731 Exam 1
residual limb hygiene [amputation OT interventions]
-ensure skin integrity -remove bandage 2/3x day -clean bandage every 2 days -clean w/ lukewarm water and mild soap 1-2x/day
primary progressive MS
-non-ambulatory and incontinent of urine -dysphagia, dysarthria -severely compromised LE -varying UE limitations
causes of LBP
-obesity -poor fitness -reduced muscle strength and endurance -poor body mechanics
cognitive changes in ALS
-occurs in 50% of population -20% dementia -frontal love dysfunction -executive function impairment -perseveration
what are risk factors for developing cognitive problems for ALS
-older age -bulbar onset -reduction in functional vital capacity -fam history of dementia
DeQuervain's Tenosynovitis
-pain over radial/dorsal aspect of wrist -APL and EPB share tendon sheath
multifocal TBI
-several areas in brain that are injured -know which area is affected
forms of ALS
-sporadic vs familial -sporadic 90%-95% -familial 5%-10%
lateral epicondylitis
-tennis elbow -pain at lateral epicondyle caused by problems with extensor tendon
fracture healing terms
-unstable -stable -clinically healed -healed
advanced stages of MS
-varying degrees of paralysis -total LE paralysis -impaired cognition -neurogenic bladder -severe visual impairment
conus medullaris syndrome
Areflexic bladder, bowel, and LEs
treatment of frost bite
-Remove source of cold and slowly warm the skin -Soak affected area in warm water (104F) for 20 minutes -Apply warm compresses or blankets -Pain relief = OTC pain meds (+) aloe vera [only if skin is intact]
neurogenic bladder & bowel above T12
-SPASTIC -no control AT ALL
precautions for therapy for amputees
-Unstable medical status [complications w/ meds OR serious injury] -Psychological concerns [depression/suicide] -Reconstructive surgical procedures [recent tendon transfer/orthostatic hypotension] -Physician orders
Tendinosis
-degenerative pathological change in tendon becomes micro fragmented [NO INFLAMMATION]
stage 6 of ALS
-dep w/ bed mobility and w/c mobility -dep in ADL -extreme fatigue
Amytrophic Lateral Sclerosis (ALS)
-destruction of motor neurons w/in SC, brainstem, and motor cortex -aka Lou Gehrig's disease -UMN & LMN deficits
middle stage symptoms of HD
-disturbances in memory and decision-making -disturbances in gait begins middle stage -balance frequently compromised -bradykinesia -akinesia -dysarthria -dysphagie -saccadic eye movements & ocular pursuits are slowed
what is the Golden Window
-early fitting for prosthetics -around 30 day window
acute surgical interventions of burns
-escharotomy -fasciotomy
industrial rehab
-functional capacity evaluation -job demand analysis -pre-employment screening -on-site rehab -modified employment -education -worksite eval
advanced prosthetic training
-functional training -driver training
Dupuytren contracture
-gradual thickening of palmar fascia -inward curling of 4th and 5th
stage 4 of ALS
-hanging arm syndrome -w/c dependent -severe LE weakness -some ADLs -fatigue quick
frost bite
-ice burn condition -skin and tissue just below skin freezes -initial whiteness then dark hemorrhagic blisters
positioning burn patients
-immediately after injury -until scars from last op have matured -T-Pose, wrist extended 15-40 degrees, MCP 70-90 flexion, digits full extension
surgical treatment of TBI
-indicated for focal injury -craniotomy vs craniectomy vs EVD VS vp
LBP surgical risks
-infection -excessive bleeding -allergic reaction -nerve or SC damage -failure to relieve pain
cauda equina syndrome
-injuries involve peripheral nerves [NOT SC] -presents as flaccid paralysis
Brown-Sequard Syndrome
-ipsilateral -weakness of paralysis -loss of sensation on opposite side
externally powered prosthetics
-operated when electrodes pickup muscle impulses from residual limb
phantom limb pain OT intervention
-pain medication -acupuncture -TENS -isometric exercises of both limbs -visualization exercises -progressive relax techniques -mirror therapy -VR -controlled breathing
ASIA SCI level b
-sensory INTACT -no motor function
total body surface area
-size of burn -Rule of Nines
median nerve (Carpal Tunnel Syndrome)
-thenar muscle wasting in severe and untreated cases -Tinel's test, Phalen's test, Tendon glides, Median nerve glides
artificial disc replacement
-treatment for pinched nerve -removal of damaged disk
what indicates more positive prognosis in ALS
-younger age at onset -LMNs involving SC -deficits in either LMN or UMN (NOT BOTH) -absent or slow respiratory functions -longer time from onset of symptoms to diagnosis
inflammation [secondary healing]
0-6 weeks -Immediate formation of hematoma around fx site -Hematoma replaced by cartilaginous tissue called soft callus -Callus weakly connects and stabilize fx ends -Fragile union
UE amputation prevalence
18-30 y.o trauma = leading cause
repair [secondary healing]
2-12 weeks -soft callus converted to hard callus (ossification) -strengthens fx site
LE amputation
65+ diabetes = leading cause
remodeling [secondary healing]
9-12 weeks and beyond -Bone continues to be deposited along callus line -Wolf's Law → progressive WB and strength training to encourage bone deposits -Callus becomes more bony -Pt can participate in aggressive mobilization and strengthening
dystonia
abnormal muscle tone
indications for therapy as an amputee
any pt w/ an amputation that is medically stable (+) able to participate in ADLs and exercise programs
Glasgow Coma Scale (GCS)
assess consciousness of a patient upon physical examination
fitness for duty testing
assess person ability to meet certain physical requirements [POET, POS, PET, EFT]
stage 4 of nerve injuries
axon (+) endoneurium (+) perineurium disruption
stage 3 of nerve injuries
axon (+) endoneurium disruption
stage 2 of nerve injuries
axon disruption
secondary progressive MS
begins w/ RR pattern then evolves to progressive form
what is most common LE contracture
below knee amputation
secondary damage
brain reacts to injury w/ swelling, edema, neurochemical cascades, change in blood flow
best SCI prognosis
brown-sequard syndrome
chorea
characterized by irregular, purposeless, quick movements, randomly flow from one muscle to another
severity of burn depends on
duration of exposure (+) intensity of exposure (+) total body surface area
telescoping - phantom limb sensation
feel hand at end of residual limb NOT OG PLACE
stage 1 of nerve injuries
focal conduction block (+) no wallerian degeneration
dyskinesia
involuntary, erratic, writhing movements of face, arms, legs or trunks
congenital amputation
limb NOT formed correctly OR is missing at birth
phases of ALS
phase 1 - independent phase 2 - partially independent phase 3 - dependent
craniectomy
portion of skull is removed and placed aside
chronic traumatic encephalopathy
progressive degenerative disease thru repetitive traumatic injury
Skier's Thumb (Gamekeeper's Thumb)
rupture of ulnar collateral ligament of thumb MCP joint
stage 5 of nerve injuries
axon (+) endoneurium (+) perineurium (+) epineurium disruption
conservative treatment of TBI
based on severity (+) location (+) outcome-based evidence
vegetative state
wakefulness w/o awareness
severe neurotmesis
-complete separation of entire nerve -caused by laceration, crush, or traction -ALWAYS surgical repair
mechanism of nerve injuries (CEBAT)
-compression/entrapment -burns -avulsion/laceration -traction
progressive bulbar palsy (ALS)
-corticobulbar tracts and brainstem motor -dysphagia -slurred speech
primary lateral sclerosis (ALS)
-corticol MN destruction -involves UMN not LMN
escharotomy
-cutting thru thick scar to release eschar and its constrictive effects (promote movement) -Eschar acts like a tourniquet -Edema forming in middle layer pushes outward [eschar restricts further motion] -Comprises vascular flow
limb shaping [amputation OT interventions]
-decrease edema -promote optimal limb shaping for prosthesis -use figure 8 for wrapping
electrical mechanism
-electricity comes in contact w/ body -can cause dmg to organs
prosthetic training
-evaluation -donning/doffing -wear schedule -prosthetic knowledge -residual limb hygiene -care of prosthesis
work hardening
-formal, multidisciplinary programs for rehabilitating the injured worker -designed to maximize ability to return to employment
scar desensitization [amputation OT interventions]
-massage to discourage scar adhesion -increase circulation -aid in desensitization -reduce swelling -tapping, vibration, constant pressure, and rubbing of various textures
stage 1 of ALS
-mild weakness -clumsiness -ambulatory -ind ADLs
stage 2 of ALS
-mod, selective weakness -slight decrease ind ADLs
LBP statistics
-most common of pain in US -90% pain resolved w/in 6 weeks
Multiple Sclerosis (MS)
-most common progressive, inflammatory neurologic disease in YA -destruction of myelin sheath -sensory distortion, incoordination, visual loss, or weakness
ASIA SCI level d
-motor function PERSEVERED -MMT key muscle groups greater or equal to 3/5
ASIA SCI level c
-motor function PRESERVED -MMT key muscle groups 3/5
neuroanatomy
-nerve -epineurium -facile -perineurium -endoneurium -axon -wallerian degeneration
pain management [amputation OT interventions]
-neuroma -scar desensitization -phantom limb sensation -phantom limb pain
plateau GBS
-no further deterioration BUT no evidence of physical recovery (few weeks) -not a lot for OT to do bc laying down
complete SCI
-no voluntary motor control or sensory function preserved at S4-S5 -total paralysis (+) loss of sensation -Zone of partial preservation
clinical subtypes of ALS
-progressive bulbar palsy -progressive spinal muscular atrophy -primary lateral sclerosis
ADL retraining for amputations [amputation OT interventions]
-provide control over environment and sense of independence -first: feeding, toileting, and oral hygiene -second: dressing, bathing, and meal prep continue to second ADLs/IADLs after medical stability and wound healing
role of OT during recovery phase of GBS
-regain physical movement -increase activity [muscle imbalance, muscle belly tenderness] -energy conservation/work simplification -avoidance of overstretching/overuse of muscles
relapsing and remitting MS
-relapses that occur with either full or partial recovery -the periods of relapses are characterized by a lack of disease progression
surgical management of amputation
-remove nonfunctional limb -maintain limb length
phase 2 of tendinopathies
-restorative phase -Minimal or no pain at rest or with ROM/daily activities -Emphasis on improving flexibility, strength, and endurance -Goal is eccentric exercise
anterior SC syndrome
-results in motor paralysis below level of lesion and -involves paralysis, loss of pain, temperature, and touch sensation
L2-S5 injury
-return to active lifestyle -IND in ADLs/IADLs
cognitive deficits most associated to HD
-sequential tasks -memory deficits -mental calculations
necrotizing fasciitis
-serious bacterial infection affecting tissue beneath the skin, surrounding muscles, and organs -flesh eating disease
diffuse axonal injuries TBI
-several areas -do not know which area
stage 5 of ALS
-severe LE weakness -mod-sev UE weakness -w/c dependent -inc dep in ADLs -skin breakdown risk
stage 3 of ALS
-severe, selective weakness in ankles, wrists, and hands -mod decreased ind ADL -easily fatigued -slight decreased respiratory effort
residual limb neuroma
-small ball of nerve tissue that develops when growing axons to attempt to reach distal end of residual limb -occurs when nerves try to reattach after being cut -nerves thicken at end of residual limb
incomplete SCI
-some voluntary motor control of sensation below lvl of lesion -Sacral sparing = neural pathway btwn brain and body below lvl of injury still EXISTS
phase 1 of ALS
-stage I -stage II -stage III
intermediate prosthetic training
-starts w/ gross then fine motor movements -controls training achieve smooth movements w/ minimal delay
types of burns
-superficial (1st degree) -superficial partial-thickness (2nd degree) -deep partial-thickness (2nd degree) -full thickness (3rd degree) -subdermal (4th degree)
fasciotomy
-surgery to cut out fascia (relieve tension/pressure) -Incision is used to restore circulation -Limb-saving procedures when treating acute compartment syndrome
types/mechanism of burn injury
-thermal -chemical -electrical
paraplegia
-thoracic, lumbar, or sacral injury -LE paralysis
laminectomy
-treatment for SC compression -bony area of back of vertebra is removed allowing more room for SC and nerves
laminoplasty
-treatment for SC compression -door-like hinge created to open up lamina and reduce presure
disectomy
-treatment for SC compression -used to remove herniated disc pressing on nerve root or SC
vertebroplasty & kyphoplasty
-treatment for compression caused by OA -injection of glue-like bone cement that hardens and strengthens bone
spinal fusion
-treatment for vertebral fx, pinched nerve, and compressed SC -joins two vertebrae into single piece for increased stability
C7 - T1 injury
-triceps!!! -trunk and finger weakness -work on transfers -mod I or IND w/ ADL
T2-T12 injury
-trunk control improvements -limited upper trunk -IND in all ADLs
C1-C3 injury
-ventilator dependent -total A -limited neck movement
common LB surgeries
-vertebroplasty & kyphoplasty -laminectomy & laminoplasty -disectomy -spinal fusion -artificial disc replacement
T10-L1 injury
-weakness in legs -get em out into the community!!
vocational guidelines [return to work]
-whether a person can return to work OR should explore -general vs specific
Tendinitis/Tenosynovitis
acute inflammatory response to to injury
neurapraxia
acute short-term compression; complete recovery [days/months]
thermal mechanism
caused by flame, steam, hot liquids, hot surfaces, and radiation
phantom limb pain
changes in somatosensory area undergoes reorganization in mixed signals and confuses the brain into thinking limb is still there
recovery GBS
client begins to recover physical abilities (6mo-2yrs)
focal TBI
direct blow to head w/ external object
unilateral amputation ADL retrainings
encourage use of residual limb and unaffected limb
ataxia
errors in ROM and force of movement; delayed initiaton of movement responses
when will most improvements be achieved for SCI
first year
primary healing
fx ends aligned and compressed w/ special internal plates and screws
secondary healing
fx ends are aligned (+) bone healing occur thru three steps of healing
clinically healed [fx healing]
healing fx NO LONGER tender to pressure and can withstand gentle PROM w/o movement at fx site
stable [fx healing]
healing fx can withstand forces AROM w/o movement at fracture site
unstable [fx healing]
healing fx cannot withstand forces of AROM w/o movement at the fx site
coup-contrecoup brain injury
hit one place, brain moves and gets more damage somewhere else
phases of GBS
initial/acute, plateau, recovery
post-concussion syndrome
lingering symptoms of a mild TBI
contraindications for amputations
lvl of amputation (+) condition of residual and contralateral limb (+) stage of adjustment
functional capacity evaluation (FCE)
objective assessment of an individual's ability to perform work-related activity
work-site evaluations
on-the-job assessments to determine if person can return to work OR can benefit from reasonable accommodations to maintain employment
Digital stenosing tenosynovitis (trigger finger)
pain and inability to flex or extend finger
medial epicondylitis
pain at medial epicondyle of humerus caused by problems w/ flexor tendon
surgical indications for median nerve injury
persistent pain/numbness/tingling (+) muscle atrophy (+) dropping objects
skin function
protection (+) thermoregulation (+) metabolism (+) neurosensory (+) body image
healed [fx healing]
radiographic evidence of sufficient bone healing for fx site to withstand more aggressive PROM
symptoms of autonomic dysreflexia
rapid BP rise (+) sweating (+) severe headache (+) flushing
acquired amputation
result of cancer, trauma, or severe infections
tremors
rhythmic, alternating, oscillatory movements
ASIA SCI level e
sensory and motor function are normal
craniotomy
small piece of skull is removed then put back
types of autograft
split vs full -split = epidermis (+) portion of dermis -full = epidermis (+) entire dermis
initial/acute GBS
start of symptoms until no further decline [4 wks]
progressive relapsing MS
steady worsening of symptoms
acquired brain injury
stroke, tumor, meningitis, infections, myocardial infarction
chemical mechanism
tissue damage caused by strong acids, drain cleaners, paint thinner, gasoline
T/F normal bone healing process skips callus formation at fx and immature bone is immediately deposited
true
t/f brain is organ least able to tolerate loss of blood flow and oxygen
true
t/f early bulbar involvement in ALS indicates poorer prognosis
true
Huntington's disease (HD)
a genetic disease involving both involuntary and voluntary movement with significant cognitive deterioration
what are the steps of secondary healing
(1) inflammation (2) repair (3) remodel
patterns seen in MS
(1) relapsing and remitting (2) secondary progressive (3) primary progressive (4) progressive relapsing
what is typical wear schedule for prosthesis
-15-30min 3x/day -increase by 30min increments full day
when do you admit to a burn unit
-2nd or 3rd degree burn -total body surface area equals or exceeds 10% -speciality areas (genitalia, feet) -smoke inhalaation -electrical and/or chemical
MS cognitive deficits
-30% - 70% of MS BUT do not necessarily correlate w/ physical decline -documented in early stages
ROM, strength, and endurance [amputation OT interventions]
-AROM -isometric/isotonic exercises -endurance [pillow squeezes]
factors influencing rate and quality of hand condition repair
-Blood supply to bone -Specific bone involved -Type of location of fx -Age and general health -Total volume of damaged bone -Width of defect
Tetraplegia (quadriplegia)
-CERVICAL injury -paralysis of all 4 limbs and trunk
assessments for BPI
-COPM -BPI -pain self-efficacy questionnaire -BPI-II -ADL checklist -pain scales
how to test for lateral epicondylitis
-Cozen test -pronate forearm -pt make first -pain with extension and radial deviation
pathophysiology of HD
-DETERIORATION of caudate nucleus and corpus striatum -progressive loss of tissue in frontal cortex, thalamus, and globus pallidus -substance P and acetycholine deficiencies
neurogenic bladder & bowel below T12-L1
-FLACCID -reduced control -lose ability to detect when bladder is full
deterioration of corpus striatum in HD results in
-chorea (rapid, involuntary, irregular movements) -decrease in GABA
later stage symptoms of HD
-choreiform movements are reduced -hypertonicity & rigidity replaces chorea -severe reduction in voluntary movements -severe difficulty in eye movement -unable to walk, talk, perform BADLs
ulnar nerve injuries (Cubital tunnel syndrome & Guyon canal syndrome)
-claw hand deformity, paralysis of lumbricals and interossei -pain and numbness along medial aspect of elbow -tingling and numbness in ring and small fingers -Froment sign -Waternber's sign -Tinel's sign -Ulnar nerve glides
minimally conscious state
-clear behavior of following commands, gestural or verbal responses, intelligible verbalizations, and purposeful movements or responses
hybrid prosthetics
-combo of body and externally powered -high levels of limb loss who require more than one moveable component
C6 injury
-NO ELBOW CONTRACTURES -tenodesis time
phantom limb sensation
-PAINLESS bc neural pathway is still intact
goal setting and intervention for MS
-Problem solving compensatory strategies -Fatigue management group treatment intervention -Role delegation -AE
role of OT during acute/plateau phase of GBS
-ROM, positioning, splinting -passive activities/non strenuous social visits encouraged -mod for muscle belly tenderness
full thickness (3rd degree)
-Involves ⇒ epidermis (+) dermis; hair follicles, sweat glands, nerve endings are affected -Heal time ⇒ months -Appearance ⇒ waxy, white, leathery appearance, non-elastic -Healing process ⇒ hypertrophic scarring (keloid), REQUIRES skin grafts
ASIA SCI level a
NOTHING INTACT
How to test for De Quervain's
-Finkelstein' test -tuck in thumb -stretch tendons of first dorsal compartment
C4 injury
-INHALATION!!! but low endurance -weakness in trunk & LE -limited neck movement
subdermal (4th degree)
-Involves ⇒ epidermis (+) dermins extending into subcutaneous fat, muscles, tendons, and bones -Heal time ⇒ -Appearance ⇒ -Healing process ⇒ excision, grafting, and possibly amputation SIGNIFICANT scarring and functional limitations and deformities
superficial partial thickness (2nd degree)
-Involves ⇒ epidermis (+) dermis -Heal time ⇒ 7-21 days -Appearance ⇒ red (+) blistering (+) wet -Healing process ⇒ painful (+) no scarring (+) no surgery (+) no grafting necessary
deep partial-thickness (2nd degree)
-Involves ⇒ epidermis (+) dermis extends deeper into skin and kills more cells [NO BLISTERS BC TISSUE DEAD] -Heal time ⇒ 21-35 days -Appearance ⇒ red, dry, white areas due to dmg BV (+) moderate edema -Healing process ⇒ 21-35 days -Healing process ⇒ scarring and contractures are probable
superficial (1st degree)
-Involves ⇒ only superficial epidermis -Heal time ⇒ 3-7 days -Healing process ⇒ minimal pain and edema (+) no blisters (+) no scarring occurs
autonomic dysreflexia
-Keep upright -do NOT lay them flat [want more BP to go to lower part of body, NOT up] -Loosen clothing, remove abdominal binders or stockings → decreases BP
Progressive spinal muscular atrophy (ALS)
-LMN in SC -progressive muscle weakness
positive ALS diagnosis
-MN involving bulbar, cervical, thoracic, lumbosacral -intact bowel and bladder -absence of sensory changes -normal spinal x-ray
coma
-absence of awareness of self and environment despite max external stimuli -no periods of wakefulness occur
phase 1 of tendinopathies
-acute phase -Pain at rest that worsens with ROM/daily activities -Emphasis on reducing pain/inflammation and promote healing -Splinting and light compression garments -Gentle AROM in pain-free to prevent stiffness
types of skin grafts
-allograft [same species] -autograft [from individual] -xenograft [diff species] -synthetic skin
initial symptoms of HD
-alterations in behavior, changes in cognitive function -forgetful, difficulty concentrating -increased irritability or depression
symptoms of GBS
-ascending weakness of bilateral extremities [feet to trunk] -sensory change in legs [noticed in legs first] -weakness -inability to feel textures, heat, pain, other sensations
role of OT in burn patients
-avoid sun exposure to scar -keep scar clean and moisturized -scar massage -early mobilization -splint/positioning -removal of devitalized tissue/infection control
principles of nerve recovery
-axons regenerate 1mm/day 1 inch/month -proximal injuries require longer recovery interval -maximum length a nerve can grow to restore function
Guillain Barre Syndrome (GBS)
-body attacks peripheral nerves -destroys myelin sheath
types of prosthetics
-body powered -externally powered -hybrid -passive/cosmetic -activity specific
body powered prosthetics
-cable driven -controlled by gross body movements
C5 injury
-can supination, flexion, extension -NO wrist or finger movements -independent respiration but low endurance -WANT INCREASED TONE IN FINGER CONTRACTURES -prevent elbow contractures
radial nerve injury (Saturday Night Palsy)
-caused by direct pressure to nerve as a result of humeral fracture, elbow dislocation, or prolonged compression -let pt fail so do NOT completely immobilize
axonotmesis
-caused by mild traction or mod compression -dmg to axon distal to lesion -motor and sensory problems -complete recovery in several months
mild neurotmesis
-caused by mod-severe traction or crush -destruction axon -nerve may regenerate -more proximal = poorer prognosis
moderate neurotmesis
-caused by severe traction or crush -destruction of nearly all nerve structures -scarring impossible for nerve to move thru scar tissue -requires surgical debridement