Geri Midterm

Question 1

Alzheimer’s Disease

Answer 1

• most prevalent type of progressive dementia
• lifespan = 4-8 years after receiving dx
• probs with remembering names of individuals and recent events
• lack of interest/depression
• decline in communication ability
• decline in judgement
• disorientation/confusion (*especially in new environment)
• off-set circadian rhythm (sleep/wake cycle)
• change in behaviors
• end stage: probs with gait, speech, swallowing
• most die from secondary cause of aspirating pneumonia

Question 2

Vascular Dementia

Answer 2

• insufficient O2 blood getting to the brain
• common causes are: stroke, TIA, untreated high BP
• disease tends to plateau to huge decline
• impairments in executive functions
• confusion/disorientation
• loss of vision
• lang probs
• impaired decision making and judgement
• decrease in ability to plan and organize
• daily fluctuations in cognition
• sx can be similar to AD (Alzheimer’s) or be more localized

Question 3

Dementia with Lewy Bodies

Answer 3

• probs with attention
• impairments in memory
• sleep disturbances (violent)
• visual hallucinations (often small children and animals)
• thinking and reasoning probs
• confusion and varied alertness
• memory loss
• Parkinsonian type mvmnts
• Probable dx, has to be definitive by autopsy

Question 4

Dementia with Lewy Bodies: Parkinson’s dementia

Answer 4

-starts with motor component then cognitive issues (pt has Parkinson’s)

Question 5

Dementia with Lewy Bodies (parkinsonian onset)

Answer 5

-starts with cognition probs then motor component

Question 6

Frontotemporal Dementia

Answer 6

• common with 45-65 years old
• frontal and temporal lobe affected
• changes in personality and behavior
• lang probs
• alterations in muscle and/or motor functions
• changes in behavior
• “drunk like” behavior (slurring, uncoordinated, impulsive)

Question 7

Mixed Dementia

Answer 7

• Two or more types of dementia
• More than one type occurring together
• Often Alzheimer’s and Vascular

Question 8

Stage 1 Dementia

Answer 8

• normal
• NO cognitive changes
• NO decline in functioning

Question 9

Stage 2 Dementia

Answer 9

• normal age related changes
• NO dx
• subjective deficits in word-finding or recalling location of objects

Question 10

Stage 3 Dementia

Answer 10

• mild COGNITIVE impairment
• mental age = 12+ years
• aware of deficits
• try to hid deficits
• own strategies to compensate
• can become angry when asked questions they have difficulty with (hiding deficit)
• forgets if they do not write it down
• usually still driving
• trouble with directions in new places
• home is stills safe
• independent in ADL, IADL (may question judgement)
• slight judgement issues
• descriptions lack detail
• unable to recall names of people and objects

Question 11

Stage 4 Dementia

Answer 11

• mild dementia
• mental age = 8-12 years
• challenges set in
• things are difficult (i.e. forget to pay bills)
• repeating stories
• having trouble staying on topic in conversations
• distracted by surrounding environment
• can still learn
• good stage for implementing new learning (i.e. mobility device, checklist)
• assistance in IADLs
• still independent in ADLs
• supervision in cooking
• assisted living, suite in fam home
• asks questions over and over
• impaired comprehension
• greater effort to perform tasks

Question 12

Stage 5 Dementia

Answer 12

• moderate dementia
• mental age = 5-7 years
• cross over of being aware to not being aware
• caregiver responsibility
• NOT safe living at home alone
• live in caregiver, supervised institution
• can dress but not aware of weather outside
• disheveled look
• will not remember to wash clothes
• can bathe and toilet but hygiene is questionable (i.e. wash front but not back)
• changes can become evident in tone, reaction time, movement time, and gait

Question 13

Stage 6 Dementia

Answer 13

• moderate to severe dementia
• mental age = 2-5 years
• same level of assist for BADLs
• difficulty with utensils
• toileting program
• assistance in dressing, help with getting clothing on
• 24 hour supervision for safety
• assistance in basic tasks (dressing, eating, toileting)

Question 14

Stage 7 Dementia

Answer 14

• severe dementia
• mental age = 2 months-1.2 years
• primitive reflexes come back
• incoherent
• incapable of speech
• completely disoriented
• cannot recognize relatives
• incontinent in both bowel and bladder
• dependent on others for ALL tasks
• will not remember to breathe
• cannot sit up and hold head up
• trouble swallowing
• primitive reflexes: rooting, palmar, babinski
• contractures are most common in this stage

Question 15

ARMD (amacular degeneration)

Answer 15

• inability to see centrally
• central vision loss
• straight lines look wavy
• corrective lens surgery
• special vitamins and healthy diet can help with dry management to less the change of sx worsening

Question 16

Dry ARMD

Answer 16

• common
• macula gets thinner with age
• tiny clumps of protein growing
• can develop into wet form
• can learn to read out of periphery

Question 17

Wet ARMD

Answer 17

• less common
• more serious
• new abnormal blood vessels grow
• scarring of macula

Question 18

Cataracts

Answer 18

C=Cloudy

• cloudy lens
• common dx
• decreased color sensitivity and glare
• alot of sunlight is too bright
• surgical procedure

Question 19

Diabetic Retinopathy

Answer 19

• vision loss in diabetes
• spots or blotches
• blood vessels in retina bleed
• injections
• laser tx
• eye surgery
• important to control blood glucose level

Question 20

Glaucoma

Answer 20

• progressive optic nerve damage
• loss of peripheral vision
• headaches
• tunnel vision
• surgery
• open angle
• closed angle

Question 21

Glaucoma: closed angle

Answer 21

• not as common
• medical emergency
• increase in pressure
• bad headache
• halo around lights
• pain in the eye

Question 22

Visual Acuity

Answer 22

• the smallest high contrast detail that one can resolve
• decline in near vision is inevitable by age 40-45
• cataracts affects acuity

Question 23

Contrast Sensitivity

Answer 23

• ability to see larger low-contrast objects
• measures how faded or washed out an image can be before it becomes indistinguishable
• cataracts affected the most with contrast
• impairments in: driving, mobility, face recognition, additional ADLs

Question 24

Visual Field

Answer 24

• the amount an individual can see while looking straight ahead while fixated on one point
• when closing one eye it opens up the visual field more
• Amsler grid test (dot test, ARMD = if lines are contured or distorted it has become the WET form of ARMD)

Question 25

Medicare

Answer 25

health insurance for: - over the age of 65 years - under the age of 65 years with a specified disability - federally funded health insurance - pays for health care services - end stage renal disease - ALS

Question 26

Medicare: Automatic Eligibility

Answer 26

- over 65 years and older and receives social security benefits or railroad retirement board - younger than 65 years with certain disability if receiving social security benefits or railroad retirement board for 2 years - ALS (within the month that disability benefit starts) - paid into social security for a certain amount of years

Question 27

Medicare: Requires Enrollment

Answer 27

- over 65 years and not current getting social security benefits or railroad retirement board - has end stage renal disease - is not eligible and wants to buy in

Question 28

Medicare Part B: Durable Medical Equipment (DME) Coverage

Answer 28

- w/c - walker - 3 in 1 commode

Question 29

Therapy: Medicare Part A

Answer 29

- has to have a minimum of 3 day stay at the hospital - 100 day per benefit period - day pt gets to the SNF is when benefits start - re-access if readmitted to SNF within 30 days - inpt hospital care - surgical procedures - lab tests - skilled nursing facility - hospice care - home health care

Question 30

Therapy: Medicare Part B

Answer 30

- has a therapy cap every year - once cap is up there is a kx modifier for justification of services - preventative services - MD and other health care services and tests - outpatient care - DME - ambulance services

Question 31

Therapy: Medicare Part C

Answer 31

-health coverage option run by private insurance companies approved by and under medicare contract

Question 32

Therapy: Medicare Part D

Answer 32

- D = Drugs - prescription drug coverage option run by private insurance companies approved by and under contract with Medicare - helps to cover cost of prescription drugs

Question 33

Individual

Answer 33

- treatment of one pt at one time by one therapist - the pt is receiving the therapists full attention - Medicare part A and B: tx session mins may be billed in full - what we should be planning for

Question 34

Co-treatment

Answer 34

- only one pt - 2 different disciplines treating pt as a team - both disciplines have different treatment focus - identify why we provide co-treatment (justification)

Question 35

Co-treatment: Medicare part A

Answer 35

-both disciplines with different focus can bill tx in full

Question 36

Co-treatment: Medicare part B

Answer 36

- entire time billed for day cannot exceed actual time the pt got - time must either be divided by disciplines or one therapist may bill for the entire time

Question 37

Concurrent

Answer 37

- tx of 2 pts by same therapist at same time performing DIFFERENT TASKS with one therapist - OT splitting attention between pts

Question 38

Concurrent: Medicare part A

Answer 38

-bill full time under concurrent tx

Question 39

Concurrent: Medicare part B

Answer 39

- does NOT exist | - have to bill as group

Question 40

Group: Medicare part A

Answer 40

- tx of 4 or more pts by one OT | - tx of 4 ore more pts at the same time who are doing the same or similar activities with one therapist

Question 41

Group: Medicare part B

Answer 41

- tx of 2 or more pts (no more than 4) by one OT | - tx of 2 or more pts at the same time who are doing the same, similar, or different activities with one therapist

Question 42

Skilled Services (Billable)

Answer 42

- set up time if it proceeds tx - rehab aide bringing over equip - education if pt is present and involved - re-eval as long as pt is involved and it is part of tx process - attended modalities (i.e. ultrasound) - development of maintenance program and caregiver training with the pt present in preparation for d/c - time spent incorporating documentation into tx if pt is involved for educational purposes - point of care services (iPad, computers)

Question 43

Non-Skilled Services (NOT Billable)

Answer 43

- actual time on modality that is unattended - demonstration and performance of HEP - initial eval - time spent talking to pt if they refuse tx - non-therapeutic rest break (i.e. bathroom) - working outside requirements of the therapy mode - services requested by family - documentation when pt is not present - non-skilled portion of administering modality

Question 44

Medicare Part B (8 min rule)

Answer 44

- reimbursement based on 8 min rule - bill for whatever modalities (CPT codes) we are providing for exact amount of mins - reimbursement is based on value of CPT codes

Question 45

Medicare Part B: Untimed Codes

Answer 45

- group - modalities - evaluation