SCFHS Occupational Therapy Complete Review Guide 2026–2027

4. Brunnstrom stages: 1 flaccid, 2 spasticity begins with minimal synergy, 3 voluntary synergy with peak spasticity, 4 movement out of synergy as spasticity declines, 5 complex movement independent of synergy, 6 isolated joint movement.
5. Constraint-induced movement therapy (CIMT) usually requires about 20° of active wrist extension and 10° of finger extension.
6. Unilateral neglect is treated with visual scanning anchored on the neglected side; pusher syndrome uses a visual vertical reference and reaching toward the stronger side.
7. The flaccid shoulder after stroke is supported on a lap tray or arm trough in good alignment, and the arm is never pulled, to avoid subluxation.
8. Cord levels: C4 has no functional arm movement and uses a power chair with sip-and-puff or head control; C5 moves shoulder and elbow and needs a mobile arm support and universal cuff for feeding; C6 extends the wrist and uses tenodesis.
9. C7 has triceps and can do depression push-ups for transfers and pressure relief; C8 brings functional finger flexion; a person with complete T10 paraplegia can be independent in self-care and transfers.
10. AIS: A complete, B sensory-only incomplete with sacral sparing, C motor incomplete with fewer than half of key muscles below the level at grade 3 or more, D at least half at grade 3 or more, E normal. The motor level is the lowest key muscle at grade 3 or more with those above normal.
11. Autonomic dysreflexia occurs at T6 and above: pounding headache and hypertension; sit the patient up, loosen clothing and check bladder and bowel.
12. Parkinson disease: resting pill-rolling tremor that lessens with movement, rigidity, bradykinesia; micrographia is treated with large-amplitude writing on targets, and freezing of gait is broken with visual cues such as a line on the floor.
13. Hoehn and Yahr: 1 unilateral, 2 bilateral without balance impairment, 3 bilateral with postural instability, 4 severe disability but still walking, 5 wheelchair or bed bound. Schedule demanding tasks in the medication 'on' period.
14. Multiple sclerosis: fatigue is key and is managed by energy conservation (sitting, avoiding heat, scheduled rests). The Uhthoff phenomenon is a temporary worsening in heat. The MFIS measures the impact of fatigue.
15. ALS affects motor neurons and sensation is spared; plan equipment early (power chair with head support) and use eye-gaze communication devices in advanced disease.
16. The remedial approach aims to restore the cognitive skill itself; the adaptive approach modifies the environment and task and trains the carer. Toglia's multicontext approach trains awareness and one strategy across varied tasks.
17. Assessments: MoCA is more sensitive than MMSE for mild impairment; EFPT observes real tasks; LOTCA is a cognitive-perceptual battery; BIT tests neglect; AMPS rates motor and process skill quality; Fugl-Meyer measures upper-limb motor recovery.
18. Modified Ashworth: 0 no increase, 1 slight catch, 1+ catch then minimal resistance through less than half the range, 2 marked increase through most of the range, 3 considerable increase, 4 rigid. Rigidity is resistance independent of speed in both directions.
19. NDT uses key-point handling and weight-bearing on the affected side; Rood uses neutral warmth and slow stroking to inhibit tone; the PNF D2 flexion pattern combines shoulder flexion, abduction and external rotation.
20. Serial casting gives prolonged low-load stretch to reduce contracture; after botulinum toxin, combine stretch, orthoses and functional training while tone is low. A resting orthosis holds slight wrist extension, slight finger flexion and an abducted thumb.

Common mistakes in this chapter

• ✕ Ideomotor apraxia (fails on command but performs automatically) differs from ideational apraxia (errors in sequencing and using objects in a multistep task).
• ✕ Right-hemisphere stroke gives neglect, impulsivity and poor insight; left-hemisphere stroke more often gives slow, cautious behaviour and language difficulty.
• ✕ In one-handed dressing, the affected arm goes in first and comes out last.
• ✕ In autonomic dysreflexia, do not lay the patient flat: sit him up, lower the legs, loosen tight clothing, then check the catheter and bowel.
• ✕ For orthostatic hypotension after a cervical injury, tilt the chair back and elevate the legs rather than keeping the patient upright.
• ✕ Parkinson tremor is worse at rest and lessens with purposeful movement; the intention tremor of MS gets worse as the hand nears the target.
• ✕ Modified Ashworth 1+ is a catch followed by minimal resistance through less than half the range, not the whole range.
• ✕ A screen such as the MMSE can look normal despite executive problems; observe a real task (EFPT) or use the MoCA.