NBCOT OTR key terms

A structured interview and record review that captures a client's roles, routines, values, interests, and perceived barriers, giving the therapist a picture of what the person needs and wants to do.

Breaking a task into its component steps, materials, and required abilities so the therapist can judge which parts a client can perform and where support is needed.

A test given with the same instructions, materials, and scoring rules every time so results can be compared across people or over time.

A test scored by comparing a client's performance with that of a representative peer group, producing percentile ranks or standard scores that show standing relative to others.

A test scored against a fixed standard of mastery rather than against other people, showing whether the client can perform a specific skill or meet a defined benchmark.

The consistency of scores when the same test is given to the same people on two occasions, indicating how much a score is likely to change from measurement error alone.

The degree to which two or more examiners score the same performance the same way, which matters most when a tool relies on clinical judgment or observation.

Observation and measurement of a client performing real tasks in the actual settings where those tasks happen, capturing the demands and supports of the environment rather than a clinic simulation.

A self-report tool that lists common life roles and asks the client to mark which roles were performed in the past, are performed now, and are valued for the future.

A method that writes several possible outcomes for one goal, from less than expected to much better than expected, so progress can be scored on a five-point scale.

A grading procedure in which the therapist resists a client's active movement through a joint range and assigns a score based on how much force the muscle can generate.

Use of a protractor-like instrument to measure the angle of a joint at rest and at the end of active or passive movement, documenting range and tracking change over time.

Deliberately adjusting the difficulty of a task, by changing time, effort, complexity, or amount of assistance, so the client works at a level that is challenging but achievable.

Changing the task, tools, or environment so a person can complete an occupation despite a lasting limitation, rather than building the underlying skill first.

Techniques that work around a deficit, such as one-handed shoe tying or a memory checklist, so daily tasks can be done safely without restoring the lost function.

Repeated practice of the actual occupation a client wants to relearn, on the theory that the nervous system improves most at the exact task being rehearsed.

A protocol that restrains the less affected arm and drives intensive, graded use of the more affected arm during functional tasks to counter learned nonuse.

Application of electrical current to a muscle to produce contraction, used to help re-educate movement, maintain range, or support a weakened limb during functional training.

A planned schedule of sensory experiences such as movement, deep pressure, touch, and sound, tailored to an individual and woven through the day to support regulation and participation.

Changing the physical or social surroundings, including layout, lighting, furniture height, noise, or caregiver routines, so a person can participate more safely and independently.

Planning and pacing daily activities with rest breaks, prioritized tasks, and efficient body mechanics so fatigue does not prevent completion of important occupations.

Techniques that reduce stress on painful or unstable joints, including respecting pain, using larger joints, avoiding prolonged gripping, and balancing activity with rest.

A custom or prefabricated device worn to support, align, protect, or position a body segment, often used to maintain range, reduce pain, or improve function.

Structured instruction and practice for family or paid helpers so they can safely assist with transfers, daily care, and use of equipment between therapy sessions.

Obtaining a client's voluntary agreement to evaluation or treatment after explaining the purpose, expected benefits, risks, alternatives, and the right to refuse or withdraw.

The duty to protect a client's health information from unauthorized disclosure, with limited exceptions such as suspected abuse, imminent danger, or a valid court order.

The range of services and procedures a clinician is trained and legally permitted to perform, defined by state licensure law and professional standards.

The overseeing occupational therapist's responsibility to assign, guide, review, and remain accountable for services delivered by an occupational therapy assistant, following state and payer rules.

The core values used to reason through clinical dilemmas: beneficence (help), nonmaleficence (do no harm), autonomy (respect choice), justice (fairness), and veracity (truthfulness).

Failure to provide the care a reasonably competent therapist would provide under similar circumstances, resulting in harm; proving it requires duty, breach, causation, and damages.

Action taken to protect or advance a client's rights, access, and well-being, from securing equipment to speaking up with payers or policymakers.

Combining the best available research, the therapist's clinical expertise, and the client's values and circumstances when choosing an evaluation or intervention approach.

The written record of evaluation findings, goals, interventions, and progress, which communicates care, justifies reimbursement, and serves as legal evidence.

The standard that a service must be reasonable, specific to the diagnosis, and expected to improve or maintain function in order to be covered and paid.

The ongoing process of recognizing one's own assumptions and adapting communication, assessment, and intervention to a client's culture, language, identity, and preferences.

A legal obligation to notify designated authorities when a clinician suspects abuse, neglect, or exploitation of a child, older adult, or dependent adult, even without proof.