OTLE cheat sheet

The OT process follows referral → evaluation → intervention planning → intervention implementation → outcome measurement → discharge, with re-evaluation looping back whenever goals or status change.

Top-down reasoning starts from the client's roles, routines, and desired occupations, then analyzes underlying capacities only as needed; bottom-up reasoning starts from component deficits and builds toward function.

The Occupational Therapy Practice Framework describes client factors, performance skills, performance patterns, contexts/environments, activity demands, and occupations as interactive domains of concern.

Clinical reasoning types: scientific (diagnostic), narrative (understanding the client's story), procedural (sequencing sessions), interactive (in-the-moment response to client), and conditional (imagining future scenarios).

Ethical reasoning is a distinct reasoning mode applied when competing obligations arise, such as autonomy versus safety in discharge planning.

Goal writing uses the SMART rule: specific, measurable, attainable, relevant, time-bound; a measurable goal names the occupation, the assistance level, and the criterion for success.

Therapeutic use of self is a deliberate, reasoned use of the therapist's personality, insight, and communication as part of intervention, not incidental friendliness.

Evidence-based practice integrates best available research, clinician expertise, and client values and preferences; all three must be documented when justifying a plan.

Piaget stages: sensorimotor (0–2 y), preoperational (2–7 y), concrete operational (7–11 y), formal operational (11 y and older); object permanence emerges in the sensorimotor stage.

Erikson psychosocial stages pair each life phase with a crisis: trust vs mistrust (infancy), autonomy vs shame (1–3 y), initiative vs guilt (3–6 y), industry vs inferiority (6–12 y), identity vs role confusion (adolescence), intimacy vs isolation (young adulthood), generativity vs stagnation (middle adulthood), integrity vs despair (older adulthood).

Fine motor grasp develops proximally to distally: palmar grasp around 4–6 months, pincer grasp around 9–12 months, and dynamic tripod grasp typically by 4–6 years.

Typical gross motor milestones: independent sitting 6–8 months, cruising or walking with support 9–12 months, independent walking 12–15 months, running 18–24 months.

Developmental screening tools include the Ages and Stages Questionnaire, the Denver Developmental Screening Test II, and the Bayley Scales; screening identifies risk and does not diagnose.

Common pediatric conditions include cerebral palsy (nonprogressive motor impairment), autism spectrum disorder (social communication and restricted behavior), and developmental coordination disorder (motor skill difficulty affecting daily activities).

Adult conditions frequently seen in OT include stroke (contralateral hemiparesis), traumatic brain injury (diffuse and focal deficits), spinal cord injury (level determines function), and arthritis (joint pain, deformity, fatigue).

Aging changes include reduced visual acuity and contrast sensitivity, presbycusis, decreased reaction time, sarcopenia, and reduced postural control; these interact with task demands rather than determining disability alone.

Performance patterns are habits (automatic routines), routines (repeated established sequences), roles (socially defined expectations), and rituals (symbolic actions with meaning).

The Person-Environment-Occupation model holds that performance results from the fit among person, environment, and occupation; change the fit rather than only the person.

The Ecology of Human Performance framework organizes intervention into establish/restore, alter, adapt/modify, prevent, and create.

Environmental levels include physical, social, cultural, institutional, and virtual contexts; each can be a barrier or a support.

Activity demands include objects used and their properties, space demands, social demands, sequencing and timing, required actions and skills, and required body functions and structures.

Participation is involvement in life situations as defined by the International Classification of Functioning, Disability and Health; it is distinct from activity capacity measured in a clinic.

Universal design and visitability principles (zero-step entry, wide doorways, lever handles, adequate lighting) reduce the need for individualized modification.

Occupational balance and occupational deprivation are population-level concepts: deprivation results from external barriers that prevent access to meaningful occupation.

Reliability concerns consistency of measurement; validity concerns whether a tool measures what it claims. A test can be reliable without being valid, but not valid without being reliable.

Standard scores: z-score mean 0, SD 1; T-score mean 50, SD 10; standard score mean 100, SD 15; percentiles are not equal-interval and cannot be averaged.

Sensitivity is the proportion of people with the condition correctly identified; specificity is the proportion without the condition correctly identified; lower cutoffs raise sensitivity and lower specificity.

The minimal detectable change is the amount of change beyond measurement error; the minimal clinically important difference is the smallest change a client or clinician considers meaningful.

Common adult assessments include the Barthel Index, Functional Independence Measure, Action Research Arm Test, Box and Block Test, and the Canadian Occupational Performance Measure.

The COPM is a client-centered, individualized outcome measure that scores self-perceived performance and satisfaction on a 1–10 scale and is sensitive to change.

Intervention approaches in the Practice Framework are create/promote, establish/restore, maintain, modify, and prevent.

Goal attainment scaling converts individualized goals into a five-point scale from −2 (much less than expected) to +2 (much better than expected), with 0 as expected outcome.

Documenting baseline, target, and method of measurement before intervention is what makes later outcome claims verifiable.

Core ethical principles: beneficence, nonmaleficence, autonomy, justice, veracity, and fidelity; informed consent operationalizes autonomy.

Informed consent requires capacity, disclosure of risks and benefits, understanding, voluntariness, and documentation; consent may be withdrawn at any time.

Supervision requirements specify that the supervising therapist retains responsibility for the services delivered by assistants and students and must be available as required by jurisdiction.

Scope of practice is defined by state or provincial statute and rules, not by employer policy; when the two conflict, the statute governs.

Mandatory reporting duties typically cover suspected abuse or neglect of children, older adults, and dependent adults; reporting is required even when the suspicion is not confirmed.

Confidentiality may be breached only under legal mandate or serious imminent risk; minimum necessary disclosure applies to releases of information.

Jurisprudence covers licensure, credentialing, and reimbursement rules, including Medicare therapy thresholds and documentation supporting medical necessity.

A conflict of interest exists when personal or financial interest could influence professional judgment; it must be disclosed and, where possible, avoided.

Competence is an ethical obligation: practicing outside one's training requires supervision or referral, regardless of licensure status.

SOAP note structure: Subjective (client report), Objective (measurable findings), Assessment (clinical interpretation and progress toward goals), Plan (next steps and frequency).

Documentation must be timely, accurate, objective, and defensible; avoid subjective labels and record observed behavior and quoted statements instead.

Skilled terminology describes the clinical decision-making and cueing provided, not just the activity performed; payers reimburse for skill, not for the task.

Interprofessional collaboration requires role clarity, shared goals, and closed-loop communication; use a structured handoff such as SBAR (Situation, Background, Assessment, Recommendation).

Teach-back confirms client understanding by asking the client to explain or demonstrate, rather than asking whether they understood.

Health literacy accommodations include plain language, chunking, visual supports, and interpreters rather than family members for clinical communication.

Release of information must specify recipient, purpose, content, and expiration, and must comply with applicable privacy law and the client's authorization.

Conflict in teams is addressed by focusing on the shared client goal and using objective data rather than by escalating personalities.

Placeholder merged domain entry: the OT process is iterative and re-entered at any stage when new information changes the client's status or priorities.

Screening determines the need for evaluation and is not itself an evaluation; it does not establish a diagnosis or a plan of care.

Evaluation includes the occupational profile (client's perspective and priorities) and the analysis of occupational performance (observation and measurement).

Discharge planning begins at evaluation and considers the discharge environment, caregiver capacity, and the client's own goals.

Re-evaluation is required when there is a change in condition, a plateau, or a new setting, and it updates goals and the plan of care.

Clinical reasoning should be documented as the rationale linking findings to the chosen intervention, not left implicit in the plan.

Collaborative goal setting with the client improves adherence and is a documented expectation of client-centered practice.

Reflexes integrate in a predictable sequence: rooting and sucking (birth), palmar grasp (birth to 4 months), asymmetric tonic neck reflex (birth to 6 months), and Moro reflex (birth to 4–6 months).

Primitive reflexes that persist beyond expected integration suggest neurological involvement and warrant referral.

Body functions include mental, sensory, neuromuscular, cardiovascular, respiratory, digestive, metabolic, and skin functions; impairment is a problem in function or structure.

Sensory processing differences may present as hyperresponsiveness (avoidance) or hyporesponsiveness (reduced registration); intervention matches the sensory profile.

Pain, fatigue, and endurance are body functions that directly limit occupational performance and should be measured, not assumed.

Neuroplasticity principles: practice must be task-specific, sufficiently intense, salient to the client, and repeated with feedback to drive reorganization.

Spasticity, rigidity, ataxia, and tremor are distinct motor signs requiring different handling and intervention strategies.

Health conditions interact with occupational performance through their course (acute, progressive, stable) and their impact on energy, sensation, and movement.

The International Classification of Functioning, Disability and Health separates body functions and structures, activities, participation, environmental factors, and personal factors.

Task analysis breaks an occupation into steps and identifies the specific performance skills and body functions each step requires.

Activity analysis describes the demands of an activity independent of any particular client; task analysis applies it to one client in context.

Grading adapts the task demand up or down by changing time, weight, distance, complexity, or assistance level; adapting changes the task or environment instead.

Home modification priorities follow the client's daily routine and the location of falls or near-misses rather than a generic checklist.

Assistive technology ranges from no-tech to high-tech and is selected by matching the user's abilities, the task, and the environment, with training and follow-up.

Caregiver training and environmental cues are interventions in their own right and require their own goals and documentation.

Participation restrictions are measured by frequency and variety of engagement in life situations, not by capacity in a clinical setting.

Norm-referenced tests compare a client to a normative sample; criterion-referenced tests compare performance to a defined standard or criterion.

Inter-rater reliability is essential for observational scales; intra-rater reliability matters for repeated measurement by one clinician.

Standard error of measurement estimates the spread of a client's hypothetical observed scores around the true score and informs confidence intervals.

A cutoff score chosen for screening favors sensitivity; a cutoff chosen for confirmation favors specificity.

Goal writing specifies the occupation, the assistance or cueing level, and the criterion; progress is reported against that baseline.

Outcome measures should be valid for the population, responsive to the expected change, and feasible for the setting.

Frequency and duration of intervention are plan-of-care decisions that must be justified by the client's needs and documented.

Reimbursement documentation links impairment findings to functional limitations to the skilled intervention and to measurable progress.

Licensure is granted by a state or provincial board and is required to practice; certification and membership are separate credentials.

Unprofessional conduct commonly includes practicing beyond scope, failing to supervise, falsifying records, and practicing while impaired.

Documentation is a legal record: alterations must be dated, signed, and explained, and entries must never be erased or backdated.

Informed refusal: a client with capacity may decline recommended treatment, and the refusal and its education should be documented.

Duty to warn or protect may arise when a client poses a serious threat to an identifiable person; follow the jurisdiction's statute.

Reimbursement fraud includes billing for services not delivered, upcoding, and services not medically necessary; intent is not required for a finding of error.

Continuing competence requirements vary by jurisdiction and typically include documented professional development hours.

A therapist who observes unsafe or unethical practice has an obligation to address it internally and, where required, report it to the board.

Objective documentation uses observable, measurable language: assistance level, time, distance, accuracy, and cues required.

Progress notes should connect the session's data to the goal and state the clinical interpretation and the plan.

Communication with clients with aphasia benefits from supported conversation techniques: yes/no verification, written keywords, and reduced rate.

Interpreter use requires a qualified interpreter, not a family member, when clinical information or consent is discussed.

Team meetings should produce documented decisions with named owners and deadlines; verbal agreements without documentation are not durable.

SBAR provides a consistent structure for handoffs and escalation of a deteriorating client.

Cultural humility includes asking about the client's explanatory model of illness and preferred decision-making role.

Discharge summaries must include the client's status, equipment, referrals, and instructions, and must be shared per authorization.

Screening determines the need for evaluation and is not itself an evaluation; it does not establish a diagnosis or a plan of care.

Evaluation includes the occupational profile (client's perspective and priorities) and the analysis of occupational performance (observation and measurement).

Discharge planning begins at evaluation and considers the discharge environment, caregiver capacity, and the client's own goals.

Re-evaluation is required when there is a change in condition, a plateau, or a new setting, and it updates goals and the plan of care.

Clinical reasoning should be documented as the rationale linking findings to the chosen intervention, not left implicit in the plan.

Collaborative goal setting with the client improves adherence and is a documented expectation of client-centered practice.

Reflexes integrate in a predictable sequence: rooting and sucking (birth), palmar grasp (birth to 4 months), asymmetric tonic neck reflex (birth to 6 months), and Moro reflex (birth to 4–6 months).

Primitive reflexes that persist beyond expected integration suggest neurological involvement and warrant referral.

Body functions include mental, sensory, neuromuscular, cardiovascular, respiratory, digestive, metabolic, and skin functions; impairment is a problem in function or structure.

Sensory processing differences may present as hyperresponsiveness (avoidance) or hyporesponsiveness (reduced registration); intervention matches the sensory profile.

Pain, fatigue, and endurance are body functions that directly limit occupational performance and should be measured, not assumed.

Neuroplasticity principles: practice must be task-specific, sufficiently intense, salient to the client, and repeated with feedback to drive reorganization.

Spasticity, rigidity, ataxia, and tremor are distinct motor signs requiring different handling and intervention strategies.

Health conditions interact with occupational performance through their course (acute, progressive, stable) and their impact on energy, sensation, and movement.

The International Classification of Functioning, Disability and Health separates body functions and structures, activities, participation, environmental factors, and personal factors.

Task analysis breaks an occupation into steps and identifies the specific performance skills and body functions each step requires.

Activity analysis describes the demands of an activity independent of any particular client; task analysis applies it to one client in context.

Grading adapts the task demand up or down by changing time, weight, distance, complexity, or assistance level; adapting changes the task or environment instead.

Home modification priorities follow the client's daily routine and the location of falls or near-misses rather than a generic checklist.

Assistive technology ranges from no-tech to high-tech and is selected by matching the user's abilities, the task, and the environment, with training and follow-up.

Caregiver training and environmental cues are interventions in their own right and require their own goals and documentation.

Participation restrictions are measured by frequency and variety of engagement in life situations, not by capacity in a clinical setting.

Norm-referenced tests compare a client to a normative sample; criterion-referenced tests compare performance to a defined standard or criterion.

Inter-rater reliability is essential for observational scales; intra-rater reliability matters for repeated measurement by one clinician.

Standard error of measurement estimates the spread of a client's hypothetical observed scores around the true score and informs confidence intervals.

A cutoff score chosen for screening favors sensitivity; a cutoff chosen for confirmation favors specificity.

Goal writing specifies the occupation, the assistance or cueing level, and the criterion; progress is reported against that baseline.

Outcome measures should be valid for the population, responsive to the expected change, and feasible for the setting.

Frequency and duration of intervention are plan-of-care decisions that must be justified by the client's needs and documented.

Reimbursement documentation links impairment findings to functional limitations to the skilled intervention and to measurable progress.

Licensure is granted by a state or provincial board and is required to practice; certification and membership are separate credentials.

Unprofessional conduct commonly includes practicing beyond scope, failing to supervise, falsifying records, and practicing while impaired.

Documentation is a legal record: alterations must be dated, signed, and explained, and entries must never be erased or backdated.

Informed refusal: a client with capacity may decline recommended treatment, and the refusal and its education should be documented.

Duty to warn or protect may arise when a client poses a serious threat to an identifiable person; follow the jurisdiction's statute.

Reimbursement fraud includes billing for services not delivered, upcoding, and services not medically necessary; intent is not required for a finding of error.

Continuing competence requirements vary by jurisdiction and typically include documented professional development hours.

A therapist who observes unsafe or unethical practice has an obligation to address it internally and, where required, report it to the board.

Objective documentation uses observable, measurable language: assistance level, time, distance, accuracy, and cues required.

Progress notes should connect the session's data to the goal and state the clinical interpretation and the plan.

Communication with clients with aphasia benefits from supported conversation techniques: yes/no verification, written keywords, and reduced rate.

Interpreter use requires a qualified interpreter, not a family member, when clinical information or consent is discussed.

Team meetings should produce documented decisions with named owners and deadlines; verbal agreements without documentation are not durable.

SBAR provides a consistent structure for handoffs and escalation of a deteriorating client.

Cultural humility includes asking about the client's explanatory model of illness and preferred decision-making role.

Discharge summaries must include the client's status, equipment, referrals, and instructions, and must be shared per authorization.