Phys dys Midterm

What's the role of OT for individuals who use a prosthesis or have an amputation?

". . . the therapeutic use of everyday life occupations with persons, groups, or populations for the purpose of enhancing or enabling participation"

OTs role: Chronic joint disease(s)

(Promote function and participation) May vary based on the direction of the treatment team: Relieving pain Reduce impact any stress on soft tissue surrounding site of injury Collaborate with PT to complement interventions Patient education: lifestyle redesign, occupational functioning, etc.

OTs role: Acute stage of injury

(Reduce pain and improve comfort) Relieve pain Reduce swelling and inflammation Assist with wound care Maintain alignment of injury Restore function at the site of injury

Moberg Pickup Test purpose

- Assesses hand dexterity - Determine functional ability of hand with median nerve lesion The Moberg Pickup Test is a structured assessment that measures the speed of picking up and placing small household items with vision and vision occluded. A difference in time and behavior of hand picking up items indicates possible median nerve sensory impairment.

Role of OT in burn recovery: positioning, contracture prevention, scar management, functioning OT evaluation

- Burn mechanism - Area of burn - % TBSA - depth/degree of burn - Joints involved - Medical procedures - Social history - Occ profile - ROM (passive and active) - ADLs/mobility as able

Superficial partial thickness burn

- Epidermis and superficial dermis - moist - blisters (what sets them apart from superficial) - bright pink or red - very painful - heals within 3 weeks

Superficial burn

- Epidermis only - skin remains intact - Localized inflammatory response - Pink/red - 3-5 days to heal spontaneously - ex: sunburn - these types of burns are painful!

Nutrition

- Important for wound healing - High protein - Increased metabolic rate after injury - Calorie needs depend on % TBSA - Intubated patients will require nasogastric or gastric tube

9-hole peg test purpose

- Measures finger dexterity among clients of all ages; assesses eye-hand coordination and manual dexterity The test is administered by asking the client to take pegs out of a container and place them one by one into holes on the board, as quickly as possible. The client must then remove the pegs after all holes are filled. Clients are scored based on their total time to place pegs in and take pegs out of the board.

Box and Block Test purpose

- Measures gross manual dexterity The Box and Blocks Test measures unilateral gross manual dexterity. The patient is seated at a table facing a box that contains 150 blocks. The goal of the test is to move as many blocks as possible, one at a time, into an empty adjacent compartment in 1 minute. Higher scores indicate better gross manual dexterity.

Problem List

- Part of initial assessment - "Problem list" that identifies major areas of occupation that have been affected by client's condition - Contributing factors identified: client factors, performance skills, performance patterns & context/environment - Priorities are then set with the client and caregivers

Precautions for HIP

- Person may have weight bearing and/or movement precautions and care instructions from surgeon - May differ depending on surgical technique, injury, comorbidiites, specialized protocol and latest evidence

Interventions for someone post THA or hip fx:

- Posting visual aids to support precautions - Strengthening (before or after surgery) - Patient education: surgery and recovery, terminology, prevent further injury, common mistakes to avoid, habits/routines - Home assessment - chairs, equipment - Training in use of AT and tools/DME - family/support system education

Objective measurements on evaluation

- ROM testing may not be possible due to surgeon's orders. The site of injury (tendon, bone, joint) requires rest. - If client is given specific protocol, OT measures ROM (controlled, within surgeon's limits) and documents this on evaluation. - Strength is often deferred as well, unless otherwise specified by surgeon. This should also be documented on evaluation.

Addressing endurance through intervention Remediation BIOMECHANICAL

- Repeating exercises - Grading exercise/activity (increase duration, reps, distance, weight)

SOAP note

- Standard method of client-care documentation - Helps organize information - Based on problems identified on assessment - Problems are numbered and subsequent progress and d/c notes are so structured - Format can be used for initial, progress and d/c note

Jebsen-Taylor Test of Hand Function purpose

- The Jebsen Hand Function Test was designed to provide a short, objective test of hand function for activities of daily living. It has 7 items (writing, card turning, Manipulate Small Common Objects, Simulated feeding, Stacking Checkers, Moving Large Light Object, Moving Large Heavy Objects) - Used to assess hand function with and without a prosthesis

Deep partial thickness burn

- epidermis and deep dermis - less painful (bc damage to nerves!) than superficial partial thickness - red, mottled, waxy white - wet - may require skin grafting (surgery) - No blisters

Full thickness burn

- epidermis, dermis, and hypodermis - white or gray - leathery - dry and hairless - insensate (no sensation) - better to have painful burn than not painful! - requires skin grafting (surgery)

Deep full thickness burn

- extends into fat, muscle, tendon, and bone - black, charred - not appropriate or grafting - requires amputation

A variety of strategies including ergonomic approaches at home and work, exercise, activity pacing, planning, sleep hygiene, and stress management are suggestions in which area? A) Fatigue management B) Workplace adjustment C) Vocational rehabilitation D) Behavioral change

A) Fatigue management

What is the recommended splinting position of the hand following a burn injury? A) MP joints 70°-90° of flexion, IP joints fully extended, first web open, thumb in opposition B) MP joints fully extended, IP joints in 20-30° of flexion, first web open, thumb in opposition C) MP joints in neutral, IP joints fully extended, first web open, thumb in flexion D) MP joints 70-90° of flexion, IP joints fully extended, first web open, thumb in flexion

A) MP joints 70°-90° of flexion, IP joints fully extended, first web open, thumb in opposition

Phong is working as an executive assistant, and was diagnosed with carpal tunnel syndrome secondary to overuse of a computer keyboard. Phong was referred to OT for conservative treatment prior to consideration of surgical intervention. What may you recommend? A) night splinting with wrists in neutral, median nerve gliding exercises, and analysis of activities in which Phong uses his hands B) immobilization of the affected wrists, retraining in daily activities using only the unaffected extremity C) refer back to surgeon, conservative treatments of carpal tunnel syndrome are ineffective and time consuming D) scar massage and desensitization

A) night splinting with wrists in neutral, median nerve gliding exercises, and analysis of activities in which Phong uses his hands

Evaluation of a patient post THA, hip fx should include:

Access to tools/equipment Support system Assess UE function Coordination Planning, executive function, organization memory Motor planning, praxis posture/core strength Visual aids in plain language

TENS indications

Acute pain Post-operative pain Chronic pain Nonsurgical management of knee conditions

ROM

All body joints have "normal" ROM that is possible, determined by: Joint structure Elasticity of connective tissue, muscles, tendons, skin and other soft tissue surrounding joint - Body-structure function - Moveable ROM = strength

Endurance

Also called "activity tolerance" Ability to sustain effort and resist fatigue Two types - Cardiopulmonary - Muscular

General Rules for Positioning: (LAB)

An individual with mobility impairment should have repositioning performed every 2 hours until they are able to reposition on their own. While positioning the client, the bed should be flat. After positioning, the head of the bed should be at 300 to prevent aspiration/choking.

OT's role in diabetes

Assess occupational challenges related to diabetes self-management Physical, psychological, or social consequences of diabetes Diabetes complications - Low vision and neuropathy Occupational balance between self-care, work, leisure, and self- management activities

Which part of SOAP: Client requires min to mod assist to incorporate use of affected hand for stabilization during making a sandwich, due to R CVA hemiparesis

Assessment (problem statement):

Your client is diagnosed with s/p distal humeral fracture was referred to OT one week ago to begin AROM and pain management. Today the client arrived with severe pain of the forearm with passive stretching, pale, bluish skin color, and absence of forearm radial pulse. What should the OT do first? A) Apply a hot pack and perform AROM only. B) Contact the MD directly as the client is presenting with signs of Volkmann ischemia. C) Have the client bring this up with the physician on their next scheduled visit, this may be a sign of a flexor tendonitis. D) Defer treatment until symptoms subside.

B) Contact the MD directly as the client is presenting with signs of Volkmann ischemia.

How should scar massage be performed? A) Light pressure, circular motions, without lubricant B) Deep pressure, circular motions, with lubricant C) Deep pressure, circular motions, without lubricant to maximize superficial debridement D) Light pressure, parallel motions, with lubricant

B) Deep pressure, circular motions, with lubricant

Many patients with burn injuries will experience psychosocial distress or trauma. The occupational therapist should address this by: A) Discouraging the patient from asking questions. B) Encouraging the patient to speak about the burn injury if they feel comfortable doing so. C) Choosing treatment activities that protect and isolate the person. D) Avoiding addressing these issues.

B) Encouraging the patient to speak about the burn injury if they feel comfortable doing so.

If an occupational therapist is doing range of motion exercises and feels a hard end feel and that the area is warm to the touch, what should the occupational therapist consider and convey to the physician? A) Potential for infection B) Potential for heterotopic ossification C) Potential noncompliance issues with patient D) Potential for broken bone

B) Potential for heterotopic ossification

After a hip fracture or total hip arthroplasty, the therapist directs the client to perform occupational performance tasks safely. The surgeon has provided the following ROM restrictions: no hip flexion beyond 90 degrees, no hip rotation, no crossing operated leg and no hip adduction of operated leg. What task may threaten the integrity of the surgical procedure? A) Reaching into a cabinet above shoulder level B) Squatting to get a pan off the bottom shelf of a low kitchen cabinet C) Sitting on a chair with an extra cushion D) Lying in bed with an abduction pillow

B) Squatting to get a pan off the bottom shelf of a low kitchen cabinet

What type of activity modification would you recommend to a client who is diagnosed with rotator cuff tendonitis? A) Perform arm circles bilaterally 3x each day, encouraging the client to "work through the pain" B) Teach the use of one-handed techniques only. C) Educate the client to avoid above shoulder level activities. D) Use a bath mitt on the involved extremity to wash the opposite axilla.

C) Educate the client to avoid above shoulder level activities.

A person with arthritis has been an active member of a knitting group that donates items to a local shelter and would like to continue this activity. The OT should: A) Use a leisure checklist and encourage the person to develop new leisure skills. B) Recommend that the person shop for the yarn instead of knit so she can be part of the group. C) Teach the client ways to minimize the risk so she can continue to enjoy the activity. D) Recommend that the person participate in the group for social reasons but give up knitting.

C) Teach the client ways to minimize the risk so she can continue to enjoy the activity.

What is the primary purpose of static splinting? A) To improve circulation in an edematous joint B) To increase range of motion available in joint C) To reduce soft tissue and joint pain D) To prevent scar formation during an exacerbation

C) To reduce soft tissue and joint pain

Which of the following ADL recommendations adheres the most to the principles of joint protection? A) Carrying a purse or back pack with fingers for better control B) Pushing open a door with your outstretched hand C) Using a built-up handle on your toothbrush D) Carry as many grocery bags as possible to make one trip from the car

C) Using a built-up handle on your toothbrush

Identify parts of the COAST goal: Client will perform a three step meal prep with 2 or fewer verbal cues for sequencing and safety from w/c level in rehab kitchen within 2 weeks.

C: Client will O: perform a three step meal prep A: with 2 or fewer verbal cues for sequencing and safety S: from w/c level in rehab kitchen T: within 2 weeks

Joint protection (Rehabilitation frame of ref)

Can apply to patients with OA and RA Client and caregiver education Assistive tech (hands-free phones) Energy conservation Ergonomics principles: Respect pain Distribute load over multiple joints Pace activities (i.e. microbreaks, alternate tasks with differing difficulty levels, etc.) Avoid staying in one position for too long Use correct patterns of movement

Problem statement Examples

Client is unable to dress self independently due to decreased AROM in bilateral UE Client requires max assist to dress self due to ½ AROM in bilateral UE - Identify the area of concern - Identify the contributing factor

Problem Statement Format

Client requires ___(assist level)___ in ___(performing what occupational task)__ due to __(contributing factor)__. ex: Client requires moderate assist in typing due to lack of active finger and thumb ROM

Elements of a COAST goal

Client, Occupation, Assist Level, Specific Condition, Timeline

things to consider for COAST goals

Client-centered: a client priority Occupation based Assist level is clear and measurable Specific condition clarifies circumstances Timeline seems realistic and appropriate - Will another OT practitioner be able to use this goal accurately with the client?

Evidence from the text shows that individuals who adhere to joint protection techniques have higher rate of ADL scores is an example of which part of RTSS

Clinical Reasoning

Practicing use of adapted task methods will help client safely perform meal prep without the need for AE is an example of which part of RTSS

Clinical Reasoning

What theory or evidence supports your choice of ingredients is called

Clinical Reasoning

HF/E considers

Complex interactions between the human and other humans the environment tools products equipment and technology HF/E considers the physical, cognitive, and psycho-social safety and health aspects of living and working. It is best practice to utilize HF/E strategies in advance Does this always happen?

role of OT burns: Rehabilitative phase: outpatient

Continue inpatient goals - Range of motion - Strengthening - Activity tolerance - Scar management - ADLs/IADLs Return to work/school Driving

You have a client with RA with significantly reduced active and passive ROM of the hands. Which adaptation would address this limitation? A) Grab bars in tub B) Small round knobs on cabinets C) Pull down shelving D) Lever type handles on sink

D) Lever type handles on sink

What is the most important treatment goal for any client with an upper extremity fracture? A) Regain pre-injury strength of the involved extremity. B) Maximize their passive range of motion. C) Maximize function of the uninvolved extremity. D) Restoration of occupational functioning.

D) Restoration of occupational functioning

What durable medical equipment (DME) would most likely be recommended for a 78 y/o client s/p THA with partial weight-bearing restrictions who needs to take a shower in a tub shower? A) Crutches, shower chair B) Straight cane, stand to shower C) No DME is necessary D) Rolling walker, transfer tub bench

D) Rolling walker, transfer tub bench

Effects of cold therapy

Decrease pain by increasing pain threshold, decrease acute edema, nerve conduction, inflammatory response, metabolic rate, spasticity, and increase tissue stiffness

Contraindications precautions for cold therapy

Decrease sensation/cognition sensitivity/tolerance (can be allergic to cold) Decrease circulation Hypertension Raynaud's syndrome Frostbite Peripheral vascular disease Very young/old Adverse: tissue damage

Scar formation

Delayed healing increases risk of scaring

using RTSS framework for clinical reasoning when planning interventions for client. First step:

Develop problem list - What problems do you identify when reading this case scenario? - What is the client's diagnosis & resulting impairements in body function? - What additional factors are impacting occupational performance?

Assessments/evaluations for Diabetes and amputation

Diabetes self management questionnaire (Diabetes) Questions about Glucose Management Dietary Control Physical Activity Health-Care Use COPM (Diabetes and Amputation) Measure designed to detect "self-perceived change in occupational performance problems over time" - Self-Care, Productivity. & Leisure

How limited ROM impacts someone

Difficulty w/ occupational performance: reaching, grasping, transfers, mobility, dressing, etc.

Joint protection strategies

Distribute load over several joints Reduce force and effort in activities Use correct patterns of movement Use strongest, largest joints for the job Avoid staying in 1 position too long Use AT, pace activities & work simplification Maintain strength & ROM

Pre-operative occupational therapy care:

Dominance retraining Instruct one-handed techniques and adaptive equipment that may be helpful Evaluation of ROM of both upper and lower extremities, core strength, and endurance

Dressings

Dressing type dependent on size and degree of burn - Topical antimicrobials - Antibiotic ointment - Silver (has antimicrobial properties, so used in burn wound care) - Most dressings change daily Agent may change based on colonization of wound

Interventions for cardiac and pulmonary conditions

Early mobilization in mechanically ventilated patients vs. control group Supervised or unsupervised structured exercise program vs. control group Short-term pulmonary rehabilitation compared to brief advice

Phases of burn treatment

Emergent phase - (OT here but limited to ROM bc patient in a lot of pain - goal is medical stability) - First 72 hours Acute phase - Until wounds close Rehabilitation phase - After wounds heal

What may endurance limitations be caused by

Fatigue Pain Cardiopulmonary conditions (i.e. COPD) Deconditioned muscles (muscular conditions: MD, ALS, CP) Age Genetics Sedentary lifestyle Hospitalization

What may ROM limitations be caused by?

Fracture Edema Pain Orthopedic or neurological disease Muscle weakness Muscle spasticity Skin tightness Prolonged immobilization Contraindications (ex: recent surgery)

Takeaways burn lecture

Frequent ROM/stretching - Look for skin blanching Therapy is painful - coordinate with pain medication Compression gloves/sleeves - Edema and scar management - Athletic compression garments work well (underarmour) Positioning and splinting schedules - Use prefabricated splints - Pillows, wedges, etc. for positioning Scar massage - circular or perpendicular to scar - Look for skin blanching (whiteness)

Wound management

Goal to prevent infection - Regular cultures/biopsies to monitor infection - Bacterial, fungal Hydrotherapy - Soap and water - Remove dead skin

How to measure ROM

Goniometers (PROM) Self report Observation Active vs passive (and what indicates i.e. muscle weakness vs spasticity)

Superficial Heating

Heat transmitted through conduction or convection - Conduction: heat exchanged between 2 surfaces in physical contact (hot pack (HP), paraffin) - Convection: heat exchanged through movement of heated particles (fluidotherapy) - seen in heat therapy

Effects of superficial heat

Helps with stiffness - want to increase the elasticity of tissues, also decreases pain by increasing threshold, inc. nerve conduction, vasodilation...

Contraindications/precautions for superficial heat

Impaired sensation/cognition Tumors Cancer Acute inflammation DVT/blood clot On pregnant abdomen Bleeding tissue Infection Advanced cardiac disease Children Acute edema Adverse effect: burn

Target, ingredient, or MoA: Client education provided via written handouts, demonstration, use of teach back method to ensure understanding

Ingredients

Common assessments and interventions for osteoarthritis and rheumatoid arthritis

Initial interview: ask how long patient has been taking DMARD or any biologic drug (RA), prior level of care, home, support system- functional gains may be expected Overall body movement can be assessed using "Gait, Arms, Legs, Spine" (GALS) Musculoskeletal screening exam, 5-10 minutes In RA and OA, it is important to record overall hand appearance Volumetry- measures hand girth ROM with goniometer, grip strength (JAMAR), pinch strength Other: Jebson, Nine-hold peg test Some of these tests are part of the Arthritis Hands Function Test (AHFT)

Orthopedic Conditions

Injuries, diseases, deformities to - Bones - Joints - Related structure of bones/joints - Muscles - Tendons - Ligaments - Nerves

What may strength limitations be caused by?

Injury (musculoskeletal) Stroke Age (age-related physiological) Paralysis Immbolitiy (deconditioning) Atrophy

orthopedic conditions: ________ communication is key

Interprofessional - reach out to Ortho & team when in doubt - Significant risks if we misguide the patient: Surgery failure, medical complications, injury & permanent harm

Indications for superficial heat

Joint stiffness Tissue adhesions Contractures Sub acute arthritis/inflammation Cumulative trauma Muscle spasms Pain- not inflammatory

Phases of rehab: amputation Prepropsthetic

Limb wrapping: - Edema control - Residual limb shaping - Protection - Techniques may differ upper vs. lower, client factors, surgeon preference

Biomechanical frame of ref: why

Limitation in moving freely, having adequate strength, or sustaining motion over time

How do we measure strength? How may limited strength impact someone?

Measure: - MMT - Dynamometer Impacts - Ability to perform ADLs & IADLs - Posture & stability - Sense of self/self-worth - Independence - Participation in society, etc.

How do we measure endurance? How may limited endurance impact someone?

Measure: - Number of repetitions - Measure how long they can sustain the activity - Distance in which they travel during activity Impact - Lack of mobility - Limited social participation

Learning by doing, lengthening tissues, increasing # of sarcomeres, and information processing are all what part of RTSS

Mechanism of Action - addresses HOW/WHY ingredients are expected to work

Evaluation tools for cardiac and pulmonary conditions

Medication transfer screen revised (MTS-R), Berg Balance Scale, Section GG (measures motor function), FIM, Menu task assessment (screens for cognitive abilities), COPM (assesses client outcomes in self care, productivity, & leisure)

role of OT burns: Rehabilitative phase: inpatient

Most wounds are closed Focus on scar management - Scar massage - Compression Contracture prevention Strengthening Maximize function and independence (ADLS/IADLs) Education Coping/self-esteem

NMES indications (for thumb abduction + wrist extension)

Muscle spasm Impaired range of motion Muscle re-education Disuse atrophy Edema reduction Spasticity Denervated muscle

Strength

Muscles provide forces to maintain a posture or position & moving body in space - Create movement & stability through force on bones Allows us to engage in meaningful activities Force = push or pull that produce, arrest or modify movement. Amount of force varies by: - Muscle size - Number of muscle fibers recruited, and - Capacity of the muscle Muscles work simultaneously for stability and mobility

Features of biomechanical frame of ref: used for which problems/conditions

Musculoskeletal problems and orthopedic conditions

Vacuum-assisted closure (VAC)

Negative pressure wound therapy - Evacuates fluid Sealed dressing - Reduced risk of infection Decreased number of dressing changes

Amputation and prosthetic care

Neuropathy: nerve damage Amputee Rehabilitation and Preprosthetic Care

Problem list example:

New diagnosis and lack of knowledge re: RA ​ Moderate to severe fatigue (Rating of 7/10 on Modified Fatigue Scale)​ 6/10 pain during UE activities that req. strength & forceful grip​ Difficulty performing daily occupations necessary to be independent in her current living situation (apartment with partner) and full-time school responsibilities.​ Worries about impact of her RA diagnosis/condition on relationship with partner

Hip common precautions

No hip flexion past 90 No hip rotation No crossing operated leg No adduction operated leg Full weight bearing Partial weight bearing (50% of body weight) Toe-touch weight bearing (only weight on foot) Non-weight bearing

OT's role in amputations and prosthesis

OT should assess client's: Pain and/or sensation of residual limb and phantom limb Neuromusculoskeletal and sensory impairments Occupational performance Fit, use, and care of prosthetic device

Which part of SOAP: Client is 72 y/o male s/p R CVA 2 weeks ago. PMH of hypertension, type II diabetes, and heart disease.

Objective

Interventions for RA and OA

Orthotics: improve joint stability and help realign joints by promoting the open pack position in the acute stage - less edema, inflammation, pain - Splints promote functional hand position Pair with removal, gentle ROM, and use of joints for ADLs Various types depending on target and joint Edema management (biomechanical): Can apply to patients with OA and RA Edema - Tolerated usage of affected joint - Elevation - Kinesio tape/coban Therapeutic activities and exercises (biomechanical) Aerobic exercises - Cycling & running - 1hr 4x/week Resistance training - Reduces systemic inflammation - Contraindicated in acute phase Aquatic aerobic programs - Proven effective for those with OA Home exercise programs - Improved self-esteem & quality of sleep - Decreased pain and depressive symptoms

Indications for cold therapy

Pain Edema Acute arthritic flare Acute bursitis/tendonitis Acute/chronic muscle spasm

Assessments for amputations and prosthetics

Pain assessment, Neuromusculoskeletal and sensory assessments (Functional ROM and MMT & Bilateral and unilateral hand function (Box and Blocks Test & Jebsen-Taylor Test of Hand Function (JTHF)), TAPES Trinity Amputation Prosthetic Evaluation Scale (A self-administered questionnaire that addresses 3 domains related to client's experience of their prosthetic:)

Which part of SOAP: Client will be able to make a sandwich utilizing visual cues to incorporate compensatory strategies without physical assistance within one week

Plan

role of OT burns: Acute care phase

Positioning Edema management Splinting Range of Motion ADLs and mobility as able Cognitive retraining - Anti-deformity positioning - Opposite of flexed fetal position - want to avoid positon of comfort - Spread out legs and arms and avoid chin tuck

Reasons for Bed Positioning:

Promotes stretching/inhibits contracture development Supports comfort Decreases pain Provides sensory input to hemiplegic side Prevents decubitus ulcers

Phases of rehab: amputation Prosthetic training

Psychosocial support Stabilize limb volume Limb care: Desensitization, scar management Strengthening to prep for prosthetic Maximize independence in ADL: Adaptive strategies, AT, change of dominant UE, etc. Train in incorporating prosthetic into occupations Repetition and practice: Build tolerance for prosthetic Develop wear schedule and strategies to prevent injury.

functional considerations for hip precautions

Putting on pants!

3 components of biomechanical FOR

ROM, strength, endurance

Addressing strength through intervention

Remediation: BIOMECHANICAL - Appropriately graded exercise - Graded up activities with weight, resistance, repetition - Home exercise programs - Body weight or functional training - Changing environment - aquatic therapy

Medical management for frostbite

Rewarming Hydrotherapy Dressing changes Surgery often delayed - Wound can take months to declare itself Self-amputation

Ergonomics

Scientific discipline with the understanding of interactions among humans and other elements of the system, and the profession that applies theory, principles, data, and methods to design in order to optimize human well-being and overall system performance

Interventions: using MOHO

Self Advocacy - Important factors to consider ex. personal causation, values and interests, habituation - Occupational Therapy has a role in helping client identify their own self-care strategies such as " testing blood sugar, appointments, diet, exercise, managing medication" (Klinedinst et al., 2022). Education - Occupational Therapy has a role in client and caregiver education - How to incorporate protective and compensation techniques for for peripheral sensory - Promoting healthy food choices - Instruct in the use of nonvisual devices to draw up and measure insulin - Taking care of feed and avoiding foot ulcers

HF/E Who is qualified?

Self help: A few hours of learning and review of popular press articles and self eval checklists Skilled help: A licensed or certified professional (OT, occupational health nurse, physiatrist) with specialized training Expert help: Certified Professional Ergonomist

Interventions for amputations and prosthetics

Self-advocacy Education REAL intervention Amputation and prosthetic care interventions

Cardiac and Pulmonary Interventions (rehabilitation frame of reference)

Self-care retraining - Energy conservation & work simplification strategies - Recommendations to modify tasks (adjusting body mechanics to minimize fatigue and work of breathing) Inpatient cardiac rehabilitation - Prevent muscle loss from bed rest - Monitor and assess ability to function - Instruct patient in appropriate home activities Pulmonary rehabilitation - Aim to restore individual's exercise capacity and improve ADL performance Safe and appropriate early mobility - Significantly improves functional outcomes Provide education - client/caregiver education (i.e. energy conservation strategies and stress management in home and in community) - Medication management - Patient education about individual risk factors (i.e. psychosocial adjustment, stress, and anxiety) - Ongoing dietary/lifestyle education (no smoking, low-fat low-sodium diet, increased physical activity

Assessments for RA and OA

Sequential Occupational Dexterity Assessment (SODA) - detailed hand assessment that measures bimanual dexterity activity in RA Ergonomic Assessment Tool for Arthritis (EATA) - determines risk at work for people with arthritis The Health Assessment Questionnaire (HAQ) and HAQ-DI (disability index) - screens individuals in 8 areas of functioning (eating, hygiene, walking dressing, reach grip, getting up, etc.) Michigan Hand Outcomes Questionnaire - a 37-item tool used to evaluate overall hand function/satisfaction along with hand aesthetics, work, pain levels, and ADLs. Arthritis: The Arthritis Impact Measurement Scale-2 (AIMS2) - a 101-item tool that measures the negative impacts of arthritis arm function, dexterity, work, social activities, IADLs, ADLs, dexterity, pain, mobility, physical activity, and mental health (depression and anxiety)

Medical Management for burns

Skin grafting, which occurs primarily in the acute phase when the patient is medically stable, is required when the dermal bed is sufficiently destroyed to prevent or significantly impair spontaneous regrowth of the epithelial tissue. Skin grafting is generally performed for all full-thickness burns and for large, deep partial-thickness burns. Skin grafting entails both excision of necrotic (dead) tissue and the placement of skin or a skin substitute over the wound bed.

Respiratory management for burns

Smoke inhalation - Common with injury in enclosed space Mechanical ventilation - Some people require tracheostomy

Ultrasound indications

Soft tissue shortening Pain control Tendon and ligament injuries Introduction of medication (phonophoresis) Dermal ulcers Surgical skin incisions Carpal tunnel syndrome Tissue with high collagen content and tissue boundaries

Which part of SOAP: "I could sit." "I was working very hard."

Subjective

SOAP NOTE components (explained)

Subjective: - Client's report of limitations, concerns, and problems Direct quote from client or family member or a paraphrased statement Place in context Should relate to the intervention or occupation; is carefully chosen to make/highlight a point May describe: pain, fatigue, expression of feelings, concerns, attitudes, goals Objective: Medical information and history Age, past medical history (PMHx), general appearance Measurable, observable data from OT evaluation Length, setting, and purpose of session Observations of session activities & performance Professional, concise, specific Note: organize categorically & chronologically Assessment: OT interpretation of evaluation results and impact on performance Professional opinions/judgments based on subjective and objective data 3 P's: Problems, Progress, Potential Appraisal of progress, limitations, & benefit from OT Do NOT introduce anything here that you did not discuss in S or O An Initial Evaluation SOAP would need this in A: - Problem statements - Rehabilitation potential - Expected benefit from OT Follow-up SOAP notes may include: - Tolerance for OT and interventions Plan: Initial Evaluation SOAP - How often OT will see client (frequency & duration & length of session) (**Setting dependent!!) - Purpose of therapy & specific interventions - Short term & long term goals Progress or Contact Note SOAP - Frequency & duration & length of session - If goals have been met - Newly added goals - Purpose of continued therapy

Post-operative occupational therapy care:

Support group referral Self-management training of incision and wound care Continued ADL training in one-handed/legged techniques and adaptive equipment Edema control Pain management

Target, ingredient, or MoA: Improved ability to use joint protection techniques during meal prep

Target

In Biomechanical FOR, the ____ and ____ context must be present

Temporal and environmental

Biologic Dressings

Temporary dressings that promote skin growth - Biosynthetic material - Collagen and silicone - Remain in place for longer time periods - Less pain from daily dressing change - Biobrane (used for partial thickness burns) - Integra (used for deeper burns)

Addressing ROM through intervention Remediation: BIOMECHANICAL

Thermal modalities (warm) Stretching Massage Strengthening/exercises Splinting Activity grading (increasing/decreasing repetition)

Goal of fracture treatment

To achieve precise and effective stabilization for optimal recovery and resolution of function

Role of OT in addressing orthopedic conditions

To assist clients in regaining their musculoskeletal function in order to return to performing their meaningful occupations

Causes of orthopedic conditions

Traumatic events Cumulative trauma Congenital differences

T or F: Timing, amount, and type of therapy depends on: (a) location and type of fracture, (b) method of reduction, and (c) maybe age of patient.

True!

Features of biomechanical frame of ref: what

Uses biomechanics & kinematics & physics to understand a client's occupational performance limitation Ex: limitation in client's ROM

Phases of rehab: amputation Perioperative

Wounds healing: Edema control, scar management Pain control: Phantom pain, wound pain Psychosocial support Strengthening, limb care Strategy training: AT, adaptive strategies for transfers & tasks Ends when all wounds healed

Shoulder - Challenging recovery Therapy goals:

a) relieve pain b) restore movement and muscle strength c) allow callus formation and approximation of bony fragments and d) return to maximal functioning Immobilization results in stiffness + pain -> optimized mobility Rotator cuff pathologies - if internal rotation difficult - functional activities affected include reaching into pockets, buckling seat belt, pulling up pants, bra strapping, toilet hygiene etc.

Fracture healing phases

inflammation, repair, remodeling

Apply biomechanical frame of reference for evaluation of

persons who have limitations in occupational performance because of physical impairments for evaluation & treatment purposes

upper extremity fractures: Orthopedic surgeons debate "____" or "______"

rest or movement

Bed mobility is

the ability to bridge in bed, roll from supine to side-lying, scoot up and down in bed, move from supine to sitting and sitting to supine, and sit at the edge of the bed. Teaching bed mobility skills to clients with weakness promotes ADL participation.

Cryotherapy

therapeutic use of cold - Application of any substance that lowers tissue temp by conduction; First vasoconstriction (15-20min) followed by vasodilation

Ergonomics and human factors (HF/E) are often used interchangeably or as a ____

unit