orthotics midterm

high temperature materials

-unique benefit: longer use life -material is not self bonding (must use rivets)

epidermis

-upper layer -protects against elements and pathogens -regulates fluids -has a bunch of stratums..

lowest force for dynamic splinting

-use lowest force that accomplishes moving a body part -excess stress tears tissue

drape rule

generally inverse to resistance to stretch (high drape means low resistance to stretch)

claw hand

lumbricals and interossei are affected, imbalance of strength between IP flexors and extensors, extensor digitorum is only good extensor and acts on the MCPs, tenodesis effect results in claw hand

OT role: prevent loss of function during wound closure

-exercise -splinting -positioning

OT role: facilitate wound closure

-client education -wound care: cleaning, debridement -managing edema during inflammatory stage

dynamic splint use

-assists weak mm. -passively assists newly repaired structures (flexor tendon repair) -permits movement while maintaining good position

hypodermis aka subcutaneous adipose

-between dermis and fascia -responsible for thermoregulation

lumbrical bar

-blocks extension of 2nd-5th MCPs -used to substitute for missing lumbricals -sometimes used as base for outrigger

Fain article: skills awareness

-cognition and clinical reasoning -motor skills (forming splint, using tools, selecting materials) -perception (drawing patterns) -adaptability -communication and clarification (w/ doctor) -environmental or work demands (time restraints, reimbursement) -follow up (critiquing the splint)

scar

-composed of disorganized collagen and ground substance -lacks elastic, less prone to stretch and recoil

dermis

-connective tissue made of extracellular proteins, collagen and elastic fibers -cushions from stress and strain, houses blood supply -responsible for remodeling and repair -a partially intact dermis is crucial for epidermis regrowth (papillary, reticular)

splinting purposes

-edema reduction -supports/immobilizes joints -maintains ROM -prevents contracture -promotes function -relieves pressure pts -protects newly placed grafts

load exceeds elastic limit

-elastic limit=yield point -plastic change occurs -when load is removed, damage/distortion persists

full burn (4th degree)

-extends into subdermal fat -white or brown, leathery, dry -little or no pain, hair pulls out easily

torque

-extent to which a force causes rotation of a body part about a joint axis -torque=force x lever arm

dynamic D5 mobilizing orthosis

-fifth-digit capsular tightness -extensor extrinsic tightness or -scar adhesions to extensor digitiorum or extensor digiti minimi

longitudinal arch

-flexible: allows digits to flex and extend -maintained by intrinsic hand muscle activity

distal transverse arch

-formed by metacarpal heads -flexible: allows for opposition and dexterity -metacarpals 2/3 stable, 4/5 relatively mobile

boxer's fracture

-fractures at the neck or middle third of the 2nd-5th metacarpals (most commonly 4th and 5th) -common cause is punching a wall -option to splint in intrinsic plus

gamekeeper's thumb

-gamekeepers is repetitive force, skier's is sudden force -thumb is disrupted by moving laterally in a hyperextended function, damaging the MCP ulnar collateral ligament -splint holds thumb in neutral palmar abduction

safe/intrinsic plus resting hand splint

-good for fracture, crush, CVA, burns -don't force edematous hand into posture

"functional" resting hand splint

-good for trauma that can't tolerate more extreme safe position -differences: less MCP flexion, thumb IP flexed

scar mgmt: massage

-helps loosen contracted soft tissue -improves skin texture and circulation -helps with discomfort and tightness

total end range time (TERT)

-improvement in ROM is directly proportional to length of time a joint is held at end range -the longer the TERT, the more quickly a contracture resolves -narrow range for safe amount of force

dynamic

-moves part using energy stored by material (rubber band, spring) -provides a constant force -outrigger to long axis of the bone=90 degrees -permits active motion in opposite direction -force is intermittent because splint is removed periodically

antideformity positioning (jesus christ super star)

-neck in extension -shoulders abducted/externally rotated -arms supine -hips/feet neutral -knees straight

items

-no pillow beneath head -gel cushions to prevent occipital breakdown -folded blanket under shoulders to promote extension -avoid pillows under knees (promoting flexion)

mallet finger

-avulsion force to distal phalanx causing rupture of extensor mechanism -splint DIP into extension

Polyflex II

-opaque -stretches easily -partial memory, moderate drape/conformability -temporary self-bond; requires treatment to bond permanently -moderate surface impressionability

Polyform :)

-opaque -stretches very easily (poor resistance to stretch) -no memory, high drape conformability -temporary self-bond, requires treatment to bond permanently -treated, easily marred

when

dynamic splints typically during day time, substitute static at night

split thickness skin graft (STSG)

epidermis and some of the upper layer of the dermis is harvested and used to cover the wound defect. The intact dermis can signal re-epithelization. Donor sites can heal secondarily in two weeks or so.

low drape product

ezeform, orthoplast

QQ True of false. Because lever arm B (LA-B) is longer than lever arm A (LA-A), the torque acting upon the distal segment (the hand) is less than the torque acting upon the proximal segment (forearm).

false. This is a static splint and thus the torques acting upon the distal and proximal segments of the splint are the same. What differs are the forces acting upon the hand and forearm. Because the lever arm of the distal splint segment is shorter, a greater force is needed to maintain the wrist joint in a static state. The opposite is true of the proximal segment of the splint. Less force is required to maintain a static wrist given that the lever arm here is much longer.

subdermal (5th degree)

fascia, muscle, tendons, bone

stress *

force/pressure per unit applied to soft tissue

skin graft

generally needed when dealing with full-thickness or deep partial-thickness injuries resulting in defects in skin greater than a quarter in diameter. In these cases, the wounds are too large and have an inadequate capacity to contract, or are at risk for heavy scarring if allowed to close secondarily.

LTT

low temp thermoplastic

LLLD

-as successful as high load short duration stress -less likely to exceed breaking pt of tissue and induce inflammation

random info contd

-Perforated materials have less working time. -Opaque rubber-based materials have longer working time. Thicker materials have a longer working time. -All materials with memory are prone to shrinkage. -Final products = Thicker materials are more rigid, non-perforated are also more rigid.

crepitus

-Sensation of grating (gravel) or squishing (walking in wet sneakers) May be palpable, audible, or just reported by client

orthoses are NOT

-a splint: cast or strapping to stabilize fracture -elastic stockings -neoprene braces

stress deprivation

-activity levels are reduced below habitual -immobilization=most severe deprivation -results in lost collagen strength, cartilage degeneration, joint adhesions -for this reason, select dynamic over static when possible

OTA vs. OT in hand therapy

-cannot become certified by HTCC -can be AP credentialed in hands through AOTA

Boutenniere's

-cause: often intrinsic tightness -injury to extensor mechanism and proximal phalanx pops through buttonhole created by the lateral bands

scaphoid fracture

-caused by foosh -wrist is forced into hyperextension and radial deviation

swan neck deformity

-caused by stretching of volar plate at PIP joint, damage to attachment of extensor tendon at base of distal phalanx -treat with buttonhole splint -PIP joint should be placed in slight flexion while volar plate and dorsal dislocations should be placed between 10-30 of flexion -encourages therapeutic contracture of the soft tissue that prevents dorsal instability of the middle phalanx on the proximal phalanx

loading

-causes deformation through the application of force on the structure being stressed

MCP ulnar drift

-classic RA sign -results from soft tissue laxity and erosions caused by synovitis -weakens radial collateral ligaments -extensors migrate to ulnar side of MCPs -wrist rotates (metacarpals radially deviate)

pain control

-client education -medication use -heat -ice -weight loss

low drape

-easier for novice splinter -or if patient cannot hold the position

deQuervain's tenosynovitis

-inflammation of APL and EPB at the wrist -rest inflamed tendon sheaths by immobilizing joints they cross: wrist, thumb CMC, thumb MCP -position for precision grasp to maintain writing ability

power grip (hammer)

-injury: ulnar nerve mms paralyzed, MCP flexion is prevented; radial nerve=drop wrist -orthosis: functional extension (15-30 degrees), natural deviation, conform contour to transverse arch, allow mobility of 4th and 5th metacarpals, allow distal transverse arch (DTA) to deepen

Dupuytren's

-knots form in palmar fascia and tendons get stuck, pulling fingers into the hand

corrective purpose

-lengthen soft tissue -mold scar tissue -encourage shortening of soft tissue

creep

-lengthening that occurs due to tensile forces within the plastic range of deformation -elongation will trigger inflammation -resulting scar tissue will restrict movement -further tension means tissue will eventually fail

promoting tissue resorption

-loose packed positioning -underloading the lax joint tissues -neutralize any potential malaligning forces -promotes resorption of redundant soft tissue to restabilize the joint

Ezeform

-low stretch/drape (resists stretch), -opaque -moderate memory -slightly tacky to touch, sticks to surface, self-bounds but is not permanent -low surface impressionability -holds working temperature the longest

polyform

-low temp -high drape -self adheres only if coating is scraped or dissolved -very rigid final product

thinner materials

-low temp -lighter weight, faster cooling, more drape, more flexible when cooled -more appropriate for smaller body parts

volar finger gutter orthosis (lil guy)

-maintain PIP joint in 0 degrees extension -prevents excessive shortening of collateral ligaments -boutonnière deformities, zone II or III extensor tendon repairs, PIP collateral ligament sprains or PIP arthritis

static

-maintains body part in one position -rest tissues, provide external support, intermittently gain or maintain motion which has little resistance

collagen

-major load-carrying element -provides tensile strength

positioning purposes

-minimize edema -prevent contractures -maintain soft tissues in elongated state -protect nerves, tendons, healing skin -alternate every 2-4 hours

serial static

-molded in a stationary position with tissues at maximum length -casting, force is evenly distributed -changed frequently to accommodate decreased resistance of tissues (ideally every other day) -worn for long periods so tissue adapts to new position

low temp materials

-most easily fabricated, widest variety of materials, most common (only material used in our course) -perforated vs. micro perforated vs. solid

OT role: promote psychological adjustment

-pain mgmt -stress mgmt -referrals -therapeutic use of self

partial thickness burn (2nd-3rd degree)

-papillary or some reticular dermis -red and blistered -appears wet because of serum from capillaries -edematous

claw hand posture

-patients default to this position in acute pain stage (extremities go to fetal position) -tissues shorten, contractures occur -counteract by positioning in intrinsic plus to maintain tissue length

lever arm

-perpendicular distance from axis of rotation to the line of application of force -when the lever arm is lengthened, less force is needed to generate torque to produce rotation -to maximize mechanical advantage: use longest lever arm possible without restricting movement of other joints ex: wrist orthosis--distal level arm from wrist to hand is short, forearm lever arm is long, wrist strap applies counterforce

superficial burn

-pink/red -epidermis only -mildly painful -blanch to touch, no blistering, sunburn

oblique angles 1 and 2

-preserve dual obliquity -#1: second thru 5th metacarpals progressively shorter towards ulnar side of hand -#2: 4th and 5th metacarpals move more freely during functional activities

hand splint: safe (intrinsic plus) position

-prevents dorsal hand edema/contracture to prevent claw hand -also maintains 1st webspace and prevents wrist flexion contracture

edema mgmt

-primarily addressed thru positioning during fluid resucitation/inflammatory stage -elevate extremities to promote drainage during granulation stage -during maturation: compression garments, massage, Tubigrip

Tubigrip/compression garments

-promote healing -support new blood vessels and prevent edema -protect fragile new skin -assist in itch control -wear at all times except when bathing/applying lotion

resting hand orthosis

-protective purpose for wrist and hand -places most joints in their natural resting posture -encourages resorption of overstretched ligaments -rests inflamed joints, edema -good for clients with RA/osteoarthritis of the hand

protective purpose

-protects against forces that cause pain/deformity/slowed healing -prevents or deters subluxation of joints/tendons -stabilize unstable parts, support soft tissue -protect vulnerable/healing structures -prevent damage to skin

serial static/static progressive use

-provide LLLD stretch to increase ROM -gain strength -uses slight constant force to lengthen contracture -encourages tissue remodeling

buttonhole PIP hyperextension blocking orthosis

-restricts PIP motion in one direction, allows it in the other - PIP volar plate injuries or PIP joint dorsal dislocations, and for those with passively correctable swan neck deformities

strain

-result of stress -expressed as change in length of soft tissue/original length x 100

continuous passive motion (CPM)

-results in increased wound tensile strength -early postoperative stage

static progressive

-similar to dynamic design but the application of force is static -holds the joint at easy maximum available length -force is concentrated through the surface area of the part applying pressure -force application is small, applied tension is variable

hemostasis

-stage 1 of wound healing -regulation of bleeding via vasoconstriction and clotting

inflammatory

-stage 2 of wound healing -localized vasodilation increases blood flow for edema and clean up of debris (WBC's, macrophages) -2 to 5 days -wounds that stay in this stage longer fail to signal next stage, resulting in chronic wounds

proliferative/fibroblastic

-stage 3 of healing -triggered when inflammation is controlled -angiogenesis nourishes fibroblasts -fibroblasts develop rudimentary skin/granulation tissue -2 days to 3 weeks

maturation

-stage 4 of healing -collagen crosslinks to increase tensile strength (problem begins here) -3 weeks to 2 years -at final stage, new skin has 80% strength of former skin

loose-packed position

-when joint is unstable and tending to sublux, removes tension -resting position, minimally congruent, tissues are lax -position is midrange, maximal joint play, joint surfaces can be distracted by moderate tensile forces -effused joint should be loose packed because inflammation should not be stretched -MCPs: full extension

if the area of force application is too small..

..high pressure results, causing irritation -increase surface area to improve force distribution -ex: wider strap is better than narrow

the greater the surface area of the trough..

..the less pressure pressure=force/surface area. but too deep of a trough will be difficult to get on and off.

exercise considerations

1. Muscle elasticity can be enhanced through moist heat in preparation for exercise/pain control. 2. Exercise should not worsen joint pain/inflammation however may lead to some muscle soreness. It is important that your clients be educated on the difference. 3. It is important for your clients to find abalance between rest and exerciseso as to not increase inflammation/fatigue. Should significant fatigue or pain onset, clients should cease exercise immediately. 4. Be aware of any medications your clients are taken that may complicate an exercise regiment 5. Do exercises when pain/stiffness is best and restrict the number of repetitions of exercises when inflammation is present. 6. Exercise should be performed in a slow and controlled fashion throughout the arch of motion and all medical precautions/contraindications should be adhered to during exercise.

OT intervention standards 1 and 2

1. joint protection 2. energy conservation

to control joints..

3 forces 2 lever arms

QQ: For which client would it be most appropriate to use a highly perforated material:

A client with hand arthritis where support of the 1st thumb CMC joint is needed.

primary wound closure

A primary wound is closed using stitches or tape (steri-strips). This is done only when the remaining defect is small and with little risk of wound contamination.

sheet graft

A skin graft that has undergone no alteration before application. This graft type offers optimal cosmesis and function.

wet dressings

Antibiotic soaks maintain a moist wound bed while preventing the development of infection. The bulk prevents the wound from trauma (e.g., Silvadene "slurry") and will often soften eschar for more effective debridement.

biological dressings

Includes the use of cadaver and pig skin as temporary skin substitute. These are nearly always rejected by the recipient as they move out of an immunocompromised state. Biological dressings buy time until the client has sufficient donor skin available to cover the wound.

wound vac

Negative pressure wound therapy removes exudate, -promotes granulation tissue development, -secures a graft to the wound bed -prevents bacteria

QQ To ensure that your transcriptionist client wear the wrist splint you have made for him, you should employ which of the following strategies:

Offer your client options when selecting splint materials and strapping colors

QQ: To reduce the likelihood of a splint causing excessive pressure on your client's arm, the therapist should:

Pad bony prominences prior to splinting- Padding the bony before splinting is ideal. The padding will diminish pressure to the bony region and the splint will still conform well to the now padded bony region so as to diminish pressure to those areas bordering the prominence.

stress-strain relationship

Phase 1: Soft tissue elongates due to stress, elastin elongates, collagen uncoils and elongates in the direction of the stretch. 2: The stress applied and strain of soft tissue increase together exponentially. 3: Continued application of stress produces little more tissue elongation. Yield point: Changes in the physiological make-up of skin occur (remodeling). beginning of the plastic phase. Break point: The point at which soft tissue has exceeded its capacity to elongate and is subject to tearing (lead to inflammatory response).

secondary wound closure

Secondary closure is used when the wound is at risk for contamination (i.e., wound close to rectum). In this instance the wound would granulate and re-epithelialize without stitches or grafting. Clients with such injuries might be referred to a skilled OT for wound care to facilitate closure.

QQ True or false. When creating a static single joint orthosis, two forces and two lever arms are necessary to control the joint being splinted.

Three forces are required, 2 at each end of the lever arms and one counterforce at the joint axis. If a counterforce is not applied the joint will be allowed to move in one direction. Refer to figure 3.5 on pg 55 in your McKee text.

200g/half pound of force

adequate to stress the PIP joint capsule

full thickness skin graft (FTSG)

all of the dermis and epidermis are harvested to cover a region requiring padding, and where excessive wound contraction is not desired (e.g., palms and plantar surface of feet). The donor site is covered with a split-thickness skin graft.

strain rate

amount of tissue elongation per unit of time

stress

application of a load

grafts

autograft=own skin xenograft=pig skin homograft/allograft=cadaver skin integra=dermal substitute, permanent but incapable of regenerating

RA fatigue

caused by: -generalized inflammation (like chronic flu) -weakening of mm. (take more energy to move) -poor cardio fitness

thumb MCP/CMC stabilization splint

cmc in mid position, mcp slight flexion

skin is composed of

collagen, elastic fibers, ground substance

contraction vs. contracture

contraction is when edges move inward to close a wound contracture is caused by shrinking of a scare thru collagen remodeling, wound contracture that occurs over a joint can cause ROM impairment

orthosis

device that supports body part to control, correct, or compensate splint-temporary, brace-permanent

Fluidotherapy

dry heat therapy -beneficial for ROM -edema mgmt -superficial wound closure

meshed graft

graft in which multiple slits have been made, so it can be stretched to cover a large area. The interstices (slits) re-epithelialize and are subject to scarring, which has the potential to negatively impact function and cosmesis. These are sacrificed at times to close large wounds, avoid creating large donor wounds, and prevent the onset of infection.

why care about angle of pull? (90 degrees)

if pull if too proximal-->joint compression if pull is too distal-->joint distraction hint: finger sling migration is a hint that it is not at 90

rheumatoid arthritis RA

inflamed joints should be in loose packed position to minimize tensile forces

ground substance

is a gel-like substance found amongst collagen and elastin, and is thought to provide skin with its natural suppleness.

QQ: Which of the following low temperature thermoplastics would be most suitable for an entry level occupational therapist who is to make a hand-based thumb spica and is not yet comfortable in his or her splinting skills:

kay splinting basic III

elastin

offers skin elasticity while networking closely with collagen fibers. Elastin returns stretched collagen to its resting state.

OT intervention standard 3

orthotics read the chapter oh ****

QQ Which is the best option for a repair of a 2 cm x 2 cm x 2 cm indentation on splint made of a material with high memory:

place splinting material in splint pan and completely remold.

medium drape

polyflex, aquaplast

scaphoid

poor blood flow to proximal "pole," heals slowly

paraffin baths

promote softening of scar tissue

proximal transverse arch

rigid

counterforce

should generally be applied directly over target joint in volar designs

deforms

shows stress

DeQuervain's

tenosynovitis of the two sheaths surrounding the thumb

flap

the use of soft tissue to cover areas that are generally without good blood supply (i.e., over bone or tendon). Often this soft tissue will remain connected to its own blood supply or will require microvascular surgery to ensure the vasculature supplying the transferred soft tissue is connected to vasculature once supplying the region of the defect.

3 points of contact

to control a given joint

pseudo dynamic

uses an existing motion to substitute for lost motion

dorsal based strapping

usually at proximal end of orthosis

carpal tunnel

wrist should be positioned in neutral or slight flexion to minimize pressure in carpal tunnel

precision grasp (writing)

-allow full ROM for thumb, or at least opposition of index and middle fingers -necessitates flexion/neutral position: if orthosis puts pt. into extension, pt. must compensate using shoulder abduction

assistive purpose

-assist movement and positioning of weak or paralyzed muscles -harness/redirect an existing movement -replace missing movement -correct unwanted posture

an orthosis that resists flexion..

-applies extensor force -molds to the flexor surface of the limb -key force (strap) crosses the extensor surface, centered over target joint axis

Aquaplast T Ultra perf

-160-170 (but may need less as it is perforated) -translucent (clears when heated) -slight resistance to stretch -full memory, moderate drape/conformability (thinner = more drapable) -temporary self-bond, requires treatment to bond permanently -treated, resists mars

line of pull (dynamic)

-90 degrees relative to longitudinal segment of structure being acted upon -towards scaphoid to promote finger flexion

random info LLTs

-AQUAPLASTS require slightly higher temperatures to mold (160- 170) compared to other opaque materials (150-160). -Rubber opaque materials hold their temperature longer. -Working time depends on thickness, material type and whether or not the materials are perforated.

orthosis nomenclature sequence

-Custom vs. preformed vs. prefabricated -Surface in contact with (e.g., dorsal, volar, radial) -Location of the base (e.g., finger, hand, forearm) -Design category (Static, static-progressive,etc.) -Target [e.g., Bone (phalanx), joint (IP), region (thumb)] and -Objective (e.g., protective, blocking, assistive) E.g. Custom-fabricated Anterior arm-based serial-static elbow Extension mobilizing orthosis

OT intervention

-address elongation of skin/soft tissue that occurs in phase 1-3 -stress will result in resorption/reconfiguration of collagen fibers without inflammation and scarring

ultrasound

-addresses peri-articular adhesions -increases collagen extensibility -helps with pain

TBSA rule of 9's

-adult body is divided into 11 parts -add up 9% for each part that is burned

figure 8 extension blocking orthosis

-aka claw hand deformity orthosis -lower ulnar nerve injuries -ours acted on 4th and 5th digits (combined ulnar and median injury would be 2nd-5th) -blocks MCP extension (45-60 flexion), allows extensor digitorum to exert energy onto other joints

distal radius fracture

-aka colles if bone displaces dorsally, smith's if bone displaces volarly -usually caused by fall on outstretched hand FOOSH -traditional looking cast or orthosis to keep bones in line

cumulative trauma

-aka overuse injury, repetitive strain injury i.e. tendonitis, tendosynovitis -remodeling process is outpaced by fatigue process -continuous loads exceeding elastic range -repeated low stress causes structure to enter plastic range

close-packed position

-objective is to maintain tissue length, creates tension -joint surfaces are close together/fully congruent and held tightly by maximum tension in the joint capsule and ligaments -ligaments and capsule taut/twisted -joint surfaces cinched together, articular cartilage compressed -knee ex: full extension, lateral rotation of tibia, locked knee, "screw home" mechanism -MCPs: full flexion

Tailor Splint

-opaque -balanced stretch -partial memory -moderate drape/conformability -temporary self-bond, needs treatment to bond permenantly -moderate surface impressionability

synthetic dressings (occlusive, semi occlusive)

-provide the wound with a restrictive covering. -results in a moist environment ideal for epitheliazation; -prevents colonization of bacteria within the wound; -reduces irritation of exposed free nerve endings -ideal for partial thickness wounds where there is little exudate and no evidence of infection.

papillary layer of dermis

-provides oxygen/nutrition to basal layer of epidermis to maintain active cell division -deep ridges into epidermis prevent shear, provide tensile strength

soft tissue contractures treatment

-resolved by applying constant tensile force within elastic range -gently stretches contracted tissues -fibroblasts sense tension and signal increased collagen synthesis to elongate fibers

Hepburn's guidelines

-stress should not be perceived as "stretching" until 1 hour after wearing -should be comfortable for 12 hours -after removal, no more than stiffness or mild ache that quickly resolves -keep the stress below 1.5 percent

load exceeds plastic limit

-structure will fail -bone will fracture, tendon/ligament will rupture

tenodesis

-synergistic coupling -wrist extension with finger flexion, wrist flexion with finger extension (wrist extension takes up the slack in extrinsic finger finger flexors, fingers are pulled passively into extension)

low load

-temporary deformation occurs within elastic range -if load is removed before elastic limit of tissue is reached, the structure will return to original shape -deformation resolves, full recovery

conformity to contour

-thermoplastic should conform with no gapping -material not in contact with skin serves no purpose -pad bony prominences before splinting

reticular layer of dermis

-thick, densely packed collagen fibers -primary location of elastin

Aquaplast Resilient-T

-translucent (clears when heated) -high resistance to stretch -full memory, low drape/conformability (thinner = more drapable) -temporary self-bond, requires treatment to bond permanently -treated, resists mars

Aquaplast original

-translucent (clears when heated) -moderate resistance to stretch -full memory, moderate drape/conformability (thinner = more drapable) -permanent self-bond * -resists mars

neoprene

-use when soft support is preferred -do not absorb/wick sweat--lead to skin problems (millaria aka prickly heat) -other risks: chemicals, allergic reactions, don't put over open wounds -good for children: comfortable, provides passive stretch, allows activeness, socially acceptable appearance

splinting for arthritis

To decrease inflammation To provide support to weakened joint To avoid deformity To increase ROM (with Dynamic Splinting) To increase function To support a healing joint capsule after joint replacement surgery

OT intervention 4

exercise: ROM/stretching

OT intervention 5

exercise: strengthening