, J. H., Kreutzer, J. S., & Cifu, D. X. (2001).
http://www.strokecenter.org/wp-content/ Benefits of an inpatient pulmonary rehabilitation
uploads/2011/08/barthel.pdf program: a prospective analysis. Archives of physical
medicine and rehabilitation, 82(3), 347-352.
Canadian Occupational Performance Measure
(COPM) 8. oherty, R. F. (2003). Cardiopulmonary
D
http://www.thecopm.ca dysfunction in adults. In Crepeau, E. B., Cohn,
E., & Schell, B. A. B. (Eds.), Willard & Spackman’s
Montreal Cognitive Assessment (MoCA):
Occupational Therapy (807-819). Philadelphia:
http://www.mocatest.org Lippincott Williams & Wilkins.
The Short Portable Mental Status Questionnaire
9. acNee, W. (2006). ABC of chronic obstructive
M
(SPMSQ):
pulmonary disease: pathology, pathogenesis, and
http://www.npcrc.org/files/news/short_portable_ pathophysiology. BMJ: British Medical Journal,
mental_health_questionnaire.pdf 332(7551), 1202.
The Mini Mental State Examination (MMSE): 10. W
orld Health Organization (WHO). (2016).
http://www.dementiatoday.com/wp-content/ Chronic obstructive pulmonary disease (COPD).
uploads/2012/06/MiniMentalStateExamination.pdf Retrieved from http://www.who.int/respiratory/
copd/en/

11. H
an, M. K., Postma, D., Mannino, D. M., 23. Raghu, G., Nyberg, F., & Morgan, G. (2004). The
Giardino, N. D., Buist, S., Curtis, J. L., & Martinez, epidemiology of interstitial lung disease and its
F. J. (2007). Gender and chronic obstructive association with lung cancer. British Journal of
pulmonary disease: why it matters. American Cancer, 91(Suppl 2), S3–S10.
journal of respiratory and critical care medicine,
176(12), 1179-1184. 24. American Lung Association (n.d.). Lung and health
diseases: Sarcoidosis. Retrieved from http://www.
12. F
ord, E. S., Murphy, L. B., Khavjou, O., Giles, W. lung.org/lung-health-and-diseases/lung-disease-
H., Holt, J. B., & Croft, J. B. (2015). Total and state- lookup/sarcoidosis/learn-about-sarcoidosis.html
specific medical and absenteeism costs of COPD
among adults aged≥ 18 years in the United States 25. King, T. E., Pardo, A., & Selman, M. (2011).
for 2010 and projections through 2020. Chest Idiopathic pulmonary fibrosis. The Lancet,
Journal, 147(1), 31-45. 378(9807), 1949-1961.
13. M
acNee, W. (2006). ABC of chronic obstructive 26. Raghu, G., & Brown, K. K. (2004). Interstitial
pulmonary disease: pathology, pathogenesis, and lung disease: clinical evaluation and keys to an
pathophysiology. BMJ: British Medical Journal, accurate diagnosis. Clinics in chest medicine, 25(3),
332(7551), 1202. 409-419.
14. M
ayo Clinic (n.d.). Diseases and conditions: COPD 27. Mayo Clinic (n.d.). Diseases and conditions:
tests and diagnosis. Retrieved from http://www. Interstitial lung disease treatment and drugs.
mayoclinic.org/diseases-conditions/copd/basics/ Retrieved from http://www.mayoclinic.org/
tests-diagnosis/con-20032017 diseases-conditions/interstitial-lung-disease/
basics/treatment/con-20024481
15. M
ayo Clinic (n.d.). Diseases and conditions: COPD
treatments and drugs. Retrieved from http://www. 28. American Lung Association (n.d.). Lung and health
mayoclinic.org/diseases-conditions/copd/basics/ diseases: Learn about ARDS. Retrieved from http://
treatment/con-20032017 www.lung.org/lung-health-and-diseases/lung-
disease-lookup/ards/learn-about-ards.html
16. R
osto, E. (Ed.). (2009). Pathophysiology Made
Incredibly Easy!. Lippincott Williams & Wilkins. 29. Leaver, S. K., & Evans, T. W. (2007). Acute
respiratory distress syndrome. British Medical
17. M
erck Manual (n.d.). Aspiration pneumonitis Journal, 7616, 389.
and pneumonia. Retrieved from http://www.
merckmanuals.com/professional/pulmonary- 30. National Institutes of Health. National Heart,
disorders/pneumonia/aspiration-pneumonitis- Lung and Blood Institute (n.d.). Diseases and
and-pneumonia Conditions Index. Acute Respiratory Distress
Syndrome (ARDS): What Is ARDS? Retrieved from
18. C
enter for Disease Control and Prevention (CDC). https://www.nhlbi.nih.gov/health/health-topics/
(n.d.). Pneumonia. Retrieved from http://www.cdc. topics/ards
gov/pneumonia/epic/overview.html
31. Pierrakos, C., Karanikolas, M., Scolletta, S.,
19. M
ayo Clinic (n.d.). Diseases and conditions: Karamouzos, V., & Velissaris, D. (2012). Acute
Pneumonia tests and diagnosis. Retrieved from respiratory distress syndrome: pathophysiology
http://www.mayoclinic.org/diseases-conditions/ and therapeutic options. Journal of clinical
pneumonia/basics/tests-diagnosis/con-20020032 medicine research, 4(1), 7-16.
20. A
merican Lung Association (n.d.). Diagnosing and 32. Ware, L. B., & Matthay, M. A. (2000). The acute
treating pneumonia. Retrieved from http://www. respiratory distress syndrome. New England Journal
lung.org/lung-health-and-diseases/lung-disease- of Medicine, 342(18), 1334-1349.
lookup/pneumonia/diagnosing-and-treating.html
33. Mayo Clinic (n.d.). Diseases and conditions: ARDS
21. C
ollard, H. R. Merck Manual (n.d.). Overview of symptoms. Retrieved from http://www.mayoclinic.
interstitial lung disease. Retrieved from http:// org/diseases-conditions/ards/basics/symptoms/
www.merckmanuals.com/home/lung-and-airway- con-20030070
disorders/interstitial-lung-diseases/overview-of-
interstitial-lung-diseases 34. National Institutes of Health. National Heart,
Lung and Blood Institute (n.d.). How is ARDS
22. C
hapman, J.T. (2010, August 10). Interstitial diagnosed? Retrieved from https://www.nhlbi.nih.
lung disease. Retrieved from http://www. gov/health/health-topics/topics/ards/diagnosis
clevelandclinicmeded.com/medicalpubs/
diseasemanagement/pulmonary/interstitial-lung- 35. Shelly, M. P., & Nightingale, P. (1999). ABC of
disease/ intensive care: respiratory support. BMJ: British
Medical Journal, 318(7199), 1674.

36. N
ational Institutes of Health. National Heart, 47. T
ortora, G. J., & Derrickson, B. H. (2008).
Lung and Blood Institute (n.d.). Diseases and Principles of anatomy and physiology. John Wiley &
Conditions Index. Acute Respiratory Distress Sons.
Syndrome (ARDS): How is ARDS treated? Retrieved
from https://www.nhlbi.nih.gov/health/health- 48. W
ebMD. (n.d.). Asthma health center: Hypoxia
topics/topics/ards/treatment and hypoxemia. Retrieved from http://www.
webmd.com/asthma/guide/hypoxia-hypoxemia
37. M
acIntyre, N. R. (2001). Evidence-based
guidelines for weaning and discontinuing 49. R
estrepo, R. D., Wettstein, R., Wittnebel, L., &
ventilatory support: a collective task force Tracy, M. (2011). Incentive spirometry: 2011.
facilitated by the American College of Chest Respiratory care, 56(10), 1600-1604.
Physicians; the American Association for 50. A
merican Thoracic Society (n.d.). Inpatient
Respiratory Care; and the American College of oxygen therapy: Oxygen delivery methods. Retrieved
Critical Care Medicine. Chest Journal, 120(6_ from http://www.thoracic.org/copd-guidelines/
suppl), 375S-396S. for-health-professionals/exacerbation/inpatient-
38. H
aas, C. F., & Bauser, K. A. (2012). Advanced oxygen-therapy/oxygen-delivery-methods.php
ventilator modes and techniques. Critical care 51. M
iles, M. C., & Peters, S. P. (n.d.). Merck Manual
nursing quarterly, 35(1), 27-38. Consumer Version: Asthma. Retrieved from http://
39. A
merican Lung Association (n.d.). Lung and health www.merckmanuals.com/home/lung-and-airway-
diseases: Recovering from ARDS. Retrieved from disorders/asthma/asthma
http://www.lung.org/lung-health-and-diseases/ 52. A
boussouan, L. S., & Mireles-Cabodevila, E.
lung-disease-lookup/ards/recovering-from-ards. (2014). Noninvasive Positive Pressure Support.
html Retrieved from http://www.clevelandclinicmeded.
40. W
ebMD (n.d.). Lung disease and respiratory health com/medicalpubs/diseasemanagement/
center: Arterial blood gases. Retrieved from http:// pulmonary/noninvasive-positive-pressure/
www.webmd.com/lung/arterial-blood-gases 53. H
all, J. B., & McShane, P. J. (n.d.). Merck Manual
41. A
merican Thoracic Society (n.d.). What are Professional Version: Overview of mechanical
bronchodilators? Retrieved from https://www. ventilation. Retrieved from http://www.
thoracic.org/copd-guidelines/for-patients/what- merckmanuals.com/professional/critical-care-
kind-of-medications-are-there-for-copd/what-are- medicine/respiratory-failure-and-mechanical-
bronchodilators.php ventilation/overview-of-mechanical-ventilation
42. W
ebMD (n.d.). Lung disease and respiratory health 54. M
erck Manual (n.d.). Pleural effusion. Retrieved
center: Bronchoscopy. Retrieved from http://www. from http://www.merckmanuals.com/
webmd.com/lung/bronchoscopy-16978 professional/pulmonary-disorders/mediastinal-
and-pleural-disorders/pleural-effusion
43. A
merican Thoracic Society (n.d.). What are
corticosteroid (anti-inflammatory) medications? 55. L
ight, R. W. (n.d.). Merck Manual Professional
Retrieved from https://www.thoracic.org/copd- Version: Pneumothorax. Retrieved from http://www.
guidelines/for-patients/what-kind-of-medications- merckmanuals.com/professional/pulmonary-
are-there-for-copd/what-are-corticosteroid-anti- disorders/mediastinal-and-pleural-disorders/
inflammatory-medications.php pneumothorax
44. J ohn Hopkins Medicine (n.d.). Decannulation. 56. Lechtzin, N. (n.d.). Merck Manual Professional Ver-
Retrieved from http://www.hopkinsmedicine.org/ sion: Pulmonary function testing (PFT). Retrieved
tracheostomy/living/decannulation.html from http://www.merckmanuals.com/profession-
al/SearchResults?query=Pulmonary+Function+-
45. L
echtzin, N. (n.d.). Merck Manual Professional Testing++(PFT)&icd9=MM786%3bMM787
Version: Dyspnea. Retrieved from http://www.
merckmanuals.com/professional/pulmonary- 57. American Thoracic Society (n.d.). Patient
disorders/symptoms-of-pulmonary-disorders/ information series: Pulse oximetry. Retrieved from
dyspnea https://www.thoracic.org/patients/patient-
resources/resources/pulse-oximetry.pdf
46. M
erck Manual (n.d.). Bladder catheterization.
Retrieved from http://www.merckmanuals. 58. Cleveland Clinic (n.d.). Diseases and conditions:
com/professional/genitourinary-disorders/ Pursed lip breathing. Retrieved from http://
genitourinary-tests-and-procedures/bladder- my.clevelandclinic.org/health/diseases_
catheterization conditions/hic_Understanding_COPD/
hic_Pulmonary_Rehabilitation_Is_it_for_You/
hic_Pursed_Lip_Breathing

59. M
ayo Clinic (n.d.). Patient care and health Home Health Care Management & Practice, 25(5),
information: Sepsis. Retrieved from http://www. 224-228.
mayoclinic.org/diseases-conditions/sepsis/home/
ovc-20169784 71. M
atheson Education and Training Solutions.
(n.d.). The Matheson FCE Model: FAQs. Retrieved
60. B
ortle, C.D. & Levitan, R. (n.d.). Merck Manual from https://www.roymatheson.com/about/
Professional Version: Airway establishment matheson-fce-faqs
and control. Retrieved from http://www.
merckmanuals.com/professional/critical-care- 72. S oer, R., van der Schans, C. P., Groothoff, J. W.,
medicine/respiratory-arrest/airway-establishment- Geertzen, J. H., & Reneman, M. F. (2008). Towards
and-control#v927748 consensus in operational definitions in functional
capacity evaluation: A Delphi survey. Journal of
61. C
hristiansen, C. H. (1999). Defining lives: Occupational Rehabilitation, 18, 389–400.
Occupation as identity: An essay on competence,
coherence, and the creation of meaning. American 73. K
endrick, K. R., Baxi, S. C., & Smith, R. M. (2000).
Journal of Occupational Therapy, 53(6), 547-558. Usefulness of the modified 0-10 Borg scale in
assessing the degree of dyspnea in patients with
62. B
ilics, A. R., Hanson, D. J., ASD, O. M. D., COPD and asthma. Journal of Emergency Nursing,
Higgins, S. M., Linda Orr, M. P. A., Parham, D., ... 26(3), 216-222.
& Harvison, N. (2004). The philosophical base of
occupational therapy. Therapy, 49(1026). 74. K
aramanli, H., Ilik, F., Kayhan, F., & Pazarli, A.
C. (2015). Assessment of cognitive impairment
63. A
merican Occupational Therapy Association. in long-term oxygen therapy-dependent COPD
(n.d.). Occupational therapy’s role in chronic patients. International journal of chronic obstructive
disease management [Fact sheet]. Bethesda, pulmonary disease, 10, 2087.
MD: Author. Retrieved from http://www.
aota.org/-/media/Corporate/Files/AboutOT/ 75. T
ombaugh, T. N., & McIntyre, N. J. (1992). The
Professionals/WhatIsOT/HW/Facts/FactSheet_ mini‐mental state examination: a comprehensive
ChronicDiseaseManagement.pdf review. Journal of the American Geriatrics Society,
40(9), 922-935.
64. A
merican Occupational Therapy Association.
(2014). Occupational therapy practice framework: 76. E
rkinjuntti, T., Sulkava, R., Wikström, J., &
Domain and process (3rd ed.). American Journal of Autio, L. (1987). Short Portable Mental Status
Occupational Therapy, 68(Supp. 1). Retrieved from Questionnaire as a screening test for dementia
http://dx.doi.org/10.5014/ajot.2014.682006 and delirium among the elderly. Journal of the
American Geriatrics Society, 35(5), 412-416.
65. I . E. C. E. Panel. (2011). Core competencies for
interprofessional collaborative practice: Report of 77. S chweickert, W. D., Pohlman, M. C., Pohlman,
an expert panel. Interprofessional Education A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., ...
Collaborative Expert Panel. & Schmidt, G. A. (2009). Early physical and
occupational therapy in mechanically ventilated,
66. D
esai, S. V., Law, T. J., & Needham, D. M. (2011). critically ill patients: a randomised controlled
Long-term complications of critical care. Critical trial. Lancet (London, England), 373(9678), 1874-
care medicine, 39(2), 371-379. 1882.
67. U
niform Data System for Medical Rehabilitation. 78. C
ouch, R., & Ryan, K. (2000). Physical therapy
About the FIM system (n.d.). Retrieved from and respiratory care: Integration as a team in
http://www.udsmr.org/WebModules/FIM/Fim_ pulmonary rehabilitation. In J. Hodgkin, R. C.
About.aspx Bartholome, & G. Conners (Eds.), Pulmonary
rehabilitation: Guidelines to success (pp. 173-211).
68. M
ahoney, F.I., Barthel, D. (1965). Functional Philadelphia: Lippincort.
evaluation: The Barthel Index. Maryland State
Medical Journal, 14, 56-61. 79. C
ourtney, C., & Escobedo, B. (1990). A stress
management program: Inpatient-to-outpatient
69. L
aw, M., Baptiste, S., McColl, M., Opzoomer, A., continuity. American Journal of Occupational
Polatajko, H., & Pollock, N. (1990). The Canadian Therapy, 44(4), 306-310.
occupational performance measure: an outcome
measure for occupational therapy. Canadian 80. C
anadian Association of Occupational Therapists
Journal of Occupational Therapy, 57(2), 82-87. (n.d.). Relaxation therapy/techniques & anxiety
management. Retrieved from http://www.caot.ca/
70. G
allagher, R., Stith, N., & Southard, V. (2013). default.asp?pageid=1327
Evaluation of the Missouri Alliance for Home
Care Fall Risk Assessment Tool and Home-Based
“Balanced Approach” Fall Reduction Initiative.

The Role of Occupational Therapy
in Pulmonary Rehabilitation
(3 CE Hours)
1. Lung injury associated with Acute Respiratory 5. A non-invasive means of measuring oxygen
Distress Syndrome (ARDS) is commonly saturation levels in the blood with a small
described as having three distinct but device that is usually attached to a fingertip, but
overlapping phases. The proliferation phase, can also be used on a toe or an ear: ________.
characterized by tissue damage and narrowing a. Positive end expiratory pressure (PEEP
of air space, is the ________ phase. b. Pulmonary function test (PFT)
a. Final c. Pulse oximetry
b. First d. Tracheostomy
c. Second
d. Third 6. Individuals blow into the mouthpiece of the
device and are encouraged to exhale normally
before inhaling slowly. An indicator within the
2. ________ can be further classified as hospital- chamber of the device will rise upon inhalation
acquired, community-acquired, or ventilator- providing an observable measure of volume
acquired. that may be recorded to assess progress.
a. Acute Respiratory Distress Syndrome (ARDS) a. Incentive spirometry (IS)
b. Chronic Obstructive Pulmonary Disease b. Non-invasive positive pressure ventilation
(COPD) (NIPPV)
c. Interstitial Lung Disease (ILD) c. Pulse oximetry
d. Pneumonia (PNA) d. Pursed-lip breathing
3. ________ is not a single disease but rather an 7. The most common form of ________ is the
umbrella term used to describe progressive lung beta-adrenergic agonist. It is most commonly
diseases that include emphysema and chronic inhaled so that it can work rapidly.
bronchitis. It is considered preventable, but it a. Bronchodilator
is also a progressive, life-threatening disorder b. Incentive spirometry
in which the lungs are irreparably damaged c. Mechanical ventilation
making it difficult to breathe. d. Oxidizer
a. Acute Respiratory Distress Syndrome (ARDS)
b. Chronic Obstructive Pulmonary Disease 8. The primary focus of OT in this setting is to
(COPD) promote strength, endurance, and mobility
c. Interstitial Lung Disease (ILD) within the context of ADL and IADL re-training,
d. Pneumonia (PNA) and provide client/caregiver education,
including energy conservation strategies, in
4. Regardless of etiology and type, the primary order to manage conditions at home and in the
clinical signs and symptoms of ________ are community upon discharge: ________.
similar, and include dyspnea and a non- a. Acute Care Hospitals
productive cough. Additional symptoms, such b. Home Care, including Independent and
as increased sputum production, hemoptysis Assisted Living Facilities
associated with microscopic hemorrhages, and c. Inpatient Rehab and Skilled Nursing Facilities
wheezing, as well as non respiratory related d. Long-term Acute Care
symptoms, such as myalgia and joint pain may
help to further classify the disease. 9. A 30-point questionnaire designed to measure
a. Acute Respiratory Distress Syndrome (ARDS) cognitive impairment, most commonly used
b. Chronic Obstructive Pulmonary Disease as a screen for dementia but can be used to
(COPD) estimate cognitive impairment associated with
c. Interstitial Lung Disease (ILD) illness or injury: ________.
d. Pneumonia (PNA) a. Borg Rating of Perceived Exertion Scale (RPE)
b. Functional Capacity Evaluation (FCE)
c. Short Portable Mental Status Questionnaire test
(SPMSQ)
d. The Mini Mental State Examination (MMSE)

10. A combination of interview, tests, and 15. Interventions include simple strategies such as
observations typically completed over the eliminating unnecessary steps, sitting versus
course of 4-6 hours and designed to assess standing if possible, setting up task equipment
an individual’s functional ability to perform in advance to minimize extraneous effort, and
specific tasks associated with employment: using lightweight tools or utensils: ________.
________. a. Activity tolerance and energy conservation
a. Canadian Occupational Performance Measure techniques
(COPM) b. Stress management / relaxation strategies
b. Functional Capacity Evaluation (FCE) c. Therapeutic exercise programs / upper
c. Missouri Alliance for Home Care (MAHC-10) extremity function
d. Modified Borg Scale for Perceived Dyspnea (RPD) d. Ventilation strategies / breathing techniques
16. Pursuant to safe discharge planning, OT/OTAs
11. A standardized multi-factor screening tool used address ________.
to determine fall risk that may be used with a. Caregiver education
all home care clients, including those who are b. Fall prevention training
bed-bound and those with significant mobility c. Home safety training
impairments: ________. d. All of the above
a. Barthel Index (BI)
17. Considerations clients should be aware of when
b. Functional Capacity Evaluation (FCE)
flying with O2 include ________.
c. Missouri Alliance for Home Care (MAHC-10)
a. Airlines are required by the Americans with
d. The Montreal Cognitive Assessment (MoCA)
Disabilities Act (ADA) to provide O2 service on flights
b. Federal regulations permit the transportation
12. A 10 item ordinal scale used to measure ADL of personal O2 canisters aboard
performance that is most commonly used c. Passengers can often purchase canisters from
in inpatient rehabilitation, skilled nursing the airlines for use during the flight
facilities, and home care: ________. d. All of the above
a. Barthel Index (BI)
18. Considering Case Study #1: If appropriate for
b. Borg Rating of Perceived Exertion Scale (RPE)
a client with COPD, the inclusion of adaptive
c. Functional Capacity Evaluation (FCE)
equipment during ADL re-training can help to
d. Functional Independence Measure (FIM®)
________.
a. Minimize the effort of reaching lower
13. A process of passive, active, and progressive extremities during bathing and dressing, which
movement during critical illness to counter can exacerbate shortness of breath
the effects of sedation and immobility that b. Limit the workload on staff during ADLs
may lead to neurocognitive deficits and c. Give individuals the opportunity to trial new gadgets
physical debilitation. It may be performed by d. Decrease stress on joints while performing ADL tasks
any member of the interdisciplinary team,
including OTs: ________. 19. Considering Case Study #2: When providing
a. Early mobilization energy conservation education an OT or OTA
b. Pursed-lip breathing may encourage clients to ________.
c. Self-assessment a. Plan activities in advance to minimize
d. Therapeutic exercise programs / upper extraneous steps
extremity function b. Perform tasks sitting down to minimize fatigue
c. Include rest breaks as needed throughout the activity
d. All of the above
14. Making larger meals to freeze, letting dishes air
dry, grouping task items together to minimize 20. Considering Case Study #3: When preparing
unnecessary searches, sliding rather than an individual for discharge, why is
carrying items, shopping with someone who interprofessional collaboration so important?
can carry grocery bags, or using grocery home a. It helps the different disciplines learn about
delivery services, are all examples of energy each other’s roles and responsibilities during
conservation techniques commonly embedded the discharge process
into ________. b. It enables the team to develop a more
a. ADL re-training comprehensive and safe discharge plan for the
b. IADL re-training individual
c. Stress management / relaxation strategies c. It breaks down communication barriers
d. Therapeutic exercise programs / upper between disciplines
extremity function d. It helps the client feel supported during the
discharge process

ANSWER SHEET
First Name:_______________________________ Last Name: ______________________________ Date: ________________
Address: ________________________________________________________City: ___________________________________
State: ____________________________________ ZIP: ___________________Country_________________________________
Phone: __________________________________ Email: ________________________________________________________
NCBOT #:_______________________________________________________________________________________________
Other: License/certification # and issuing state/organization_________________________________________________
Clinical Fellow: Supervisor name and NCBOT account #____________________________________________________
Graduate Student: University name and expected graduation date___________________________________________

** See instructions on the cover page to submit your exams and pay for your course.
By submitting this final exam for grading, I hereby certify that I have spent the required time to study
this course material and that I have personally completed each module/session of instruction.
The Role Of Occupational Therapy

in Pulmonary Rehabilitation - Final Exam
1. A B C D 5. A B C D 9. A B C D 13. A B C D 17. A B C D
Accessibility and/or special needs concerns?

Contact customer service by phone at (888) 564-9098
or email at support@pdhacademy.com.
Refund and general policies are available online at

http://pdhacademy.com/policies/

THE ROLE OF OCCUPATIONAL THERAPY
IN PULMONARY REHABILITATION
(3 CE HOURS)
COURSE EVALUATION
Learner Name:_____________________________________________ Completion Date: ______________________________
❑ PT ❑ PTA ❑ OT ❑ OTA ❑ SLP ❑ SLPA Other: _______________________________________
Disagree Agree
Orientation was thorough and clear 1 2 3 4 5
Instructional personnel disclosures were readily
available and clearly stated 1 2 3 4 5
Learning objectives were clearly stated 1 2 3 4 5
Completion requirements were clearly stated 1 2 3 4 5
Content was well-organized 1 2 3 4 5
Content was informative 1 2 3 4 5
Content reflected stated learning objectives 1 2 3 4 5
Exam assessed stated learning objectives 1 2 3 4 5
Exam was graded promptly 1 2 3 4 5
Satisfied with learning experience 1 2 3 4 5
Satisfied with customer service (if applicable) 1 2 3 4 5 n/a
What suggestions do you have to improve this program, if any?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
What educational needs do you currently have?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
What other courses or topics are of interest to you?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________

Ot - Role of Ot in Pulmonary Rehab

Uploaded by

Copyright:

Available Formats

Ot - Role of Ot in Pulmonary Rehab

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ot - Role of Ot in Pulmonary Rehab

Uploaded by

Copyright:

Available Formats

CONTINUING EDUCATION

for Occupational Therapists

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 1

2 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 3

4 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 5

6 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 7

8 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

Typical Settings Associated with Occupational

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 9

10 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 11

12 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 13

14 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 15

16 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 17

18 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 19

20 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 21

22 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 23

24 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

RESOURCES 6.  han, S.C.C. (2004). Chronic Obstructive

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 25

26 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 27

28 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 29

30 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

Address: ________________________________________________________City: ___________________________________

State: ____________________________________ ZIP: ___________________Country_________________________________

Phone: __________________________________ Email: ________________________________________________________

Other: License/certification # and issuing state/organization_________________________________________________

Clinical Fellow: Supervisor name and NCBOT account #____________________________________________________

Graduate Student: University name and expected graduation date___________________________________________

The Role Of Occupational Therapy

Accessibility and/or special needs concerns?

Refund and general policies are available online at

OCCUPATIONAL THERAPISTS The Role of Occupational Therapy in Pulmonary Rehabilitation | 31

❑ PT ❑ PTA ❑ OT ❑ OTA ❑ SLP ❑ SLPA Other: _______________________________________

What suggestions do you have to improve this program, if any?

What educational needs do you currently have?

What other courses or topics are of interest to you?

32 | The Role of Occupational Therapy in Pulmonary Rehabilitation OCCUPATIONAL THERAPISTS

You might also like

RESOURCES 6. han, S.C.C. (2004). Chronic Obstructive

Address: ______________________City: _

State: __________________________ ZIP: _Country_________________________

Phone: Email: ______________________