(eBook PDF) Adult Physical Conditions

Intervention Strategies for

Occupational Therapy Assistants
Visit to download the full and correct content document:
https://ebooksecure.com/download/ebook-pdf-adult-physical-conditions-intervention-s
trategies-for-occupational-therapy-assistants/
 Intervention
Strategies for
-------------------. Occupational
Therapy
Assistants
5918_FM_i-xxviii 16/03/18 4:19 PM Page vii
As educators of occupational therapy assistant (OTA) stu-
dents, we have consistently struggled to find one textbook
that is specifically written for OTA students and that pro-
vides what they need to learn about occupational therapy
(OT) for adults with physical conditions. We have often
discussed how managing this deluge of material was both
confusing and difficult. We used portions from numerous
textbooks, along with other resources, to cobble together the
needed content on physical conditions and interventions.
We wanted one comprehensive book that could be used
throughout an OTA curriculum, contain up-to-date and
relevant evidence and research, and offer students a fresh
perspective. So, together, we decided we needed to write
that “dream textbook.” That is how this project began to-
ward achieving our goal of having a thorough and relevant
resource.
RATIONALE AND GOALS
As this project’s editorial leaders, an OTA and occupational
therapist, we are clinicians and educators with many years of
experience, and we each brought our unique perspectives to
the project. We assembled a team of 43 contributing authors,
including OTAs and occupational therapists, as well as
educators and/or researchers. Our shared mission has been
to ensure that the textbook provides abundant evidence, the
foundations of OT practice, and the practical, functional con-
tent that the OTA student craves. As editors, we have endeav-
ored to give the chapters a consistent voice while maintaining
the unique identity of the chapter authors and their expertise.
We feel strongly that textbooks, just like therapeutic
interventions, need to provide the “just right challenge.”
With the aid of this book, the student will gain competence
and confidence in addressing a variety of adult conditions
and interventions.
Students often have limited time to read and may have
minimal resources available to buy numerous textbooks.
Many OTA students have varied life experiences, often
returning to school after pursuing a different career, start-
ing a family or upon deciding on OT as a second or third
career. Thus, today’s students typically have numerous
other responsibilities in addition to school. To meet this
challenge, this book is intended to be user-friendly and has
been specifically written for the OTA, who is often a student
with needs different from those of the traditional OT stu-
dent. During our years of frustration with finding the right
textbooks and in our focus groups with OTA students in the
very beginning stages of this project, we realized that some
preface
students do not read their textbooks; and, if they do read,
that task is given the least priority; or that they simply skim
the pages. Our awareness emphasized the need for this
book, and we knew this book must be interesting, practical,
approachable, functional, and a useful resource. Our hope
is that the student uses the book as the “go-to” resource
through college and beyond as a new practitioner.
One option in some OTA programs is to use textbooks
specifically written for the OT student. Although there
is certainly crossover of content, OT and OTA programs
have different needs and must meet a slightly different set
of Accreditation Council for Occupational Therapy Educa-
tion (ACOTE®) standards. We have worked to match the
book content and features with the unique educational
needs of the OTA student and to make life easier for faculty
by providing a unified resource that aligns with accredita-
tion standards at this time. Because of the requirement for
the ACOTE® standards to be revised every 5 years, we
specifically chose to not match chapter contents with the
standards in the textbook, but added them instead to the
online Instructor’s Guide.
Our ultimate goal for this text is that it will help students
become professional, knowledgeable, creative, and compe-
tent OTAs.
APPROACH
We have deliberately used client-first approaches through-
out the book despite a trend in some groups to put the
disability first. We believe that many clients are tired of
being identified with their disability instead of their abilities
and personhood. By using the terminology “client,” rather
than “patient,” throughout, we align with the principles of
Occupational Therapy Practice Framework: Domain & Process,
3rd edition (OTPF-3). We have also consciously chosen the
term “occupational therapy practitioner” when a task can
be completed by either the OTA or the occupational thera-
pist and use the specific terms occupational therapist or
OTA, when warranted.
We embrace the unique nature of each client and every
client–practitioner interaction, and thus, the intervention
portions, rather than reading as a “cookbook,” present the
evidence and tools to hone the clinical reasoning skills of
students. The features included in each chapter were specifi-
cally created to further help students connect the concepts
learned to practical applications of clinical reasoning skills.
The text contains over 300 original photos that show-
case clients with disabilities as well as current equipment
vii
5918_FM_i-xxviii 16/03/18 4:19 PM Page viii
viii Preface
and technology. We worked to include a diversity of mod-
els, male and female OTAs, and individuals of different
ages. Many photos capture occupations occurring in their
natural environments or in specialized therapy settings.
In addition to photos, the text includes a number of line art
illustrations that are original and intentionally designed to
demonstrate specific concepts.
ORGANIZATION OF THE TEXT
Adult Physical Conditions: Intervention Strategies for Occupational
Therapy Assistants contains 37 chapters organized into four
sections and has appendices and a comprehensive glossary at
the end. We have integrated the guidelines of the OTPF-3,
used the most up-to-date evidence, and included useful and
interesting features, such as sample treatment and documen-
tation and real-world case studies, to best illustrate chapter
contents.
The chapters intentionally use cross-referencing to avoid
redundancy, wherever possible. For example, the chapters
on brain injury and degenerative diseases speak to those on
disease-specific issues related to cognition and refer to the
chapter on cognition as well. Chapter 13, Transfers Across
the Continuum: Safety and Management, is intentionally
comprehensive to enable readers to locate information on
this topic quickly in one location. For example, this chapter
includes transfers for clients with hemiplegia, severe weak-
ness, amputations, and so on, instead of placing that con-
tent in condition-specific chapters. Our thought was that
the reader would prefer to look for information on a transfer
with a client with hemiplegia in one place, whatever may
be the root cause of the hemiplegia. As every OT practitioner
understands, tremendous differences exist among clients
with the same diagnosis, and the foundational chapters will
set the stage and be a reference as well.
Chapter 37, the final chapter of the book, is also a bit
different. Its focus is on adult individuals with disabilities
that began in childhood, such as cystic fibrosis and Duchenne
muscular dystrophy, and the ways in which those condi-
tions have affected the transition into the different stages of
adulthood. This unique chapter explores how the OTA may
encounter and manage clients with life-long disabilities as
well as additional new conditions. This material is impor-
tant in an adult-focused textbook and should not only be
taught in a pediatric class, as a client with Down syndrome
may have chronic diabetes, obesity, and a hip replacement,
or a young adult with autism may experience ongoing
sensory issues or experience a workplace brain injury.
Upon a quick glance at the table of contents, many
educators may note that we have not included separate
chapters on the older adult and sexual activity. Rather, we
chose a different approach, weaving the topic of older adult
issues and sexual activity throughout book instead of placing
it in a separate chapter. The chapters include an Older Adult
feature box, except in cases where it is helpful to highlight
specific differences between older and younger populations.
With regard to sexual activity and intimacy, we argue that
discussing this subject in a separate chapter would only
perpetuate the unfortunate trend of discussing sexual
activity only if forced to instead of viewing it as another ADL
that is part of a full and meaningful life. Sexual activity is
discussed along with every other ADL in the context of
every pertinent diagnosis. We hope this will lead students
to genuinely connect with the importance of sexual activity
and intimacy for every adult, like any other ADL, such as
bathing, dressing, and self-feeding.
OVERVIEW OF CHAPTER CONTENT
Section I, Foundations of Physical Rehabilitation, Process, and
Practice, provides to the OTA student an insight into concepts
of disability, health and wellness for both the client and the
OT practitioner, and the principles of teaching and learning.
This section assists students to clearly understand the key
elements of professionalism in OT and the expected behaviors
that facilitate the transition of the student to becoming an
OT practitioner. The last chapter discusses development of
the occupational profile and analysis of performance skills.
Section II, Foundations of Movement and Function, includes
essential, skill-based content, such as measuring and assess-
ing client performance skills, all of which affect clients. Even
content, such as range of motion and manual muscle testing,
are holistically addressed by including not only upper and
lower extremities but also intervention strategies for manage-
ment. Most of the content in this section lays the foundation
for subsequent chapters and is vital for the first-year student.
Section III, Foundations of Intervention, facilitates student
understanding of all types of mobility, assistive technology,
home modification, physical agent modalities, and methods
of fabricating and managing orthotics. Technology, whether
it is low-tech or high-tech and whether it is used at home, at
work, or in the community, is an invaluable tool in the OT
practitioner’s kit. Driving and community mobility often
mean independence for the adult and are critical issues that
must be addressed even by the general OT practitioner.
Section IV, Health Conditions and Interventions, examines
the adult physical conditions that are most commonly treated
by OT practitioners and explains evidence-based intervention
strategies. In addition to the conditions discussed in other
textbooks, this book includes more topics in the chapters
titled “Bariatric Factors and Management,” “Polytrauma and
Complex Multiple Conditions,” “Chronic Disease Manage-
ment: Utilizing a Self-Management Approach,” and “The
Pediatric Client—All Grown Up.” Three chapters with a
unique approach are “Cerebrovascular Accident: Critical
Aspects and Components of Care,” “Traumatic and Acquired
Brain Injury: Management and Treatment,” and “Spinal Cord
Injury and Disease: Factors and Essential Care.” The chapter
on cerebrovascular accident combines the latest evidence,
numerous intervention strategies, and integration with over
10 other foundational chapters. The chapter on traumatic
brain injury is organized by Rancho Los Amigos Level of
5918_FM_i-xxviii 16/03/18 4:19 PM Page ix
Cognitive Functioning Scale with treatment interventions
arranged by client symptoms. Finally, the chapter on spinal
cord injury and disease includes a useful table organized
by level, with skilled intervention examples, and a quick
reference for chapter content presented by level of injury.
SPECIAL CHAPTER FEATURES
Each chapter contains a number of special features that will
benefit students in their OT educational journey. These are
as follows:
Putting It All Together: Sample Treatment
and Documentation
Throughout many years of teaching, we have seen OTA stu-
dents struggle to connect what they learn in the classroom
and laboratory to what they will actually do in a real-life sit-
uation. Students are often confused about what to document
or by the documentation process itself. A frequent comment
has been: “I struggle with how to put it all together.” Putting
it All Together, included at the end of the chapters, is specifi-
cally designed to help students overcome this challenge.
This feature will help students become more prepared to
use clinical reasoning and provide skilled, client-centered
care. It begins with a glimpse of what an OTA might read
in a client’s chart—the occupational profile and basic inter-
vention plan and goes on to illustrate the clinical reasoning
process, providing a list of the tasks/activities performed in
the first treatment session, corresponding goals, and ratio-
nales for selecting each task. Next is sample documentation
written in the traditional SOAP note format. Finally, the
student is asked to create two treatment sessions in the
same format as part II (to facilitate clinical reasoning) and
to write a corresponding SOAP note for each. As students
practice with this format, they will build the foundation for
the bridge to fieldwork and entry-level clinical practice. Be-
cause each chapter author wrote the Putting it All Together
feature in his or her chapter, the student will see the slightly
different styles of setting goals and writing SOAP notes,
which is authentic to clinical practice and demonstrates
that there is more than one way of “how to do it right.”
Evidence-Based Practice
Although the contents of all of the chapters were written from
an evidence-based perspective, this feature highlights one
or more very recent research articles on a topic relevant to
each chapter, with the reference(s) for accessing the resources
included in the box.
OT Practitioner’s Viewpoint
In this feature, each chapter author shares a personal story
of first-hand experience relevant to the chapter topic. Our
intention is to replicate what it would be like for the student
to sit down with a seasoned practitioner and listen to a bit
of wisdom or personal anecdotes.
Preface ix
The Older Adult
This feature highlights and examines certain aspects of the
chapter content that are unique to aging and the older adult
population. Not every older adult has significant health con-
cerns, and many older adults are living long and healthy
lives. Therefore, many health issues discussed will be relevant
to adult clients of any age. Our goal is to help the OTA student
integrate the unique concerns that affect older adults while
learning the content pertinent to that function or health con-
dition. One difference to note occurs in Chapter 33, “Cere-
brovascular Accident: Critical Aspects and Components of
Care,” where this feature showcases “The Younger Adult,”
because although much of the chapter’s content is about the
older adult, a large number of younger adults are also expe-
riencing strokes, and this topic may be less familiar to readers.
Communication
Timely, accurate, and clear communication is crucial to all
aspects of health care, and this feature focuses on an aspect
of communication unique to the chapter topic. Whether the
terms and types of teamwork are interdisciplinary, multidis-
ciplinary, or interprofessional, the bottom line is that OTAs
and other healthcare professionals must communicate with
each other and the client to achieve the best outcomes.
Technology and Trends
Technology advances at an exponential rate, making it
challenging to pin down anything as new and innovative.
Instead, the intent of this feature is to show how common
technologies may be used in unique ways and to introduce
technologies that are not yet commercially available.
LEARNING TOOLS
Each chapter includes a number of learning tools, which
include:
n Learning Outcomes These serve to frame the con-
tent of the chapter and also provide a quick self-check
for the reader at the completion of a chapter to ensure
that the key learning objectives have been mastered.
n Key Terms These are listed alphabetically at the be-
ginning of each chapter and bolded upon first use in
the chapter itself. Each key term is defined in the Glos-
sary at the end of the book.
n Review Questions Ten multiple-choice questions at
the end of the chapters test understanding of and criti-
cal thinking about the chapter content. Since this text
is designed to be used across the curriculum, the level
of difficulty of the multiple-choice questions increases
through the book, with the earlier chapters having
more knowledge-based questions and the later chapters
requiring higher critical thinking skills. Seven to eight
questions in each chapter follow the traditional multiple-
choice question format of four possible answers and
5918_FM_i-xxviii 16/03/18 4:19 PM Page x
x Preface
only one correct answer. Two to three questions follow
a different format, having six options from which
three correct answers are required to be selected.
This aims to challenge the students to analyze multiple
options; many times in OT practice, there is not just
one single right answer but numerous potential solu-
tions. Answers are provided in Appendix B.
n Case Studies Case studies at the end of the chapters
are designed to further illustrate important learning
points from the chapter. Most are real-world examples
from the authors’ clinical practice. The case studies
are of varying lengths, and each includes questions
designed to develop critical thinking skills. A few cases
are formatted in a slightly different manner when they
are unique to a particular condition or area of practice.
ANCILLARIES
The ancillaries include an Instructor’s Guide, PowerPoint
presentations and a Test Bank. These ancillaries are available
at https://davisplus.fadavis.com/ to instructors who adopt
and require the textbook.
The Instructor’s Guide includes key documents from
the book (e.g., the Putting It All Together features), which
can be either printed or uploaded in a learning manage-
ment system (LMS) as assignments or resources for stu-
dents, such as a Quick Reference Table to Goniometry and a
Quick Reference Table to Manual Muscle Testing (we strongly
encourage instructors to print these tables for educational
use or make available to students via the LMS). The Instruc-
tor’s Guide also includes suggestions for lab activities and
other valuable resources. The PowerPoint presentation
for each chapter consists of basic chapter content plus key
concepts designed for creative, interactive learning, and
many instructors will assign them before class to spark
interaction. This fresh approach is less about sitting
through a lecture and more about collaborative learning
and the development of critical thinking skills. These
presentations are available to the educator to use “as is”
or can be modified to suit individual teaching needs.
Although printed in black and white in the textbook, the
photos will be available in full color in the online resources
in an Image Bank available to educators.
5918_FM_i-xxviii 16/03/18 4:19 PM Page xi
Amy J. Mahle (sounds like “mail”)
has been an occupational therapy
assistant (OTA) for over 10 years.
As many OTAs do, she found her
career in occupational therapy
(OT) later in life, with prior ca-
reers in social services and as
a small business owner. As an
OTA, she has worked in adult
outpatient and acute care clinical
settings and on a Brain Injury
Team, and she has also assisted in the development and
implementation of a Constraint-Induced Movement Ther-
apy program. Amy enjoys creative design and problem-
solving to help individuals overcome challenges, which
has resulted in numerous Innovative Product Design
Awards. She transitioned from clinical practice to acade-
mia on a part-time basis, eventually becoming a full-time
Assistant Professor in the OTA program at Cabarrus
College of Health Sciences in Concord, North Carolina
where she earned the Educational Excellence Award.
Most recently, she became the founding Program Director
of the OTA program at Rowan-Cabarrus Community
College in Salisbury, North Carolina. She regularly pre-
sents on various topics at national, state, and local levels
and is especially passionate about students developing
into professionals and about providing personal service
to the profession and the community. She has served
for several years on the board of the North Carolina
Occupational Therapy Association, as Education and
Research Chair, President, and most recently, Member
at Large.
about the authors
Amber L. Ward has been an
occupational therapist for over
24 years—10 years in inpatient
rehabilitation and more than
14 years as a full-time Occupa-
tional Therapy Coordinator, work-
ing with individuals with ALS,
muscular dystrophy, and other
neurological disorders. Amber has
been a coordinator of a seating and
wheeled mobility clinic for 12 years
in addition to working in her outpatient department. She has
treated a wide variety of clients of all ages and functional levels
throughout her career. She has been an adjunct professor for
9 years in the OTA program at Cabarrus College of Health
Sciences in Concord, North Carolina, in addition to working
in the clinic. She received the RESNA Assistive Technology
Professional certification in 2004, the Seating and Wheeled
Mobility certification in 2014, and AOTA board certification
in physical rehabilitation in 2010. Amber frequently speaks
on a variety of topics at local, state, national, and international
conferences. She loves to create solutions for clients with func-
tional challenges, and she is affectionately referred to as “Mac-
Gyver” by those in her field. She has served for many years on
the board of the North Carolina Occupational Therapy Asso-
ciation as Technology Special Interest Section Chair, Secre-
tary, President (two terms), and, most recently, Member at
Large. She has authored two journal articles about powered
wheelchairs for persons with ALS and a number of other book
chapters and journal articles. She is slated to receive the Roster
of Fellows Award presented by the American Occupational
Therapy Association just after book publication, and is proud
to be added to the amazing list of professionals honored to use
FAOTA in their signature.
xi
5918_FM_i-xxviii 16/03/18 4:19 PM Page xii
5918_FM_i-xxviii 16/03/18 4:19 PM Page xiii

contributors

Luis de Leon Arabit, OTD, MS, OTR/L, BCPR, Renee Causey-Upton, OTD, MS, OTR/L
C/NDT, PAM Chapter 26
Chapter 23 Assistant Professor
Supervisor Eastern Kentucky University
Department of Occupational Therapy Richmond, Kentucky
Adventist Health White Memorial
Megan E. Edwards Collins, PhD, OTR/L
Los Angeles, California
Chapters 6 and 8
Claribell Bayona, OTD, OTR/L Assistant Professor
Chapter 24 Occupational Therapy Department
Senior II Occupational Therapist Winston-Salem State University
NYU Langone Medical Center Winston-Salem, North Carolina
Manhattan, New York
Melinda Cozzolino, OTD, OTR/L, MS, CRC, BCN
Cynthia S. Bell, PhD, OTR/L, FAOTA Chapter 33
Chapter 6 Associate Professor and Graduate Chair
Associate Professor and Chair of Occupational Therapy Faculty Coordinator of Graduate Studies
Winston-Salem State University Ithaca College
Winston-Salem, North Carolina Ithaca, New York
David H. Benthall, MS, OTR/L Katrina Duhon Delahoussaye, MSOT/L
Chapters 25 and 26 Chapter 17
Occupational Therapist Staff Occupational Therapist
Durham VA Medical Center Center for Work Rehabilitation, Inc.
Durham, North Carolina Lafayette, Louisiana
Jamie Bittner, MS, OTR/L Anne E. Dickerson, PhD, OTR/L, SCDCM, FAOTA
Chapter 37 Chapter 16
Occupational Therapist Professor
Southeastern Cooperative Educational Programs East Carolina University
Norfolk, Virginia Greenville, North Carolina
Susan Blair, OTR/L, BCPR, BCG Heather S. Dodd, MS, OTR/L
Chapter 7 Chapter 28
Clinical OT Staff Developer/Lead OT Clinical Specialist
Novant Health UNC Hospitals, NC Jaycee Burn Center
Winston-Salem, North Carolina Chapel Hill, North Carolina
Salvador Bondoc, OTD, OTR/L, BCPR, CHT, FAOTA Denise K. Donica, DHSc, OTR/L, BCP, FAOTA
Chapter 23 Chapter 37
Chair and Professor of Occupational Therapy Associate Professor
Quinnipiac University East Carolina University
Hamden, Connecticut Greenville, North Carolina
Melissa D. Brawley, MS, OTR/L Joanna Edeker, PT, DPT
Chapter 36 and Appendix A Chapter 29
Home Health & Acute Care Occupational Therapist Physical Therapist III
BAYADA Home Health Carolinas HealthCare System
Carolinas HealthCare System Carolinas Rehabilitation
Carolinas Medical Center–Main Charlotte, North Carolina
Charlotte, North Carolina

xiii
5918_FM_i-xxviii 16/03/18 4:19 PM Page xiv

xiv Contributors

Elizabeth A. Fain, EdD, OTR/L Amy J. Mahle, MHA, COTA/L

Chapter 18 Chapters 1, 2, 5, 21, and 28
Assistant Professor Program Director
Occupational Therapy Department Occupational Therapy Assistant Program
Winston-Salem State University Rowan-Cabarrus Community College
Winston-Salem, North Carolina Salisbury, North Carolina
Paul A. Fontana, LOTR, FAOTA Lisa Michaud, OTR/L
Chapter 17 Chapter 10
Owner/Manager Occupational Therapist
Center for Work Rehabilitation, Inc. Carolinas HealthCare System
Lafayette, Louisiana Carolinas Rehabilitation
Concord, North Carolina
Lori Goodnight, MS, OTR/L
Chapter 20 Sharon D. Novalis, PhD, OTR/L
Subject Matter Expert Chapter 30
Relias Learning Assistant Professor
Cary, North Carolina Chatham University
Pittsburgh, Pennsylvania
Susan Hardesty, MS, OTR/L
Chapter 28 Anna Petry, MOTR/L
Occupational Therapist Chapter 17
Burn and Wound Therapy Co-Team Leader Occupational Therapist
Department of Rehabilitation The Therapy Center
Eskenazi Health–Richard M. Fairbanks Burn Center Jennings, Louisiana
Indianapolis, Indiana
Lisa Pierce, COTA/L, LLCC, CEAS
Cathrine Balentine Hatch, MS, OTR/L Chapter 27
Chapters 25 and 26 Certified Occupational Therapy Assistant
Lead Occupational Therapist
Jennifer C. Radloff, OTD, OTR/L, CDRS
Piedmont Health SeniorCare
Chapter 13
Burlington, North Carolina
Clinical Assistant Professor, Academic Fieldwork
Helen Houston, MS, OTR/L Coordinator
Chapter 13 Department of Occupational Therapy
Occupational Therapy Clinical Specialist East Carolina University
Vidant Health Greenville, North Carolina
Greenville, North Carolina
Vivian Resnik, MHA/MBA, OTR/L
Kelly McCoy Jones, OTR/L Chapter 12
Chapter 21 Rehabilitation Director
Occupational Therapist Legacy Healthcare Services
NorthEast Rehabilitation Charlotte, North Carolina
Concord, North Carolina
Marjorie E. Scaffa, PhD, OTR/L, FAOTA
Brenda Kennell, BS, MA, OTR/L Chapter 4
Chapters 5 and 21 Professor
Program Director University of South Alabama
Occupational Therapy Assistant Program Mobile, Alabama
Central Piedmont Community College
Sanchala Khanolkar Sen, MSc, OTR/L, BCPR
Charlotte, North Carolina
Chapter 9
Brittany Lorden, MHS, OTR/L, CLT Occupational Therapist/Clinical Specialist
Chapter 29 Novant Health Forsyth Medical Center
Occupational Therapist III Adjunct Faculty
Carolinas HealthCare System Department of Occupational Therapy
Carolinas Rehabilitation Winston-Salem State University
Charlotte, North Carolina Winston-Salem, North Carolina
5918_FM_i-xxviii 16/03/18 4:19 PM Page xv

Contributors xv

Megan McDermond Shein, OTR/L Heidi A. Van Keulen, OTR/L, CBIS

Chapter 32 Chapter 34
Director of Rehabilitation Services Occupational Therapist III
Genesis Rehab Services Carolinas HealthCare System
Charlotte, North Carolina Carolinas Rehabilitation
Charlotte, North Carolina
Karol Spraggs-Young, OTD, OTR/L, CHT
Chapters 19 and 22 Amber L. Ward, MS, OTR/L, BCPR, ATP/SMS
Occupational Therapist Chapters 11, 12, 14, 15, 31, and 32
St. Luke’s Hospital Occupational Therapy Coordinator
Columbus, North Carolina Neurosciences Institute Neurology, Carolinas
Adjunct Instructor, Cabarrus College of Health Sciences Neuromuscular ALS/MDA Center
Concord, North Carolina Carolinas HealthCare System
Charlotte, North Carolina
LaToya Nicole Stafford, OT/L, MBA/MHA, CAPS
Adjunct Instructor, Cabarrus College of Health Sciences
Chapter 3
Concord, North Carolina
Senior Living Program Manager II
BAYADA Home Health Francine Waskavitz, MS, CCC-SLP
Charlotte, North Carolina Chapter 12
Speech-Language Pathologist
Raheleh G. Tschoepe MS, OT/L
Legacy Healthcare Services
Chapter 35
Charlotte, North Carolina
Assistant Professor
Occupational Therapist Stephanie C. Wood, OTR, CDRS
University of North Carolina–Chapel Hill Chapter 11
Division of Occupational Science and Occupational Occupational Therapist, Guest Lecturer on Cognition
Therapy
Chapel Hill, North Carolina
Jordan Tucker, PT, DPT
Chapter 24
Assistant Professor
Academic Coordinator of Clinical Education
Jefferson College of Health Sciences
Physical Therapist Assistant Program
Roanoke, Virginia
5918_FM_i-xxviii 16/03/18 4:19 PM Page xvi
5918_FM_i-xxviii 16/03/18 4:19 PM Page xvii

reviewers

We would like to thank the following reviewers for their Jennifer C. George, OTD, OTR
thoughtful guidance and expertise: Instructor
Rutgers University
Mary Kay Arvin, OTD, OTR, CHT
Scotch Plains, New Jersey
Assistant Professor
University of Southern Indiana Theresa D. Gergen, EdD, OT/L
Evansville, Indiana OTA Program Director
Roane State Community College
Janice Bacon, MEd, OTR/L
Oak Ridge, Tennessee
Program Director
Washburn University Laura Green, BS, MOT, OTR/L
Topeka, Kansas Lead Faculty Coordinator
Kirkwood Community College
Brandi L. Buchanan, OTD, OTR/L
Hiawatha, Iowa
Associate Professor
A.T. Still University Nancy Green, MHA, OTR/L
Mesa, Arizona OTA Program Chair
Cabarrus College of Health Sciences
Kara Lindsay Cantoni, OTR/L
Concord, North Carolina
Occupational Therapist
Carolinas HealthCare System Tamla Heminger, OTR, MEd
Carolinas Rehabilitation OTA Program Director
Charlotte, North Carolina UA Cossatot
Ashdown, Arkansas
Michael Chan, OT
Professor Cassady Anne Hoff, MSOT, OTR/L
Mohawk College OTA Program Director
Hamilton, Ontario Casper College
Casper, Wyoming
Megan Cook, OTR, OTR/L
Assistant Dean of OTA Lisa Ellen Hubbs, MS, OTR/L
Northern Virginia Community College OTA Program Coordinator
Springfield, Virginia Suffolk County Community College
Brentwood, New York
Elizabeth Joy Crawford, MSRS, OTR/L
OTA Program Coordinator Amber Jenkins, MLS, OTR/L
Trident Technical College Coordinator
Charleston, South Carolina Metropolitan Community College
Kansas City, Missouri
LuAnn Demi, MS, OTR/L
Program Director Stephanie Johnston, MA, OTR
The Pennsylvania State University Professor/Fieldwork Coordinator
Dubois, Pennsylvania Lone Star College
Tomball, Texas
Dianna Fong-Lee, MA, BSc (OT)
OTA and PTA Program Coordinator and Faculty Amy Kampschroeder, OTR/L
Conestoga College Instructor
Kitchener, Ontario Cape Fear Community College
Wilmington, North Carolina
Jennifer Lynn Geitner, COTA/L, BS
Academic Fieldwork Coordinator Linda Kelly, PhD, LOTR
Pueblo Community College Program Director
Pueblo, Colorado Delgado Community College
New Orleans, Louisiana

xvii
5918_FM_i-xxviii 16/03/18 4:19 PM Page xviii
xviii Reviewers
Brenda Kennell, BS, MA, OTR/L
Program Director
Central Piedmont Community College
Charlotte, North Carolina
Jeanne M. Kerschner, OT
Clinical Director and Instructor
Pennsylvania College of Technology
Williamsport, Pennsylvania
Jeanette Krajca, MS, OTR
OTA Program Director
Navarro College
Corsicana, Texas
Brenda K. Lyman, OTR/L, OTD
Professor/Associate Dean
Salt Lake Community College
West Jordan, Utah
Cynthia Lynn Meyer, MEd, MS, OTR/L, OTA
OTA Program Director and Professor
South Arkansas Community College
El Dorado, Arkansas
Mary M. Malone, MS, OTR/L
Professor
North Shore Community College
Danvers, Massachusetts
Claudia Jean Miller, OTD, OTR/L
OTA Program Chair
Cincinnati State and Technical College
Cincinnati, Ohio
Ave Marie Mitta, MS, OTR/L
Program Director
Jefferson College of Health Sciences
Roanoke, Virginia
Michelle Parolise, MBA, OTR/L
Program Coordinator
Santa Ana College
Santa Ana, California
Kimberly Renee Prevo, MS, OTR/L
Assistant Professor
Kirkwood Community College
Cedar Rapids, Iowa
Connie Rooks, MAT, COTA/L
Program Director
Western New Mexico University
Silver City, New Mexico
Jennifer J. Saylor, MEd, OT/L
Professor and Director
River Valley Community College
Claremont, New Hampshire
Karyn Shenker-Gould, OTR/L
Assistant Professor
Maria College
Albany, New York
Michelle M. Sheperd, EdD, OTR
Dean of Specialty Program
Brown Mackie College
Woodridge, Illinois
Rae Ann Smith, OTD, OTR/L
Program Director
Allegany College of Maryland
Cumberland, Maryland
Chris Sorrells, OTR/L, CHT
Instructor
Pima Medical Institute
Denver, Colorado
Amy VanCamp, OTD
Academic Fieldwork Coordinator
Clinical Assistant Professor
University of New Hampshire, College of Health
and Human Services
Durham, New Hampshire
Christine Vicino, MA, OTA/L
OTA Program Director
Grossmont College
El Cajon, California
5918_FM_i-xxviii 16/03/18 4:19 PM Page xix
We first acknowledge Christa Fratantoro, at F. A. Davis,
who believed and assisted in our vision and skillfully guided
us with grace and positivity to bring it to fruition. Jill Rem-
betski, we especially thank you for your extreme patience,
careful direction, and unwavering encouragement through
every stage of preparing this book for publication. You are
both worthy of the title “editor extraordinaire.” We also rec-
ognize others at F. A. Davis who believed in our project—
George Lang, Amelia Blevins, Paul Marone, Julie Chase,
Bob Butler, and many others. We are especially grateful
for F. A. Davis’s approach to design, which, in our visually
intense environment, serves the content well.
As we embarked on this arduous, yet worthwhile and
exciting journey of writing and editing a comprehensive
textbook on adult conditions and OT interventions, we
knew that we needed to surround ourselves with experts
who were also passionate about teaching, learning, and OT.
With much appreciation, we recognize all of our dedicated
and talented contributing authors, who agreed to write
a chapter for a textbook with two unknown main authors/
editors. We are forever grateful for your contributions to the
profession and, specifically, OTA education.
Throughout the project, we personally called upon
several colleagues who have specialty knowledge or expe-
rience in a particular setting to help provide editorial assis-
tance. We are incredibly grateful to Leah Holland Fisher
(Chapter 11); Amy Wright (Chapter 12); Molly Shannon,
Tammy Pereboom, and Amy Wright (Chapter 14); Jessica
Pedersen (Chapter 15); Christa Gallie-Weiss (Chapter 33);
and Kara Cantoni (Chapter 35). The collective knowledge
and experience of these experts served to make this textbook
even stronger in its content. We would like to acknowledge
Brenda Kennell, BS, MA, OTR/L, for her expertise and con-
siderable time in assisting us in the final stages of thoughtful
editing to ensure this book is the best possible resource
for instructors and students.
For the majority of the photographs, we owe special
thanks to Jason Torres, who climbed up and down ladders
acknowledgments
for 4 days to get the “perfect shot.” You are a master. We
are grateful to Emily Rheinbolt, of Em Brooker Photogra-
phy (Amy’s daughter), who was ready at a moment’s
notice for multiple mini-photoshoots with special people
and environments that we could not have otherwise cap-
tured. Many students, former students, family, friends, and
clients with conditions or disabilities and their caregivers
assisted with the photoshoots and generously gave of
their time. Starla Daniel and Jonesha Wallace volunteered
especially long hours to assist with many aspects of the
main photoshoot.
We were very fortunate to have gracious hosts allow us
to use their spaces and equipment. We are deeply grateful
to Rowan-Cabarrus Community College and Dr. Wendy
Barnhardt for permitting us to use the beautiful OTA pro-
gram laboratory and North campus for the majority of
the main photoshoot. We also thank Cress Goodnight and
Novant Health for assistance in coordinating and hosting
photoshoot locations at Novant Health–Rowan Medical
Center and Novant Health Rehabilitation Center – Salisbury.
We thank Diane Spicer, her therapy team, and clients at
The Laurels of Salisbury. And finally, we express our appre-
ciation of Nancy Green and Cabarrus College of Health
Sciences for use of their OT laboratory and to several of their
graduate OT students who were willing models.
We also want to acknowledge others who brought hard-
to-find equipment and helped make these amazing photos
possible—Amy Street and Steven Shope from Hanger, Inc.;
Sandy Erwin from Invacare Corporation; Robert Flanagan
and Worth Williams from National Seating & Mobility;
Allen McKinley from Marketing Sales Logistics and his ca-
nine assistant Murphy; Regina LeFauve from Bioness; Derek
Fletcher from R82; Brenda Kennell from Central Piedmont
Community College; Tammy Pereboom from the North
Carolina Assistive Technology Program; the Neurosciences
Institute Neurology–Charlotte, North Carolina; and the loan
closet and staff at the Carolinas Neuromuscular ALS/MDA
Center.
xix
5918_FM_i-xxviii 16/03/18 4:19 PM Page xx
5918_FM_i-xxviii 16/03/18 4:19 PM Page xxi

contents in brief

unit I unit III

Foundations of Physical Rehabilitation, Foundations of Intervention 343
Process, and Practice 1 chapter 14 Assistive Technology and Home
Modifications 343
chapter 1 Client-Centered Occupational Therapy:
Disability and Participation 1 chapter 15 Seating and Wheeled Mobility 369

chapter 2 Professional Considerations for chapter 16 Driving and Community Mobility 394
Occupational Therapy Assistants 19
chapter 17 Work Rehabilitation and Retraining 419
chapter 3 The Continuum of Care and the Changing
Healthcare Environment 37 chapter 18 Physical Agent Modalities 450
chapter 4 Health Promotion and Wellness for the chapter 19 Orthotics: Fabrication and
Client and Practitioner 57 Management 479
chapter 5 Teaching and Learning With Clients and
Community 82 unit IV

chapter 6 Developing the Occupational Profile

Health Conditions and Interventions 503
and Analyzing Occupational chapter 20 Orthopedic Considerations: Spine,
Performance 108 Pelvis, Hip, and Knee 503

unit II chapter 21 Arthritic Diseases: Factors, Adaptations,

and Treatment 525
Foundations of Movement and Function 125
chapter 22 Comprehensive Hand Management 555
chapter 7 Range of Motion: Assessment and
Intervention 125 chapter 23 Orthopedic Considerations: The
Shoulder 589
chapter 8 Movement, Motor Control, Sensation,
Wounds, and Pain 155 chapter 24 Amputations and Prosthetics:
Components, Training, and
chapter 9 Muscle Strength: Assessment and Treatment 614
Management 185
chapter 25 Chronic Disease Management: Utilizing
chapter 10 Vision and Visual Perception 219 a Self-Management Approach 640
chapter 11 Cognition 244 chapter 26 Cardiopulmonary Conditions and
Treatment 668
chapter 12 Self-Feeding, Swallowing, and
Communication 274 chapter 27 Bariatric Factors and Management 704
chapter 13 Transfers Across the Continuum: Safety
and Management 299

xxi
5918_FM_i-xxviii 16/03/18 4:19 PM Page xxii

xxii Contents in Brief

chapter 28 Burns Across the Continuum chapter 34 Traumatic and Acquired Brain Injury:
of Care 724 Management and Treatment 886

chapter 29 Oncological Care and Treatment 747 chapter 35 Spinal Cord Injury and Disease: Factors
and Essential Care 908
chapter 30 Human Immunodeficiency Virus:
Factors and Considerations 768 chapter 36 Polytrauma and Complex Multiple
Conditions 957
chapter 31 Motor Unit and Myopathic Diseases:
Considerations and Treatment 788 chapter 37 The Pediatric Client—All Grown Up 981

chapter 32 Degenerative Diseases of the Central appendix A Lines, Leads, and Tubes 1012
Nervous System: Understanding and
Management 809 appendix B Answers to Review Questions 1017

chapter 33 Cerebrovascular Accident: Critical Glossary 1020

Aspects and Components of Care 838 Index 1035
5918_FM_i-xxviii 16/03/18 4:19 PM Page xxiii

contents

unit I chapter 5 Teaching and Learning With Clients and

Community 82
Foundations of Physical Rehabilitation, Brenda Kennell, BS, MA, OTR/L and
Amy J. Mahle, MHA, COTA/L
Process, and Practice 1 Learning Theory and Models 83
Learning Styles 85
chapter 1 Client-Centered Occupational Therapy: Locating and Developing Client Education 86
Disability and Participation 1 Education and Training Methods 90
Amy J. Mahle, MHA, COTA/L Addressing Client-Centered Learning and Outcomes 93
Physical Disability 2 Client Motivation 95
Philosophy of Occupational Therapy Related to Physical Client-Centered Care 96
Disability 4 Engaging the Client 97
Theories, Models of Practice, and Frames of Reference 6 Strategies for Groups 100
Adjustment to Disability 9 Interprofessional Communication 101
Role of the Occupational Therapy Assistant 12 Engaging the Community 102

chapter 2 Professional Considerations for chapter 6 Developing the Occupational

Occupational Therapy Assistants 19 Profile and Analyzing Occupational
Amy J. Mahle, MHA, COTA/L Performance 108
Paradigm Shift to Being a Professional 19 Cynthia S. Bell, PhD, OTR/L and
Advocacy 26 Megan E. Edwards Collins, PhD, OTR/L
Evidence-Based Practice 30 Occupational Profile Overview 108
Lifelong Learning 32 Analyzing Occupational Performance 112
Normal Analysis of an Activity 113
chapter 3 The Continuum of Care and the Changing Connecting Occupational Performance and Activity Analysis
Healthcare Environment 37 to Intervention 120
LaToya Nicole Stafford, OT/L, MBA/MHA, CAPS Documentation 121
Reimbursement and its Effect on the Continuum 38 Levels of Assistance–Common Terminology for Healthcare
Acute Care 39 Professionals 121
Post-Acute Settings 42
Healthcare Advancements and Reformation 53 unit II
chapter 4 Health Promotion and Wellness for the Foundations of Movement and Function 125
Client and Practitioner 57
Marjorie E. Scaffa, PhD, OTR/L, FAOTA chapter 7 Range of Motion: Assessment and
Principles of Health and Wellness Practice 57 Intervention 125
Quality of Life 58 Susan Blair, OTR/L, BCPR, BCG
Health Literacy 59 Why Is Measuring Range of Motion Important? 126
An Occupational Perspective on Health 61 How Is Range of Motion Measured? 126
The Role of Occupational Therapy in the Promotion of Health Assessing the Client for Range of Motion 127
and Well-Being 63 Performing Range of Motion Assessment 129
Health Promotion Practice Examples 65 Understanding Movement in Planes 130
Psychosocial Impact 69 Preparing the Client for Measurement 131
Practitioner Health and Wellness and Professional Self-Care 73 Range of Motion Intervention 144

xxiii
5918_FM_i-xxviii 16/03/18 4:19 PM Page xxiv

xxiv Contents

chapter 8 Movement, Motor Control, Sensation, chapter 12 Self-Feeding, Swallowing, and

Wounds, and Pain 155 Communication 274
Megan E. Edwards Collins, PhD, OTR/L Amber L. Ward, MS, OTR/L, BCPR, ATP/SMS,
Coordination 155 Vivian Resnik, MHA/MBA, OTR/L, and
Sensation 158 Francine Waskavitz, MS, CCC–SLP
Reflexes, Equilibrium, and Righting Reactions 160 The Social Impact of Self-Feeding 275
Tone 167 Self-Feeding and Eating 275
Stages of Motor Learning and Recovery 169 Self-Feeding Impairments 276
Wound Development and Management 173 Swallowing 282
Pain Assessment and Management 179 Swallowing Impairments 282
Communication 289
chapter 9 Muscle Strength: Assessment and Communication Impairments 290
Management 185 Compensatory Strategies for Communication 292
Sanchala Khanolkar Sen, MSc, OTR/L, BCPR Implementation of Strategies During Occupations 295
Manual Muscle Testing Terminology 185
Causes of Muscle Weakness 186 chapter 13 Transfers Across the Continuum: Safety
Screening Tests 186 and Management 299
Manual Muscle Testing 187 Jennifer C. Radloff, OTD, OTR/L, CDRS and
Relationship Between Joint Range of Motion and Muscle Helen Houston, MS, OTR/L
Strength 188 Injury Prevention 299
General Principles of Manual Muscle Testing 188 Preparing for Transfers 300
Manual Muscle Testing of the Upper Extremity 192 Traditional Transfers 304
Manual Muscle Testing of the Lower Extremity 205 Fall Prevention 317
Grip and Pinch Strength 209 Safe Patient-Handling Equipment 319
Basic Intervention Strategies for Improving Muscle Strength 210 Transfers for Postsurgical Restrictions 323
Transfers for Specific Deficits 324
chapter 10 Vision and Visual Perception 219 Transfers into Motor Vehicles 334
Lisa Michaud, OTR/L
Treatment Team 219 unit III
The Visual System 220
Vision Conditions Related to Neurological Impairments 223
Visual Perception 230
Foundations of Intervention 343
Low Vision 233
Psychosocial Impact of Visual Deficits 239
chapter 14 Assistive Technology and Home
Modifications 343
chapter 11 Cognition 244 Amber L. Ward, MS, OTR/L, BCPR, ATP/SMS
Stephanie C. Wood, OTR, CDRS and Activities of Daily Living 344
Amber L. Ward, MS, OTR/L, BCPR, ATP/SMS Instrumental Activities of Daily Living 352
Education and Work 354
Neuroanatomy of Cognition and Functional Limitations Communication 354
Associated With Damage to Each Lobe 245 Vision 356
Acute and Degenerative Conditions that Can Lead to Cognitive Hearing 357
Decline 247 Computer, iPad®, Tablet, and Phone Access 358
Cognitive Rehabilitation Therapy 249 Door Options, Alerting, and Electronic Activities of Daily
Internal and External Cognitive Strategies 253 Living 359
Attention and Concentration Impairments 253 Leisure 360
Memory Impairments 256 Service Animals 361
Executive Function Impairments 259 Creating Custom Assistive Technology Devices 361
Behavioral Impairments 261 Choosing Correctly 362
The Cognition In Vision 264 Device Use and Abandonment 362
Awareness 264 Who Pays? 362
Cognitive Rehabilitation With Degenerative Conditions 265 Assistive Technology Research 363
Cognitive Rehabilitation in Various Settings 265 Resources: Rehabilitation Engineering Society of North America,
Individual Versus Group Treatment 265 State Agencies, and the Internet 363
Importance of Family Involvement 266 Home Modifications for Disability 364
Importance of the Therapeutic Relationship in Achieving
Goals 267
Importance of Generalizing Skills into “Real-Life”
Environments 268
Another random document with
no related content on Scribd:
medium, a computer virus, or computer codes that damage or
cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES -

Except for the “Right of Replacement or Refund” described in
paragraph 1.F.3, the Project Gutenberg Literary Archive
Foundation, the owner of the Project Gutenberg™ trademark,
and any other party distributing a Project Gutenberg™ electronic
work under this agreement, disclaim all liability to you for
damages, costs and expenses, including legal fees. YOU
AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE,
STRICT LIABILITY, BREACH OF WARRANTY OR BREACH
OF CONTRACT EXCEPT THOSE PROVIDED IN PARAGRAPH
1.F.3. YOU AGREE THAT THE FOUNDATION, THE
TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER
THIS AGREEMENT WILL NOT BE LIABLE TO YOU FOR
ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE
OR INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF
THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If

you discover a defect in this electronic work within 90 days of
receiving it, you can receive a refund of the money (if any) you
paid for it by sending a written explanation to the person you
received the work from. If you received the work on a physical
medium, you must return the medium with your written
explanation. The person or entity that provided you with the
defective work may elect to provide a replacement copy in lieu
of a refund. If you received the work electronically, the person or
entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund.
If the second copy is also defective, you may demand a refund
in writing without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set

forth in paragraph 1.F.3, this work is provided to you ‘AS-IS’,
WITH NO OTHER WARRANTIES OF ANY KIND, EXPRESS
OR IMPLIED, INCLUDING BUT NOT LIMITED TO
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR
ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied

warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this
agreement violates the law of the state applicable to this
agreement, the agreement shall be interpreted to make the
maximum disclaimer or limitation permitted by the applicable
state law. The invalidity or unenforceability of any provision of
this agreement shall not void the remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the

Foundation, the trademark owner, any agent or employee of the
Foundation, anyone providing copies of Project Gutenberg™
electronic works in accordance with this agreement, and any
volunteers associated with the production, promotion and
distribution of Project Gutenberg™ electronic works, harmless
from all liability, costs and expenses, including legal fees, that
arise directly or indirectly from any of the following which you do
or cause to occur: (a) distribution of this or any Project
Gutenberg™ work, (b) alteration, modification, or additions or
deletions to any Project Gutenberg™ work, and (c) any Defect
you cause.

Section 2. Information about the Mission of

Project Gutenberg™
Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new
computers. It exists because of the efforts of hundreds of
volunteers and donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the

assistance they need are critical to reaching Project
Gutenberg™’s goals and ensuring that the Project Gutenberg™
collection will remain freely available for generations to come. In
2001, the Project Gutenberg Literary Archive Foundation was
created to provide a secure and permanent future for Project
Gutenberg™ and future generations. To learn more about the
Project Gutenberg Literary Archive Foundation and how your
efforts and donations can help, see Sections 3 and 4 and the
Foundation information page at www.gutenberg.org.

Section 3. Information about the Project

Gutenberg Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non-
profit 501(c)(3) educational corporation organized under the
laws of the state of Mississippi and granted tax exempt status by
the Internal Revenue Service. The Foundation’s EIN or federal
tax identification number is 64-6221541. Contributions to the
Project Gutenberg Literary Archive Foundation are tax
deductible to the full extent permitted by U.S. federal laws and
your state’s laws.

The Foundation’s business office is located at 809 North 1500

West, Salt Lake City, UT 84116, (801) 596-1887. Email contact
links and up to date contact information can be found at the
Foundation’s website and official page at
www.gutenberg.org/contact

Section 4. Information about Donations to

the Project Gutenberg Literary Archive
Foundation
Project Gutenberg™ depends upon and cannot survive without
widespread public support and donations to carry out its mission
of increasing the number of public domain and licensed works
that can be freely distributed in machine-readable form
accessible by the widest array of equipment including outdated
equipment. Many small donations ($1 to $5,000) are particularly
important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws

regulating charities and charitable donations in all 50 states of
the United States. Compliance requirements are not uniform
and it takes a considerable effort, much paperwork and many
fees to meet and keep up with these requirements. We do not
solicit donations in locations where we have not received written
confirmation of compliance. To SEND DONATIONS or
determine the status of compliance for any particular state visit
www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states

where we have not met the solicitation requirements, we know
of no prohibition against accepting unsolicited donations from
donors in such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot

make any statements concerning tax treatment of donations
received from outside the United States. U.S. laws alone swamp
our small staff.

Please check the Project Gutenberg web pages for current

donation methods and addresses. Donations are accepted in a
number of other ways including checks, online payments and
credit card donations. To donate, please visit:
www.gutenberg.org/donate.

Section 5. General Information About Project

Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could
be freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose
network of volunteer support.

Project Gutenberg™ eBooks are often created from several

printed editions, all of which are confirmed as not protected by
copyright in the U.S. unless a copyright notice is included. Thus,
we do not necessarily keep eBooks in compliance with any
particular paper edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,

including how to make donations to the Project Gutenberg
Literary Archive Foundation, how to help produce our new
eBooks, and how to subscribe to our email newsletter to hear
about new eBooks.