OT PROCESS FINAL EXAM QUESTIONS & ANSWERS, Exams of Nursing

Download OT PROCESS FINAL EXAM QUESTIONS & ANSWERS and more Exams Nursing in PDF only on Docsity! OT PROCESS FINAL EXAM QUESTIONS & ANSWERS Who do OTs need a referral from, if health insurance will reimburse services? - Answers -Physician Which of the following is not within the domain of OT? Client Factors Context/Environment Performance Skills Scope of Practice - Answers -Scope of practice Which term below is NOT part of the context subdomain? Physical Personal Social Values, Beliefs, Spirituality - Answers -Values, Beliefs, Spirituality --> Client Factors What does the s in SOAP stand for? - Answers -Subjective What are the different client factors? - Answers -Values, Beliefs, and Spirituality Body Functions Body Structures What are the different performance skills? - Answers -Motor Skills Processing Skills Social Interaction Skills What are the different performance patterns? - Answers -Roles, Routines, Rituals, and Habits What are the different Contexts & Environments? - Answers -Contexts: -Cultural -Personal -Virtual -Temporal Environments: -Physical -Social Purpose of the Occupational Therapy Scope of Practice - Answers -Defines OTs scope of practice Delineates the domain of practice/services The dynamic practice of OT eval/intervention and describes the education/certifications required to practice OT Informs clients, policy makers, funding and referral agencies of OTs scope of practice Occupational Therapy Scope of Practice: Referrals - Answers -Referrals are not required per OT BUT laws and payment policy's may require a referral Occupational Therapy Scope of Practice: Persons/Groups/Populations - Answers - Services are provided to persons, groups, or populations Occupational Therapy Scope of Practice: Autonomous Practitioner - Answers -"OTs are responsible for the safety and effectiveness of the occupational therapy service delivery process" Practice Settings - Answers -Acute Care Hospital Skilled Nursing Facility Home Health In-patient Rehab Out-patient Rehab Pediatric Settings Acute Care Hospital - Answers -EX: injury, illness, surgery Goal: Medical stabilization--> when needs are no longer acute OTs Role -IADL/BADL performance within the scope of illness/injury -Seek to restore prior level of function (PLOF) -Recommend discharge location/assess for discharge location (SNF, Outpatient Rehab, Inpatient Rehab, Home with homecare, etc.) Skilled Nursing Facility (SNF) - Answers -More medical care needed Cannot participate in 3 hrs/day of therapy Can participate in lower intensity therapy (up to 1.5 hrs/day) Home Health - Answers -Must be so limited that they are homebound Inpatient Rehab - Answers -Potential to participate in up to 3hrs/day diet PMH/PSH consultations/other disciplines nursing and physician notes precautions -things to watch out for -EX: hx of falls, thickened liquids, allergies note "out of the norm" Evaluation Approaches - Answers -Bottom Up Top Down Bottom Up Evaluation Approach - Answers -Use with major or urgent health concerns -EX: burns, coma, multiple traumas, fractures, hand trauma Settings: -Acute care, esp. ICU "If body functions improve, so will occupation" Start with fundamental factors to understand the client's limitations, disabilities, strengths Occupational Performance Client's roles and meaningfulness Top Down Evaluation Approach - Answers -Use when occupational performance is the major concern Limited # of standardized assessment tools for occupations Emphasizes a holistic approach Assess client's roles and meaningfulness -determine what tasks define each role -consider whether client can do these tasks -determine probably barriers Foundational factors to understand clients limitations, strengths, disabilities, etc. Best evaluation approach - Answers -Combination of bottom up and top down Parts of an Evaluation - Answers -Occupational Profile Performance analysis -Clinical observations -Standardized assessment Evaluation: Occupational Profile - Answers -Informal or Formal Interview -PLOF -PMH/PSH -Use structured interview (like COPM) if appropriate What is the correct order of the OT Process? - Answers -Referral, Evaluation, Treatment, Monitor Outcomes What is NOT part of the intervention process? - Answers -Intervention timeline What are the two main parts of an evaluation? - Answers -Occupational profile & Occupational analysis of performance When would a screen be used? - Answers -To determine if a full eval is needed A splint is an example of what type of intervention? - Answers -Preparatory Method What are the 2 components of a problem statement? - Answers -Area of occupation & contributing factor Who is the scope of practice written for? - Answers -Consumers & Other professionals outside of OT "Sequencing dressing" falls under what subdomain? - Answers -Process skills The purpose of COAST is to: - Answers -Outline goal writing What group is the primary audience of the OTPF - Answers -OTs What practice setting requires that the person tolerate 3 hours of therapy per day? - Answers -Inpatient therapy T or F: In SOAP notes, the first step of the objective section includes a statement about the length, setting, & purpose of the treatment session - Answers -True What type of intervention focuses on facilitating the client to attain specific concrete skills to meet specific goals? - Answers -Education and Training Social interaction skills are what type of skills? - Answers -Performance skills What part of the SOAP format for documentation does the phrase "continue OT 5x/wk for 2 wks to address BADL and IADL" fit in? - Answers -P (plan) Which of the following is a part of the screen? OT profile Occupational performance analysis Recommendation for continued tx or discharge Brief consult on current performance - Answers -Brief consult on current performance T or F: COAST stands for client, occupation, assist level, setting, timeline - Answers - False Client, occupation, assist level, specific condition, timeline Hotpacks are an example of what type of intervention? - Answers -Preparatory Method What intervention approach focuses on keeping a client at a current level of function? - Answers -Maintain Approach A ball, basketball hoop, and basketball shoes would go into what part of an activity analysis? - Answers -Objects and Properties used A client's garden would be what part of an activity analysis? - Answers -Space demands Patty had a really tough time tying her shoe. She cried and grew really frustrated, but with your OT coaching she did the task successfully and ended with a big smile on her face. The OT's role in this activity is an example of what? - Answers -Therapeutic use of self What is NOT a primary part of the evaluation process? - Answers -Activity Analysis What are the 5 Domains of OT? - Answers -Occupations Client Factors Performance Patterns Performance Skills Contexts & Environments What are the different of occupations? - Answers -BADLS, IADLS, Rest & Sleep, Leisure, Work, Education, Play, Social Participation Evaluation: Performance Analysis - Answers -Clinical Observations and at least 1 Standardized/Specific Assessment 3. (contributing factor) results in (what occupational deficit) EX: Inability to flex hips over 90 degrees results in mod A with sit <> stand from toilet to/from walker Components of a Treatment Plan - Answers -Frequency -EX: 2x/week Duration -EX: for 4 weeks Recommended Treatment -EX: Utilizing equipment training, BADL training, Patient education Established with patient/caregiver EX: client will be seen 1x per week for 8 weeks to address sensory integration, BADL, functional cognition & education. Client and caregiver agree to plan Goal writing - Answers -Goals MUST be collaborated and agreed upon with the client Why? --> Sets the basis for the therapeutic relationship -helps clients see where they can get, motivate, and encourage -set the precedent for active participation in the intervention Long term goals: occupation and function -1 to 3 month time length Short term goals: specific skill building -2 to 4 week time length Goal writing criteria: COAST - Answers -C: client will (perform, demonstrate, complete, etc.) O: occupation A: assist level/predicted level of measurement S: specific conditions (location, adaptive equipment, modified technique) T: timeline -short term goals: 2-4 wks -long term goals: 1-3 months--may be discharge date Measurable Goals - Answers -Assist level and specific conditions Goal must be clear and attainable Quantity helps to prove that carryover is happening To continue justifying OT services to funding sources Ways to quantify goals -% of time -# of reps -# of minutes/seconds/days of social participation, activity, tolerance, etc. Use specific performance skills, body functions, and assessments to measure improvement Think consistency--> anyone can read and know exactly when the client has met that goal Purpose of Intervention - Answers -Meet established goals and carry out treatment plan Intervention approaches - Answers -1. Create/Promote 2. Establish/Restore/Remediate 3. Maintain 4. Modify/Compensate/Adapt 5. Prevent Intervention approaches are global approaches which specify what type of approach is "best practice" to meet goals --can help guide types of intervention used in each treatment session Create/Promote - Answers -No preexisting condition necessary Aims to optimize performance for everyone through education or programming Establish/Restore/Remediate - Answers -Most often used treatment approach Enable the emergence of skills that are not currently present Or bring back performance skills or body functions that have been damaged Often a longer time period to recovery Maintain - Answers -Focus is on keeping client at current level of function, preventing decline in function Modify/Compensate/Adapt - Answers -2nd most often used treatment approach Changes performance through adaptive equipment or changes to environment, context, or activity Immediately improves performance Used frequently for conditions or deficits that will not remediate Used often in coordination with remediation Prevent - Answers -Anticipates and blocks barriers to participation Intervention Types - Answers -1. Occupations and Activities 2. Preparatory Methods and Tasks 3. Education and Training 4. Advocacy 5. Group Interventions Occupations and Activities - Answers -Occupations -daily life activities that match/support the goal Activities -selected tasks to support performance skills and performance patterns to enhance occupational engagement -normally components of occupations -are alway meaningful, relevant, and at the client's level of interest Preparatory Methods and Tasks - Answers -Preparatory Methods -modalities, devices, & techniques to prepare the client for occupational performance -PASSIVE participation -EX: splints, ESTIM, etc. Preparatory Tasks -actions targeting specific client factors or performance skills -ACTIVE participation required -may not hold inherent meaning or relevance -EX: swing, obstacle, tactile sensory kit Education and Training - Answers -Education -relearn occupation, health, well-being, participation --> helps client acquire helpful behaviors, routines, habits --> goal is to enhance understanding P of SOAP note - Answers -Plan Frequency, duration, purpose fo continued therapy Purpose = specific interventions that will be utilized to address deficits Intervention Documentation - Answers -Completed after each session in a contact/daily note -SOAP -Different formats per setting Summarized monthly in a progress note Occupations-As-End - Answers -Activities and tasks that comprise the patients perceived life roles Performing occupations within a natural, meaningful context Occupation-As-Means - Answers -An activity that is to be used to restore one or more skills Using occupations or activities in a way to restore one or more skills List the 5 Approaches to Intervention - Answers -Create, Promote Establish, Restore, Remediate Maintain Modify, Compensate, Adapt Prevent What two are the most commonly used treatment approaches? - Answers -1. Most commonly used approach: Establish, Restore, Remediate 2. Second most commonly used approach: Modify, Compensate, Adapt What approach requires no pre-existing conditions and aims to optimize performance for everyone through education or programming - Answers -Create, Promote What approach enables the emergence of skills that are not currently present or brings back performance skills/body functions that have been damaged? - Answers -Establish, Restore, Remediate What approach focuses is on keeping the client at a current level of function, preventing decline in performance - Answers -Maintain What approach changes performance through adaptive equipment or changes the environment, context or activity and immediately improves performance? It is frequently used in coordination with a remediation approach for conditions or deficits that will not remediate - Answers -Modify, Compensate, Adapt What approach anticipates and blocks barriers to participation? - Answers -Prevent What are the 5 types of intervention? - Answers -Occupations and Activities Preparatory Methods and Tasks Education and Training Advocacy Group Interventions During the second part of the session Susan has Brandon work on a series of table-top activities using Handwriting without Tears (HWT) materials. After completing the HWT activity Susan is helping Brandon to print his first and last name. In addition to the HWT materials Susan provided verbal instructions, feedback on his performance, and encouragement to Brandon throughout his activity. The verbal cues, feedback, and encouragement provided by Susan are examples of what? - Answers -Coaching The OT identifies the client's concerns about occupations and daily life performance, and the client's priorities and values are explored. The OT analyzes the client's occupational performance to identify performance issues and factors that hinder or facilitate performance. The actions taken by the OT are part of what process? - Answers -Evaluation process Jane is a 76 year old grandmother who recently had a CVA and is in a skilled nursing facility in a rural location. She reports that her family is her world (her daughter and her family live right next door), and she enjoys knitting and spending time watching her grandchildren. In the SNF, she is feeling very isolated and growing depressed. When you treat Jane, you intentionally relate activities and tasks back to watching her grand children and her "grandmother" role. Through this, you notice that her motivation to get better improves through her treatment sessions. What is the primary approach that you are using? - Answers -MOHO The OTPF describes performance skills as "features of what one does, not what one has, related to observable elements of actions that have implicit functional purposes". The categories that make up performance skills include: - Answers -Motor skills Process skills Social skill You are working with a 22 year-old client who diagnosed with post-concussion syndrome. You asked him to identify activities that are giving him the most difficulty. The client reports that since his concussion he has trouble sleeping at night and is tired all the time. He has trouble paying attention during his evening college class and is not doing well in class. He also works part time at a gas station and has trouble keeping up if things get too busy and his boss has written him up several times. he says he is having difficulty being with his friends because they say he is "different" since his accident. He gives an example: he has trouble paying attention during activities such as frisbee golf and keeping score during the game. When you complete your evaluation what categories would you refer to when identifying his reported problems? - Answers - Rest and Sleep, Education, Work, Play and Leisure Patty leads an OT exercise group. Most often they use theraband or hand weights and perform UE shoulder flexion, adduction/abduction, internal/external rotation, bicep curls, triceps, wrist flexion/extension to maintain upper extremity strength and support occupational performance. What FOR is patty using? - Answers -Biomechanical According to the OTPF, the sequence of the OT process is... - Answers -Evaluation, intervention, and outcomes "Client will demonstrate toilet transfer with mod I 2 times in 2 weeks" This goal is missing what component of the COAST? - Answers -S--Specific Conditions An OT is working with a 35 year old man that has had an incomplete spinal cord injury at the C6 level. She orders a tub bench with waist strap for the shower. This is an example of what? - Answers -Adaptation/Modification "Client will attend 1 occupational therapy session weekly x 6 weeks to address visual perception, strengthening, and IADL performance" this statement would belong in what area of a SOAP note? - Answers -P: Plan Judy is a student, friend, and a worker. These are examples of her... - Answers -Roles STG: "Client will verbalize 5 shoe tying steps x 4 I'ly after 1 request in 2 weeks" LTG: "Client will complete 2/4 steps of shoe tying with 1 v/c using 2 different color shoelaces 4 times in 4 weeks" What would be the best FOR to use as the primary approach to meet these goals? - Answers -Skill Acquisition Susan is working with Brandon, a 7 year old with autism that has SUR (sensory under- responsivity). Brandon's parents have asked the OT to focus on activities to improve You are working with a 4th grader with Dyslexia. You use the SETT framework to trial text-to-speech software, WYNN Wizard. It is effective in nearly immediately improving her reading comprehension. What FOR are you using to improve her reading comprehension? - Answers -Rehabilitative "Ct utilized static tripod grasp to handwrite 4 sentences on ruled paper, 3 words each with irregular spacing and overall fair legibility." This is an example of a statement that would go in what section of a SOAP note? - Answers -O: Objective "Client will thread and don pants with mod I using reacher sitting EOB, with min A to stand at RW to pull up pants over hips, in 2 weeks." What FOR does this goal utilize concepts from? - Answers -Rehabilitative Olive has experienced a TBI with resulting impulsiveness and minimal left hemiplegia, and is in inpatient rehab. Last week, to work on memory and attention to cues, the OT used worksheets with the goal of "finding the differences" in a quiet room, where she participated well. In today's OT session, Olive went into a quiet kitchen. Olive will practice making a Turkey sandwich by following 5 written steps to retrieve the items from the refrigerator, opening/close containers, spread mayo and layer ingredients in a specific sequence. Next week the OT will begin working with Olive doing similar tasks in busier environments. Her LTG is to make Macaroni and Cheese mod I. What is the primary FOR being used to help Olive reach her goal? - Answers -Cognitive Rehab MOHO - Answers -Model of Human Occupation MOHO Population of Focus - Answers -General model of practice that applies to all people, in all settings Focus of MOHO - Answers -Our mind-body connection is imperative, and influences our internal motivation and (external) performance of occupations Interaction between the person and the environment MOHO Addresses - Answers -Motivation for occupation Routine patterning of occupations Nature of skilled performance Influence of environment on occupation MOHO's Theoretical Base - Answers -Biology -We are designed to be active Thinking, feeling, and doing (actions) are results of people's biological makeup interacting with the environment -Nature vs. Nurture Open Systems Theory -Capable of change -Through feedback -Regardless of our environment, we are able to change things within ourselves to become better or worse MOHO's theory regarding change - Answers -By influencing a person's environment or performance, we may change their identity, adaptation, and competence MOHO: Open System Cycle - Answers -Input: external information taken in through the senses -->Person: volition, habituation, mind-brain-body --> Skill action/Occupational performance --> Environment: physical and social components A dynamic process in constant motion We get an idea of how a person is feeling through their externally displayed goal- directed actions Volition - Answers -Motivation for occupation Habituation - Answers -The organization of occupation into patterns or routines Performance capacity - Answers -Physical and mental abilities underlying skilled occupational performance AKA: mind-brain-body performance What are the 2 main constructs of MOHO - Answers -Person and Environment MOHO: Function looks like - Answers -Exploration Competence Achievement MOHO: Dysfunction looks like - Answers -Helplessness Incompetence Inefficacy MOHO is the primary frame when... - Answers -*You are building an occupational profile with a client *When a child is having a difficult time exploring their environment *When someone is showing a lack of motivation--decreased participation *When someone is lacking the skills to succeed in their roles *When there is more than just a pure physical deficit EX: with a physical deficit, the person is feeling depressed, has bad coping skills, feels ineffective in their roles, etc. *When there is a disconnect between what the person can do and what the person wants to do/values *When someone is having a difficult time completing meaningful occupations efficiently due to their environment Biomechanical Frame of Reference Population/Focus - Answers -Used in patients that have musculoskeletal disorders or orthopedic injuries Whenever a patient presents with decreased structural stability, strength, and ROM that is NOT of neurologic origin -Edema, pain, etc. Do NOT use if spasticity is present Uses prep method and prep task types of intervention Establish, restore, remediate approach Bottom up approach -By fixing the physical deficits, occupational performance will improve Patient can already move in a normal movement pattern Theoretical Basis for Biomechanical FOR - Answers -Kinesiology Anatomy Physiology ROM -Angles and directions of human movement Kinematics -Underlying concepts of maintaining balance and stability Loss of selective movement control (contralateral) Abnormal tone Associated Reactions -Involuntary on the affected side, with voluntary movement on unaffected side Presence of primitive reflexes which can interrupt voluntary control Theories regarding CHANGE in NDT - Answers -Hypertonia: -Passive muscle elongation -Reflex inhibiting patterns (RIPs) -POSITIONING -WEIGHT SHIFTING to inhibit hypertonia Hypotonia: -Joint compression -Joint traction -WEIGHT SHIFTS to facilitate increased tone Reflex Inhibition combined with FACILITATION of normal movement patterns -Automatic Reactions Limb control is facilitated through disassociation of synergy patterns, reflex inhibition, and limb weight shift HANDLING: -Use of HANDS-ON technique to address problems with tone and postural control -EX: being able to put more input through joints and heavy weight can change posture PLACEMENT: -OT placing hands on "key points of control" -EX: holding on the joints to reduce the sensory impact of your hands FACILITATION: -Giving the client's the sensation of normal movement -Going with the typical order of movement -EX: range the shoulder, then elbow, then wrist, then fingers RIPs: -Positioning clients in ways that reduce tone by inhibiting specific primitive reflexes Hands on physical input to facilitate movement pattern changes -Heavy weight shifting -Weight bearing -Proprioception -Quadruped: helps to break up tone NDT is the primary FOR when - Answers -*When spasticity is present *When patients have motor issues and tone is present *WHEN PATIENTS HAVE ABNORMAL MOVEMENT PATTERNS *When patients have spasticity or hypotonia affecting their movement patterns *When clients have persistent primitive reflexes *For patients with CP and the presence of tone *When the focus is on remediation body skills through addressing motor control problems *When primitive reflexes reemerge following TBI or spinal cord injury *When clients lack postural control Motor Skill Acquisition FOR Population/Focus - Answers -Emphasis is placed on learning in a natural setting TASK SPECIFIC Emphasis is on OCCUPATION Mainly used in pediatrics, but may be applicable to adults as well Task oriented approach to relearning motor skills Specific guidelines for restoring functional movement Restoration/Remediation approach Goal: Specific task accomplishment Associated with the occupation and activity intervention type Theoretical basis for (Motor) Skill Acquisition FOR - Answers -Psychology, behavioral sciences, neurology, medicine, and allied health research Began from the study of normal development Restoration of function should NOT be separate from specific tasks or environments Practice is important -In specific and random order Transfer of learning is easier in similar conditions Schmidt's Schema: Movement characteristics to consider -Timing of components will be different for different tasks -Relative forces reduced by components -Sequence of events involved in action -Spatial configuration Open Tasks: -Environmental factors change from trial to trial Closed Tasks: -Tasks in which temporal environmental factors remain stationary and fixed from trial to trial Learning Theory Through the Skill Acquisition FOR function looks like: - Answers -No specific criteria Defined within specific tasks Smooth, efficient movements Through the Skill Acquisition FOR dysfunction looks like: - Answers -Stiff coordination, jerky movement quality Difficulty performing tasks Theory regarding CHANGE in the Skill Acquisition FOR: - Answers -We can impact change and motivation through analyzing the match between person and task Impacting Change: -Trial and Error -Practice and Refinement Impacting Motivation: -Client-centered selection of tasks -Challenging yet meaningful Use open tasks when possible In early stages, use blocked (consistent) practice In the middle stages, once the client can perform movement at any level, introduce random practice Arrange the session to learn several tasks at the same time, and randomly (avoid repetition) Theoretical Basis for Cognitive Rehabilitation FOR - Answers -Based on neurophysiological, neurobiological, and neuropsychological principles Developmental and information processing Provides a framework for cognitive learning Through the Cognitive Rehabilitation FOR function looks like: - Answers -Appropriate performance with cognitive subcomponents Adequate level of arousal Performance with daily tasks at a typical level for function of that person Through the Cognitive Rehabilitation FOR dysfunction looks like: - Answers -Negative variance from function Impacting CHANGE through the Cognitive Rehabilitation FOR - Answers -We can impact change by encouraging the client to complete tasks to their ability level, increase the difficulty as the client master's tasks, use specific strategies for each component, and by addressing components of cognition first: -Perception -Visual motor organization -Thinking operation -In clinic environment (quiet vs. noisy) Cognitive Rehabilitation FOR is primarily used when: - Answers -*When a client has a neurological disability that affects their cognition -Difficulties with motor planning, spatial neglect, visual perception, self awareness, attention, memory, and executive functioning *When client's have neglect *Enhancing retained cognitive abilities *When you want to develop self-awareness *When you need to use remedial cognitive training strategies for: -visual perception -visual-motor integration -thinking operations *When you want to implement learning strategies for BADLs *When you need to improve executive functions *Following a TBI or concussion that has impacted cognition Sensory Integration FOR Population/Focus - Answers -Used in ALL settings: acute care to home health to outpatient pediatric settings Primary Diagnosis: -Pediatrics: Attention hyperactivity, poor postural control, balance, apraxia, inefficient cognitive processing -Adult Mental Health -Coma -Geriatrics: Dementia Remediation of body skills Theoretical Basis of SI FOR - Answers -Neuroscience: sensory integration Developmental theories Sensory Integration: the brain's ability to organize sensory information received from the body and the environment, and to produce an adaptive response Jean Ayres on Sensory Integration 1972: "The neurological process that organizes sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment" 5 Assumptions of SI: 1. Plasticity of the CNS -Plasticity: the brain is able to reorganize itself 2. Sensory Integration develops in stages -Tactile, proprioceptive, and vestibular integrate within the first year of life -Emotional stability and body perception: the ability to PROCESS tactile, proprioceptive, and vestibular input --> resulting in quality coordination -Emotional stability and body perception happens during the second year of life -Integration of auditory and other senses results in speech and language -Purposeful activity: requires eye directing hands and body to work together -At 4/5 years old your senses should be well integrated --> Hand dominance and eye dominance should be established 3. The brain works as an "integrated whole" 4. Adaptive interactions: -Feedback based on current performance has the potential to change future performance 5. Sensorimotor activities are motivating to clients -Performing sensorimotor activities increases self-esteem and self-actualization Through the Sensory Integration FOR function looks like: - Answers -The ability to complete daily tasks without disturbances from other sounds, people, or environmental stimuli Self Regulation: -The ability to modulate arousal level to meet the current demands of the environment The ability to discriminate between sensory information received Postural Stability and motor planning is adequate for gross and fine motor development Through the Sensory Integration FOR dysfunction looks like - Answers -Sensory Processing Disorder: -Sensory Modulation Disorder: sensory over-responsivity, sensory under-responsivity, sensory seeking/craving -Sensory Based Motor Disorder: Postural disorders, dyspraxia, etc. -Sensory Discrimination Disorder Modulation: Regulate, adjust, adapt -Brain level: balancing of excitatory and inhibitory inputs and adapting to environmental changes -Behavioral level: Responses that match the demands and expectations of the environment -Motor Plan: the ability to make effective and planned movements **Requires functional vestibular and proprioceptive systems as well as the rest of the senses -Discriminate: the ability to perceive stimuli present in the environment as well as recognize what the stimulus is and where it is located Impacting CHANGE through the Sensory Integration FOR - Answers -Change occurs through guided sensory input -Individual or group activities Sensory input should be provided in the context of interaction with the environment -Results in neurological changes within the client Just-Right Challenge: -Activities should be tailored to present challenge to the child that is not too easy or too difficult