OTA Theory & Treatment of Physical Dysfunction

SOTP (systematic occupational therapy practice)

(4 parts) critical, analytic, scientific thinking, and action process -a way to organize and apply and support interventions.

total shoulder arthroplasty (TSA)

(aka: total shoulder replacement TSR) -more often performed when there is a degenerative/inflammatory condition. (such as OA)

steps to don sling

(done with arm supported) step 1: gentle pull the sling on to affected arm until elbow in the back of sling step 2: swing strap around body with unaffected arm then clip and adjust so that arm and forearm are positioned above elbow and close to body step 3: reach around body with unaffected arm and clip and adjust waist belt

coronary artery disease (CAD)

(most common type of heart disease in US & leading cause of death) -a condition affecting arteries of the heart that reduces the flow of blood and the delivery of oxygen and nutrients to the myocardium; most often caused by atherosclerosis

Americans with Disabilities Act (ADA)

(previously the Rehabilitation Act of 1973) Legislation passed in 1990 that prohibits discrimination against people with disabilities. Under this Act, discrimination against a disabled person is illegal in employment, transportation, public accommodations, communications and government activities.

job tasks (ergonmics)

(what is required of them for their work; physical & demands) -positioning -repetition physical demands (lifting, walking, sitting, phone use, comperter use, etc.)

initial problem statement

(why they are referred) -identification and clarification of the problem to be addressed by the intvention -What is the end vision? what is the purpose?

psychosocial impact of disability

* Adjustment to disability * Impact of disability on family (also friends/employers/anyone who knows them) * comorbid mental disorders (increased risk) * Society: how other see person with disability (PWD), avoid reject devalue (spread factor), labels, segregated, unfounded assumptions

reactions of individuals with disability

* Anxiety*: tension, fears, fast breathing etc. * Depression*: sadness, sleep disturbances, lack of interest, suicide ideation * Denial*: it's just a bad dream or just temporary *Repression*: reduced recall *Projection*: putting words into other's mouths * Displacement*: takes anger out on family/loved one *Sublimation*: substitute a desire for a more socially acceptable action *Aggression*: overt physical behaviors (hostile), or bravado *Dependency*: do this, do this *Regression*: past, dependency roles *Rationalization*: blaming others, devalue of goals "it's because I am disabled" *Compensation*: excelling in one are to the exclusion of others *Fantasy*: Dreaming *Passing*: denial of limitations, hiding true issues, concealing

OT and health promotion (for disability)

* client-centered care *enable *Empower *advocate *educate

work conditioning

*1st step* -(workman's comp) -focus on specific physiological issues resulting from injury *flexibility, strength, endurance *eventually work up to 4-6 hour day *individualized program to restore and improve specific work performance skills

ADA bathrooms

*60 inches diameter floor space to turn around in w/c (accessible stall or single bathroom) *sink: mirror, soap dispenser, paper towel dispenser, clearance underneath, depth and height of sink, style of faucet *toilet: height (17-19), grab bars, toilet paper placement and orientation, flush control

TSA OT interventions

*ADL/IADL retraining* -including donning/doffing sling (education on how to don/doff; safely) -Clothing considerations (loose clothing, button down shirt; educate on how to safely don/doff shirts/pants) -AE recommendations (Sock aides, shoe horn, reacher) -fall prevention (education on techniques to complete ADLs/IADLs & safe mobility) -> Grab bars *Safety with functional mobility/balance due to restricted use of affected UE* *Ensure attention to whether affected UE is dominant vs non-dominant* *Education on sleeping positions and bed mobility* (May need to sleep in recliner or prop pillows under arm) **Make sure they are NOT extending arm

symptoms of RA

*AM joint stiffness at least 1 hour* -blood rheumatoid factor **diagnosis if 4 or 7 factors present -Tenderness with warmth and swelling over the affected joints. -Symmetrical joint involvement -joint inflammation (flair), fatigue, fever, demonstration of remissions and exacerbation (may also affect vertigo and immune system) *acute pain during exacerbation* *chronic pain from progressive joint damage* -Active inflammation causes joint destruction *NSAIDS, celebrex, methotrexate, gold shots, infusions

complications of disability

*Attribution*: process by which people make sense of their experiences (health promoting attributions: faith, acceptance, personal responsibility) *Pain*: perception is a personal experience and is affected by psychological stress and psychosocial factors (chronic pain: difficulty concentrating, altered mood, social withdrawal, hopelessness; how to help: recognition & validation, grading/adapting, positioning, emotional support) *Sleep*: critical occupation! Address sleep environment and sleep hygiene *secondary conditions*: more than just comorbidities (includes non-medical events: isolation, increase dependence on other); (conditions that affect the general population: obesity, diabetes); (problems that can arise at any time during life span: breast cancer, accessibility)

cervical precautions

*BLT for neck* -no push/pulling (strains neck) -no arms overhead (no resistence overhead) -No side to side (no twisting) -limited use of arms -log rolling in bed -> keep head/neck neutral -on/off w/ neck brace education (correct placement) -skin integrity, brace on at all times (even in shower)

general transfer implications (body mechanics for transfer)

*Body mechanics for transfer* -Wide base of support -Maintain lumbar neutral spine -Bends at hips and knees -Uses weight shift for standing transition of weight -Avoids twisting of lumbar spine -Keeps pt close to reduce lever arm of weight -Moves in a smooth and controlled manner -KNOW YOUR CAPABILITIES!!

splint classification

*By type* -Dynamic -Static -Serial static -Static progessive *by purpose* -Restriction splints -Immobilization splints -Mobilization splints *By design* -single-surface -Circumferential

goals

*Done by OT, but OTA needs to recognize what makes a good goal* -relevant/significant -measureable (quanitative) -achievable/realistic -behavioral/observable (i.e. safety awareness, assistance) -time limited

factors related to health literacy

*Education *Motivation *Understand *access to resources

neuropraxia

*GOOD PROGNOSIS* -a peripheral nerve injury that is usually the result of nerve compression or repetitive stress. -Sensory changes may occur, but recovery is expected -carpal tunnel and cubital tunnel

causes of back pain

*LBP (low back pain)* significant cause of disability, 70-80% of people experience at some point *Radiculopathy:*Compression of nerve root (due to bone spurs, herniated or degenerated discs, arthritis, fractures, facet joint problems, etc) can cause pain and possible neurological symptoms radiating along path of nerve and into arm/leg *Sciatica:* radicular pain that radiates along path of sciatic nerve from lower back down each leg *Ankylosing spondylitis:* type of arthritis of spine that causes inflammation between vertebrae and in the joints between spine and pelvis-this can fuse the vertebrae together *spinal stenosis:*narrowing of spinal vertebrae which puts pressure on the nerves and spinal cord and causes pain, numbness, paresthesia and loss of motor control *osteomyelities:* infection of the bone caused by bacteria or fungus spread from bloodstream, open fracture or surgery (ppl with DM, HIV, PVD are more prone) *spondylolisthesis:* forward or backward displacement of one of the vertebrae (most often lumbosacral area)-compresses nerve roots, common to see leg weakness *degenerative discs:* intervertebral discs (serve as shock absorbers) can degernerate over time *Herniated or ruptured disc:* soft inner core of the disc can extrude and inflame a nearby nerve root

how to make a splint

*Make a pattern* -trace hand and forearm (palm down, fingers together, thumb ABD a little) -indicate thumb web space, CMC joint, ulnar and radial styloid, 3/4 length of forearm -cut paper pattern and trace onto thermoplastic with wax pencil *cut material* -heat slightly and cut out pattern gently -long smooth strokes -be wary of cut edges sticking to each other -place stockinette on pt and position them as needed -heat material until it is pliable and easy to mold and place on pt *use goniometer to check proper angles* -when cooled, check for fit and mark any places that need adjustment and where velcro goes -remove splint, make adjustments, trim smooth and flare edges as needed and apply strapping

ORIF vs external fixation

*ORIF (open reduction internal fixation)* -Surgery with internal fixation for improved alignment and healing -Durable, strong implants (stainless steel and titanium) -Plate and screws -nailing and rods *External Fixation* -surgical treatment used to set bone fractures in which a cast is not sufficient for proper alignment of fracture. -Stabilizing frame outside of body -Metal pins or screws are placed into the bone through small incisions -Often temporary treatment for fractures-may be used in multi-trauma when a patient is not ready or stable enough for an ORIF, or may stabilize bone until enough healing occurs.

post-operative (TSA/TSR)

*OT/OTA Role* each post-op protocol varies by surgeon, so communication and knowledge of particular surgeon's protocol is key. -TSA/TSR precautions

work levels

*Part of JA* -Sedentary: 10lb of force, (lift, push/pull, carry) occasianally. Occasional stand, walk, primarily sitting -Light: 20lbs of force occassionally, 10lbs frequently. Frequent walking/standing or use of foot/hand controls in sitting. Frequent repetition/pacing -Medium: 20-50lbs occasional, 10lbs constantly -heavy: 50-100lbs occasionally, 25-50 frequently, 10-20 constantly -very heavy: over 100lbs occasionally, 50lbs frequently, 20lbs constantly

What are the 2 different approaches to total hip arthroplasty/replacements (THA)?

*Posterior THA* *Anterior THA*

comparison of practice settings

*Practice setting length of time frequency of services* -Acute care days to 1-2wks daily -Rehab Weeks daily, 3hrs a day -Subacute rehab weeks to months daily to weekly -SNF months to yrs daily, weekly,monthly -Home & community wks to months daily to weekly based settings -ALF months to yrs weekly,monthlyconsult -Home health wks to months weekly -outpatient wks to months weekly -Day treatment months to yrs daily, weekly -work site wks to months weekly, monthly consult

general transfer implications (preparing for a transfer)

*Preparing for a transfer* -environmental/safety -lock w/c brakes, -remove footrests -gait belt-scoot forward-feet back -"nose over toes" lean forward-push from surface sitting on (i.e. w/c, chair, EOB) -reach back when returning to sitting

practitioner health and wellness

*Professional Self-Care:* must attend to own health and wellness needs *increase energy, lower stress *adequate sleep, proper nutrition, physical activity *good body mechanics *infection control *stress management strategies *prevention of compassion fatigue

ADA ramps

*Ramp rule of thumb 1:12 (for every inch of vertical height, there is at least 12 inches of ramp run); i.e. 3 steps 7" in heights: 7+7+7= 21" 21"x1ft= 21ft (for 1:16 21"x 16= 33.6" 33.6"/12= 28ft) *1:16 recommended for outdoors *level landing of 60 inches square (top, bottom, and any turns) *handrails on both rides required if ramp has rise of more than 6 inches

types of notes (documentation)

*SOAP: framework for all other types *Narrative: 4 subsections: problem, program, progress, plan *EMR (electric medical record)

What are the different types of total shoulder

*TSA*: humeral head is replaced by ball-shaped prosthesis and glenoid is resurfaced/replaced with prosthetic component *Reverse total shoulder arthroplasty (RSTA)*: -indicated for degenerative/inflammatory condition, but also some involvement or deficiency of the rotator cuff -when rotator cuff damaged or weak, the muscles are unable to effectively support the newly repaired joint, so the reverse technique in indicated -ball and socket of glenohumeral joint is reversed: semicircular ball is placed in the glenoid and the polyethylene cap is implanted into humerus -Good deltoid function is needed to stabilize the joint when rotator cuff is not assisting with providing support

objective

*WHAT: you do during your session *WHAT: your pt does in response to what you do *LEVEL OF ASSISTANCE: needed (don't forget types of cueing: verbal, tactile, visual; & WHY they needed this level of A and cues) *Play-by-play so another therapist could replicate what you did *no opinions or bias i.e. During bathing client required Min A with 5 VCs to safely enter tub. i.e. Therapist modeled safe tub transfer while adhering to hip precautions. Pt independently mirrored safe transfer technique.

congestive heart failure (CHF)

*a weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues.* -causes: CAD, infection -hypertrophy: heart can enlarge with an increased workload -heart can't keep up with moving fluid -fluid backs up into the lungs/body making it difficult to breathe (make the heart work even harder)

role of OT with ADA

*advocacy *use activity analysis to evaluate how the physical environment will affect performance (adapt task? persons abilities? environment?) *(ergonomics) May also be working for the employer or businesses to help establish policies, determine accessibility, and what accommodations would be reasonable (includes sensitivity training)

ADA basics

*always look at the surface (stable? firm? slip-resistant?) *route (inside or outside) should be 36" wide *presence of curb cuts or curb ramp *signs indicating location of accessible entrance *door hardware must be operable with no grasping, pinching or twisting (using a clenched fist) *height of door handles and other controls (signs too)

bed positioning guidelines

*bony area need protection* 1. patients that don't/can't move well 2. patients with decreased sensation 3. patients with decreased nutrition 4. patients with medication effects 5. patients with wounds

depths of burns (classified as?)

*classified by depth* · Superficial Burn: first degree o Involves only the epidermis, appears like a sunburn · Partial-thickness burns: second degree o Extended through the epidermis and into the dermis · Full-thickness burn: third-degree o Involve epidermis and dermis and extend into hypodermis or subcutaneous fat · Subdermal burns: fourth degree o Involve all layers of skin and subcutaneous tissue (fat, muscle, bone)

treatment interventions

*collaboration required (client, family, OTA, OTR, other disciplines)* -specific activites and sequence of activity to influence occupational performance and address goals/desired outcomes. -client response is constantly assessed -on-going modifications (don't forget environment) -grading

OTPF changes for 4th ed

*device care is no longer considered ADL *Health management is no longer considered IADL *NEW AREA OF OCCUPATION: HEALTH MANAGEMENT*

joint school

*educate on:* -what to expect -introduce equipment: reacher, long handled shoe horn, sock-aide, long handled sponge, elastic laces, dressing stick, styles of benches/seats, grab bars, toilet riser, hip wedge -safety proof home -plans for walker, cane -pet issues -meals -other (exercises before surgery, support, shopping, meds, sex, etc.)

AE/DME for ADL's (bariatrics)

*equipment is heavier because larger/longer* -BSC -W/C (manual or power) -Beds -Rolling shower commode chair -Long-handled sponge/mirror -large toilet seats -TTB -sock aid/reacher -toilet aid/bidet -blow dryer

client demonstration (for home environment assessment)

*evaluate home & how the client interacts with environment* -use of AE/DME in home areas -transfers to all surfaces: toilet, tub, sofa, chair, bed, dining room chair -dynamic movements: reach to the cupboard, closet drawers, mail -access in and out of home: open door, screen door, garage, turn key (observe routine) -Activity tolerance with functional mobility demand in home

bariatric risk factors

*genetics *lifestyle *environment *emotional *sleep *medications *age *medical condtions (a fib, COPD, arthritis, limit activity)

Metabolic Equivalent (MET)

*how much energy is required for each task* ADL: 1-2: eating, transfers, g/h 2-3: sponge bath, dressing, seated warm shower 3-4: standing warm shower, BM, stairs 24 ft/min 4-5: hot shower, sexual intercours 5-6: sexual intercourse, stairs 30ft/min 6-7: walking with braces/crutches IADL: 1-2: drve automatic car, drawing, knitting 2-3: dusting, vacuum, meal prep, dishes 3-4: make the bed, sweeping, mopping, gardening 4-5: changing bed linen, raking, weeding 5-6: biking 10mph on level ground 6-7: skiing, shoveling snow, walking 5 mph

angles of the hand and wrist (ergonmics)

*how should they be aligned* -in correct alignment (straight with no radial/ulnar deviation and/or over flexed/extension) -preventative measures to protect joints

universal design (ADA)

*idea that spaces are designed for ALL to access, not just able-bodied, or not just individuals with disabilities

prevention of compassion fatigue

*monitoring oneself for work-life balance *reducing guilt for caring for oneself *stress reduction

neurotmesis

*most severe* -a nerve injury in which the nerve has either been lacerated or transected and will require surgery in order to improve. -3-4mm per day after several weeks to begin regenerating

OT's role (for bariatrics)

*not our job to cure them* -help restructure and adapt their lifestyle to promote function -physcial activity (build into routine, CHECK VITALS!!) -dietary treatment (health maintence): organizing kitchen, planning ahead using dietitian education, organizing shopping lists, food diary/log, family ed for positive support -positioning to relieve presure (dense foam vs pillows) -caregiver ed for safe handling/transfers -energy conservation -breathing techniques -work simplification (compensatory strateges) -sleep (mattress & frame to support weight, manage CPAP machine) -leisure -home modification

occurance levels

*part of JA* -Rare: 1-2 times ove the course of a day -Occasional: one third of day -Frequently: one third to two thirds of the day -Constantly: two thirds to continuous

public accommodations

*physical environment *allowing access to services *integrated access *policy change *access to interpreters or auxiliary aids and services

decubiti

*pressure sore* who is at risk: -neurologically involved patients -orthopedic patients -elderly with co-morbidities -patients with psycho-social issues -pediatric patients -LE amputee -nutritionally compromised patients

work conditioning program

*principle: not just he injured area is affected* -respiratory, endurance, strength, flexibility -strength will decrease by 4% per day during the FIRST WEEK of inactivity, after 12 weeks *68%* -oxygen intake declines by 27% in 3wks *Consist of 4 hrs of progrssive and aggressive therapy per day, 5 days a week for 4-6 weeks* -can progress to combo work and therapy (2 days of real work, 3 days of work conditioning) *Includes stretching, PAM's, HEP, proper material handling and lifting techniques, safety training* -i.e. body mechanics, hand manipulations -i.e. injured knee on the job: may injure back as well because not using knee properly *Job related tasks*

training session intermediate (for amputation)

*prosthetic control: operate each component, control skills* -reach, grasp, release -variance of weight, size, texture -sequence of Large and Hard to Small and fragile -Varience of planes of motion -trasfer of dominance training -alternate method training and one hand techniques

energy conservation

*saving energy* finding ways to use less energy or to use energy more efficiently -remember to plan, prioritize, and pace yourself through each task: -Plan: our your daily schedule (when does pt have the most energy in the day) -Prioritize: your tasks, so you get the most important things done first -Pace: yourself, so you can get more done (so you don't overexert yourself) Take rest breaks

health management occupation

*social and emotional health promotion and maintenance *symptom and condition management *communication with the health care system *medication management *physical activity *nutrition management *personal care device management

surgical options for spine

*spinal fusion:* join or fuse, two or more vertebrae so there is no movement between them. (bone or metal implants to hold 2 bones together until new bone grows between them) *laminectomy:* decompression surgery that enlarges the spinal canal to relieve pressure on the spinal cord or nerves (creates space by removing lamina) *foraminectomy:* decompression surgery that is performed to enlarge the foramen (passageway where spinal nerve root exits spinal canal) *descectomy:*Surgery to remove herniated disc material that is pressing on nerve root or spinal cord. *artificial disk replacement:*newer surgical procedure for relieving LBP. (replaced with mechanical device to help restore motion to the spine) *interlaminal implant:* U-shaped implant that fits between the spinous process in lumbar region of spine. *Kyphoplasty:*creates space in a compressed or collapsed vertebrae with balloon-type device and injection of special cement to restore damaged vertebrae's height to relieve pain.

collecting ducts (lymphatic system)

*there are 2 in the body* -thoracic duct -the right lymphatic duct

materials for splinting

*thermaplastic materials* -drape: high drape conforms easily to contours -memory: more means more forgiving; easy to reheat -thickness: rigidity and durability *Strapping* -velcro -soft *patterns* -paper towels, tissue, paper, etc. *Other* -stockinette -padding for bony prominences -heat gun -hot water bath/electric skillet

signs of compassion fatigue

*trouble sleeping/exhaustion *hypersensitivity, exaggerated response *diminished interest in regular activities *reduced ability to feel sympathy or empathy *anger and irritability *absenteeism or poor work skills *difficulty separating work life form personal life *depersonalization (don't work on building relationships) *physical and emotional exhaution

plan

*what are we going to do next? -allows the pt to plan for next time *Not a restatement of POC or a goal; it's how we get there i.e. continue POC with emphasis on education and safety on hip precautions. Next session client will prepare lunch for self with adherence to precautions

subjective

*what the pt/caregiver says that is relevant to your therapy session *what you observe about the pt or the environment that is relevant

height-adjustable table posture

*while sitting at desk* -shoulders relaxed -straight back -circulation in legs -healthy hips & knee joints -feet flat on the floor *while at standing desk* -shoulders relaxed -straight back -pelveis in neutral alignment -circulation in legs -hip, knees, & ankle joints aligned with gravity line

assessment

*your PROFESSION OPINION/INTERPRETATION as to WHY the pt is progressing or decline (problems/progress/potential) *WHY the pt needs further skilled OT services (justify continued treatment: "client would benefit from...) i.e. Client was assessed for safety awareness during LB dressing and had poor insight into increased fall risks by breaking precautions. Client would benefit from further education on compensatory techniques for self care and increased safety.

leukemia

- is a cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system. types: *Acute myeloid (or myelogenous) leukemia (AML) *Chronic myeloid (or myelogenous) leukemia (CML) *Acute lymphocytic (or lymphoblastic) leukemia (ALL) *Chronic lymphocytic leukemia (CLL)

screening

-(done by OT) general review of percieved NEED and avility to BENEFIT from OT or refer to another service -May include observation/interview of client

ergonomics

-(or human factors) is the scientific discipline concerned with the understanding of interactions amoung humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. -Science of work

RA OT treatment

-*rest and education* (8-10 hrs of sleep & AM and PM rest breaks) -*therapeutic exercise* (maintain strength for structural support, avoiding disuse atrophy, improve/maintain ROM, avoid undue stress of joints, work in comfort range, daily exercise, pain lasting 1-2 hours after exercise in indicative of excess, resistive exercise in contraindicated during inflammatory periods) -*therapeutic activity/occupation* aimed at maximizing participation in daily life, avoid patterns of deformity, avoid over stress to joints, limit resistance, avoid use of hand in static positions for extended periods of time, build rest breaks, use of hand splints may be indicated during flare periods. -*PAMs* for relieving pain and improving ROM -*Splinting* reduction of inflammation, decrease pain, support unstable joints, properly position joints, limit undesired motions, increase ROM, typically used during the acute phase -*Joint protection* -*Work simplification and energy conservation*

prostate cancer (common DX)

-1 in 7 men diagnosed, 1 in 38 will die -risk factors: poor diet, obesity, smoking, sedentary lifestyle

ramp spectications

-1:12; 1:16 to 1:20 whenever possible -Ramps must be a minimum of 36 inches wide. Some areas require wider ramps. -All edges must be protected to keep anyone from slipping off -All ramps shall have top and bottom landings as wide as the ramp itself and at least 60in long -landing size must be at least 5ft square -ramps must have handrails on both sides if their rise is greater than 6in or their length is greater than 72in -cross slopes (areas where a ramp slopes sideways, perpendicular to the ramp's length) must be less than 1:50, and surfaces must be slip-resistant and stable -A level landing is required at the bottom and top of the ramp -Maximum threshold height (at building entry) is 3/4 inch (19mm) for exterior sliding doors and 1/2 in (13mm) for other types of doors without modification.

Cancer prevalence

-2nd leading cause of death in the US -Higher rate in older people since life span is longer (62% of the cancer population is over 65 y.o.; mosu consider age related comorbidities)

colorectal cancer (common DX)

-3rd most common in both men and women -early screening is key to survival and less intense tx

ADA light switches

-48" max height -can the control be operated with one hand & without tight grasping, pinching or twisting of the wrist

person-environment-occupation performance model (PEOP)

-A model that explains that interaction between the person, environment, occupation, and performance of those occupations in five dimensions (psychological, neurological, spiritual, physiological, and motor factors) to understand how these dimensions interact with one another to promote well-being and quality of life; formerly the PEO model.

frame of reference

-A multifaceted perpective that helps the practitioner to focus on addressing the underlying causes that limit occupations, whether due to activity limitation, impairment, or restriction, in order to assist a client to meet their desired goals.

clinical reasoning

-A therapists clinical judgement and sequential reasoning that manifests as sound thinking to optimize outcome performance -*professional expertise*

modificaiton/recommendations (for home environment assessment)

-AE/DME -Structureal changes to home -willingness -finacial ability (renter vs homeowner) -common considerations: ramp, railings, grab bar in bathroom, removal of shower doors, removal of throw rugs, comfort height toilet, tub transfer bench, elevation to bed, chair lifts, lever handle door knobs, pull out shelves, removal of extra funiture, bedside coomode, smart home *document recommendations & why you recommended*

caregiver instruction (for home environment assessment)

-Activities that require assess: all transfers, use of AE/DME, ADL assist -Return demonstration -Work simplification and energy conservation instruction

Why we have steps for the OT process

-Allows for client focus, detailed determination of needs and sequence to address identified areas of concern including potential and tiem frame. -Necessary for effective outcoumes -Required for reimbursement of services -In keeping with recognized standard of care practices.

secondary lymphedema

-Any condition that damages lymphatic system. (much more common) causes: -surgery -radiation treatment for cancer -cancer -infection

characteristics/considerations that you should include when planning a home exercise program for an elderly Pt

-Assess and prioritize- relate to function (i.e. working tri-ceps to be able to get in/out of a chair) -Make purposeful decisions: choose an exercise to help the Pt. get function back and let the Pt. know why a certain muscle is being exercised. -Train in all 3 planes: up/down, side to side, diagonals, crossing midline -Supplement and complement with isolation: isolate certain muscle groups when it applies to function. -Utilize seated exercises only for a particular purpose: don't lower the level of participation -Order most complex to least complex: do most demanding exercises first -Maximize safety and success: (i.e. may need extra help such as co-lead with another therapist) -Breath control is important (make sure they are not holding their breath) -Warming up with flexibility exercises prior to strengthening exercises -Progress slowly -Have means of grading up/down -Monitor pain and rest breaks as needed

measurement (for lymphedema)

-Axilla (measure in cm) -4 in down (mid biceps) -Elbow crease (measure in cm) -4 in down (mid forearm) -wrist (measure in cm) -MCP (measure in cm) -Digit (measure in cm) *will vary for each compression garment vendor*

lymphedema vs edema

-Both can be pitting or nonpitting -Lymphedema does not resolve with elevation (except in early stages), edema does -Some causes of edema can be alleviated by diuretics, will not help lymphedema -edema is part of the circulatory system; lymphedema is part of the immune system (removes excess fluid from body tissues and returns it back to the bloodstream)

bones of the hand

-Carpals (8): scaphoid, lunate, triquetrum, pisiform, trapezoid, trapezium, capitate and hamate ("some lovers try positions that they can't handle") -Metacarpals (5) -Phalanges (14) -radius & ulna (styloid process' and boney prominece)

top-down approach

-Client's ability to participate in occupations identified as important

medical model reasoning

-Diagnosis-predetermined evaluation-standard problem list-prescribed treatment. -Model fails to recognize client-centered intervention.

joints of the hand

-Distal radioulnar joint (DRUJ): supination and pronation -Carpometacarpal joint (CMC): common place for osteoartritis of the thumb -Metacarpophalangeal joint (MCP): knuckles -Proximal interphalangeal joint (PIP): knocking knuckels -Distal interphalangeal joint (DIP)

OT role (for CHF)

-Education on gradual resuming of activity -help determine optimal level of function -> Grading of tasks (i.e. self-awareness to recognize signs, educate, help them learn what to do with limitations)

evaluation (for amputation)

-Etiology and onset of amputation -age, hand dominance, co-morbidities -residual ROM, strength, sensation, skin integrity, stump shape -presence of pain -client goals and expectations -education on precautions (NWB affected limb & positioning)

model of human occupation (MOHO)

-Focuses on intervention on a client's volition (willingness to do something) and the client's havituation (how the client does things), which leads to improved competence, identity, and occupational adaptation.

trigger finger

-Inflammation and thickening of the tendons of the finger makes it difficult to flex or extend the finger, may become stuck and then snap into position -flexed finger locks into position -pulley gets stuck

DeQuervain's Tenosynovitis

-Inflammation of the abductor pollicis longus and extensor pollicis brevis, resulting in pain, crepitation and swelling over the radial styloid, -Finklestein's test is typically positive Conservative -intervention includes: activity modification orthotic positioning tendon gliding exercises ergonomic education

psychosocial aspects (for amputation)

-Loss: OT can listen -shock: OT acknowlege feelings -disbelief: establish client goals with wants and needs -helplessness: establish areas of competency -anger: listen and collaborate on goals -hopelessness: demonstrate progress -depression: reflect upon gains to goals -changes to self-concept: create experiences of hope -competency: allow opportunity for success and failure -social isolation: listen

ganglion cysts

-Mass on synovial lining of a joint or tendon sheath; can be painful

fine motor assessment (FM)

-Minnesota rate of manipulation -Purdue Peg Board -Crawford small parts dexterity test -9-hole peg test -Bennet hand tool dexterity test -Jebsen hand function test -box and blocks -O'Conner finger dexterity

RA medication side effects

-NSAIDs: stomach pains, ulcers, kidney and liver effects -Celebrex: bleeding, risk of heart attack or stroke -Prednisone: HTN, nervousness, weight gain, thin skin, round face -Gold: kidney function -Methotrexate: liver function -Plaquenil: visual changes -Biologics (Enbrel, remicade, Humira): injection reactions (benedril) and upper respiratory infections

What are the different weight bearing restriction?

-NWB (non weight bearing) -TTWB (toe touch weight bearing) -PWB (partial weight bearing) -WBAT: (weight bearing as tolerated) -FWB: (full weight bearing)

precautions (for after amputation )

-NWB residual limb -be mindful of positioning -keep residual limb and anything that comes into contact with clean to prevent infection

TSA/TSR precautions

-NWB through affected UE -no lifting more than 1-2lbs with affected UE -Avoid shoulder extension beyond neutral -Avoid shoulder abduction past 45 degrees -Avoid shoulder ER past 30 degrees -Avoid should IR past 60 degrees -Limit should PROM in flexion to approximately 90-100 degrees (for 2 weeks) *HEP (pendulum 20X clockwise & 20X counter-clockwise, ROM while in supine)

what are the two types of surgical repairs for a LE fracture?

-ORIF: open reduction internal fixation (pins, rod, plate/screws) -CRIF: closed reduction external fixation (pins, external fixator) *non-surgical: closed reduction, cast/brace

treatment continuum (of physical disabilities practice)

-OT focus: enhancing occupational performance to support participation across contexts -Be mindful of supports and constraints in each practice setting.

interventions used for burn patients

-Patient education & training: to increase understanding in the areas of wound healing, the importance of preserving independence in ADLs and IADLs, the need for continued activity and exercise, the causes and effects of scar contracture, and scar management techniques and principles. -Modalities: for wound and pain management -Therapeutic techniques: such as exercise and activity tolerance to work towards functional activities. -Orthoses: are tools to progress throughout the burn healing process and managing scarring

3 goals for post burn patients

-Prevent and minimize scarring and contractures. -Prepare a person for future occupations, including social activities. -Address psychosocial factors because the Pt. may undergo many emotional and physical changes during recovery.

types of notes

-SOAP (framework for all other types) -Narrative (4 subsections: problem, program, progress, plan) -EMR

functional capacity evaluation (FCE)

-Specialized assessments: objective data, normative comparisons, reliable and valid i.e. KEY, WorkWell, Matheson, Blankenship, Baltimore therapeutic equipment company (BTE) -Work areas: lifting, standing, sitting, bending, carry, push/pull, kneeling, climbing, fingering, reaching etc. -takes 2-8 hrs to complete, can be computerized, but not as effective (ideally it takes place over 5 days; need to know if they can replicate activities) -Includes distraction testing: time the task, make it a competition, talk to them during task, switch up order -Uses activities described in JA (ACTIVITY ANALYSIS)

rigid braces (spine)

-TLSO: thoracolumbar sacral orthosis -Form fitting plastic braces that limit spinal movement -On when client is up and OOB, but off when in bed -Per MD orders, can be worn up to 10-12 weeks post-op

outcomes of TSA

-TSA typically has greater ROM results and reduced need for revisions when compared to hemiarthroplasty -complications: loosening of components, joint instability, rotator cuff tears -Full shoulder ROM in NOT typically achieved with shoulder replacements -prosthesis lasts ~15-20yrs

how can the OTA affect a client who has a physical dysfunction?

-The OTA affects a client whou has a physical dysfunction by educating/training the client to use compensatory and adaptive techniques to participate in occupations.

maximum medical improvement (MMI)

-The point at which no further medical progress or recovery is expected. -ready to return to work

bottom-up approach

-Therapists assessment of structure and functional perfromance i.e. biomechanical approach

full body assessment

-Vital signs -grip, ROM, MMT, fine and gross motor (i.e. 9 hole peg, Purdue, Minnesota), balance, sensation, provacative tests, measurements

gastric balloon (bariatrics)

-Weight loss surgery, balloon placed inside of the stomach to reduce the amount of space for food. -placed in the stomach, left in 6 months.

cancer detection

-X-ray (lung) -CT: Contrast/noncontrast -MRI -Bone scans: skeletal system (METS) -PET scan -Biopsies -Lymph node biopsies -colonoscopy -symptom presentation

axonotmesis

-a severe nerve injury that may be the result of a crush or traction injury. -Motor loss is expected, and although there is the potential for recovery, it may take a long time -1-3mm per day

work hardening program

-able to tolerate a full 8 hr day at work (5 days a week) -individualized program to maximize a person's ability to RTW (base simulated activity on JA) -Interdisciplinary (both OT & PT involved) -Use real or simulated work activities with conditioning tasks; not weight circuits or machines -Address productivitiy, safety, physical tolerances, and worker behaviors *-6weeks, 8hours a day* -Reach full potential by the end so ready to RTW (also gain confidence in abilities)

OT role (for pulmonary diseases)

-address psychosocial issues: 96% of people with COPD report disabling anxiety; OT can help encourage safe participation in meaningful occupations -energy conservation: *posture to decrease dyspnea (SOB; lean forward to open chest) *pursed-lip breathing (should take longer to exhale), *diaphragmatic breathing (check while in supine with book on diaphragm) *relaxation (calm body to help breath better) -work simplification: simplify task/ less steps -grading: forward/backward chaining, set-up assist -lifestyle modification: help create healthy lifestyle; educate -Environmental modifications -education for pt and family: including disease process

OT role (for cardiac disease)

-address risk factors that can be changed -Educate/reinforce precautions -energy conservation -grading activities -address psychosocial issues (such as guilt, fear, anxiety) -monitor Pt response in activity (monitor vitals to ensure safe parameters, educate to be self-aware of symptoms)

THA dressing

-adherence to precautions: no crossing legs, reaching forward in sitting, down to floor -use AE/DME for safe participation -caregiver training

restrictive procedures (bariatrics)

-adjustable gastric banding (AGB)/lap band -vertical banded gastroplasty (VBG) -vertical sleeve gastrectomy (VSG)

risk factors (for lymphedema)

-advanced age -obesity -inactivity -injury, infection -restriction (i.e. tight clothing, blood pressure)

MI (miocardial infarction)

-aka: heart attack A blockage of blood flow to the heart muscle.

What are the indications for a TKA (total knee arthroplasty)

-alleviate pain -regain motion -improve joint alignment/stability -allow engagement in customary activity

work site assessments

-allows assessment of the "envionment" of work -allows comparison of performance factors to work demand (what the client is able to do vs what is required for them to do) -allows consideration of modification/adaption

bariatric surgical interventions

-alter digestive process -restrictive procedures -malabsorptive procedure -combined (Most common: Gastric bypass) -gastric balloon -vagal nerve block (vblock)

spinal functional sort

-assessment that measures the client's percieved functional ability -show them picures and have them say if they are: able/restricted/unknown if they can do the task in picture

malabsorptive procedure (bariatrics)

-biliopancreatic diversion (BPD)/duodenal switch

neuro-oncological conditions

-brain: common site for metastases *glioblastoma multiforme (GBM) *meningiomas -spinal cord: *can be complete or incomplete like SCI *can be primary or metastatic

breast cancer (common DX)

-can also occur in men -if caught early, 5-year survival rate is 99%

risks factors (for cardiac disease)

-cannot be changed: heredity, gender, age -can be changed: high BP, smoking, cholesterol levels, sedentary lifestyle -contributing factors: diabetes, stress, obesity, sleep apnea, high triglycerides

OT role with shoulder

-carefully analyze shoulder dysfunction and identify potential deficits in order to develop interventions, protect the joint, and facilitate optimal UE function

median nerve damage

-carpal tunnel syndrome -sensory changes, weakness, numbness,m tingling

AE/DME (for ergonmics)

-chairs -adjustable monitor arm mounts -anti-vibration gloves -anti-fatigue/pressure mats (helps joints)

medial epicondylitis (golfer's elbow)

-characterized by pain on the palm-side of the forearm -pain in elbow and wrist on medial side of forearm -grip with wrist flex

monitoring pt (for cardiac disease)

-check symptoms (HR, BP, O2 sat, breathing rate) -get Pt perception (Borg rate of perceived exertion scale; score of 6-20) 6: no exertion at all; no SOB, muscle fatigue, difficulty breathing; 19: extremely strenuous level. most strenuous work ever experienced *help bring awareness to when they are pushing their body too far & need to cut back*

what allows performance in occupation?

-client factors -performance skills -performance patterns -context -environment

community mobility (for home environment assessment)

-client factors: physical skills, cognitive skills, social skills, perceptual -Use of AE/DME in community: WC, walker, scooter, cane -negotiate curbs, sidewalk, crossing streets etc. -Access to church, bank, public buildings, grass, snow, ice -use of public transit

interventions

-client-centered interests -supports well-being -occupation-based (i.e. making coffee) -precautions/contraindications -related to the goals of POC (important for documentation and reimbursement) -Activity analysis (determine specific deficits during task/occupation) -grading/modifying/adapting -cost (time, manpower, monetary) -SKILLED SERVICE: providing education, hands-on, evaluation, monitoring, that can only be provided with someone of your training -->reimbursement

Work conditioning (job related tasks)

-climb stairs, ladder, etc. -carry: weight and distance/time (i.e. carry crates) -lift: (a specific amount of weight) *Waist to floor (WF) *Waist to shoulder (WS) *Shoulder to overhead (SO) -walk -push pull *OT makes sure they do this safely. Make sure they do not use accessory motions (indicates they are compensating & not using proper body mechanics; "babying injury")

financial impact (bariatric)

-clothing -food -medical services *"cosmetic" *access to services: (i.e. may need an ambulance for transportation) -DME: SC, W/C lifts on cars -Home modifications: doorways, floor reinforcement, etc. -travel

patient-driven payment model

-code 6: independent (pt completes entire task, no assist) -code 5: set-up or clean-up assistance (helper sets up or cleans up, pt completes task) -code 4: supervision or touching assistance (helper provides verbal cues or steadying-touching assistance or CGA to complete activity) -code 3: partial/moderate assistance (helpers does LESS than HALF the effort) -code 2: substantial/maximal assistance (helper does MORE than HALF the effort) -code 1: dependent (helper does ALL of the effort)

AE/DME for toileting

-commode (only thing covered be insurance) -elevated toilet seat -rails -extended equipment for toileting needs (picture)

role of OTA (industrial rehab)

-communication to OTR -put the objective to the llpt subjective (inconsistencies); observation & activity analysis to help determine if what the pt is reporting is consistent with what is being seen -grade activities in line with goals -distract pt during activities (boredom, ensure adherence to program, safe performance)

OT intervention (for particiption in occupations)

-compensatory strategies -adaptive strategies -environmental changes -joint protection

treatment planning

-consideration of theories in practice and treatment approaches -includes client participation (family) -Identifies measurable expectations, time frames

ulnar nerve damage

-cubital tunnel syndrome -numbness, tingling with sustained elbow flexion -guyon's canal (at the wrist) -claw posture

risk factors (for issues with ergonomics)

-cumulative trauma disorder (CTD): repetition, forceful exertions, awkward positions, pressure contact, vibration, cold environment -tool use -Diagnosis: carpal tunel syndrome (CTS), cubital tunnel, radial tunnel, trigger finger, dequervain's, tendonitis, lateral epicondylitis, intersection syndrome, Guyon's tunnel, digital tenosynovitis, trigger thumb

chronic back pain

-deep, aching, dull, or burning in one area of the back traveling down the legs -more than 3 months -numbness, tingling, burning, shooting, radiating pain down legs -walking, daily activities difficult at time

ergonomic consultation

-demands of job and context compared with abilities (physical and psychosocial) *what we look at* -modification/adaptions: equipment, environment, method -preventative function (prevent work injury) -pt/organization education (i.e. siminars on safety) -individualized interventions

non standardized

-dependent upon clinical skill (ROM, MMT, FROM) *Top-down approach* *Bottom-up approach*

work hardening (psychosocial)

-depression (no longer a provider for family), have been in pain for a long time, huge opportunity to build rapport -Educate on diagnosis or realistic outcomes -educate on why simulations are important: what the point? (make sure they can do these tasks) -not always possible to reach a pain free outcome; maximize function within pain tolerance (pain management) -vocational counselor needed if pt unable to return to previous position (helps them find a new position)

splint pattern

-design on flexible paper, toweling -Splint blanks -X-ray patterns -Allow for length/width adjustments

sitting at desk (what to look at; ergonomics)

-desk height -screen height -orientated to keyboard -phone -are they taking rest breaks? what kind of chair

work capacity evaluation (WCE)

-determine baseline and areas not WNL for work setting *Initial interview: * *precautions from injury still in play *Past medical history (PMH): chart review *Job analysis (JA): description of physical job requirements *Pt perception of current abilities/limitations for areas of occupations *full body assessment

training session initial (for amputation)

-discuss goals with client -demonstrate prosthesis fx -teach donning/doffing -design wearing schedule and adjust as appropropriate -hygiene -care of prosthesis

fractures/dislocations (of elbow)

-distal humerus, olecranon, radial head -nurse-maid's elbow; seen in kids from swinging by the arm

what are the precautions for a TKA?

-do not want the knee to make any TWIST motion -pain and edema management

single-surface splint

-does not go all the way around; need straps to create pressure

repositioning/transfers (for bariatrics)

-draw sheet -caregiver ed on body mechanics (you use them too!) -get enough help (keep pt dignity in mind) -use devices when possible (lifts, boards, etc.) -walk the pt through the transfer verbally first (step-by-step process, what equipment) -small movements

OT interventions for TKA

-dressing: difficulty reaching feet (use reacher, sock-aide, shoe horn) *compression socks are worn 24hrs a day to prevent blood clots & control swelling* -transfers: lifting leg into and out of bed, toilet -self cares: shower chair, grab bar, long-handled sponge -IADL: work simplification methods, DME, energy conservation

OT/OTA role (for spinal injury)

-education on spinal precautions -If no spinal precautions ordered by MD-education on body mechanics stills important -ADL/IADL training with spinal precautions *including don/doff TLSO *AE: such as dression with reacher & sock aide *Home modifications: grab bars, walkers, stairs *get out of bed or sitting EOB

movements to focus on for the shoulder

-elevation/depression (scapular) -retraction/protraction (scapular) -rotations of scapula -shoulder flexion/extention -IR/ER -Horizontal abduction/adduction

what are the therapy implications for a TKA?

-engage in activity -frequent movement is ideal (move every 1 to 2 hours) -WBAT unless other circumstances -ice in between activity -encourage both flexion and extension -encourage normal gait patterning, try to diminish "peg" leg (because they have been compensating) -adapted techniques for ADL -DME for home: grab bar, walker basket, sock-aid

adjuctive methods

-eval, exercise, facilitation, positioning, stimulation, PAMs, splints, compression etc. PREPARATION

RA AE/DME

-extended or built-up handles -Hip kit items (reacher, sock aid, dressing stick, long-handled sponge) -shower chair, elevated toilet seat, grab bars, toilet wands, -light weight items: plastic items (plates, glasses) -electric appliances i.e. can opener -lever handles -long-handled dust pan, pet care items

pragmatic reasoning

-extends beyond the interaction of the client and therapist. -This form of reasoning integrates several variables, including the demands of the intervention setting, the therapist's competence, the client's social and financial resources, and the client's potential discharge environment.

valvular disease (mitral valve)

-fails to close, blood regurgitated back into L atria -volume overload; fluid in lungs->SOB->A FIB (irregular and ineffective contractions in both atria; can cause blood clots/emboli that can travel to brain) *valves are pressure dependent*

guarding techniques when patient is falling

-firmly use gait belt for control -widen your stance and pull patient to you as able. -bend your knees, pulling patient to your core -slow momentum downward -protect the head on leg -use calm, reassuring voice -lower patient to floor

tendon lacerations

-flexor or extensor -categorized by zone (I is distal, VIII proximal; thumb has it's own) -surgeon protocol

rehabilitaion FOR

-focuses on the client's ability to return to the fullest possible physical, mental, social, vocational, and economic functioning. -The emphasis is placed on the client's abilities and using the current abilities, coupled with tchnology or quipment, to accomplich occupational performance.

choking guidelines

-follow BLS recommendations -ask: are you choking? -get assistance in place

levels of amputation

-forequarter -shoulder disarticulation -transhumeral -elbow disarticulation -transradial -wrist disarticulation -transcarpal -transmetacarpal -transphalangeal

training session advanced (for amputation)

-functional use training: realistic, natural context for ADL, IADL, sports, leisure (i.e. dressing, fishing, work) -Goal: spontaneous use, timeliness, energy control.

TSA/TSR progression of ROM

-general progression -*0-2 weeks*: pendulum ex's limited PROM -*2-4 weeks*: larger PROM ranges may be initiated. Could include table slides, dowel exercises. -*4-6 weeks*: PROM gradually increase to WNL, greater AAROM/AROM, still NWB and minimal lifting -*6 weeks and beyond*: strengthening ***Surgeon specific protocols to follow***

some considerations for shoulder

-glenohumeral joint -acromioclavicular joint -sternoclavicular joint -scapulothoracic joints

enabling activities

-grasp/release tasks, picking up objects, clothing buttons, pegboards, memory games, computer tasks, crafts (active participation, elicits sensory, motor, cognitive sicial systems)

pain syndromes

-headache pain _low back pain -arthritis -complex regional pain syndrome -myofascial pain syndrome -fibromyalgia -cancer pain disability related pain

molding splint

-heat cut out splint shape to soften -position patient in gravity assisted position as able. Verbally inform patient of steps -Remove splint material, lay flat and dry -when cool enough to touch place on patient, and using light but adequate touch mold and contour with moving touch to fit patient while maintaining positioning and respect for arches, joint positioning and function -As cooling continues, bevel edges, flair forearms etc. -Mark and trim edges or adjustments

Intervention for decubiti

-heel protectors/boots/splints -air beds -positioning wedges -turning schedule -nutrition -exercise -hygiene

individual factors (ergonmics)

-height -current Dx

industrial rehabilitation

-helps employees return to work safely after an injury or illness

humeral fracture (medical management)

-hemiarthroplasty or humeral head replacement (humeral head/fractured area removed and replaced with endoprosthesis)

lung cancer (common DX)

-highest mortality rates for both men and women, but incidence is declining (decreased smoking, no longer use asbestos)

THA IADLs

-homemaking: slide on counter, use of walker basket, tray, walker bag, cross body bag minimal load -laundry: reacher, transport with walker, golfer's bend -Meal prep: transport, reaching into cupboards/refrigerator, where put walker, grocery shopping *try to keep items between shoulder & knee) -pet care: reacher, access to outdoors, poop patrol

terminal device

-hook or hand -voluntary open/close

OT intervention (for manage edema)

-ice, elevation, AROM, gentle compression -can impair healing and increase pain -manage pain and PAM's (are similar)

pain management for TKA

-ice: 20min every hour; rotate location -elevation -activity pacing -scar management (only when healed) -constipation (common w/ pain meds) -coping strategies (mentally, physically, good communication) -CPM (continuous passive motion) machine: a machine used to help rehabilitate a limb. constantly moves the knee through ROM

home enviroment assessment purpose

-identify specific factors that may influence a clients ability to engage in selected occupations -identify needs for modification/adaption with reference to current performance factors -safety -identify methods to improve performance for caregivers -determine goals and remediation strategies to further advance performance to allow PLOF

rule of 30:30

-if you are in the same position for 30 min you need to take 30 secs and move in opposite direction

radiation therapy

-implantation of radioactive seeds into tumor or surrounding tissue -beam radiation: side effect is burn side effects: *immunosuppression *fatigue *skin irritation/burns *soft tissue fibrosis *delayed wound healing *edema *hair loss

static progressive splint

-includes a static mechanism that adjusts the amount or angle of traction acting on a part. -static mechanism that adjusts

mobilization splints

-increase limited ROM or restore/help function from nerve injury or muscle dysfunction

panniculus

-increased pain in low back, LE, limits activity, hinders amb, causes lymphedema, urinary stress incontinence, impact skin integrity (maceration) -graded by severity (1-5) -hygiene: difficult to reach, increased moisture/pressure

lateral epicondylitis (tennis elbow)

-inflammation or degenerative changes at common extensor tendon that attaches to lateral epicondyle of elbow. -repeated overuse of wrist extensors. clinical symptoms include difficulty holding or gripping objects and insufficient forearm functional strength

advances in myoelectics neuroprosthetics

-integrated tactile information -integrated proprioceptive/kinesthetic information -intrafascicular electrodes in afferent nerves to detect limb position of prosthesis

procedural resoning

-is concerned with getting things done, with "what has to happen next." -This reasoning process is closely related to the medical form of problem solving. -The emphasis is often placed on client factors and body functions and structures when this form of reasoning is used.

conditional reasoning

-is concerned with the contexts in which interventions occur, the contests in which the client performs occupations, and the ways in which various factors might affect the outcomes and direction of therapy. -Using a "what if?" or conditional approach, the therapist imagines possible scenarios for the client.

interactive reasoning

-is concerned with the interchanges between the client and therapist. -The therapist uses this form of reasoning to engage with, to understand, and to motivate the client. -Understanding the disability from the client's point of view is fundamental to this type of reasoning.

ecology of human performance (EHP)

-is the interaction of the person, the task (activity demands), and the context. Occupational performance is intertwined with, and the product of, the interactin of these three variables.

psychosocial care (for cancer)

-isolation -fear of disease progression -general anxiety *OT: relaxation strategies, mental imagery, breathing strategies, warming techniques, biofeedback, sleep, support groups, putting affairs in order* --> OT also helps to find support groups, coping skills, pt/caregiver ed on caregiver burnout

droplet precautions

-isolation -mask on therapist -mask on patient outside of room -hand washing

OT intervention (for strngthening)

-isometric: muscles contracts, joint doesn't move -isotonic: constant resistance throughout ROM i.e. putty, therabands -isokinetic: changing resistance with constant velocity (need special equipment)

PIP dislocations

-jammed finger -joint stability through orthoses

performing an ergonmic assessment

-job tasks -individual factors -environment

signs of OA

-joint pain and tenderness that worsens over time -joint stiffness and loss of movement *morning stiffness lasting more than 30 minutes; gelling: stiffness after periods of inactivity* -crepitus: audible, popping of joint, can feel joint while they move -nodes: DIP, PIP (osteophytes) -one joint or several: cartilage becomes worn, ends of bones thicken with formation of irregular bony deposits (osteophytes), loss of mechanical structure.

seizure guidelines

-keep the person safe... move items away that could cause injury. -move other people away -allow patient to rest quietly -get medical assist

environment (ergonmics)

-lighting -noise -temperature -physical set-up; what is in the room (i.e. desk, file cabinet) -who else nees to use this space? (is it a shared space? then need to accomodate both individuals)

contact precautions

-limited to room contact as able -wear gloves -if splash is possible wear gowns, googles, mask, double as needed. -equipment stays in the room. -hand washing

more OT roles (for cancer)

-lymphedema management -neurological symtoms (hemiplegia, neuropathy, neuro sensitiviities) -Post surgical concerns -Transportation -Cognition -psychosocial aspects

OT treatment (for lymphedema)

-measurement and tracking -manual lymphatic drainage (MLD) and HEP -wrapping -compression garments -pneumatic compression devices -exercise and activity modification

treatment for phantom limb pain

-medications -acupuncture -biofeedback -virtual reality -mirror therapy (helps to rewire the brain) -imagery (tests to help the brain determine what side of the body is being shown) -use of shrinker/ed on positioning -TENS -music therapy -desensitization of the nerves

course of actions (for cardiac disease)

-medications (diuretics, decrease BP, "blood thinners", lower cholesterol) *know what side effects to look for* -Arrhythmias: pacemaker (constant impulse or only if HR drops below a set BPM), implantable cardioverter-defibrillator (ICD): can do both -CHF: heart or heart-lung transplant -Status post myocardial infaraction (S/P MI): in ICU for 2-3 days; hospital for 4-6 days **can happen again if lifestyle is not changed -CAD: angioplasty/PTCA (percutaneous transluminal coronary angioplasty) surgery through femoral artery with balloon & place a stent to keep artery open -CABG (coronary bypass graft): crack sternum, ribs, and take out diseased area and use heathy blood vessels from other places of body. (diverts blood around narrowed or clogged parts of the major arteries to improve blood flow and oxygen suppply to the heart)

course of action (for pulmonary disease)

-medications: anti-inflammatories (calm muscles), bronchodilators (open bronchiols), expectorants (mucus loosen) -Oxygen: too much can increase CO2 and cause R side heart failure; ventilator for acute exacerbations -PNA (pneumonia) and flu shots recommended *covid high risk*

OT intervention (for sensory reeducation)

-mirror visual feedback -safety education (avoid temp extremes, sharp, rely on vision) -returns in this order: pain & temperature, moving touch, constant touch, touch localization, two-point discrimination, stereognosis -Desensitization: exposure to various sensations to normalize input and decrease pain

phalangeal fractures/dislocation

-most common distal phalanx -mallet finger (extensor tendon disturbed too) -Boutonniere' deformity -Swan-neck deformity

side effects (from bariatric surgery)

-nausea -acid reflux, heartburn -stomach ulcer -bloating -diarrhea -vomiting (many more etc)

what are the precautions for anterior THA?

-no external rotation -no adduction -no extension beyond neutral *no big steps*

What are the precautions for posterior THA?

-no hip flexion greater than 90 degrees -no internal rotation -no adduction

static splint

-no moveable components

hypoglycemia guidelines

-observe symptoms: moist clammy skin. pale color. anxious/nervous appearing, inattentive to what you are saying. -offer juice, glucose packets.

evaluation

-occupational profile -standardized or non-standardized assessments -evaluation of client performance (strengths/deficits) -includes analysis of priorities and PLOF -Judgement of appropriateness of further OT services.

treatment in physical disabilities setting

-onset to maximum independence -Adjuctive methods -Enabling Activities -Purposeful activity -Occupational performance

conservative treatments for the shoulder

-oral or injected drugs (reduce pain and inflammation) -exercises -activity modification (education)

causes of shoulder conditions (lead to TSA)

-osteoarthritis -bio-mechanical disorders, anatomic conditions -inflammatory conditions -proximal humeral fractures

sensory issues (for bariatrics)

-pain -sensitivity -proprioception issues (i.e. can't see feet can increase falls) -skin breakdown (i.e. if they are not very mobile they are more prone to bed sores).

types of prostheses

-passive/cosmetic -body powered (hook type) -Myoelectric -hybrid

pelvis fractures

-pelvis is made up of 3 bones (ilium, ischium and pubis) -Acetabulum: hollow cup, socket for head of femur (makes up hip joint) -often from falls or trauma with substantial force (i.e.MVA) -very painful -often have limited WB status

how does physical dysfunction effect occupation?

-physical dysfunction effects occupation by limiting function and engaging in occupation.

factory interventions (ergonomics)

-positioning -rest breaks (rule of 30:30, take breaks) -proper lifting (body mechanics) -noise (can they concentrate with the amount of noise; is the noise damaging) -lighting (can they see? adaquete lighting) -tool use (are they using tools repetively)

airborne precautions

-positive pressure rooms, vented to outside -closed door -wear mask (check sign on door) -therapy in the room. Items stay in the room -hand hygiene

surgical management (for amputation)

-preserve limb length -preserve joints -retain health soft tissue -adequate blood supply -pain-free and functional use of remaining limb -adequate for prosthetic fitting and functional use.

OT focus (for cancer)

-preventative -Impairments from the cancer itself -Impairments from the treatments -Impairments from late effects of both (HOSPICE) *QOL*

OT objectives (for cancer)

-preventative i.e. smoking cessation, ed on AE/DME, lifestyle changes -Restorative i.e. strengthening, (I) with ADL's, address neuro sx, participation in IADL's, energy conservation, work simplification, AE/DME -Supportive i.e. adaptive strategies -Palliative i.e. pain management, family ed and training, ROM, pressure injury prevention

steps in SOTP

-problem statement -need statement -goals/objectives -reflexive intervention -outcome assessment (help structure POC & goal; narrow down what is the BIGGEST priority)

outcome assessment

-process to assess the worth or efficacy of intervention -pre and post testing (most efficient/effective way of treating pt. from insurance)

Dupuytren's contracture/disease

-progression contraction of fascia in the palm; nodules that can fix flex of MCP -usually 4th digit -open/closed fasciotomy then referred to OT

prevention programs (ergonomic)

-protect and facilitate wellness -early intervention -treatment to avoid re-injury -universal design (able to use by everyone) -Rule of 30:30 -pitfalls of programs (depend on equipment that can be expensive)

immobilization splints

-protection to prevent injury, rest, reduce swelling, promote alignment for healing

pneumatic compression

-pump that intermittently inflates and provides gradient pressure distally to proximally. -multiple chambers that facilitate flow of lymph in correct direction -expensive, insurance can cover, but needs to show evidence of "failed conservative measures"

radial nerve damage

-radial tunnel syndrome -pain in medial to lateral epicondyle over extensor muscles; no sensory loss or weakness

work hardening

-real work activities to improve job performance/tolerance *must be able to tolerate at least 6 hrs of physical activity a day/5 days a week *will reach maximum medical improvement (MMI) within the program (6 weeks) or job goal requirements.

discharge planning

-recommendations for further OT services -recommendations for home modifications, support services, etc. -HEP -Equpment requirements Begins upon admission (constant communication between OTR and OTA)

psychological/emotional impact (bariatrics)

-rediculed & descriminated against by family and peers, healthcare workers, society, etc. -depression, low self-esteem/worthlessness -eating disorders -poor body image -helplessness -guilt -social isolation -sexual dysfunction -anger -boredom

vagal nerve block (bariatrics)

-reduces hunger signals

rejection of prosthesis

-rejection rates: myoelectric 23%, body powered 26% *reject because of the the prosthesis being uncomfortable, thinks it looks funny, doesn't fit *OT Implications:* -be encouraging -need for client ed, and follow-up for addressing problems -create opportunities for sucess and support

things to include in notes

-relevant subjective information -leave out judgement & negative statements -unobserved actions/behaviors: be careful! -always document client response to tx -you note should have enough detail that another therapist could read it and replicate what you did with your client.

adjusting splints

-remove splint from pt when cool and using spot heating with heat gun or dipping into spint pan trim and adjust for fit and position -smooth all edges -determine strap placements for stabilit, joint control and ease of use and apply -Does the fit appear appropriate, are all potential pressure areas addressed, does the pt appear to tolerate, can the pt/caregiver manage the use as directed?

dynamic splint

-resilient components that produce motion

OT role (for CAD)

-restricted activity for 6 weeks -strengthening after 6 weeks to make remaining heart tissue stronger -how does this relate to areas of occupations? (impact what occupations they can perform and how they do them: adaptive, compensatory, energy conservation; watch vital signs)

occupational performance

-resumes role or activty in applicable environment. -transistion to community level (ultimate goal)

OT intervention (for scar management)

-scars can cause adhesions to underlying tissue and limit movement and impair sensation -massage (circles along or friction: against scar), compression

scholarly, peer-reviewed sources

-scholarly journals, trade or professional articles or books -magazine articles, books and newspaper articles from well-established newspapers, websites (.org, .edu, .gov) i.e. OT practice, OT toolkit, Textbooks

AE/DME for driving (bariatrics)

-seat belt extensions -hand controls

assessment (ergonomics)

-seated, standing, combo. Walking, static stance, reaching distance -work surface heights -Tool use: weights, hand position, force, rotation, glove use -repetitions (is it a repetitive motion?)

sensorimotor FOR

-several FORs are included in the sensorimotor category, such as proprioceptive neuromuscular facilitation (PNF) and neurodevelopmental treatment (NDT). -These approaches have a common foundation: they view a client who has sustained a central nervous system (CNS) insult to the upper motor neurons as having poorly regulated control of the lower motor neurons.

AE/DME for tub/shower

-shower bench/chair -grab bars (NOT the SUCTION ones) -extended shower head

fad diets

-slow metabolism, poor nutrition, rapid weight loss (1-2lbs is safe) -i.e. keto, zone, paleo, 5:2, Alkins, South Beach -69% fail

grab bar recommendations

-space between the wall and the grab bar 1 1/2 inches -clearance between the grab bar and projecting objects at least 1 1/2 inches

method (for home environment assessment)

-specific details are identified: room, stairs, furniture, pets, people residing etc. -Dimensions of doorways, hallways, walkways, heights of surfaces -floor surfaces: rugs, tile, thresholds (can a walker slide easily) -lighting -access to phone, smoke detector, etc. -activity patterns *observation, activity analysis, who is living there, who can help*

post-op (for spinal care)

-spinal precautions -rigid braces

therapy implications for THA

-support healing via controlled movement/motor learning -support engagement in selected occupations -adapt or modify environment to support engagement within precautions -adapt or modify activity methods (AE/DME, reacher, sock-aide, toilet riser, shower chair, leg lifter, etc.) -regain physical functioning diminished during progression of disease

cancer treatments

-surgery (varied in intensity and effect) *reconstruction surgeries -radiation (burns, fatigue) -chemotherapy (varied drugs, doses, cycles, intensities, after effects) *oral chemotherapy (expensive) *often used as a combination of these* (usually 2 at the same time)

post-surgical phase (for amputation)

-suture removal 2-3 weeks -promote limb shrinking and shaping -desensitization -ROM and strength of residual joints/muscles -psychosocial adjustment -maximal participation in occupations -early ed regarding prosthetics (types, names, use)

lymphedema symptoms

-swelling throughout UE/LE -Feeling of heaviness or tightness -Restricted ROM -Aching or discomfort -Recurrent infections -hardening or thickening of the skin (fibrosis)

RA surgical considerations

-synovectomy, tenosynovectomy (wrist and hand) -tendon repair and release -nerve decompression -relocation of displaced tendons -arthroplasty (joint replacement) -arthrodesis (joint fusion)

De Quervain's tendinopathy

-tenosynovitis of first compartment tunnel (snuff box) -Finkelstein's test -conservative usually, but can be surgical release

biomechanical FOR

-the understanding of kinematics and kinesiology serves as the foundation for this FOR. -The practitioner views the limitations in occupational performance from a biomechanical perspcetive, analhyzing the movement required to engage in the occupation. -Based on principles of physics, the force, leverage, and torque required to perform a task or activity are assessed

re-evaluations

-time frame may be established by payer -may indicate sufficient progress, or lack of progress -May indicate need for change of approach -May be needed for apprval of continued service by payer -provide pt with objective evidence of improvement -OTR responsible, OTA may participate with service competency

chemotherapy

-toxic chemicals -side effects: loss of hair, peripheral neuropathy (wrist drop, foot drop), thrombocytopenia, fatigue, anemia, anxiety, loss of vision/hearing, pain in extremities, loss of sensation, taste, chemo brain

AE/DME for transfers (for bariatrics)

-transfer boards (limit 600lbs) -stand assist lift (limit 600lbs; watch girth too) -FWW (limit 400lbs) -glide lateral air transfer device (supine only; limit 1000lbs) -Z-slider -Hoyer (600-1000lbs limit) -turn and position system (TAPS, limit 800lbs)

spint tracing

-transfer pattern to splint material -score material to shape that is manageable -heat in splint pan to saften -remove material and place flat on work surface -cut out specific pattern on material (avoid stretching and avoid jagged cuts with scissors. Round corners

wrapping (for lymphedema)

-tricofix (cotton stockinette) -artiflex (padding) -comprilan (wrap) -elastomull (smaller wrap for fingers)

good body mechanics

-upright posture with neutral spine/pelvis -sit with good lower back support -Lift with legs, keep back straight, hold load close to body, don't twist while lifting

compression garments (for lymphedema)

-use after the wrapping method has made limb smaller. -helps to maintain lymphedema

hybrid prosthesis

-uses both body and electrical power -offers more choices for shorter residual limbs

narrative reasoning

-uses story making or story telling as a way to understand the clients experience -The client's explanation or description of life and the disability experience reveals thems that permeate the client's understanding and that will affect the enactment and outcomes of therapeutic interaction.

documentation (industrial rehab)

-usually are coming in daily -include pt subjective complaints -objective is professional observation of pt response to tasks -weekly progress notes -frequent re-evaluation (10 days) -concise, accurate, well written (sent to all involved including lawyers) communication is key

valvular disease (aortic valve)

-valve doesn't close -> CHF or Ischemia -Stenosis: narrowing of valve -> pressure overload (left ventricle works harder ->hypertrophy->decreased cardiac insufficiency->confusion->syncope->death *usually requires surgery to replace valve; OT helps with post-surgery*

signs of RA

-warm -swollen -painful -red *symptoms present often in flu like manner of fever, fatigue, weight loss, morning stiffness*

mask donning

-wash hands before putting on your mask -put it over your nose & mouth and secure it under your chin -try to fit it snugly against the sides of face -make sure you can breathe easily -CDC does not recommend use of masks or cloth masks for source control if they have an exhalation valve or vent

Pt education for splinting

-wear schedule: when and how long to wear splint (when to remove) -maintenance: how to clean/care for materials *never leave in a hot car* -Donning/Doffing: need help? How protect hand when splint is off -Possible issues to look for: *swelling *Stiffness *Numbness *Pain *Red marks that still remain after an hour *Blisters

THA transfers

-what approach/precautions (anterior or posterior) -general considerations: chairs with arms, higher height chairs, no slope back, scoot forward and lower operated leg. No twist with toilet hygiene or while standing -shower only no tub, grab bar, nonslip surface. sideways step over (bend at the knee). tall seat -car: no slope, passenger seat all the way back, seat-back reclined, car cane?

emergency situation (for home environment assessment)

-what to do if? what is the plan? -fire, power is out, fall, recognizing hazards i.e. medical alert button, pt ed on how to use and recognize hazards

ultrasound modality

-when used in rehabilitation (aka therapeutic ultrasound) has a deeper heat than superficial modalities and can be used to heat deeper structures and tissues to promote soft tissue healing. *(Deep thermal modality) Involves sound waves that penetrate tissue, causing vibration of molecules and resulting friction generates heat *1MHz: heats tissue up to a depth of 5cm (deep structures) *3MHz: more superficial application 3cm *Duty Cycle: The period that ultrasound is being delivered during the treatment time.

AE/DME (for home environment assessment)

-where do they get it? -how much does it cost? -what featrues are necessary for pt? *could give a handout with pictures of what they need)

return to work (RTW)

-work capacity evaluation -work conditioning -work hardening -functional capacity evaluations *typically done following an inury of an employee at work (worker comp cases)*

circumferential splint

-wraps around a part and covers all surfaces with equal pressure

purposes of splinting

1. Protect, immobilize, support: healing bones, healing tendons, reduce immflammation, healing tissue. 2. To position during tissue healing 3. To correct alignment or prevent deterioration of alignment 4. To aaist weak function 5. To control or provide limits of motion 6. To provide for force to increase motion 7. To allow for modification in ADL 8. To provide sensory-motor inhibition in UMN injury

stages of RA

1. Synovitis: no destructive changes. intermittent stiffness 2. Pannus: some cartilage destruction, x-ray evidence of osteoporosis, slight bone destruction. No joint deformity, but possible end range limitation. Some muscle atrophy, possible tenosynovitis. 3. Fibrous ankylosis: X-ray evidence of bone and cartilage destruction along with obvious osteoporosis. Joint deformities, presence of muscle atrophy, presence of nodules 4. Bony ankylosis

tips to pace yourself to save energy

1. get at least 6 to 8 hours of sleep each night. 2. rest for 20 to 30 minutes at least twice a day. If you get tired, stop and rest for 15 minutes whether you have finished the task or not 3. alternate easy tasks with hard tasks or spread a task out over the day 4. focus your energy on the things you can do 5. ask for help if the demands on our energy are too much. hire help as needed. 6. avoid stress

Doffing PPE

1. gloves 2. goggles 3. gown 4. mask 5. wash hands

Donning PPE

1. gown 2. mask 3. goggles 4. gloves

How to get up from a fall

1. prepare 2. rise. 3. sit *demonstrate for pt 1st, then if they are willing have them practice*

general tips for energy conservation

1. sit when doing a task. Standing takes more energy 2. Do work with your arms instead of your legs. Working with your legs takes more energy. 3. Wait 30 min after eating before doing a task. Work done after a meal causes more demand for oxygen to your heart 4. Avoid doing activities in temperatures above 80 degrees F with humidity and below 20 degrees F. Extremes of heat and cold have dangerous effect on the heart.

tips to improve health literacy

1. supplement text with pictures 2. tailor medication schedules or health promotion activities to fit a person's daily routine, using daily events as reminders. 3. Use clear captions, ample white spaces, pictures/diagrams to attract attention and reinforce educational message. 4. Shorten sentences to 10 words or less to make written material easy to read. 5. Use concepts no higher than 5th-6th grade level 6. speak in clear, simple, culturally sensitive language to connect with patients from all literacy levels. (include body language)

CDC standard precautions

1. wash hands before and after and if soiled during treatment. 2. Use protective equipment if coming in contact with fluids or the possibility 3. Proper disposal of waste 4. Sharps disposal in proper containers. 5. Clean work surfaces.

morbidly obese

100lbs or more overweight

breathing parameters

12 to 18 breaths per minute

intrinsic muscles of the hand

19 intrinsic muscles (lumbricals and interossei)

obeses

20% higher than expected weight

extrinsic muscles of the hand

24 extrinsic muscles (flexor and extensor tendons)

pulse rate parameters

60 to 100 beats per minute

Oximeter reading in a normal, healthy person

96-100

malignant tumor

A cancerous tumor that is invasive enough to impair the functions of one or more organs.

affect

have an effect on; make a difference to.

lymphedema (in the legs)

swelling due to an abnormal accumulation of lymph fluid within the tissues

lymphedema

swelling of the tissues due to an abnormal accumulation of lymph fluid within the tissues *no cure* can be managed best is prevention: being aware of risk factors for lymphedema

gout

hereditary metabolic disease that is a form of acute arthritis, characterized by excessive uric acid in the blood and around the joints

Swan neck deformity

hyperextension of PIP joint and flexion of DIP joint

digital nerve damage

impair sensation of hot/cold, sharp/dull, localized touch, touch discrimination.

action process

implementation: process of collecting information for critical reasoning

glaucoma

increased intraocular pressure

lateral epicondylitis

inflammation of elbow muscles; caused by strong gripping; tennis elbow

myositis

inflammation of muscle tissue

restriction splints

limit joint ROM but do not completely stop joint motion.

lymphatic vessels

located throughout the body in almost all of the tissues that have blood vessels -more superficial than circulatory system, thin, flat vessels

nausea/emesis

look for vomiting or signs that the Pt feels sick to the stomach

thrombocytopenia

low platelet count

(with sling on arm) use reacher, sock aide, shoe horn

lower body dressing following TSA. Your pt has difficulty with donning/doffing pants and shoes following surgery. Train you pt in the use of AE that may assist your pt.

glioblastoma multiforme (GBM)

malignant brain tumor of immature glial cells

sarcoma

malignant tumor of connective tissue (bones & soft tissue) types: *angiosarcoma *bone sarcoma *chondrosarcoma *chordoma *Ewing's sarcoma *gastrointestinal stromal tumors (GIST) *giant cell tumors off bone *Gynaecological sarcoma *Kaposi's sarcoma *Leiomyosarcoma *Liposarcoma *neurofibrosarcoma *Osteosarcoma *Retroperitoneal sarcoma *Rhabdomyosarcoma *soft tissue Ewing's sarcoma *soft tissue sarcoma *synovial sarcoma

boxer's fracture

metacarpal fractures; 5th metacarpal is most common

Heberden's nodes

nodes on the DIP

Bouchard's nodes

nodes on the PIP

· Name 4 psychosocial impacts for cardiac and pulmonary diseases

o Disabling anxiety: afraid of making condition worse with activity and become short of breath. o Progressing isolation: limited activity participation o Depression: Are not able to engage in occupations that they use to. o Passive acceptance: give up and tell themselves "this is what my life is now, I just have to sit here and do nothing." o Lack of coping skills: have a hard time setting limits with themselves or others.

·What are 3 vital signs that should be checked regularly with this population?

o Heart rate (normal is between 60 to 100 bpm) o Blood pressure (normal is 120/80 mmHg) o Breathing rate (normal at rest is 12 to 16 breaths per minute) o O2 Saturation level (normal is 95 to 100 SpO2)

ultrasound thermal effects

o Increase extensibility of collagen structures o Decrease joint stiffness o Decrease pain o Improve blood flow o Reduce muscle spasms

ultrasound non-thermal effects

o Stimulate tissue regeneration o Pain relief o Soft tissue repair o Increase blood flow o Increase skin and cell membrane permeability o Phonophoresis: Enhance transdermal drug administration

the importance of being aware of the side effects of medication

o To ensure we know what side effects to look for because it can affect their response to activities. Such as diuretics medication can cause the Pt to get up and go to the bathroom frequently and may limit their ability to engage in other occupations/activities due to limited energy.

difference between work simplification and energy conservation

o Work simplification: An intervention in which clients with chronic diseases are taught strategies to minimize fatigue and pain by modifying work tasks and employing strategies to save energy. o Energy conservation: an intervention in which clients are taught strategies to minimize muscle fatigue, joint stress, and pain by using the body efficiently and doing things to save energy.

effect

A change that is a result or consequence of an action or other cause.

asthma

A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing/SOB. - can be caused by allergens, perfume, dust; can be triggered by cold air or induced by exercise -can lead to reduced O2 levels in blood leading to hypoxemia

rheumatoid arthritis

A chronic systemic disease characterized by inflammation of the joints, stiffness, pain, and swelling that results in crippling deformities

diabetes

A condition in which the body is unable to produce enough insulin, the hormone required for the metabolism of sugar

cubital tunnel

A tunnel of muscle, ligament, and bone on the inside of the elbow

model of practice

A way of viewing the relationship of the person, environment, occupation, and desired outcomes, and can serve to help test theories.

CAD (coronary artery disease)

Abnormal narrowing of the blood vessels of the heart, predisposing to heart attacks

antagonist muscle

Allows movement in opposite direction from muscle -co-contraction

benign tumor

An abnormal mass of cells that remains at its original site in the body.

lymph nodes

Bean-shaped filters that cluster along the lymphatic vessels of the body. -They function as a cleanser of lymph as wells as a site of T and B cell activation -filter lymph

complex regional pain syndrome (chronic pain)

Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack.

primary tumor

original tumor; the source of metastasis

symptoms of covid-19

other symptoms: -fatigue -muscle or body aches -headache -new loss of taste or smell -sore throat -congestion or running nose -nausea or vomiting -diarrhea

phantom limb pain

pain in a limb (or extremity) that has been amputated -*burning, itching, pressure* -80% of amputees experience this pain

fibromyalgia syndrome

pain in the fibrous tissues and muscles

fibromyalgia

pain in the muscle fibers (vs just joint pain)

thumb spica splint

DeQuervain's, RA, Skier's Thumb, CMC Arthritis

CMC osteoarthritis

Degenerative joint disease affecting the first carpometacarpal joint (basal joint arthritis) - Wrist splint positioned 0-15 degees of extension, volar splint with wrist in neutral -avoid resistance; joint protection -can do CMC joint arthroplasty (MCP too)

chronic obstructive pulmonary disease (COPD)

permanent, destructive pulmonary disorder that is a combination of chronic bronchitis and emphysema -emphysema: alveoli become ruptured or enlarged because lungs become less elastic -peripheral airway disease: inflammation, fibrosis, and narrowing of airways -Chronic bronchitic: SOB (dyspnea) with activity and as progresses, at rest

i.e. supervision or touching assistance (code 4) and SBA

person is able to get in and out of bed with someone nearby to help if needed

i.e. of substantial/maximal assistance (code 2) and max A

person is able to pull a shirt sleeve onto their LUE, but needs help getting it over their head and getting their RUE into the sleeve as well as help to pull it down over their torso.

i.e. of partial moderate assistance (code 3) and mod A

person is able to pull pants up from their knees, but needs help to get them out of the closet and put them over their feet

i.e. of set-up or clean-up assistance (code 5) and s/u A

person is able to stand at the bathroom sink and brush their teeth if the toothpaste is put on the brush for them and it is left on the counter.

i.e. of independent (code 6) and Mod (I)

person is able to stand from the toilet using an elevated toilet seat (ETS)

i.e. of partial/moderate assistance (code 3) and min A

person is able to use a tub transfer bench (TTB) to perform a shower transfer, but needs help lifting their LLE over the edge of the tub.

i.e. dependent (code 1) and dependent

person is unable to get compression socks on; someone else does it for them

job analysis

Essential functions of job: critical performance factors, objectively assessed including amounts of time in 8 hr day spent in activity. -includes weights lifted, repetitions in time frames, performance standards, ROM requirements *cognitive functions:* best if OT can go observe job and create one themselves (usually a standard one from company; need to review thoroughly with pt)

chart review

Examining documented or collected information on a person's developmental, educational, or medical history

bursitis

Extra fluid in bursa between olecranon and skin

orthostatic

pertaining to the upright position of the body: used when describing this posture or a condition caused by it, such as Orthostatic Hypotension (a drop in blood pressure upon standing) -look for a drop in systolic blood pressure and hypotension of greater than 10 mm Hg with ta chang in postion from supine to sitting or sitting to standing

manual lymphatic drainage (MLD)

Helps circulate lymph, helping the body rid itself of toxins, waste, and excess water that can leave the face and body looking puffy and fatigued. MLD techniques: -light touch: these vessels are more superficial, greater pressure can cause further blockage -proximal to distal: but strokes are always moving proximally

internal factors of cancer

Hormones, immune conditions, inherited mutations -i.e. inherited abnormalities

hospice vs palliative care

Hospice (covered under hospice benefit from medicare A) -focus is limited to comfort and participation as able; don't expect progress (goals focus on maintenence) -direct care to patient or indirect to familty and caregivers. (home assessment, DME recommendations) -Pt is terminal; no medical treatment for cure can be sought (insurance regulations) Palliative care -focus on comfort & improve QOL -does not have to be terminal -may include medical treatments with intnet to cure -relieves suffering -improve QOL

communicable diseases modes of transmission

Indirect: -airborne -vehicleborne -vectorborne Direct: -person-to-person contact -droplet spread

communicable diseases

Infections that can spread from one person to another

trigger finger

Inflammation and thickening of the tendons of the finger makes it difficult to flex or extend the finger, may become stuck and then snap into position

psoriatic arthritis

Inflammatory arthritis with skin involvement, pitting of fingernails, and onycholysis. Treat with NSAIDs, methotrexate, or reconstructive surgery -hot and red in appearance

spinal surgeries

Laminectomy, microdiscectomy, lumbar discectomy, anterior cervical discectomy & fusion, foraminotomy (foramenotomy), spinal fusion

purposeful activity

MEANINGFUL activity, relevant to patient, a portion of desired occupation. -i.e. cutting veggies in kitchen because they like cooking

compression fractures (non surgical)

Many spine compression fractures heal in two or three months. If you have osteoporosis, a full recovery may take as long as a year.

joint protection

Methods to reduce external stress applied to impaired joints. -maintain muscle strength and ROM -use joints in the most stable position and larger joint when possible -avoid positions of deformity (i.e. ulnar deviation)

sternal precautions

No pulling or pushing up with arms when transferring No driving or sitting in front of airbag for 4 weeks post-operative No shoulder elevation above 90 degrees (limited ROM of BUE) No pushing, pulling, or lifting more than 10 lbs for 8 weeks following surgery.(~the weight of a gallon of milk) *avoid valsalva maneuvers

agonist muscle

prime mover

blood pressure parameters

Normal BP <120/<80 • Prehypertension 120-139/80-89 • HTN stage 1 140-159/90-99 • HTN stage 2 >160/>100

role of OT (industrial rehab & role of work)

OTPF: job performance, job seeking, retirement prep, volunteer work, exploration of various forms of work, RTW -onsite job analysis -development of physical job descriptions -post-hire assessments for new employees -onsite ergonomics assessment and training -RTW

angina

Pain in the heart region caused by lack of oxygen What to look for: look for chest pain that may be described as SQUEEZING, TIGHTNESS, ACHING, BURNING, OR CHOKING. Pain is generally substernal and may radiate to the arms, jaw, neck, or back. More intense or longer-lasting pain forewarns of greater ischemia

recovery phases (TSA OT role)

Post-op: -soft tissues surrounding joint must be preserved for healing -glenohumeral joint must be maintained in appropriate anatomical position -pain/inflammation controlled -AROM- encouraged in elbow, wrist, hand *follow Dr. protocol* -Only PROM allowed at shoulder joint *(per parameters set by surgeon)* -Restore ADLs, typically compensatory or adaptive strategies -shoulder sling worn 3-4 weeks post-op -NWB 6-8 weeks -no lifting > 1-2lbs -AROM: non-affected areas -AAROM/PROM *90 degrees shoulder flexion *45 degrees shoulder abduction *Neutral shoulder extension *IR/ER as designated by surgeon -Codman's pendulum exercises

resting hand splint

RA, Crush injuries, burns, spasticity due to upper motor neuron lesions, flaccidity -20-30 degrees in extention -45-60 degrees in flexion -15-30 degree PIP and DIP flexion

Transtheoretical Model

STAGES: *Precontemplation*: there is no intention of taking action to modify behaviors (maybe lack of knowledge, past failed attempts, poor motivation) *Contemplation*: intention to change, but in the future (~6mo) *Preparation*: ready to change in the next month, shown some initiative *Action*: carry out the plan (last at least 6mo for is to be a meaningful change) *Maintenance*: prevent relapse (temptation is still there) *Termination*: can maintain new behaviors even when stressed. (really possible?)

macular degeneration

progressive damage to the macula of the retina

osteoarthritis (OA)

progressive, degenerative joint disease with loss of articular cartilage and hypertrophy of bone (formation of osteophytes, or bone spurs) at articular surfaces -primary: may be localized or diffuse -secondary: caused by trauma, infection, or abnormalities.

occupational justice

promotion of social and economic change to increase individual, community, and political awareness, resources, and equitable opportunities for diverse occupational opportunities which enable people to meet their potential and experience well-being *(interventions, access to health care and other services, physically accessible environments, legislature that supports equal opportunity)*

serial static splint

Slow, progressive increases in ROM by repeated remolding of the splint or cast. **no movable or resilient parts.

standardized testing

quantitative information -protocol driven: reliable, valid

health literacy

The capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. *low health literacy equates to poor health prognoses*

primary lymphedema

rare, usually congenital -problems with formation of lymphatic system

Codman's pendulum exercises

Therapeutic exercise for the shoulder joint in which the client bends forward at the waist with the arm perpendicular to the floor, then rocks the body side-to-side allowing the relaxed arm to freely move in a clockwise and counterclockwise direction

the most common amputation

Trans-radial

myoelectric prosthesis (electrical)

Type of prosthesis for persons with an upper limb deficiency or amputation uses electrical signals from existing muscles in the residual limb to control the movement of the artificial device -More acceptable cosmesis, decreased harnessing, better grip, ability to work overhead, less scapular contribution for function. -Emg at motor points for optimal electric response -Client must be able to hold muscle contraction for 2 sec then relax for 2 sec *-requires agonist and antagonist relationship* -transhumeral: bicep/tricep -transradial: wrist extensors and flexors

precautions for hip fractures

Typically no hip precautions

gamekeeper's/skier's thumb

Ulnar collateral ligament injury of thumb-> instability of MCP joint. Skier's thumb: acute condition (ex. P fall) Gamekeeper's: chronic hyperabduction injury Mech: forced abduction of thumb (UCL function nis to resist vs valgus foces)

bed mobility with log rolling with BLT

You have an 84 year old female with T12-L2 compression fractures. She is having difficulty with getting in/out of bed safely. You need to train pt in proper body mechanics for log rolling in/out of bed

sit with good lower back support and neutral spine, use AE for toilet hygiene (no bending or twisting)

Your pt is post-op lumbar fusion. you are to train proper body mechanics for toileting following back precautions.

scaphoid fracture

a break in the scaphoid bone in the thumb -can take a long time to heal; poor blood flow

carcinoma

a cancer arising in the epithelial tissue of the skin or of the lining of the internal organs such as liver or kidney. types: *Basal cell carcinoma. *Squamous cell carcinoma. *Renal cell carcinoma. *Ductal carcinoma in situ (DCIS) *Invasive ductal carcinoma. *Adenocarcinoma.

Lupus

a chronic autoimmune disease characterized by inflammation of various parts of the body -butterfly rash, raised red patches on the skin, ulcers in mouth/nose, light-sensitive, swelling/pain in 2 or more joints, low blood counts, spilling protein in the urine, seizures, inflammation in lungs/heart, blood antibodies, and antinuclear antibodies *need to have 4/11 factors to be diagnosed*

rheumatoid arthritis (RA)

a chronic systemic disease characterized by autoimmune inflammatory changes in the connective tissue throughout the body -insidious onset: progresses gradually and suddenly and has damaging effects -Cronic, systemic, autoimmune disorder, marked by the inflammatory process -Typical onset in mid 20's to '50s with a significant disability within 10-20 yrs. -women 3:1 -symmetrical patterning often seen; but don't necessarily progress equally

malignancy

a dangerous cancerous growth that sheds cells into body fluids and spreads to new locations to start new cancer colonies -graded for the rate of growth: low grade and high grade. Cancers are staged to predict prognosis and identify treatment strategies -tumors may present with hormone-like substances that disrupt organ function and may give a clinical picture of a different disorder.

ankylosing spondylitis

a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae

lymphoma

a general term applied to malignancies affecting lymphoid tissues (also includes bone marrow, thymus, spleen, tonsils, lymph nodes) Types: (2 main types) *Hodgkin's lymphoma (Hodgkin's disease) *Non-Hodgkin's lymphoma (more common)

carpal tunnel

a passageway that runs from the forearm through the wrist

incentive spirometer

a resistive breathing device that helps patients exercise their breathing muscles OT: can help create a routine of 1 X every 10-15 minutes to help increase function

orthopnea

ability to breathe only in an upright position -What to look for: look for dyspnea brought on by lying supine. count the number of pillows that the Pt needs to breathe comfortable during sleep

juvenile rheumatoid arthritis

an autoimmune disorder that affects children aged 16 years or less (onset 2-4 years) with symptoms that include stiffness, pain, joint swelling, skin rash, fever, slowed growth, and fatigue -can affect eyes and organs *normal development is going to be affected*

cancer

any malignant growth or tumor caused by abnormal and uncontrolled cell division *abnormal cellular growth*

passive prosthesis

appearance is similar, no active grip, but may stabilize, very costly, less durable

thinking process

assess problems, evaluate interventions, define outcomes, develop a measurement

chemo brain

reduced cognitive function, can last up to a few years -being unusually disorganized -confusion -difficulty concentrating -difficulty finding the right word -difficulty learning new skills -difficulty multitasking -fatigue -feeling of mental fogginess -short attention span -short-term memory problems -taking longer than usual to complete routine tasks -trouble with verbal memory, such as remembering a conversation -trouble with visual memory, such as recalling an image or list of words

referral

request via a physician or physician care extender (CRNP, PA) *Need referral to get OT services*

external factors of cancer

behaviors, environments -i.e. smoking, pollution

BMI

body mass index -can be swayed by musculature, edema

oval-8 ring Splint

boutonniere deformity, swan neck deformity, combined median/ulnar injury

bariatric

branch of medicine that deals with all stages of obesisty

metastatic tumor

secondary growth from a malignant tumor

Deductive reasoning

testing of theory (have a question & then test it) (data collection/measurement)

valsalva maneuver

the action to exhale with the nostrils and mouth, or the glottis, closed. This increases pressure in the middle ear and the chest, as the bracing to lift heavy objects, and is used as a means of equalizing pressure in the ears.

VALPAR 9

standardized assessment: timed task, move shapes to matching, overhead reaching

body powered prostheses (mechanical)

cable tension activated by biscapular abduction or humeral flexion -lighter weight, durable, less expensive, increased visualization -shoulder figure 8 harness: suspends prosthesis, allows tension force on cables to operate TD -Elbow hinge & wrist unit -terminal device: hook or hand, voluntary open or voluntary close

medial epicondylitis

characterized by pain on the palm-side of the forearm

TNM staging

classifies cancer according to tumor size, node involvement, metastasis

Inductive reasoning

collection of data in natural setting: observation, interview (recognition of themes, similarities emerge through repetition)

CHF (congestive heart failure)

condition in which the heart cannot pump enough blood to the rest of the body

patient zone

contact with Pt skin, body fluids, or mucous membranes

oncology

study of cancer

osteoarthritis

degenerative joint disease

pseudogout

deposition of calcium pyrophosphate crystals w/in joint space; usually affects large joints (knee), > 50 yo, both sexes affected equally

log rolling

supine to sit from bed: step 1: Bend your knees while lying on your back (as you move keep knees and shoulders bent in same direction) step 2: Roll onto your side with an arm on each side step 3: push up from unaffected arm at the elbow until you are in sitting position; gently lower legs to the floor.

nociception

detection of tissue damage via peripheral nerves

dyspnea

difficult or labored breathing -what to look for: look for SOB with activity or at rest. make note of the activity and the amount of time it took to resolve.

COPD (chronic obstructive pulmonary disease)

disease with enlarged lung spaces, usually from smoking can cause shortness of breath

diaphoresis

excessive sweating -look for cold, clammy sweat

FOOSH (distal radiaus)

fall on outstretched hand -surgical and non-surgical repair

Boutonniere deformity

flexion of PIP joint and hyperextension of DIP joint

ganglion cyst

fluid-filled sac arising from joint capsules or tendons, typically in the hand

lymphedema certification

four components of Complete Decongestive Therapy (CDT) and the management of lymphedema affecting a variety of peripheral body parts - upper and lower extremities, head and neck, exterior genitalia, truncal swelling, pediatric lymphedema, post-surgical and post-traumatic swelling, lymphedema caused by chronic venous insufficiencies and other pathologies, lipedema and more.

chronic renal failure

gradual and progressive loss of kidney function

metastases

the development of secondary malignant growths at a distance from a primary site of cancer. -still named for the part of the body that it originated

body mechanics

the proper use of the body to facilitate lifting and moving and prevent injury *lift symmetrically *no twisting *Use large muscle groups in the legs -*not safe for 1 person to lift more than 51lbs*

dupuytren's disease

thick & contracted=flexion deformities wound care, edema mgmt (above heart), ext splint, A/PROM, strength when wounds heal, scar management, occ based w/ flex & ext

reflexive/intervention

thinking and action that occurs during interventions -critical thinking and analysis that occurs with process and outcomes intervention (monitoring progress and revision of intervention in response) *our profession lens*

the primary cause of UE limb loss

trauma

chondroma

tumor in cartilage; usually benign Types: *Chondromas are classified according to their location:* *enchondroma: within the bone (within the medullary cavity), * periosteal chondroma: on the surface of the bone, *soft tissue chondroma in the soft tissue.

meningiomas

tumors that grow between the meninges

lymph

watery fluid

work conditioning vs work hardening

work conditioning: focus on specific work performance skills work hardening: real work activities to improve job performance/tolerance *both program end with FCE *worker's comp is usually the payer source *used when MMI is reached

wrist cock-up splint

wrist in 10-20 degrees of extension to prevent contracture, allows for digits to function

educate on what to expect after surgery and precautions; exercises include pendulum, stretches while in supine

you are training a pt in precautions and exercises following post-op rTSA. AS well as training in donning/doffing sling. pt is 1 week out from surgery. what exercises would you train the pt in.

Educate on compensatory techniques (1 handed), AE

you have a 62 year old pt that has a rTSA. The pt reports difficulty in performing ADLs such as upper body dressing due to poet op precautions and wearing the arm sling.

What is the difference between acute pain and chronic pain?

· Acute pain: clear onset or cause, biological response, predictable and responsive to treatment. · Chronic pain: Continues for more than 12 weeks, likely begins as acute pain, no biologic purpose, unpredictable response to treatment (typically causes significant change in quality of life).

joint protection strategies

· Avoid activity that stresses joint with push, pull, or twist · Decrease weight lifted by a joint, weight supported by a joint, how often the joint is used (incorporate energy conservation) · Respect pain (listen to your body; it is trying to tell you something) · Maintain muscle strength and ROM · Use joints in most stable position and larger joints when possible · Avoid positions of deformity (i.e. drinking out of a regular coffee mug) · Avoid staying in one position for long periods of time.

AE or environmental modifications to help people with arthritis be more independent

· Extended or built-up handles (so they don't have to grip as much) · Reacher, sock aide, dressing stick, long-handled sponge · Shower chair, elevated toilet seat, grab bars, toilet wands · Light-weight items such as plastic plates and glasses · Electric appliances such as an electric can opener · Lever handles to help with twisting (i.e. to open jars) · Long-handled dust pan and pet care items

4 stages of wound healing

· Hemostasis · Inflammation · Replication/proliferation · Synthesis/remodeling

interventions OTA's can use to assist with pain management

· Medication · Activity tolerance · Body mechanics, posture training · Energy conservation, pacing, joint protection · Splinting · Adaptive equipment · Relaxation, biofeedback, distraction · Modalities

differences of OA and RA (symptoms/causes/treatment, etc.)

· OA is a degenerative disease while RA is an autoimmune disease. · Onset of OA usually develops slowly over period of years, while RA usually develops suddenly, within weeks or months · Disease process for OA in noninflammatory and is characterized by cartilage destruction. Disease process for RA is inflammatory and characterized by bone erosion and synovitis. · OA can affect one joint or several while RA has symmetrical patterning of affected joints. · Morning stiffness for OA usually lasts less than 30 minutes while for RA usually lasts at least one hour.

energy conservation strategies that can be used with arthritis diagnoses

· Organize work areas · Sit when possible · Adjust work heights · Gather supplies together · Use lightweight tools · Complete tasks in one area before moving to another area

similarities of OA and RA (symptoms/causes/treatment, etc.)

· Symptoms for both include stiffness in the morning, pain, limited ROM, warmth or tenderness in affected joint. and many joints can be affected. Both OA and RA can progress to affect joint function. · Treatment for both focuses on the reduction of pain, improving overall function, and reducing the potential for long-term disabilities. · There is no cure for both OA and RA.

ultrasound Precautions/contraindications

· Ultrasound should not be applied to: open wounds, metastatic lesions or active cancer, areas with decreased sensation, metal implants, pacemaker, pregnancy, eyes, breasts, sexual organs, open fractures, the growth plates in children, and acute infection. · Only use specific approve frequencies because higher than recommended standards can generate too much heat and can destroy tissue. · Limit therapeutic ultrasound to 14 treatments because more than 14 treatments can decrease both red and white blood cell counts.

spinal precautions

•Think "B.L.T." -No bending at the waist -No lifting more than 10 pounds -No twisting Keep the shoulders and hips lined up •Avoid pulling »Don't pull yourself out of bed or allow someone else to pull you up »Log roll when getting out of bed »Don't pull up on the handrail when climbing the stairs