OTA & PTA

HLTH35
Lab Manual

Faculty
Weeks 1-7: Deryck Pollard
deryck.pollard@flemingcollege.ca

Weeks 9-15
Kelly McKnight
Kelly.mcknight@flemingcollege.ca

NOTE
You are responsible for the content of this manual. The culminating PSE in Semester Four will require you to
perform skills taught in this course. It is therefore highly recommended that you continue to review the skills
contained within this lab manual.
 Basic Clinical Skills
I
Lab Manual
Table of Contents

Course Learning Objectives......................................................................................................................................... 4

Week One: Terminology............................................................................................................................................... 5
Week Two: Planes & Axes............................................................................................................................................ 6
Week Three: Evaluating Posture.................................................................................................................................. 7
Lab Activity One: Evaluating Posture (Plumb Line)......................................................................................................... 7
Lab Activity Two: Evaluating Posture (Grid).................................................................................................................... 7
Lab Activity Three: Lying Posture.................................................................................................................................... 7
Lab Activity Four: Sitting Posture.................................................................................................................................... 8
Post Lab: Posture Activity............................................................................................................................................ 9
Week Four: Lifting Lab................................................................................................................................................ 10
Lab Activity One: Lifting Objects.................................................................................................................................... 10
Lab Activity Two: Lifting People..................................................................................................................................... 10
Week Five: Bed Mobility & Positioning..................................................................................................................... 11
Lab Activity One: Bed Mobility....................................................................................................................................... 11
Lab Activity Two: Bed Positioning................................................................................................................................. 11
Week Seven: Balance Lab.......................................................................................................................................... 12
Lab Activity One: Somatosensory System..................................................................................................................... 12
Lab Activity Two: Somatosensory Vestibular and Visual Systems................................................................................12
Lab Activity Three: Balance Training............................................................................................................................. 12
Weeks Nine & Ten: Transfers..................................................................................................................................... 13
Lab Activity One: Overview of Equipment/Aids Used in Transferring............................................................................13
Lab Activity Two: Review of Transfer Process.............................................................................................................. 13
Lab Activity Three: Independent and Standby Sitting & Standing Transfers.................................................................13
Lab Activity Four: Standing Transfer, Dependent Pivot................................................................................................. 14
Lab Activity Five: Standing Transfers............................................................................................................................ 14
Lab Activity Six: Sitting or Lateral Dependent Transfer................................................................................................. 14
Lab Activity Seven: Sitting or Lateral Assisted Transfer................................................................................................14
Lab Activity Eight: Wheelchair to Floor & Floor to Wheelchair Transfers-.....................................................................14
Strong R/L Extremities & Weak L/R extremities (hemiplegia)........................................................................................14
Lab Activity Nine: W/C to Floor & Floor to W/C Transfers-............................................................................................ 14
Strong Upper Extremities & Weak/Paralyzed Lower Extremities (paraplegia)...............................................................14
Week Twelve: Collecting Data- Vitals........................................................................................................................ 15
Lab Activity One: Assessment of Respiration................................................................................................................ 15
Lab Activity Two: Assessment of Pulse......................................................................................................................... 16
Lab Activity Three: Assessment of Blood Pressure (bp)................................................................................................ 17
Week 14 & 15: Documentation (Focus on SOAP notes).......................................................................................... 18
Lab Activity One: Documentation Practice.................................................................................................................... 18
2
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Course Description
This course contributes to the learning outcomes, knowledge and skills required to function as a safe,
competent occupational therapist assistant and physiotherapist assistant. This course examines normal
functional movement and its components. The learner's ability to correctly observe, facilitate and enhance
functional movement through proper handling techniques are developed through lecture and lab. Proper
techniques for recording and reading vitals is introduced. Foundational documentation skills are taught.

Course Learning Objectives

Upon successful completion of this course, students will be able to
1. Describe body movement using appropriate anatomical terminology.
2. Demonstrate proper body mechanics in the application of therapeutic interventions.
3. Identify parameters of normal posture, bed positioning, balance, and deviations from the norm.
4. Demonstrate safe, therapeutic positioning, lifting, and transferring strategies.
5. Demonstrate knowledge and application of observation skills in detecting and recording vital signs, recognizing
normal and/or abnormalities in breathing, pulse, and blood pressure.
6. SOAP notes

Lab Use Guidelines

p Labs are most beneficial when students come prepared.
p Students should read lab outlines prior to attending labs.
p Students should come to labs ready to participate. There are limited lab opportunities to learn specific skills;
students must use lab time wisely.
p Disruptions caused by students arriving late or leaving early can impact others’ learning. Please inform faculty,
when possible, of the need to leave a lab early and make every effort to arrive on time.
p It is disruptive to faculty and peers when students start to pack up before the end of lab. Please wait until the lab
instructor has dismissed the class to return lab items to their rightful place.
p Students are required to wear lab shirts, suitable pants and closed toe shoes while in lab. Certain labs may warrant
a modification to this dress code (e.g. shorts). Please read lab outlines ahead of time to determine appropriate
dress. Students who are not dressed appropriately may be asked to leave.
p Students are expected to act in a professional manner in lab.
p Consumption of food is not permitted in the lab. Foods can bring unwanted odour, insects, and potential risk to
equipment.
p There are situations when taking pictures or recording instructions would assist student learning. It is expected that
cell phones and other electronic devices will be utilized in lab for this purpose only. Lab instructors should be
consulted prior to such activities.
p It may be possible to book the lab outside of regular lab times to practice skills.
p If equipment in the lab is found to be faulty, please notify the lab instructor promptly so that it can be fixed or
removed.
p Should an injury or adverse reaction occur while in lab the Student Accident/Incident Report must be completed
(Incident Report). A QR code that links to the accident report is displayed in the lab. During scheduled lab time, the
instructor should be immediately notified. It may be necessary to follow up with the campus nurse.

Practice Lab Policy

OTA & PTA students are encouraged to use the lab to support the consolidation of skills taught during instructor-led
lab time.
p Students can book the OTA & PTA lab for practice sessions when it is not in use.
p Proper lab booking procedure must be followed.
p All students are welcome to participate in booked lab sessions, regardless of who has booked the room.
p All students must sign in and out of the lab. Students must sign their own name and record time spent in the lab;
another student is NOT able to do this.
p Equipment arrangements must be made with the appropriate faculty member 48 hours prior to the booking.
p The student arranging the borrowing is responsible for the equipment during the lab practice time.
p Equipment and surfaces used during the practice lab MUST be cleaned and equipment must be returned to its
original location.
p It is forbidden to take pictures/videos of activities occurring in the lab without expressed permission by the
appropriate faculty member.
3
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
p No items may be removed from the lab without written consent from faculty.
p The lab must be left in an orderly, tidy fashion i.e. no garbage, recycling, personal papers, etc. left behind.
p Failure to follow the above will impact lab privileges.

Week One: Terminology

Learning Objectives
1. Student will describe individual joint movements using proper terminology (unit 4).

Pre-Lab Preparation
1. Review the Terminology lecture.
2. Read through lab material.

Instructions
1. Participate in lab activity as outlined below.
2. Keep notes throughout the lab for personal use.

Supplemental Resources
1. Lippert, Chapter One (Osteokinematic Movements)

Lab Activity: Joint Movements

1. As a large group, review movements (with demonstration) at all joints.
2. Complete matching handout with a partner.

NOTES:

4
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Week Two: Planes & Axes

Learning Objectives
1. Student will understand and describe the three planes and axes used to describe human movement
(Unit 4).
2. Student will describe human movement referencing the terms of the planes and axes around which they
occur (Unit 4).

Pre-Lab Preparation
1. Review Planes and Axes lecture.
2. Read through lab activities.

Supplemental Resources
1. Lippert Chapter One (Planes & Axes)
2. Pierson Chapter Four (Cardinal or Anatomic Planes of Motion)
3. Video on course page (Planes and Axes)

Instructions
1. Participate in all lab activities.
2. Take notes as appropriate to use for study and PSE preparation.
3. Participate in class discussion.

Lab Activity One: Demonstrating Plans and Axes

a. As a class, review the 3 planes and 3 axes using the laser levels, sliding boards, and pointers.

Lab Activity Two: Relating Movements to Plane and Axes

a. In small groups of 3-4, use the flip chart paper to list movements in the 3 planes.
b. Large group discussion.
c. Repeat the above for the 3 axes.

Lab Activity Three: Extension of Concepts into Activities

a. In your small group, compare the planes and axes used when stacking cones to those used moving
boxes from a counter to an over-counter shelf.
b. Compare the planes and axes used when shooting a basketball to those used swinging a baseball bat.
Will this impact training?
What plane do you think is often neglected when we train?

NOTES:

5
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Week Three: Evaluating Posture

Learning Objectives
1. Student will analyze standing posture using simple tools such as a plumb line and wall grid (Unit 2).
2. Student will compare the wall grid to the plumb line as a tool to assist in posture analysis (Unit 4).
3. Student will determine the parameters required to achieve ‘ideal’ posture in various positions (Unit 3).
4. Student will match individuals to appropriate workstations based on simple ergonomic recommendations
(Unit 3).

Pre-Lab Preparation
1. Review Posture lecture.
2. Read through the lab material.
2. Ensure you wear pants that can be rolled up to the knees.

Supplemental Resources
1. Lippert Chapter 20
2. Pierson Chapter Four (Posture and Body Control)
3. Video on course page (Evaluating Posture)

Instructions
1. Complete all lab activities with a partner, answer questions as applicable.
2. Keep your own notes in preparation for studying.
3. Participate in large group discussion.
4. Postural Assessment can be anxiety provoking, encourage your lab partner to do several shoulder
shrugs and/or march on the spot to achieve their ‘natural’ posture.

Lab Activity One: Evaluating Posture (Plumb Line)

a. Lateral View
With your partner, use the plumb line to evaluate each other’s standing posture from both sides.
What structures should line up?
Are there any deviations in your partner(s)? If this was a patient would you consider this routine,
important or urgent in terms of reporting to the OT or PT?
b. Anterior/Posterior View
Use the plumb line to evaluate your partner(s) posture from both anterior and posterior views.
What structures would you expect to be at the same height?
Are you able to detect anything with one view (anterior or posterior) that you didn’t see with the other?
Is there anything you see now that wasn’t obvious with the lateral view?

Lab Activity Two: Evaluating Posture (Grid)

a. Use the wall grid to evaluate your partner(s) posture in standing using all three views (anterior, posture,
and lateral).
b. After you have finished, discuss any postural differences you found between the two.
c. What might be the advantages of using a grid over a plumb line or vice versa?

Lab Activity Three: Lying Posture

a. Use pillows, rolls, and ‘weights’ as needed to place your partner(s) in an optimal posture in lying.
b. Can you align your partner’s external auditory meatus, acromion (mid shoulder), greater trochanter,
lateral malleolus, etc. in supine? i.e., as if you were observing them from a lateral view
c. Can you achieve vertebral and head alignment with your partner(s) in side-lying? i.e., as if you were
observing them from a posterior view.

6
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

7
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Lab Activity Four: Sitting Posture

a. Evaluate your partner(s) sitting posture at each of the three tables (different heights).
Consider:
1. Feet flat on floor
2. Eyes level with computer screen
3. 5 cm distance between the thighs and desk
4. Buttocks at back of chair
5. Thighs supported by the chair
6. Head directly over shoulders
7. Back straight

Is there a good chair and table combination for your partner(s)?

Do these chairs promote proper posture? Discuss.

NOTES:

8
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

9
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Post Lab: Posture Activity

Instructions
1. Use your notes and textbook as a reference.
2. Check the box that marks where the plumb line falls when observing ‘ideal’ posture from the side.
3. Using a different coloured pen, check the boxes that correspond with your partner’s landmarks.

Landmark Anterior Posterior Through

Exterior Auditory Meatus
(Hole in ear)

Acromion Process

Thoracic Vertebrae

Lumbar Vertebrae

Greater Trochanter

Patella (kneecap)

Lateral Malleolus

10
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

11
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Week Four: Lifting Lab

Learning Objectives
1. Student will select and demonstrate proper lifts and techniques to pick up and place objects of varying
sizes and weights (Unit 3).
2. Student will demonstrate proper two and three person lifting techniques.

Pre-Lab Preparation
1. Review Body Mechanics and Lifting lecture.
2. Read through lab material.

Supplemental Resources
1. Pierson Chapter Four
2. Early p. 272 (Body Mechanics)
3. Videos on course page (Lifts- 2 person, Lifts Cont’d- 3 person)

Lab Activity One: Lifting Objects

1. In small groups, and rotating through stations, practice the following lifts:
a. Golfer’s Lift and Lift to high grid
b. Deep Squat/Traditional Lift: do you have a preference?
c. Power Lift
d. Stoop Lift
e. Half-Kneeling Lift
2. Make a list of the factors influencing the selection of a particular lift.

Lab Activity Two: Lifting People

1. Practice the following lifts at each station
a. Two-Person (firefighter’s) Lift: up and down from bed (bed to W/C, W/C to floor)
b. Two-Person (front/back) Lift: up and down from bed (bed to W/C, W/C to floor)
c. Three-Person Lift: from edge of bed to the middle of the bed
2. Make a list of what factors influence the selection of a particular lift.

If the “patient” complained of some soreness in their shoulder after the firefighter’s lift, would reporting this
be routine, important or urgent? What if they fell during the lift?

NOTES:

12
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Week Five: Bed Mobility & Positioning

Learning Objectives
1. Student will use and teach proper techniques when assisting individuals with basic bed mobility tasks
(Unit 3).
2. Student will properly position dependent clients in supine, prone, and side-lying positions (Unit 3).
3. Student will use problem-solving skills to modify bed positions as needed to accommodate contractures
or skin ulcers.

Pre-Lab Preparation
1. Review Bed Mobility and Positioning lecture

Supplemental Resources
1. Early p. 361 (Bed Positioning & Bed Mobility)
2. Pierson Chapter Five (Positioning for Treatment)
3. Videos on course page (Bed Mobility- bridge, roll, scoot, Bed Positioning- supine, prone, side-lying)

Lab Activity One: Bed Mobility

1. Watch the demo on bridging and then practice bridging with your partner with and without assistance.
2. Watch the demo on rolling and practice rolling with your partner.
3. Watch the demo on scooting and practice scooting with your partner in supine and sitting.
How would you make it easier to do scooting in sitting?
4. Watch the demo on lie to sit and practice supine to sit transfers with your partner.

Lab Activity Two: Bed Positioning

1. Use the information from your notes and the text to position your partner in supine, prone, and side-
lying.
Think about the possible areas of pressure and contracture for each position.
2. Modify your supine position for a patient who is developing plantarflexor contractures and pressure
sores on their shoulder blades.
3. Modify your prone position for a patient who is developing pressure sores on their patellae and knee
flexion contractures. If your patient says that their patellae are still sore after positioning, would this be
routine, important or urgent information?
4. How would you modify your side-lying position if your patient had contractures of their internal rotators?
Pressure sores on their malleoli?

NOTES:

13
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

14
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Week Seven: Balance Lab

Learning Objectives
1. Student will experience challenges that clients may face with respect to balance (Unit 2).
2. Student will understand, select, and grade a variety of tools used to train balance (Unit 3).
3. Student will understand and use the Berg Balance Test with normal and ‘impaired’ individuals (Unit 2).

Pre-Lab Preparation
1. Review Balance lecture.
2. Read through the lab.
3. Please bring a couple of plastic shopping bags.

Supplemental Resources
1. Early pgs. 361, 390, 421
2. Pierson Chapter Six (Outcome Measures)
3. Video on course page (balance training)

Lab Activity One: Somatosensory System

1. Walk from one end of the plank to the other (narrow side).
What input is affected here?
2. Repeat with Air Cast boots.
3. With your partner at the other end, both members walk from one end of the beam (wide side) to the
other, without touching the ground.

Lab Activity Two: Somatosensory Vestibular and Visual Systems

1. Try your patient on the wobble board, progress to eyes closed. If your “patient” was unable to perform
with their eyes closed, would this be routine, important or urgent to report?
2. Try tandem walking after spinning 10 times in a circle.
3. Try tandem walking with Air Cast boots.
4. Try tandem walking in Air Cast boots after spinning 10 times.

What systems are we affecting with these changes?

What would happen if we added eyes closed and/or serial 7’s to the last task?

Lab Activity Three: Balance Training

1. Wobble Board/Foam Roller/Bosu Ball
Progress your patient through activities that have an increasing level of difficulty.
 Start with holding on with two hands and using both feet, progress to not hands with both feet.
 Add catching a ball or eyes closed.
 Progress further with serial 7’s.
 Repeat the progression with on foot (ie decreased BOS)

2. Mat
Progress your partner from walking normally on the mat (forwards and backwards) to tandem
walking on the mat (forward and backward).
You can further challenge by having your person close their eyes.
Note: You may want to practice tandem walking on the ground first.

3. I-Joy Board (150 lb limit)

Try the I-Joy Board with two feet and then one foot.
Progress your partner to catching a ball or eyes closed if their balance is good.

15
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
NOTES:

16
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Weeks Nine & Ten: Transfers

Learning Objectives
1. Demonstrate awareness of various types of client transfers.
2. Develop the clinical skills necessary to transfer clients safely and efficiently.
3. Demonstrate competency when instructing clients and caregivers in proper body mechanics and transfer
techniques.
4. Become familiar with the various pieces of equipment that may be used to assist a transfer.

Pre-Lab Preparation
1. Review Transfer lecture.
2. Read through lab activities.
3. Bring your Pierson textbook to lab.

Supplemental Resources
1. Chapter 8, Person & Fairchild’s
2. Pgs 271-274, Early
3. Videos posted on Course Page in D2L

Instructions
1. Participate in small group activities and large group discussion.
2. Take notes and ask questions in preparation for PSE and written test.

Lab Activity One: Overview of Equipment/Aids Used in Transferring

Large Group Demonstration & Discussion:
a. transfer belt
b. transfer disc
c. transfer boards
d. transfer poles, bed rails, bars

Lab Activity Two: Review of Transfer Process

1. Large Group Discussion:
a. Preparing the Equipment
b. Preparing the Environment
c. Preparing the Clinician
d. Preparing the Client

2. Preparing for the Transfer

a. Place transfer belt on your partner, check proper fit of belt.
b. Position the wheelchair/chair parallel or at a 45-degree angle to the bed, midway between head and foot
of bed.
c. Remove or swing away footrests and armrest(s), ensure brakes are on.
d. Caster wheels should be in a forward position to increase BOS of wheelchair.
d. Equalize the surface heights (if possible).

Lab Activity Three: Independent and Standby Sitting & Standing Transfers
1. Review Figures 8.12, 8.13, 8.14 (pgs 180-181)
2. Practice instructing your lab partner to safely perform an independent transfer.
3. Consider degree of instruction, cueing, guarding required.
4. Discuss precautions & contraindications for this type of transfer.

17
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
Lab Activity Four: Standing Transfer, Dependent Pivot
1. Review Figure 8.15 (p. 179-181)
2. Practice dependent standing transfers with your lab partner (as demonstrated by instructor).
3. Consider size/height of client & yourself, chair placement, degree of instruction, cueing, and guarding
required.
4. Discuss precautions & contraindications associated with this type of transfer.

Lab Activity Five: Standing Transfers

1. Review Figures 8.16, 8.17 (pgs. 183-184).
2. Practice assisted standing transfers as demonstrated by instructor.
3. Provide constructive feedback to lab partner(s) regarding set up for transfer, clarity and level of verbal
instruction, use of demonstration, etc.
4. Consider any precautions and/or contraindications associated with this type of transfer.

Lab Activity Six: Sitting or Lateral Dependent Transfer

1. Practice dependent sliding board transfers as demonstrated by instructor.
2. Provide constructive feedback to lab partner(s) as outlined above.
2. Consider precautions and/or contraindications associated with this transfer.

Lab Activity Seven: Sitting or Lateral Assisted Transfer

1. Review Figure 8.19 (p.185)
2. Practice assisted sliding board transfers.
3. Provide constructive feedback to lab partner(s).
4. Consider precautions and/or contraindications associated with this transfer.

Lab Activity Eight: Wheelchair to Floor & Floor to Wheelchair Transfers-

Strong R/L Extremities & Weak L/R extremities (hemiplegia)
1. Review Figure 8.28 (p.195), Figure 8.29 (p.195)
2. Practice wheelchair to floor and floor to wheelchair transfers as demonstrated.
3. Develop clear, succent instructions along with effective demonstration techniques.
4. Provide constructive feedback to your peers.
5. Consider any precautions and/or contraindications associated with this type of transfer.

NOTE: For these transfers, you will be assessed on your verbal instructions, verbal and non-verbal cueing,
use of demonstration, ability to adjust to client’s responses (verbal and physical) and appropriate level of
guarding skills.

Lab Activity Nine: W/C to Floor & Floor to W/C Transfers-

Strong Upper Extremities & Weak/Paralyzed Lower Extremities (paraplegia)
1. Review Figure 8.30 and Figure 8.31 (p. 196), Figure 8.32 (p.197) and instructor demonstration.
2. Practice these transfers with a partner, working on your ability to instruct the client while keeping them
safe. Don’t forget to watch your body mechanics throughout.
3. Continue to provide feedback to your partner(s).
4. Discuss any precautions and/or contraindications to this transfer.

NOTE: For these transfers, you will be assessed on your verbal instructions, verbal and non-verbal cueing,
use of demonstration, ability to adjust to client’s responses (verbal and physical) and appropriate level of
guarding skills.

NOTES:

18
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Week Twelve: Collecting Data- Vitals

Learning Objectives: To gain competency in the
1. Measuring and recording of a client’s respiration rate, pulse, and blood pressure.
2. Ability to recognize signs and symptoms of compromised vital signs.
3. Ability to take/explain any necessary precautions and contraindications required in the event of a patient
exhibiting compromised vital signs.

Pre-Lab Preparation
1. Review Vitals lecture.
2. Bring your Pierson textbook to lab.
3. Wear appropriate clothes for running on the spot, performing jumping jacks, etc.

Supplemental Resources
1. Chapter Three-Pierson & Fairchild
2. Breathing
3. Pulse
4. BP

Instructions
1. Complete all lab activities with a partner, answer questions as applicable.
2. Keep your own notes in preparation for studying.
3. Participate in large group discussion.

Lab Activity One: Assessment of Respiration

1. Watch the video entitled ‘breathing’.
2. With a lab partner, follow the procedure outlined in Procedure 3.7.
3. Then, practice taking respiration rates on as many classmates as possible.
4. Count the respirations per minute while the person is at rest and then following a minute of physical
activity eg. of running on the spot, jumping jacks, etc.
5. Record the rates of respiration and any observations in the chart below ie. Colour of client, breath
sounds, etc.
6. Outline any instructions you would give your ‘client’ regarding their respiration rate at rest and during
exercise/activity.

Respiration Rate
Resting Respiration Following
Subject’s Name Rate/Min ‘exercise’/Min Observations (both phases)

19
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

20
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Lab Activity Two: Assessment of Pulse

1. Watch the video entitled ‘Pulse’.
2. Follow the procedure outlined in Procedure 3.4.
3. Use both the radial and carotid arteries to measure lab partners’ pulse.
It is to your advantage to practice this skill on many classmates, friends, etc.
3. Attempt to take a pulse rate at one of the other pulse measurement sites.
4. Practice taking pulse rates manually as well as with a stethoscope.
5. Describe the pulse rate you hear to your ‘client’ and record their beats per minute using the chart below.
6. Outline any instructions you would give to your ‘client’ regarding their pulse and exercise/activity.

Site (radial,
Subject’s Name carotid, etc.) Beats/Min Description of Pulse Instructions to Client

21
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
Lab Activity Three: Assessment of Blood Pressure (bp)
1. Watched the video entitled ‘BP’.
2. Using the procedure outlined in Chart 3-6, practice taking the bp of as many lab partners as possible.
3. Does physical activity change their bp reading?
3. Take bp manually as well as with the machine.
3. Take a reading on the right upper extremity and then on the left, noting any differences.
4. Record your values in the chart below.

First reading Second Reading Reading after Physical Activity

Subject’s Name (R/UE, (L/UE, sitting)
Sitting)

NOTES:

22
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

Week 14 & 15: Documentation (Focus on SOAP notes)

Learning Objectives
1. Student will correctly identify S, O, A, P statements.
2. Student will write an effective SOAP note.

Pre-Lab Preparation
1. Review Documentation Lab

Supplemental Resources
1. SOAP Notes for OTs
2. My OT Spot
3. SOAP Notes for PTs

Lab Activity One: Documentation Practice

Instructions
1. Complete the following activities with a partner(s).
2. Take up answers as a class.
3. Post lab assignment: Documentation-Dropbox by Due Date

Place an ‘S’ beside the statements which belong in the subjective section of a SOAP note.

1. _____ Kelly appeared tired and listless.

2. _____ Client said she is hearing voices telling her to cut her hair.

3. _____ Sam got dressed by himself today.

4. _____ Danielle’s mom said that Danielle hasn’t been sleeping well.

5. _____ “I am fat and ugly”

6. _____ Client is resistant to all suggestions.

7. _____ “Where am I?”

8. _____ Client made sexual comments throughout the session.

9. _____ John’s shirt was misbuttoned, untucked, and stained.

Place an ‘O’ beside the statements belonging in the objective section of a SOAP note.

1. _____ The client’s eyes were red and watery.

2. _____ Bob got angry.

3. _____ He pushed away from the table and left the room.

4. _____ She said she hated strawberries.

5. _____ Joanna wants to be recognized for good behaviour.

6. _____ The client appears bewildered when others get annoyed with him for invading their personal
space.

7. _____ The client has a habit of twisting her ring around her finger during personal conversations.
23
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual

24
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
Place an ‘A’ beside the sentences that make good Analysis/Assessment statements in SOAP notes.

1. _____ She has to be told to come out of her room.

2. _____ Client tried to use the TV remote control to call home.

3. _____ Client completed 75% of the task without assistance.

4. _____ Susan does not interact with peers.

5. _____ He cannot use public transportation independently.

6. _____ Ashton can tolerate a moderately noisy environment for up to 10 minutes.

7. _____ Client’s statements are inappropriate to the situation.

Place a ‘P’ beside the statements which reflect good “Plan” statements.

1. _____ Practice writing his name three times a day.

2. _____ Engage client in conversations about childcare.

3. _____ She should be more careful in the kitchen.

4. _____ Increase repetitions as tolerated.

5. _____ Instruct in splint care and maintenance.

6. _____ Client needs to spend more time on leisure occupations.

7. _____ Client will work on chewing food at least 10 times before swallowing.

25
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
State if the following are Subjective (S), Objective (O), Assessment (A) or Plan (P) statements.

_____ 1. Ct. noticeably short of breath after walking up stairs.

_____2. Ct. complains of left elbow pain when she tries to pick up any items.

_____3. OT to continue 3 times per week to address fine motor function.

_____4. Limited range of motion in right shoulder limits ability to bathe posterior area of body.

_____5. Ct winces when bearing weight on right leg.

_____6. Ct. has asymmetry in the shoulders, with right being significantly higher than left.

_____7. Client’s intention tremor is impacting ability to print legibly.

_____8. Grip strength in right hand is 23 pounds.

_____9. Ct. can pick up small items using a pincer grasp, but is unable to perform controlled release.

_____10. Client expressed that she feels very distressed about her condition and is fearful that she will not
make a full recovery.

_____11. Ct. weeping uncontrollably.

_____12. Increased flexor tone in right upper extremity precluding functional use of right hand.

_____13. Will request Dr. order to fabricate a right resting hand splint.

_____14. As O.T. goals have been met, ct. is discharged from occupational therapy.

_____15. Long term goal: Ct. will be able to tie shoes.

_____16. Ct. states that therapy is useless and refusing to attend scheduled O.T. appointment.

_____17. Scar tissue is creating some webbing between toes of right foot.

_____18. Ct. will be provided with a pencil grip to guide fingers into a more functional grasp pattern.

_____19. Client opened the door wearing only a sweatshirt and speaking incoherently.

_____20. Client was able to print all lower-case letters from memory, using correct (ie. top-bottom, left-right)
letter formations.

26
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
Label the statements below according to where they would best belong in a SOAP note. Use “s”, “o”,”a”,”p”. Then
use these statements to write one coherent SOAP note. You may add transitional phrases to make the note flow
better.

1._____ The client sat on the side of the bed waiting for dressing direction.

2._____ The client is unable to initiate dressing.

3._____ She walks to the kitchen when dressed carrying her purse, ready to go to day care.

4._____ When told what clothes to put on she gets dressed.

5._____ What am I supposed to wear?

6._____ The buttons on her blouse are not lined up.

7._____ While sitting there, she removes her nightclothes.

8._____ Clothing will be carefully placed in proper sequence and laid out the night before so the client can see the
clothes on the chair when she gets up.

9._____ When given cues can dress herself with minor errors.

10._____ She puts her anklets on under her TED stockings.

S:

O:

A:

P:

27
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
Case studies: Write a SOAP note for each of the following case studies.

Mrs. A is a long-term care patient at the hospital where you work. She has severe rheumatoid arthritis and is non-
ambulatory. She is often difficult to get along with. She has recently been prescribed a power wheelchair but hasn’t
been using it on the ward. The nurses have reported that when they get her up from bed, she insists on being seated
in a lounge chair, rather than her wheelchair. The OT involved as assigned you the task of taking Mrs. A for
wheelchair driving practice, as she suspects that Mrs. A. is intimidated by the new chair. Mrs. A. consented to this
plan when the OT discussed it with her. It was arranged with the nurses that Mrs. A. would be in her wheelchair for
her appointment with you.

Scenario 1
You arrive at Mrs. A’s room at the appointed time. You are surprised to find her in bed, the power wheelchair in the
corner of the room. When asked if she would like to do her OT program, she declines, begins weeping, says she
never wanted the new wheelchair, and wishes it could just be sent back, as she’s too old and stupid to learn to drive it.

Scenario 2
You arrive at Mrs. A.’s room, and she is waiting in her new wheelchair, as arranged. You review with her how the
controls work, then take her out for a drive in the hallway. You practice going through doorways, which goes well, and
you also set up a zigzag course of cones for her to steer around, which also goes reasonably well. She expresses
reluctance, and does have difficulty backing the chair up, as she cannot turn her head to see behind her. At the end of
the session, she remarks that her hand feels sore from gripping the joystick while driving.

28
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.
 Basic Clinical Skills
I
Lab Manual
Analyze the two following SOAP notes.
Write what is good about them and what needs improvement.
(You can re-write the note if you wish to illustrate your critique)

Case 1: Client is a 78 yr old woman who had a stroke affecting her left side 3 months ago. Her left arm has been in a
sling with only a little active range of motion in her elbow and shoulder. Then three days ago, she fell outside on the
sidewalk, breaking her right arm. It is now in a cast. She is attending an intensive program to facilitate movement in
her left arm.

S: “I felt so helpless with two useless arms. I can’t believe I was able to feed myself with my left arm.”
O: Client participated in 6 hrs of outpatient occupational therapy today. Fitted with a universal cuff, she was able to
feed herself using a spoon, with minimal spillage. It required her to use both elbow flexion and trunk movements
to get the applesauce scooped up and into her mouth. It was the first time she had fed herself since breaking her
arm.
A: Client is making progress in the functional use of her left arm. She was not able to get the spoon to her mouth
yesterday.
P: Continue participation in CIMT program 6 days per week as established in plan of care. Provide adaptive
equipment as needed.

Case 2: Client is a 19 yr old man who lost his left arm in a farm accident (he is right-handed) 3 weeks ago.

S: “I still can’t believe my arm is gone, it’s unreal. There are times I swear I can still feel it, like a fly crawling on
it, but when I look there’s nothing there. Nothing.”
O: withdraws from light touch within 1.5 inches of wound. He demonstrated proper stump wrapping technique.
Instructed on how to massage area in preparation for artificial arm.
A: Stump is healing well and he is on track for getting an artificial arm. He is ready to be fitted with a temporary
arm.
P: OT bid, 6 days per week, to reduce sensitivity of stump, prepare stump for artificial arm, and begin training in the
use of an artificial arm.

29
Principles & Techniques of Patient Care, 7th ed.
Early’s Physical Dysfunction Practice Skills for the OTA, 4th ed.