Phys Dis Mid-Term Review

Remodeling & Maturation

Collagen fiber mature/ more organized 28 days -> months to years

Dry ARMD (Age Related Macular Degeneration)

Lack of O2 causing atrophy of the macula. Causes yellow spots formation in the macula. Dry ARMD can end up developing wet ARMD Lose their central vision but keep their peripheral vision Affects navigation in the environment and anticipation of surrounding objects; minimal difficulty with mobility because peripheral vision is not affected​ Difficulty with reading, seeing controls of the appliances, looking at photographs, people's faces, reading, driving, fine work​

Neurotmesis

Lacerated or transected nerves

Isometric contraction

Muscle contracts but there is no movement, muscle stays the same length

Eccentric contraction

Muscle lengthens

LUMBAR SPINAL PRECAUTIONS (12 WEEKS)

NO BLT​ Bending: Staying straight: this includes log rolling out of bed. Donning back braces prior to sitting at edge of bed​ Lifting: 5-10lbs max...a gallon of milk is roughly 8lbs...that's it folks..​ Twisting: turning...nothing where your trunk moves and your feet are planted​ ​ TLSO: Thoracic Lumbar Sacral Orthosis​ Donjoy LSO: lumbar sacral orthosis

DELORME'S METHOD OF PROGRESSIVE RESISTIVE EXERCISE (PRE)​

Perform an exercise with 3 sets of 10 reps:​ First 10 reps: 50% max resistance​ Second 10 reps: 75% max resistance​ Third 10 reps: 100% max resistance

High-profile outriggers

Are attached to the orthosis; designed to come up and away from the splint to ensure the proper angle of pull during mobilization. ​

Active Assistive ROM

Used to help the client improve ROM while the client is gaining strength​ Best used when combined with a functional task i.e. self-feeding, grooming hair, brushing teeth, or reaching for an object

Dynamic Orthotic

Used to improve motion, provide controlled motion, or compensate for loss of motion​ The principles of biomechanics, rotation, torque, and parallel forces should be considered during fitting Outriggers ensure that mobilization forces are 90 degrees to the long axis of the joint. ​

Fovea

the central focal point in the retina, around which the eye's cones cluster

Toilet Training

1. Sit to stand from surface​ 2. Turn/Pivot to/from toilet/BSC​ 3. Stand to sit from turn

97110 Therapeutic Exercise

15 min to develop strength, endurance, ROM, flexibility

AROM

A client may have full AROM in gravity-eliminated yet be unable to lift their arm fully against gravity to reach for objects when seated or standing. ​ - This is a muscle strength issue, not a ROM motion issue.​ AROM deficits often occur after a fracture or soft tissue injury. ​ - When a cast or orthotic is removed, the muscles and joint are tighter, which restrict motion.

Iris

A ring of muscle tissue that forms the colored portion of the eye around the pupil and controls the size of the pupil opening

97535 Self care & home management training

ADLs and compensatory training, meal prep, safety procedures and instruction use of assistive technology devices/adaptive equipment (15+ min)

Lateral Rectus

Abducts eyeball

Apnea

Absence of breathing

Sensory reeducation

Active training strategies used in the presence of peripheral nerve injury or after a brain injury to enhance sensory awareness or compensate for lack of sensation distinct categories include protective sensory reeducation discriminate every sensory reeducation Instructing in protecting the skin and preventing injuries. Ex. Avoid extreme temp., sharp objects - use vision to compensate for lack of sensation

Movements

Active: Client does it​ Active assistive: Both do motion​ Passive: OTA does the it​ Self: Passive done by client​ Functional: Deficit but does not affect

Ophthalmologist

Addresses eye care, diagnoses conditions and medical management

PT

Addresses mobility in the environment

Medial Rectus

Adducts eyeball

Factors Affecting BP

Age - blood pressure increases as a person grows older.​ Gender - women usually have lower blood pressure than men​ Blood volume - severe bleeding lowers the blood pressure​ Stress - heart rate and blood pressure increase as part of the body's response to stress​ Pain - increases blood pressure​ Exercise - increases heart rate and blood pressure during/immediately after​ Weight - blood pressure is higher in overweight persons​ Race - black persons generally have higher blood pressure than white persons do​ Diet - a high-sodium diet increases the fluid volume in the body which increases blood pressure​ Medications - can be taken to raise or lower blood pressure​ Position - blood pressure is lower when lying down

Phantom pain

Amputation Precautions Feeling of pain in the limb/area that has been amputated. You can treated with mirror therapy and e-stem

DVT (deep vein thrombosis)

Amputation Precautions aka blood clot. Hot/Warm, Pain, red area- DO NOT MOVE THEM. If moved, blood clot/DVT can travel through vein into heart, lungs, brain

Dressing/ Wound

Amputations Precautions Maintaining a dry and clean dressing: watch for bleeding/oozing. Red= What we want Yellow= Infected Black= Dead tissue

Hyperventilation

An abnormally rapid rate of deep respiration that is usually associated with anxiety

Provocative testing

Anatomical positioning to rule out/indicate a diagnosis depending on if pain is present

Current Procedural Terminology (CPT) codes

Are used to bill for "orthotic fabrication and fitting"

L Codes

Are used to bill for a custom molded orthosis​ The HCPCS "L" codes are inclusive of a practitioner's assessment time, fabrication time, materials, teaching of donning and doffing, and providing instruction in orthosis use​ Using a specific "L" code distinguishes between a static orthosis and a dynamic or static progressive orthosis and categorizes an orthosis by the joint it crosses or supports​ A static orthosis is considered "not having joints," and a dynamic or static progressive is referred to as having "nontorsion joints, elastic bands, or turnbuckles."

Visual field

Area of the world that an individual can see at any time

Optic Chiasm

Area where 2 optic nerves meet/cross behind the eyes

Lateral training

Asking client to identify pictures of hands as either left or right. Client is assessed for time and accuracy. Client continues lateral training until they are able to identify the images correctly.

Optometrist

Assess general eye health, prescribes corrective lenses and medications. If trained, can do vision therapy and rehabilitation

Neuro-Ophthalmologist

Assess vision deficits related to neurological condition

Low-profile outriggers

Attached to the orthosis; smaller and are designed to be more streamlined.​ Although low-profile outriggers are more aesthetically pleasing, they will require more frequent adjustment because they may not be able to maintain the proper angle of pull once changes in ROM are made.

Goniometer

Axis/fulcrum, moveable & stable arm: ​ The center point of the body has numbers and serves as the axis for measuring a joint's range of motion. ​ Stationary arm is aligned with the plane of motion proximal to the joint being measured.​ Moveable arm is also aligned with the plane of motion but follows the arc of movement.

Anopsia

Blindness

Hemostasis

Body's immediate response to injury -6hrs

Precautions for ROM

Carcinoma of the bone, osteoporosis, subluxation, hypermobility of joint, newly united fracture, hemophilia, hematoma, new soft tissue injury, bony ankylosis (Fusion of two bones between a joint), or joint inflammation or infection.

CN 2 Optic Nerve

Carries visual info from retina to occipital lobe If Damaged: No vision

Glaucoma

Caused by increased pressure within the eye leading to inability to drain fluid and the buildup causes permanent damage to optic nerve​ Peripheral vision loss that can lead to tunnel vision complete vision loss if not treated​ They have good central vision and acuity​ Treatment:​ Regular eye exams​ Eye drops​ Oral medication

Limitation

Causes of joint ______________ Burn Injuries - Often develop adhesions and scar formations ​ Trauma/Surgeries - Hardware/precautions can limit ROM​ Diseases - Such as rheumatoid arthritis​ Muscle Weakness and Pain - CVA, SCI, TBI ​

Documentation basics

Clients full name and case (facility ID, MRN) number on each page of documentation (addressograph if paper; placed on documentation automatically if EHR)​ Date and Type of OT contact (Treatment, eval, screening)​ OT Practitioner signature, with a minimum of first name or initial, last name and professional designation. (In print too, if Electronic Health Records it will be e-signed, your login counts as verification) Signature of the recorder at end of document without space​ Co-sign by OTR when required (if COTA or OTA/S) ​ Compliance with confidentiality standards - HIPAA​ Facility approved terminology and abbreviations​ Errors corrected by line drawn through, initial and dated- NO WHITE OUT Adherence to professional standards of technology when documenting - ethical​ Disposal of records within law or agency requirements (Shredder box, medical records) NOT TRASH ​ Compliance with agency or legal requirements for storage of records (must be supervised or locked area for paper charts)

Isokinetic strength

Changing resistance but constant velocity

Casting

Commonly used for positioning and protection after fractures​ Can be beneficial for a variety of other conditions as well. ​ ____________ a joint on stretch, promotes tissue growth and elongation and has been shown to inhibit spasticity​ Has been used by OT practitioners in both the neurorehabilitation and orthopedic settings to improve PROM (serial casting- application and removal of a series of casts)​ Applying it to a stiff joint or tight soft tissue structure assists with stretching these structures over a period of time. ​ The ultimate goal of using casting to gain motion is improvement in the client's function. The OT practitioner should check skin and circulation regularly because the client with the neurological condition may not be able to alert the OT practitioner about problems

Integument

Consists of skin, hair, and nails​ May be indicators of underlying disease/illness​ Examination to include palpation, visual inspection for scars, unusual hair growth, wounds, etc.

Scotoma

Dark spot in the visual field

Hypoventilation

Decreased rate or depth of air movement into the lungs

MMT Procedure

Demonstrate BIL AROM of movement​ Check for compensation, differences between L/R extremity​ Complete PROM​ Make note of differences between AROM/PROM of extremity​ If full AROM is observed:​ Perform break test with correct hand placement to stabilize, palpate & apply resistance. Do NOT cross another joint.​ Assign MMT grade 3/5 to 5/5​ If partial AROM is observed:​ Assign MMT grade 2+/5 or 3-/5 ​ If no movement is observed:​ Reposition in gravity eliminated plane & ask client to repeat BIL AROM​ If full or partial movement is observed: Assign grade 2/5 or 2-/5​ If no movement is observed: Palpate for contraction and assign grade 0/5 - 1/5

Form discrimination

Discriminating the important features of different objects such as shapes, colors, and letters

Figure ground

Distinguishing the object from the background

Levator Palpebrae

Elevates eyelid

Diplopia

Eyes don't focus on same spot (double vision)

Lens

Focuses light onto retina

Proximal Humeral Fracture

Fractures: Classified by open/closed, location on bone, displacement & pattern.​ (No weight bearing) Mechanism of injury: This injury accounts for 5% of all fractures in older patients. The most common mechanism for these fractures is a fall on the outstretched hand (FOOSH!) from a standing height. In younger patients, high-energy trauma is typically the cause of injury.​ Medical/Surgical intervention: The treatment objective in proximal humerus fractures is to allow bone and soft tissue healing in a normal anatomical position to maximize function of the upper extremity. If nondisplaced, no surgical intervention is required and the arm will be slinged/braced and allowed to heal with limited to no movement allowed. In a displaced fracture, the bones may need to be reattached with plates and screws and then braced. ​ Common orthotics/braces used: Humeral fracture brace, traditional sling

UB Dressing

If Bra Wearing: Threading L arm into bra, Threading R arm into bra, hooking bra​ Overhead Shirt: Thread R arm, Thread L arm, over head, bring down over torso/trunk​ Button Down: Thread R arm, Thread L arm, bring around back, fasten closures

FACTORS AFFECTING VITAL SIGNS

Illness​ Emotions - anger, fear, anxiety, pain​ Exercise and activity​ Age - maximum heart rate decreases as we get older​ Sex - m/f​ Environment/ weather; temperature ​ Food & fluid intake- blood pressure, heart rate, etc.​ Medications - BP medicine​ Time of day - ↓ in the morning, ​ ↑ in the afternoon/evening ​ Noise - increases vitals

Certified Low Vision Therapist (CLVT)

Improves the client's function with daily skills, using the remaining vision and adaptive devices. An OT can become a CLVT

Desensitization

Include exposure to stimulation in order to normalize sensory input and to decrease pain Ex: Use of textures, immersion particles, and vibration

TRAUMATIC HAND INJURIES/CRPS​

Includes crush, amputations, fractures, & injuries that include multiple systems and tissues​ OT intervention will vary based on the location and the mechanism of the injury, whether or not the client has had surgical repair, and other comorbidities and lifestyle factors.

OT

Increases client independence at home and community, modifies environments, teaches compensatory strategies, trains on use of AE or AD

Orthotic Construction

It is best to begin orthotic construction with a pattern. ​ - A pattern will assist with a proper fit and ensure that costly material is not wasted. ​ To create the pattern, the involved portion of the extremity is traced, making note of important structures​ - The distal palmar crease​ - Thumb web space​ - Any anatomical landmarks that will aid in proper fit and design. ​ - If the involved extremity cannot be traced, the extremity on the opposite side can be used. ​ Once the extremity has been traced, a quarter to half inch is added around the perimeter of the tracing, for an average-size hand and forearm, and the pattern is cut out. ​ - If the client has a larger-than-average hand and forearm, more than a quarter to half inch increase may have to be added to the base pattern. ​ The pattern is then placed on the client and the OT practitioner makes note of any areas that should be increased/ decreased to ensure proper fit. ​ It is important to remember that for proper fit, the orthosis should cover approximately two-thirds the length of the extremity and one half the circumference of the extremity

Vitreous Humor

Jellylike substance found behind the lens in the posterior cavity of the eye that maintains its shape

Contraindications for ROM

Joint dislocation, unhealed fracture, soft tissue damage, myositis ossificans (a bone forms inside your muscle or other soft tissue) or heterotopic ossifications (abnormal bone growth of another bone)

Wet ARMD (Age-Related Macular Degeneration​)

Leaky blood vessels damaging the macula. Changes are noticed faster than the dry ARMD. Lose their central vision but keep their peripheral vision Affects navigation in the environment and anticipation of surrounding objects; minimal difficulty with mobility because peripheral vision is not affected​ Difficulty with reading, seeing controls of the appliances, looking at photographs, people's faces, reading, driving, fine work​

Cortical blindness (blindsight)

Lesion in occipital lobe/visual cortex leads to deficits/inability to process info received via optic pathway

Narrative Notes

Less structured than SOAP notes; same info​ Not completed necessarily during treatment; however, POS (point of service) documentation is becoming the new norm​ Can be used to document when OT session is not fully completed time wise​ Also used in settings where charges are based on CPT codes - billing/classification ​ 97110 (Ther Ex): 15 minutes; 97535 (Self-care): 40 minutes

Inferior rectus

Makes eye look down

Purdue Pegboard

Measures the movement of arms, hands, fingers and fingertip dexterity. ​ Test can be done in one or three trials with each hand. Tests are timed.​ This test includes four subtests that involve placing small pins into holes on the pegboard as well as assembling pins and washers.

Brachial Plexus Injury

Mechanism of injury: The brachial plexus is a network of intertwined nerves (ulnar, radial, median) that control movement and sensation in the arm and hand. Injury or damage to these nerves may cause weakness, loss of feeling, or loss of movement in the shoulder, arm, or hand. Most traumatic brachial plexus injuries occur when the arm is forcefully pulled or stretched. Many events can cause the injury including falls, motor vehicle collisions, knife and gunshot wounds, and most commonly, motorcycle collisions.​ ​ Medical/Surgical intervention: Many injuries to the brachial plexus will recover spontaneously without surgery over a period of weeks to months, especially if they are mild. Nerve injuries that heal on their own tend to have better functional outcomes. ​ - Nonsurgical intervention: Rest, activity modification, medication. ​ - Surgical Intervention: In most procedures, an incision is made near the neck above the collarbone. If the injury extends down the brachial plexus, another incision at the front of the shoulder may be required. To repair or reconnect nerves, surgeons often use high-powered microscopes and small, specialized instruments. Common procedures include nerve repair, nerve graft, and nerve transfer

Boxer Fracture

Mechanism of injury: This is a fracture of the 5th metacarpal. It is common among professional fighters, but may also be caused by hitting an object, or an object hitting the person with closed fist. A boxer's fracture may cause the knuckle of the 5th digit to appear sunken in or depressed. - Figure 22-6, pg. 570​ ​ Medical/Surgical intervention: If the fracture is easily set, it will be realigned and casted or splinted to promote immobilization and healing. In the case of more severe fractures, surgery may be required. This includes the use of plates, pins, screws, and wires to realign the bones. After surgery, a cast or splint is usually placed to immobilize for healing.​ Common orthotics/braces used: WHFO (wrist hand and finger orthosis) may be used to immobilize the hand and fingers or ulnar gutter

Lateral Epicondylitis (Tennis Elbow)

Mechanism of injury: Typically caused by repetitive motions in lateral epicondylitis, there is degeneration of the tendon's attachment, weakening the anchor site and placing greater stress on the area, causing pain with movements such as lifting and gripping.​ See also: Medial epicondylitis aka golfer's elbow​ ​ Medical/Surgical intervention: Activity modification, ice, medication, therapy, steroid injections, and NSAIDS. In cases that last 6-12 months with no relief, surgery may be an option. In this procedure, the diseased/degenerated tissue is removed through a small incision. ​ ​ Common orthotics/braces used: A tennis elbow brace is a band worn over the muscle of the forearm just below the elbow, which can reduce the tension on the tendon and allow it to heal.

Axonotmesis

More severe; crush or traction injury with motor loss & extended recovery

Shoulder Abduction

Muscles: Anterior deltoid, middle deltoid, posterior deltoid, supraspinatus Positioning for MMT Testing Against Gravity: Seated upright Gravity Reduced: Supine Hand Placement Stabilize: Scapula Resistance: Humerus

Neuropraxia

Nerve compression or repetitive stress

Optic nerve (cranial nerve II)

Nerve that carries impulses for sense of sight.

TOTAL SHOULDER REPLACEMENT PRECAUTIONS (TOTAL HEALING 9-12 MONTHS)

No active shoulder motion for 4 weeks, all planes; No active internal rotation for 6 weeks - pulling pants up from behind, etc. ​ After 4 weeks: Pendulum exercise without weight (Codman's exercises)​ Must receive MD orders for PROM. ​ Provide modalities for client per MD orders.

Bilateral hemianopia

Optic chiasm lesion

Radial Deviation

Position for ROM Testing: Seated in chair, arm on table with palm facing down NROM: 0- 20 degrees Goniometer Placement Axis: Base of 3rd metacarpal Stable: Center of dorsal wrist Moveable: Midline of 3rd metacarpal

Orthotics

Previously known as splinting​ Treatment intervention used by OT practitioners to effectively treat a variety of upper extremity diagnoses to improve occupational performance of clients​ Used throughout history for immobilization, protection, and assistance with regaining function after an injury or illness Used for:​ Protection/immobilization​ Positioning​ Improving range of motion (ROM) Materials range from: ​ Rigid thermoplastics to softer fabrics with foam padding​ Elastic and/or Velcro strapping

Tendon gliding exercises

Promotes differential glide by way of the flexor tendon and allows for joint ROM to all of the joint in the hand. Steps 1. All fingers in an extension position 2. A hook fist 3. To a roof top 4. To a straight fist 5. To a full fist 6. Then return all fingers to an extended position

Tachypnea

Rapid breathing

Superior Rectus

Responsible for looking up

Diabetic Retinopathy

Results from Type I or II diabetes​ Causes blind spots due to decreased circulation and hemorrhages ​ Symptoms dependent on blood sugar fluctuations from day to day ​ Leading cause of vision loss in USA​ Most clients have good visual acuity ​ Management of diabetes, will decrease the chances of getting DR​ Diabetic neuropathy: caused by reduced circulation; reduced sensation in extremities; LE amputations

Superior Oblique

Rotates the eye downward and away from the midline

Visual acuity

Sharpness of vision

Contracture

Shortening of a muscle leading to limited ROM of joint

Concentric contraction

Shortening of muscle

Bradypnea

Slow breathing

Inflammation

Swelling/ Pain Body removes bacteria and produces collegen. - 48hrs -> 5-7 days

Visual Pathway

Takes visual information from the eye to the processing centers in the brain

Guided Motor Imagery

Technique to treat chronic pain in UE 3 stages 1. Lateral training 2. Imagined hand movements 3. Mirror visual feedback Goal: To influence sensorimotor cortex in the brain to manage pain. Return the client with a UE condition to their occupational performance rolls. Conditions: Complex Regional Pain Syndrome (CRPS) Evidence based: Used with clients with CPRS more research is needed to support the efficacy of this technique with other diagnosis.

Sensorimotor approach

The Rood Approach: "It's all about sensory input"​ Brunnstrom: "Use what you've got"​ Proprioceptive Neuromuscular Function (PNF): "It's all about the patterns"​ Neurodevelopmental Treatment (NDT): "It's about quality of movement."

Oculomotor control

The ability of the eyes to move in all directions and move together, impairments may cause: • increased head movement • difficulty keeping place

PWB (partial weight bearing)

The doctor will decide on the amount of weight; it is typically 25-50%. The foot/hand should truly be placed on the floor for balance only.

Isotonic strength

The exertion of force against constant resistance through the range of motion at a joint

Isometric strength

The exertion of force without a change in muscle length (without movement of a limb)

Evaluation of the Wrist/ Hand

The following are done when? 1. ROM 2. Strength 3. Sensation 4. Edema 5. Integument 6. Provocative testing & palpation

Diabetic Retinopathy

The following are treatments for what? Medical management of the diabetes - Metformin, insulin​ Diet compliance​ Eye drops​ Laser treatment ​ OT: Educate clients on how to locate their most useful vision each day to be successful with ADL performance

Fractures

The orthotic is used for this when what happens? s/p Reduction (aka surgically stabilized) ​ DR, metacarpal, & phalangeal Fx's

Mirror visual feedback

The use of a mirror to help client visualizing sensory input while watching the uninvolved hand

Minnesota Manual Dexterity

Tools used: Minnesota Rate of Manipulation Test Kit. ​ Assessment of gross and fine motor dexterity and rapid eye hand coordination. There are 5 subtests: placing, turning, displacing, one hand turning and placing, and two hand turning and placing.​ Typical procedure: Patient is standing for each subtest. A practice trial is given for each test to ensure the client understands the directions. Each subtest is completed 3-5 times. The score is the total time for the subtest trials.

True

True or False Based on the principles of tissue growth and elongation, serial casting is used for clients with joint contractures caused by soft tissue or capsular tightness in the upper extremity

Orthotic Construction:​Tools for the Clinic

Towels/pillowcases​ A wax pencil/scratch awl​ A splint pan set at 155º F to 205º F ​ - If the clinic does not have a splint pan, a large electric nonstick frying pan is an inexpensive and portable substitute​ A utility knife will assist in cutting cold thermoplastic material​ A cutting mat should be placed on the countertop so that it does not get damaged by multiple cuts​ Flat-edge scissors will provide a smooth edge for cutting warm material, and curved edge scissors will facilitate cutting out contours. ​ A solvent, acetone, or a scratch awl is used to remove coating and allow the thermoplastic material to adhere to itself​ A heat gun will help spot-heat the thermoplastic material for finishing and minor adjustments​ - Will also come in handy when heating the sticky back portion of the hook velcro®, which ensures that the hook will stay put after repeated use​ * A hole punch​ * Pliers​ *Recommended: a kit with dynamic and static progressive components are also recommended

Healing fractures

Treatment usually begins w/ AROM as the client can easily control the motion at the injured joint PROM is then initiated with a stable fracture to gain further joint ROM.

True

True Why does it matter if client does PROM or AROM? Because it gives us a good baseline into their current abilities and their potential abilities.

True

True False Why is it important to avoid resistive exercises in treatment of thumb CMC OA?​ Because it will cause pain

Tinel's Sign

Typical procedure: Patient is in a seated position. The examiner then taps gently along the course of the affected nerve; starting distally and moving toward the repair to elicit tingling in the patient's fingertip. ​ This can be used to determine nerve regeneration or to elicit a pathological response of the nerve Tapping

Finger Gutter

What orthotic is used for the following? Arthritis, finger fractures, extensors tendon injuries at the finger level, soft tissue injuries, sprains, dislocations

Sclera

White of the eye; maintains the shape of the eye and protects the delicate inner layers of tissue

soft end feel (abnormal)

edema, synovitis, ligament instability/tear

MEASURING BP PROCEDURE

1. Clean the stethoscope earpieces and diaphragm with alcohol.​ 2. Locate the brachial pulse. This is where the stethoscope will be placed.​ 3. Wrap the cuff above the elbow with the arrow pointing to the brachial artery. Fasten the cuff so it fits snugly.​ 4. Place the diaphragm of the stethoscope flat on the pulse site, holding it in place with the index and middle fingers of one hand.​ 5. Locate the radial pulse.​ 6. Close the valve on the bp cuff by turning it to the right (clockwise).​ 7. Inflate the cuff until you can no longer feel the radial pulse, then inflate the cuff 30 mm hg beyond this point.​ 8. Deflate the cuff slowly by opening the valve slightly and turning it counterclockwise (to the left) with your thumb and index finger. Allow the air to escape slowly while listening for a pulse sound.​ 9. Note the reading at which you hear the first clear, regular pulse sound. This number is the systolic pressure.​ 10. Continue listening until the sound disappears. This is the diastolic pressure. Note this reading.​ 11. Open the valve completely to deflate the cuff. Remove the cuff from the patient.

LE Bathing

1. Front Peri​ 2. Buttocks​ 3. Upper R thigh​ 4. Upper L thigh​ 5. Lower L leg and foot 6. Lower R leg and foot

True

True or False Daily activities can exacerbate symptoms in thumb CMC osteoarthritis - Cooking - Showering - Dressing

Jebsen Hand Function Test

7-Item standardized test of ADL hand functioning​ Items include writing, flipping index cards, picking up small & heavy objects​ Scoring dependent on the time required to perform each task with dominant and non-dominant hand

Orthotic Education

A client education handout should be provided to the client at their level of health literacy and include instructions on the orthosis wearing schedule, how to care for the orthosis, and how to monitor for skin irritation​ A thermoplastic orthosis should not be exposed to a heat source, including the dashboard or seat of a car on a sunny or warm day, because the orthosis will lose its shape ​ A picture of the client wearing the orthosis can be used as a client education tool

Moberg pickup test (MPUT)

A standardized test to assess for hand dexterity and functional sensibility. It is a timed test first used in neurorehabilitation to evaluate hand motor activity. It is simple and quick to administer, easy to replicate and inexpensive to acquire.

Control motion

Active motion of an involved joint or previously immobilized structure.

Gross MMT

Assesses the strength of a movement by all the muscles that contribute to the movement.

Isolated MMT

Assesses the strength of isolated, individual muscles.​

Palpation

Assists in determining what anatomical structures may be involved

Mirror visual feedback

Client places painful hand inside box and the uninvolved hand outside the box, they are instructed to move the uninvolved hand and watch the mirrored hand motions. If clients don't experience pain, they are instructed to move both hands while watching the mirror.

Ulnar Collateral Ligament (UCL) Injury​ (Skier Thumb)

From hyperextension of MC joint​

Cause of muscle weakness

Lower motor neuron (LMN) diseases innervate muscle directly i.e. peripheral nerve injuries, neuropathy, SCI, Guillan-Barre Syndrome​ Primary muscle diseases:​ muscular dystrophy, myasthenia gravis​ Neurological diseases: (Upper motor neuron)​ ALS, MS​ Disuse/immobilization: ​ From fractures, burns, arthritis, trauma, amputations, etc.

Tendon Gliding

Movements that allow tendons to "glide" next to each other in order to prevent adhesions and lubricate the tendons to improve ROM and prevent or minimize discomfort.

CN 3 Oculomotor Nerve

Moves eye muscles except Superior oblique and lateral rectus If Damaged: CN III Palsy: Diplopia (Double vision), depth perception, dilated pupils, reading difficulty and convergence insufficiency

CN 6 Abducens Nerve

Moves lateral rectus If Damaged: CN VI Palsy: Diplopia. Eye drifts toward nose = turns head to the side to compensate

CN 4 Trochlear Nerve

Moves superior oblique If Damaged: CN IV Palsy: Vertical diplopia, difficulty reading, computer work and going down on stairs. Out and up rotation of eye = Head is turned down and out as compensation

Visual Scanning

Moving the eyes to focus attention on different locations on objects or in scenes.

Visual closure

Perceiving the whole picture when only pieces are available for visual interpretation

Physiatrist

Physical medicine and rehabilitation. Can refer clients to the optometrist or ophthalmologist

Ulnar Deviation

Position for ROM Testing: Seated in chair, arm on table with palm facing down NROM: 0- 30/35 degrees Goniometer Placement Axis: Base of 3rd metacarpal Stable: Center of dorsal wrist Moveable: Midline of 3rd metacarpal

Shoulder Flexion

Positioning for ROM Testing: Seated in chair, arms at side NROM: 0-170/180 degrees Goniometer Placement Axis: 1" below acromion process Stable: Parallel to trunk Moveable: Parallel to humerus

Shoulder Abduction

Positioning for ROM Testing: Seated in chair, arms at side NROM: 0-170/180 degrees Goniometer Placement Axis: Posterior glenohumeral joint (~ 1" posterior to acromion) Stable: Parallel to trunk Moveable: Parallel to humerus

Shoulder Extension

Positioning for ROM Testing: Seated in chair, arms at side NROM: 0-60 degrees Goniometer Placement Axis: 1" below acromion process Stable: Parallel to trunk Moveable: Parallel to humerus

Elbow Flexion

Positioning for ROM Testing: Seated in chair, arms at side, elbow fully extended NROM: 0- 135/150 Goniometer Placement Axis: Lateral epicondyle Stable: Along center of humerus Moveable: Along center of radius

Forearm Pronation

Positioning for ROM Testing: Seated in chair, forearm resting on table with wrist off the edge, pen/pencil in fist perpendicular to floor NROM: 0- 70/80 degrees Goniometer Placement Axis: 3rd proximal phalanx Stable: Towards floor Moveable: Towards ceiling

Forearm Supination

Positioning for ROM Testing: Seated in chair, forearm resting on table with wrist off the edge, pen/pencil in fist perpendicular to floor NROM: 0-80/90 degrees Goniometer Placement Axis: 3rd proximal phalanx Stable: Towards floor Moveable: Towards ceiling

Shoulder Internal Rotation Adducted

Positioning for ROM Testing: Seated in chair, shoulder adduction, elbow flexed to 90 degrees NROM: 0- 70/80 degrees Goniometer Placement Axis: Olecranon process (parallel to floor) Stable: Along ulna Moveable: Along ulna

Horizontal Adduction of Shoulder

Positioning for ROM Testing: Seated in chair, shoulder in 90 degrees abduction NROM: 0- 130 degrees Goniometer Placement Axis: Superior aspect of acromion process Stable: Parallel to humerus Moveable: Parallel to humerus

Horizontal Abduction of Shoulder

Positioning for ROM Testing: Seated in chair, shoulder in 90 degrees abduction NROM: 0- 40 degrees Goniometer Placement Axis: Superior aspect of acromion process Stable: Parallel to humerus Moveable: Parallel to humerus

Shoulder Internal Rotation Abducted

Positioning for ROM Testing: Seated in chair, shoulder in 90 degrees abduction, elbow flexed to 90 degrees NROM: 0- 70/80 degrees Goniometer Placement Axis: Olecranon process (perpendicular to floor) Stable: Along ulna Moveable: Along ulna

Nerve Compression

Positioning for relief of pressure on nerve​ Carpal Tunnel Syndrome (CTS), Cubital Tunnel Syndrome

Replication & Proliferation

Scar Tissue forms -3-5 days to 14-28 days

Cornea

The clear tissue that covers the front of the eye

Legally Blind

Used to qualify an individual for government assistance and services. Acuity is less than 20/200 with best correction in the better eye with glasses or after surgery, or 20 degrees of VF or less in the better eye. ​

Arthritis

Used to rest inflamed joints (decrease pain and inflammation) and position against deformity​ Osteoarthritis, rheumatoid arthritis, gout, scleroderma

Hemianopsia

Vision loss in one half of the visual field in one eye

Homonymous hemianopsia

Vision loss in one half of the visual field on the same side of both eyes

WHEN TO REPORT

Vital signs are above the normal range​ Vital signs are below the normal range​ Always document vital signs: they are considered measurable data​ Always document communications: who you spoke to, their title, follow up

Volume meter and tape measure

What are 2 different ways of assessing hand edema?

Resting Hand (Resting pan, Safe position)

What orthotic is used for the following? Can be fixed or movable Fixed: Arthritis, CVA, Burns, Traumatic Brain Injuries, Trauma Movable: Progressive or changing conditions

Thumb spica (Short/Long Opponens, Thumb Gauntlet, Thumb Immobilization)

What orthotic is used for the following? De Quervain's tenosynovitis, trauma, scaphoid fractures, arthritis, ulnar collateral ligament injuries As oppenens used to support thumb weakness to promote functional opposition

Metaphalangeal blocking

What orthotic is used for the following? Extensor tendon repairs, collateral ligament injuries of the fingers, arthritis

Dorsal Blocking

What orthotic is used for the following? Flexor tendon repairs, nerve repairs, trauma

Ulnar Gutter

What orthotic is used for the following? Fractures, wrist ligament injuries

Volar Wrist (Cock up, Wrist Immobilization)

What orthotic is used for the following? Nerve compression wrist fractures, trauma, carpal tunnel syndrome, tendonitis, ligament injuries, wrist sprain, radial nerve palsy, wrist ganglion cysts

WHEW Narrative Note

What: Content of skilled intervention ​ How: Client performance (functional levels, etc.)​ Education: Provided & check for understanding​ Why: Rationale for content of intervention

WHEN TO TAKE VITALS

When a person is admitted to a health care facility​ Several times a day for hospitalized patients​ Before and after surgery​ After some therapy procedures ​ Before, during, and after activity for patients with cardiac complications​ Whenever the person complains of pain, shortness of breath, rapid heart rate, or not feeling well​ With the person at rest in a lying or sitting position

Tendon Repair

(Orthotic used Dorsal Block)​ Protects the injured/surgically repaired anatomical structures while allowing the client to progress through restricted ROM exercise protocols​ Flexor tendon repair​ Extensor tendon repair

Hard end feel

(bone to bone) ex: elbow extension

soft end feel

(soft tissue approximation) ex: elbow flexion, knee flexion

Firm end feel

(stretch) ex: ankle DF, finger extension, hip medial rotation, forearm supination

hard end feel (abnormal)

-bone contacts bone -bony grating sensation -rough articular surfaces move past each other (ex. jt containing soft loose bodies, degenerative jt disease, dislocation)

Stages of Healing

1. Hemostasis 2. Inflammation 3. Proliferation (fibrosis scar, granulation tissue) 4. Remodeling (contractile fibroblasts, wound strength).

Feeding

1. Holding utensil ​ 2. Bringing utensil to plate ​ 3. Stabbing/Scooping food ​ 4. Bringing food to mouth

Toileting

1. LB Clothing Prior​ 2. Peri Care (cleansing)​ 3. LB Clothing after

UE Bathing

1. Left Arm​ 2. Right Arm​ 3. Chest​ 4. Abdomen

Grooming

1. Oral care​ 2. Wash and dry face​ 3. Wash and dry hands​ 4. Brush/Comb hair​ 5. Shave/Makeup Application

Sensation Return

1. Pain and Temp 2. Moving touch 3. Constant touch 4. Touch localization 5. Two-Point discrimination 6. Stereognosis (Object Identification)

The Healthcare Common Procedure Coding System (HCPCS) codes

Are assigned to the services a medical practitioner performs and are used to ensure uniformity in billing.

MMT Screening Test

Assess​ Assess AROM to determine quality of movement, such as smoothness, speed and rhythm, and any other abnormal movements such as tremors​ Assess​ Assess PROM if there is decreased AROM at a joint in order to determine available joint motion, joint integrity, and presence of tone or spasticity​ Decide​ Decide if a full MMT is required or if the assessment will be of gross MMT only.

Complex Regional Pain Syndrome (CRPS)

Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack. The exact cause of complex regional pain syndrome isn't well understood but may involve abnormal inflammation or nerve dysfunction. Why do you think therapeutic use of self is an important tool? - Because we don't know how to treat it and we may need to talk the person through the pain and maybe even depression. Why does our psychosocial training come into play in treatment of traumatic hand injuries? - Because frustration may occur in clients, and we need to know how to handle it.

Self ROM Intervention

Client is educated on how to perform his or her own PROM via HEP education and training​ - Provides focused attention on the affected UE​ - Allows clients to be active participants in their rehabilitation​ The client performs SROM by utilizing the unaffected limb to support the affected limb. ​ - Specific techniques for support at elbow:​ -- Cradling the affected forearm​ -- Threading fingers together​ -- Holding the opposite wrist​ -- Using a tabletop surface to support the limb

Imagined hand movements

Clients imagine they are moving their own hand to match the image s on the cards. Clients try to imagine the movements without pain, then progress to the use of mirror box.

Retina

Contains sensory receptors that process visual information and sends it to the brain

Dyspnea

Difficulty breathing

97530 Therapeutic Activities

Direct (one on one) patient contact by the provider. Use of dynamic activities to improve functional performance, each 15 min

TOTAL KNEE REPLACEMENT PRECAUTIONS​ (TO 12 WEEKS)

Do not cross your legs (knees or ankle)​ Keep well rested - do not let yourself become over tired​ Sit on chairs with arms - the arms make it easier for you to push up into a standing position.​ Move to the edge of the chair before you stand up. Keep the operated leg in front while getting up. ​ Do not jump.​ Do not kneel on your operated leg.​ Do not pivot on either leg. - foot planted, turn body = twisting at knee​ Avoid heavy lifting.

STERNAL PRECAUTIONS (TO 12 WEEKS​)

Do not lift more than 8 pounds. (A gallon of milk weighs 8 pounds.) ​ Do not push or pull with your arms when moving in bed and getting out of bed or a chair. ​ Do not flex or extend your shoulders over 90°. ​ Avoid reaching too far across your body. ​ Avoid reaching behind you or stretching both arms out to the side at the same time.​ Avoid twisting or deep bending. ​ Do not hold your breath during activity. ​ Brace your chest when coughing or sneezing. This is vital during the first 2 weeks at home. (Use a pillow) ​ No driving until cleared by your cardiac surgeon. ​ No over the shoulder activity until cleared by your cardiac surgeon.

TTWB (toe-touch weight bearing)

Do not place any body weight on the leg or arm. Imagine you have an egg (or bubble wrap) under the foot/hand that they are not to crush it.

MEASURING BP GUIDELINES

Do not take a blood pressure on an arm with an IV, a cast, or a dialysis shunt. ​ Do not take a blood pressure on the side that a person has had breast surgery on.​ Measure blood pressure with the person sitting or lying.​ Apply the cuff to the bare upper arm. Do not apply the cuff over clothing.​ Make sure the cuff is snug. ​ Use a large cuff if necessary.​ Make sure the room is quiet.​ If you do not hear the blood pressure, wait 30 to 60 seconds and try again. If you still cannot hear it or are unsure of your readings, have someone else check your measurements.

Neuro-optometrist or Behavioral Optometrist

Does vision therapy and vision rehabilitation related to neurological conditions

Assist Levels

Independent - No Assist​ Mod Independent- Completes task differently than the normal​ Setup/Cleanup - Items brought to them​ Supervision/SBA - Line of sight/ Within arm length​ Touching/CGA - Hand on gait belt​ Partial/MOD A- OTA does 26-74%​ Substantial/MAX A- OTA does 75-99%​ TOTAL A/DEP- OTA does 100%

MMT contraindications

Inflammation or pain in the region to be tested​ Recent surgery​ Fracture or dislocation​ Myositis ossificans (formation of bone in a joint) ​ Bone carcinoma​ Any other fragile bone condition​ Muscle spasticity​

Healing Tendon

Initially requires PROM to promote tendon gliding and to prevent joint stiffness. AROM is then initiated when the tendon has healed enough to tolerate tension on the tendon repair.

Trauma

Injuries involving multiple anatomical structures (Fx's, tendons, wounds)​ Allows access for wound care, edema/scar management, ROM of uninvolved structures

Depth perception

Knowing how far away an object is

Spatial relations

Knowing where an object is in relation to self and others

Lymphedema

Mechanical dysfunction within the lymphatic system Primary lymphedema is caused by congenital conditions. Secondary lymphedema comes from surgery treatment for cancer tumors, injury to lymph system, various insufficiency.

Distal Radius Fracture

Mechanism of injury: A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however. One of the most common distal radius fractures is a Colle's fracture, in which the broken fragment of the radius tilts upward. The most common cause is FOOSH. ​ ​ Medical/Surgical intervention: Depending on severity of the fracture, nonsurgical treatments are possible. This includes reducing (setting) the bone and placing a cast. Surgical treatments may be needed and include ORIF (open reduction internal fixation) to place plates and screws to hold the bone in place; or the use of an external fixator to maintain alignment in a comminuted fracture. ​If the bone does not move no surgery is needed. ​ Common orthotics/braces used: Casts are typically used, not necessarily the use of braces

Trigger Finger

Mechanism of injury: Condition that causes pain, stiffness, and a sensation of locking or catching when one bends and straightens their finger. The condition is also known as "stenosing tenosynovitis." The ring finger and thumb are most often affected, but it can occur in the other fingers as well. When the thumb is involved, the condition is called "trigger thumb." ​ - Medical conditions - Trigger finger is more common in people with certain medical conditions, such as diabetes and rheumatoid arthritis.​ - Forceful hand activities - The condition is known to occur after forceful use of the fingers and thumb.​ Medical/Surgical intervention: Nonsurgical interventions: rest, orthotics, steroid injections, medications, exercises and activity modification. Surgical interventions to release the A1 pulley that is blocking tendon movement so the flexor tendon can glide more easily through the tendon sheath. ​ Common orthotics/braces used: Orthotics are typically only used for nonsurgical intervention and includes blocking on the volar (palm) side of the hand extending up to the digit to maintain extension.

DUPUYTREN'S CONTRACTURE

Mechanism of injury: Contracture of fascia in palm of the hand = loss of ROM in MCP and PIP joints. Males > female​ ​ Medical/Surgical intervention: If limiting function, surgical or closed fasciotomy; OT offered following medical procedures for scar massage, ROM, strengthening​ ​ Common orthotics/braces used: Finger extension orthosis

Flexor Tendon Laceration

Mechanism of injury: Deep cut on the palm side of the fingers, hand, wrist, or forearm can damage the flexor tendons, affecting control of flexion movement in the hand. Sports/traumatic injuries may cause the flexor tendons to rupture or break. ​ Medical/Surgical intervention: Surgery performed within 7-10 days after injury, unless blood flow limited. Tendons cannot heal unless they are touching, so usually the sooner the surgery, the better the outcome is. It can take up to 2 months before the repair heals and the hand is strong enough to use without protection. It may take another month or so before the hand can be used with any force. There are numerous protocols available; you will need to know which one to use based upon the surgeon's preference. Zone I-V​ Common orthotics/braces used: Dorsal block: Orthotic is placed on the dorsal side of the hand to prevent extension. Wrist is flexed 20-30°, MCP joints flexed 70°, & IP joints flexed slightly at 10-20°. Nothing rigid (or prevents passive flexion of the fingers) on the volar side of the hand or fingers.

Extensor Tendon Laceration

Mechanism of injury: Extensor tendons are just under the skin. They lie next to the bone on the back of the hands and fingers and straighten the wrist, fingers and thumb. They can be injured by a minor cut or jamming a finger, which may cause the thin tendons to rip from their attachment to bone. If not treated, it may be hard to straighten one or more joints.​ Medical/Surgical intervention: Tears caused by jamming injuries are usually treated with orthotics. Orthotics hold the tendon in place and should be worn at all times until the tendon is healed (8 to 12 weeks). Other treatment may include stitches, pins may need to be placed through the bone across the joint as an internal splint. Surgery to free scar tissue is sometimes helpful in cases of severe motion loss. Extension ROM to be gained prior to flexion ROM. Zone I-VII.​ Common orthotics/braces used: Orthotic used to prevent flexion of the hand and fingers on the volar side of the hand. The wrist should be placed in 20° of extension, the MCP joints are positioned in 10-15° of flexion (they should not be completely straight), and the IP joints should be straight. ​

Ganglion cysts

Mechanism of injury: Ganglion cysts are lumps filled with clear fluid or gel within the hand and wrist that occur adjacent to joints or tendons. They are commonly found on top of the wrist, the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger. The cause is unknown & are most common in younger people between the ages of 15 and 40 years (women > men) and are also common among gymnasts, who repeatedly apply stress to the wrist.​ ​ Medical/Surgical intervention: Non-surgical intervention includes immobilization and aspiration of the cyst. Surgery involves removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the root of the ganglion. Even after excision, there is a small chance the ganglion will return.​ ​ Common orthotics/braces used: The wound may be sutured and wrapped but orthotic use is not common.

Total Shoulder Replacement

Mechanism of injury: In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid). Causes include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear, arthropathy, avascular necrosis, and severe fractures.​ ​ Medical/Surgical intervention: The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket. (You watched a video in MSD)​ ​ Common orthotics/braces used: Depending on the surgeon, there may be a period of immobilization. For this you would use a shoulder immobilization brace. Conventional follows anatomy vs Reversed goes against anatomy

DIP/PIP Amputation of Digit

Mechanism of injury: Injury may be caused by traumatic circumstances or by medical necessity. Amputation may occur by disarticulation of the joint or at the proximal bone. ​ ​ Medical/Surgical intervention: If amputation is traumatic (caused by an accident), the wound area will need to be cleaned and debrided prior to closure or attempt of reattachment. Most times, surgeons will attempt to disarticulate at the joint so no distal bone remains to promote further healing and function. If due to medical necessity, the amputation occurs proximal to the first area of healthy tissues and vascularisation to promote healing and function. Once the wound is closed and healing has occurred, sensory function become priority.​ ​ Common orthotics/braces used: After healing, a prosthesis may be used (passive or active) to allow for further function and for aesthetic purposes.

MCP Replacement

Mechanism of injury: MCP replacements (arthroplasty) are typically done for a few reasons. One of the most common is in patients who have RA, this is done to reduce pain, increase function, and decrease deformity. Patient who have severe OA may also be candidates. ​ Medical/Surgical intervention: In the surgical intervention, the damaged bone (MCP) is removed and silicone spacers and put in place. MCP replacement surgery is often combined with other procedures to correct deformities or disorders in the tendons, nerves, and small joints of the fingers, and thumb. The incision is typically made on the back of the hand to preserve the flexor tendons.​ Common orthotics/braces used: Typically after surgery a custom orthotic or cast is placed to prevent movement on the wrist, hand and MCP joint.

DE QUERVAIN'S TENDINOSIS

Mechanism of injury: Tendons around the base of the thumb become irritated or constricted. Swelling of the tendon/tendon sheath can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist. This is a repetitive strain injury caused by overuse in specific movement patterns (esp. by new moms). - Figure 22-13, pg. 567​ ​ Medical/Surgical intervention: Nonsurgical Interventions include orthotics, medications (NSAIDS), steroid injections and activity modifications. Surgical intervention includes: surgery to open the thumb compartment (covering) to make more room for the irritated tendons; this is done via a small incision. ​ ​ Common orthotics/braces used: Thumb Spica

Rotator Cuff Tear

Mechanism of injury: When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object. It can be caused by trauma and/or repetitive movements.​ ​ Medical/Surgical intervention: Nonsurgical treatment includes rest, activity modification, therapy, NSAIDS, and steroid injections. Surgical interventions include reattachment of the tendon to the head of the humerus. Post-surgical protocols vary between surgeons, so please ask what to follow.​ ​ Common orthotics/braces used: Shoulder Abduction Sling; Shoulder Sling Immobilizer

CARDIAC PRECAUTIONS

Monitor Heart Rate, Blood Pressure, Respirations and Perceived rate of exertion​ Heart Rate: Bradycardia (< 60 beats per minute), a drop in HR ≥ 10 bpm with exercise. Excessive tachycardia (> 120 bpm), an increase > 24 bpm above standing resting HR with a maximum of 120 bpm​ Blood Pressure: Normal ~ 120/80; anything significantly higher or lower.​ - Hypertension: high blood pressure 135/100​ - Hypotension: low blood pressure 80 or 90/60​ Anginal pain (heart/chest pain), inappropriate shortness of breath (SOB), Lightheadedness, dizziness, mental confusion, nausea, leg pain (claudication), excessive fatigue.

Forearm Supination

Muscles: Supinator, biceps brachii Positioning for MMT Testing Against Gravity: Seated upright, elbow flexed 90 degrees, forearm pronated Gravity Reduced: Seated upright, shoulder & elbow flexed to 90 degrees Hand Placement Stabilize: Elbow Resistance: Distal forearm/wrist

Shoulder Flexion

Muscles: Anterior deltoid, pectoralis major (clavicular head) Positioning for MMT Testing Against Gravity: Seated upright Gravity Reduced: Side lying Hand Placement Stabilize: Scapula Resistance: Humerus

Elbow Flexion

Muscles: Brachialis, brachioradialis, biceps brachii Positioning for MMT Testing Against Gravity: Seated upright Gravity Reduced: Side lying Hand Placement Stabilize: Humerus Resistance: Forearm

Wrist Extension

Muscles: Extensor carpi radialis longus, extensor carpi radialis brevis, extensor ulnaris Positioning for MMT Testing Against Gravity: Seated upright, elbow flexed 90 degrees, dorsal wrist facing up Gravity Reduced: Seated upright, elbow flexed 90 degrees, thumb towards ceiling Hand Placement Stabilize: Wrist Resistance: Metacarpals

Wrist Flexion

Muscles: Flexor carpiulnaris, flexor carpiradialus, palmaris longus Positioning for MMT Testing Against Gravity: Seated upright, elbow flexed 90 degrees, volar wrist facing up Gravity Reduced: Seated upright, elbow flexed 90 degrees, thumb towards ceiling Hand Placement Stabilize: Forearm Resistance: Metacarpals

2-5 Digit Flexion PIP

Muscles: Flexor digitorum superficialis Position for Testing Against Gravity: Palm up, arm resting on table Gravity Reduced: Arm resting on table, 5th metacarpal down Hand Placement Stabilize: Proximal phalanx Resistance: Middle phalange (one finger)

1st Digit IP Flexion/Extension

Muscles: Flexor pollicis longus (F), extensor pollicis longus (E) Position for Testing Against Gravity: Pt. arm on table; palm up (F), 5th metacarpal down, thumb flexed (E) Gravity Eliminated: Thumb abducted, parallel to floor (both) Hand Placement Stabilize: Proximal phalanx of thumb (both) Resistance: Distal phalanx thumb (both)

Shoulder External Rotation Adduction

Muscles: Infraspinatus, teres minor, posterior deltoid Positioning for MMT Testing Against Gravity: Side lying Gravity Reduced: Seated upright Hand Placement Stabilize: Scapula Resistance: Forearm

Shoulder Internal Rotation Adduction

Muscles: Latissimus dorsi, pectoralis major (clavicular and sternal head), anterior deltoid, subscapularis, teres major Positioning for MMT Testing Against Gravity: Side lying, shoulder adducted, elbow 90 degrees flexion Gravity Reduced: Seated upright, shoulder adducted, elbow 90 degrees flexion Hand Placement Stabilize: Scapula Resistance: Forearm

Shoulder Extension

Muscles: Posterior deltoid, pectoralis major (sternal head), latissimus dorsi, teres major Positioning for MMT Testing Against Gravity: Prone Gravity Reduced: Side lying Hand Placement Stabilize: Scapula Resistance: Humerus

Forearm Pronation

Muscles: Pronator quadratus, pronator teres Positioning for MMT Testing Against Gravity: Seated upright, elbow flexed 90 degrees, forearm supinated Gravity Reduced: Seated upright, shoulder & elbow flexed to 90 degrees Hand Placement Stabilize: Elbow Resistance: Distal forearm/wrist

ANTERIOR APPROACH HIP PRECAUTIONS (TO 12 WEEKS)

No hip extension. ​ Do not allow surgical leg to externally rotate (turn outwards). ​ Do not cross your legs. ​ No bridging or lying prone.

POSTERIOR APPROACH HIP PRECAUTIONS​ (TO 12 WEEKS)

No hip flexion greater than 90 degrees ​ No hip internal rotation (turning toes in)​ No adduction beyond neutral (crossing legs)

Abnormal blood pressure

Normal BP​ Average adult systolic range - 100 to 140​ Average adult diastolic range - 60 to 90​ Abnormal BP​ Hypertension - measurements above the normal systolic or diastolic pressures​ Hypotension - measurements below the normal systolic or diastolic pressures

Pulse Rates

Normal adult pulse rate is 60 - 100 bpm​ Abnormal if outside of that range​ Tachycardia - heart rate over 100​ Bradycardia - heart rate below 60​ Report abnormal heart rates to the nurse immediately

O2 SATURATION

Normal range: Above 90% - notify nurse if below​ Procedure: Put pulse ox onto finger. Press button. If you can't get a reading, check temp of client's finger or try another finger.

Respirations

One respiration consists of one inspiration and one expiration​ The chest rises during inspiration (breathing in) and falls during expiration (breathing out)​ Count each time the chest rises​ Count for 30 seconds and multiply X 2 = breaths per minute​ Do not let the person know you are counting their respirations​ Count after taking the pulse - keep your fingers on the pulse site ​ Normal respiratory rate for adult is 12 - 20 breaths per min.

MMT Precautions

Osteoporosis​ Subluxation or hypermobility of a joint​ Hemophilia (bleeding in a joint)​ Cardiovascular risk​ Disease or surgery​ Abdominal surgery or abdominal hernia​ Fatigue that exacerbate the client's condition

PROM Intervention

PROM does not have any effect on muscle strength or muscle tone, and does not prevent atrophy - it does lubricate the joint and prevent stiffness​ OTA must be positioned to support the affected limb while moving the arm through the appropriate arc of movement​ The limb is supported both proximally and distally across the joint​ Movement should be smooth and slow to avoid injury to joints and underlying structures​ If the scapula does not move effectively (muscle weakness or spasticity) when the arm is lifted into flexion/abduction to the full 180 degrees, it can be overstretched & and the OTA can cause long-term pain as well as subluxation

Wrist Extension

Position for ROM Testing: Seated in chair, arm on table with ulnar border facing down, thumb flexed NROM: 0- 70 degrees Goniometer Placement Axis: Center of radial wrist (anatomical snuffbox) Stable: Along radius Moveable: 2nd metacarpal

Wrist Flexion

Position for ROM Testing: Seated in chair, arm on table with ulnar border facing down, thumb flexed NROM: 0- 75/80 degrees Goniometer Placement Axis: Center of radial wrist (anatomical snuffbox) Stable: Along radius Moveable: 2nd metacarpal

Shoulder External Rotation Abducted

Positioning for ROM Testing: Seated in chair, shoulder in 90 degrees abduction, elbow flexed to 90 degrees NROM: 0- 90 degrees Goniometer Placement Axis: Olecranon process Stable: Along ulna Moveable: Along ulna

Shoulder External Rotation Adducted

Positioning for ROM Testing: Seated upright, shoulder adducted, elbow flexed to 90 degrees NROM: 0- 90 degrees Goniometer Placement Axis: Olecranon process Stable: Along ulna Moveable: Along ulna

Systolic pressure

Pressure exerted when the heart muscle is contracting​

Diastolic pressure

Pressure exerted when the heart muscle is relaxing between beats

Inferior Oblique

Rotates the eye upward and away from the midline

SITS muscles

Rotator cuff muscles - Supraspinatus - Infraspinatus - Teres minor - Subscapularis

Nerve Injury/Repair​

Similar to tendon repairs-used to protect injured/surgically repaired nerves

Shower Transfers

Sit to stand from surface​ Pivot/turn​ Stand to sit OR step into shower​ Door, lip, manage shower curtain, step into tub, step down

Hyperextension

Some define hyperextension as movement posterior to the body & extension as the return from flexion.​ Some define hyperextension as extension beyond 0°:​ - Wrist, shoulder, neck, and hip have flexion (anterior) and extension (posterior), which is normal.​ - Elbow extension beyond 0° is not normal.​

Certified Orientation and Mobility Specialist (COMS)

Specializes on traveling and mobility skills. Trains on use of sighted cane, locate obstacles, and use a guide dog. Addresses community mobility, public transportation use and crossing streets

Vitals

Temperature (Not usually our responsibility)​ Thermometer ​ Measured: Degrees Pulse​ Manually, pulse oximeter​ Measured: BMP (Beats per min) Respirations​ Eyeball it; 1 respiration = inhalation + exhalation​ Measured: Breaths per min Blood Pressure​ Cuff - wrist, upper arm​ Measured: mmHg Oxygen Saturation​ Pulse oximeter Measured: In %

Thermoplastic materials

Terms often used to describe the properties of ______________ ____________ are: Drape: ​ Refers to the ability of the material to conform to structures (when heated) without too much handling. ​ A material with the ability to drape is beneficial for smaller joints or when a specific position or contour is required. Materials with high drape may be difficult for the beginning OT practitioner to use because they require a light touch and must be handled gently​ Memory:​ The ability of the thermoplastic material to return to its original shape once reheated​ Materials with a high degree of memory require continuous coaxing while molding; however, they are frequently used for larger orthoses because they are easier to handle​ Rigidity: ​ Refers to the strength of the material when exposed to repeated stress​ Materials that offer rigidity are beneficial for an orthosis that will require long-term use or for those that support multiple or larger joints​ Adherence​ The ability of the material to bond to itself. ​ Adherence becomes important when reinforcing an orthosis or adding components to an orthosis

Visual perception

The ability to interpret the surrounding environment by processing information that is contained in visible light

Pupil

The adjustable opening in the center of the eye through which light enters

Pulse

The beat of the heart felt at an artery as a wave of blood passes through the artery​ A pulse is felt every time the heart beats​ More easily felt in arteries that come close to the skin and can be gently pressed against a bone​ The pulse should be the same in all pulse sites on the body​ The pulse is an indication of how the cardiovascular system is meeting the body's needs​ The pulse rate is affected by many factors - age, fever, exercise, fear. Anger, anxiety, excitement, heat, position, and pain. ​ Medications can be taken that either increase or decrease a person's pulse rate.

Retinal blood vessels

The blood vessel that supply oxygen to the rods and cones of the retina.

Age-Related Macular Degeneration (ARMD)

The following are treatments for what? Glasses​ Handheld magnifiers; implantation of mini telescope into eye​ Injections of medication into the eye to stop blood leaking​ Laser to destroy new abnormal blood vessels/photodynamic laser that destroys abnormal blood vessels​ Diet to slow the progress: Vit C and E, beta-carotene (Vit A), minerals zinc and copper, green, fish, fruits, nuts, low glycemic foods​ Stop smoking, do exercise, manage blood pressure and cholesterol, wear sunglasses and get regular eye exams

Edema

The following are ways to treat what? RICE: Rest, Ice, Compression, Elevation AROM Manual mobilization

Orthotic Design​Precautions​

The following are what? Client must have sensate skin​ Client must be able to perform self-inspection of skin/have a caregiver who can perform skin inspection ​ To identify potential pressure areas, rashes, or numbness caused by the orthosis. ​ Client must be able to attend routine reassessments so that the OT practitioner can ensure progress, monitor or change wearing schedules, and provide adjustments to the orthosis. ​ Edema may be a problem and may require changes in orthosis design and strapping.

Orthotic Design Contraindications

The following are what? Poor skin integrity​ Decreased cognitive status​ Undiagnosed joint instability ​ Pain​ (Can be used if pain level is below 5) Client's unwillingness to accept responsibility for the use of the orthosis​ Age & Diagnoses​ - An older client with diabetes and dementia may not be able to remember how to apply the orthosis correctly or may be unable to see well enough to be able to secure the strapping​ - A younger client with cerebral palsy may not be able to report pain or difficulties with an orthosis and will require a parent or caregiver to assist​ If the client is unable to care for himself or herself and requires the assistance of a caregiver, the caregiver should be present during fitting, education, and training with caregiver demonstrating understanding of use & and be willing to accept responsibility and assist in the application and monitoring of the orthosis

Cataracts

The lens becomes opaque, blocking the light information from entering the eye​ Can require surgery to remove the cataract - generally has very good outcomes​ OT can be involved to introduce adaptive strategies

True

True or False You use cryotherapy on shoulder when there is inflammation and heat when inflammation is gone.

Blood pressure

The measurement of the amount of force the blood exerts against the artery walls​ Blood pressure is recorded as a fraction with the systolic pressure on top and the diastolic pressure on the bottom: systolic /diastolic. Normal bp is ~120/80​ BA-BUM: The first sound occurs when the mitral and tricuspid valves close, the second when the pulmonary and aortic semilunar valves close

Ergonomics

The study of workplace equipment design or how to arrange and design devices, machines, or workspace so that people and things interact safely and most efficiently.

Open Carpal Tunnel Release

The surgeon makes a cut on the inside of the wrist, about 2", and then cuts right through the flexor retinaculum, in turn opening the space within the carpal tunnel.​

Endoscopic Carpal Tunnel Release

The surgeon makes a cut on the palm and the wrist. They insert a very small camera through one of the cuts to monitor the procedure and guide an instrument through the second cut to then cut right through the flexor retinaculum. ​

True

True or False Is the following correct Review of ROM Procedure: ​ Position client correctly (90-90-90)​ Explain purpose​ Bilateral demonstration of movement​ PROM of movement​ Place goni & direct to complete AROM again (unilateral) ​Report reading to client​

True

True or False Casts may be applied, removed, and reapplied, as the client's ROM improves (serial casting)

True

True or False Circumferential strapping (wrapping to encompass splint and limb from distal to proximal with an elastic wrap) may aid in edema reduction because it distributes pressure more evenly over the surface of skin.

True

True or False Do not do MMT if a person has spasticity

True

True or False First jumps are your systolic and last jump is your diastolic pressure when using a pressure cuff.

True

True or False First priority should be to correct ROM that limits self-care or IADLs. ​ Elbow, wrist, and fingers are especially important in ability to perform eating or grooming.​ Shoulder ROM critical for ADLs such as donning a shirt or bathing & high-level home management tasks, such as putting away laundry or retrieving items from shelves. ​ The OT practitioner must also always consider how each individual client's needs are different according to his or her specific occupations and environment.

True

True or False For serial casting of a stiff joint in the hand, an initial evaluation with ROM measurements is performed.​ The client's skin integrity, sensation, and circulation should also be assessed.

True

True or False If a fracture is displaced, you need surgery if its not you don't.

True

True or False Is the following correct Edema Measurements Volumeter: measures volume of the specific body part by using the fluid displacement method​ Body part is placed in a water-filled tank, resulting water overflow is collected and measured.​ By taking measurements over time, amount of edema can be measured and quantified USE CM not Inches in the tape measurements and make sure to start from ZERO Place below the Knuckles

True

True or False Is the following correct Sensation Testing: Moving 2-Point Discrimination Typical procedure: ​ Patient is seated and vision is occluded​ Testing of fingers; start with 8mm between two testing points. Place one or two points moving the disk-criminator proximal to distal on the distal phalanx of the fingertip. Patient responds if they feel "one", "two", or "cannot tell. Record the distance.​ Gradually decrease the distance of points. This is done until the patient is unable to discriminate between one and two points. ​ ​ For static and moving 2-point discrimination there are norms to reference.

True

True or False Is the following correct Sensation Testing: Semmes-Weinstein Monofilament Test Typical procedure: ​ Client placed into a seated position with vision occluded. ​ Starting small to big, the monofilaments are pressed onto the skin until it bends; the patient then has to verbalize if they feel it or not. ​ Used to determine pressure sensation

True

True or False Is the following correct Sensation Testing: Vibration Tools used: Tuning fork​​ Typical procedure: ​ Client in a seated/laying position with vision occluded. ​ The tuning fork is "hit" to create vibration; ​ The fork is placed on a boney prominence of the affected area to assess the presence of vibratory sensation with/after nerve repair or injury. Is normal if both the client and therapist feel it stop at the same time.

True

True or False Is the following correct Sensation Testing: ​2-Point Discrimination Typical procedure: ​ Client seated and vision is occluded. ​ Testing of fingertips; starts with 5mm between two testing points. ​ Place either one or two points on the radial or ulnar side of each finger and hold for approximately 3 seconds. Client responds if they feel "one", "two", or "cannot tell". Record the two point difference​ Gradually decrease the distance of points. This is done until the client can no longer distinguish between one and two points.

True

True or False Is the following correct Review of Dynamometer Procedure:​ Client sitting in chair, 90-90-90 ​ Black wrist strap goes around THEIR wrist; therapist supports device​ Elbow bent at 90 degrees, upper arm kept by side (may use piece of paper for cue), not resting on leg or arm rest​ Inform client that the handle will not move, but will gauge their strength​ 3 trials averaged together for each hand; reset after each trial​ Compare result to norm; inform client READ THE INSIDE #

True

True or False Is the following correct Review of Pinch Gauge Procedure:​ Client sitting in chair, 90-90-90 ​ Place black wrist strap around YOUR wrist​ Support/hold the pinch meter for the client​ Provide them with a demo of each pinch:​ Tip-to-tip: Tip of thumb and index finger ONLY)​ 3-jaw chuck: Thumb and index and ring finger)​ Lateral/Key (like holding a key)​ 3 trials each hand, each pinch, average together; reset after each trial​ Compare to norm & inform client

True

True or False Is the following sequence, correct? Environmental visual information -> enter eyes via muscle control -> looks for target -> brain receives and interprets information -> action is taken

True

True or False It is important to note that serial casting is not effective where bony restrictions are present. ​ Heterotopic ossification (HO), or deposits of extra-articular bone at the elbow, is a common cause of elbow stiffness in the client with neurological dysfunction. ​ Aggressive treatment for HO is not recommended, and therefore, casting may not be effective for the client with HO

True

True or False The following is correct Review of MMT Procedure: ​ Position client correctly (90-90-90)​ Explain purpose​ Bilateral demonstration of AROM​ PROM of movement​ AROM again with stabilization/palpation​ a. Break test if appropriate​ (Min, Mod, Max) Report reading to client

True

True or False The use of a soft orthosis has been found to be helpful for individuals with arthritis, those with poor skin integrity, and children

True

True or False This is how you calculate maximum heart rate HRmax = 220 - current age​ Vigorous activity = HRmax x .80​ Moderate activity = HRmax x .70

True

True or False Visual fields deficits (VFD) are dependent on location of CN2 optic nerve lesion

True

True or False What is the difference between a cast, commercial orthosis, custom orthosis, or buddy taping?

True

True or False What is the purpose of a "blocking orthosis"? Protection and to promote tendon gliding

True

True or False What is the typical conservative treatment for compressions to median, ulnar, and radial nerves? - Cortision shot - Brace - Education on rest

True

True or False What lifestyle or activity modifications might be necessary for someone with carpal tunnel syndrome? - Less repetitive movement - Talk to Text

True

True or False What makes an elbow fracture stable or unstable?​ Stable: If a fracture occurs but there is no movement Unstable: If the fracture moves

True

True or False When choosing an orthotic one should consider form and function

True

True or False When treating injuries and conditions in the hand early ROM decreases inflammation, joint stiffness, and reduces the scarring or adherence of soft tissue structures.

True

True or False Why do you think the flexor tendon system is divided into 5 zones and the extensor system into 7 zones? Because extensors are less dominant and to heal you need to be more specific with the locations where you are treating them.

True

True or False Why is healing and treatment different for fractures at MCP, PIP, and DIP joints? The further they are from the heart the longer they take

True

True or False Why would a physician recommend immobilization? To give the injury time to heal

True

True or False You do PROM to prevent joint stiffness or if they had spasticity, you would do it to do a prolonged stretch.

True

True or False You should not try to increase strength when there is inflammation, pain, or limited ROM.

Flow Charts

Typically, in the form of a grid​ Used widely in outpatient settings to track client progress​ Efficient way to quickly document reps, weight or level of independence

LB Dressing

Underwear: L leg, R leg, Pull up​ Pants: L leg, R leg, Pull up​ Socks: R foot and L foot; bringing over toes and bringing over heel​ Zipping​ Button/Fasten ​ Belt Management​ Shoes: R shoe, L shoe, Tie R shoe, Tie L shoe

Static Orthotic

Used for immobilization, protection, and prevention of deformities​ When fabricating and fitting an orthosis, must first complete a thorough client assessment:​ ROM, sensation, edema, skin inspection, and hand function, etc. Used for decreasing joint stiffness and effective in improving PROM Provide a low-load prolonged stretch, which is required for promoting tissue regrowth The tension on the orthosis is increased as the client's tolerance and tissue elasticity improve.​ Now considered more advantageous compared with dynamic splinting for improving ROM

Modified Moberg Pick-Up

Used to assess a person's hand ability to identify small objects with and without the use of vision. Hand dexterity is also a key factor in the ability to complete the assessment. ​ ​ Typical procedure: 12 metal objects are placed in front of the client's hand to be tested and the client is asked to pick up the object as quickly as possible and place into a container. Test can be done with vision or vision occluded. ​ ​ Scoring: Timed and recorded. Normative data is available

CERVICAL SPINAL PRECAUTIONS (TO 12 WEEKS)

Wear hard collar 24 hours a day; may be taken off by 2nd person during bathing for brief rinsing and changing of brace/pads after showering. ​ Anterior Cervical Fusion - avoid extension of neck. ​ Posterior Cervical Fusion - avoid flexion of neck. ​ AROM is patient-dependent and will be based on physician preference and the level and number of fusions.

Pinch and grip Test

What are 2 different ways of assessing hand strength?

Orthotics

What can be used for the following? Used for the promotion or facilitation of movement and preparation for functional return​ Nerve Palsy, tone, CNS (CVA/TBI/SCI)

Soft Orthosis

What may be used to treat:​ Carpal tunnel syndrome​ Cubital tunnel syndrome​ de Quervain's tendonitis​ Lateral epicondylitis​ Rheumatoid arthritis & osteoarthritis​ Joint instabilities

Blocking exercises

When the client blocks the joint on the involved hand with the uninvolved hand in order to target motion at a specific joint.

Systolic

When the heart muscle contracts and pumps blood from the chambers into the arteries ​

Diastolic

When the heart muscle relaxes and allows the chambers to fill with blood. Bp is measured in millimeters of mercury (mmHg)​

Functional ROM

When there is a deficit, but it does not affect a client's occupations Minimum ROM needed to perform areas of occupation without the use of special equipment.​ ROM needed to accomplish ordinary daily life activities​ Functional ROM is always less than "normal" ROM​

WBAT (weight bearing as tolerated)

When they stand or walk, place only as much weight as feels comfortable on the injured leg or arm. Let pain be the guide.

ROM

Why do we measure ROM? To check if client is within normal limits​ How is ROM measured? With a degree using a goniometer​ When is it inappropriate to undergo a formal ROM assessment? Pain, Fracture​ What is a compensatory movement? When you use something that is not meant to be used to move another​ When would we be looking for this during the ROM assessment? Throughout the assessment​

To compare and determine if strength training is needed

Why is it important to assess PROM and AROM?

To receive objective data, get a base line, and to find any deficits or compensations

Why is it important to do observation, standardized testing, and self-reported outcome measures?

Lateral Geniculate Nucleus

Within thalamus, processes info and sends to the visual cortex in occipital lobe via optic radiations​

9 Hole Peg Test

Wooden block with 9 holes and pegs​ Take one peg at a time and place into hole ​ Fill all 9 holes, then remove one at a time​ Complete one trial with each hand​ Provide them with a test run and a timed run

FWB (full weight bearing)

You may place your full body weight on your leg or arm. 100%

firm end feel (abnormal)

increased tone, tightening of the capsule, ligament shortening

NWB (non-weight bearing)

indicates that no weight at all can be placed on the extremity involved

Macula

yellowish region on the retina lateral to and slightly below the optic disc

Phalen's Test

​ Typical procedure: Patient is in a seated position. The patient is then asked to hold their wrist in a fully flexed position for 60 seconds. ​ The test is positive if tingling occurs. This is used to check for the production of paresthesia being present in median nerve compression. Prayer Test