Musculoskeletal Sys. Part 2

VC TRS Body Powered Grip *Cosmesis: Unfavorable *Pinch Force: Controlled strong grip > 40 lb dependent on force exerted on cable *Prehension pattern: Pinch more precise than hand, but less than hook *Weight: Aluminum, polymer, stainless steel; 4 - 16 oz. *Durability: Durable and rugged; esp. stainless *Reliability: very good; requires minimal service *Feedback: Better proprioceptive feedback, as tension on cable must be maintained for sustained grasp. *Ease of use: More effort to sustain grasp; lock available *Use in various planes: Similar to VO hook *Visibility of items grasped: Good; less than VO *Cost: Higher than hook, less than hand

VC TRS Body Powered Grip *Cosmesis: Favorable/Unfavorable *Pinch Force: *Prehension pattern: *Weight: *Durability: *Reliability: *Feedback: *Ease of use: *Use in various planes: *Visibility of items grasped: *Cost:

VO Body Powered Hook *Cosmesis: Unfavorable *Pinch Force: 1 lb/ rubber band; more rubber bands yield stronger grip but require more effort to open. *Prehension pattern: Precise, exact pinch *Weight: Lighter than hands; aluminum to stainless steel; 3-8.7 oz *Durability: Durable; stainless steel is strongest *Reliability: Very good; requires minimal service *Feedback: Some proprioceptive feedback from tension on harness and limb in socket when operating TD/elbow. *Ease of use: Effort increases with rubber bands *Use in various planes: Difficult for high planes *Visibility of items grasped: very good *Cost: lowest

VO Body Powered Hook *Cosmesis: Favorable/Unfavorable *Pinch Force: *Prehension pattern: *Weight: *Durability: *Reliability: *Feedback: *Ease of use: *Use in various planes: *Visibility of items grasped: *Cost:

Amputations Lower extremity level of amputation. a. Hemipelvectomy: amputation of half of pelvis and entire LE. b. Hip disarticulation: amputation at the hip joint. Loss of the entire LE. c. Above-knee amputation (transfemoral): amputation above knee at any level of the thigh. d. Knee disarticulation: amputation at the knee joint. e. Below-knee amputation (transtibial): amputation below knee at any level on the calf. This is the most common. f. Complete tarsal: amputation at the ankle. g. Partial tarsal: amputation of the metatarsals and phalanges. h. Complete phalanges: amputation of toe(s).

Amputations Lower extremity level of amputation. *Name and describe the 8 different LE amputations. *Which one is the most common?

Amputations Upper extremity level of amputation. a. Forequarter: loss of clavicle, scapula and entire upper extremity. b. Shoulder disarticulation: loss of entire UE. c. Above-elbow (AE) (long or short): amputation above the elbow at any level of the upper arm. d. Elbow disarticulation: amputation of the UE distal to the elbow joint. e. Below-elbow (BE) (long or short): amputation below the elbow at any level of the forearm. f. Wrist disarticulation: amputation distal to the wrist joint. Loss of entire hand. g. Finger amputation: amputation of the digit(s) at any level (i.e. transcarpal, transmetacarpal)

Amputations Upper extremity level of amputation: *Name the seven types and describe.

Anticontracture Positioning by Location of Burn *Location: Anterior elbow *Tendency: flexion *Positioning: Elbow extension splint in 5-10 degrees flexion

Anticontracture Positioning by Location of Burn *Location: Anterior elbow *Tendency: *Positioning:

Anticontracture Positioning by Location of Burn *Location: Anterior neck *Tendency: Neck flexion *Positioning: Remove pillows; use half-mattress to extend the neck; neck extension splint or collar.

Anticontracture Positioning by Location of Burn *Location: Anterior neck *Tendency: *Positioning:

Anticontracture Positioning by Location of Burn *Location: Axilla *Tendency: Adduction *Positioning: 120-degree abduction with slight ER; axilla splint or positioning wedges; watch for signs of brachial plexus strain.

Anticontracture Positioning by Location of Burn *Location: Axilla *Tendency: *Positioning:

Anticontracture Positioning by Location of Burn *Location: Dorsal wrist *Tendency: Wrist extension *Positioning: wrist support in neutral

Anticontracture Positioning by Location of Burn *Location: Dorsal wrist *Tendency: *Positioning:

Anticontracture Positioning by Location of Burn *Location: Foot *Tendency: Foot drop *Positioning: Ankle at 90 degrees with foot board or splint; watch for signs of heel ulcer.

Anticontracture Positioning by Location of Burn *Location: Foot *Tendency: *Positioning:

Anticontracture Positioning by Location of Burn *Location: Hand dorsal *Tendency: Claw hand deformity *Positioning: Functional hand splint with MP joints 70 - 90 degrees, IP joints fully extended, first web open, thumb in opposition.

Anticontracture Positioning by Location of Burn *Location: Hand dorsal *Tendency: *Positioning:

Anticontracture Positioning by Location of Burn *Location: Hand volar *Tendency: Palmar contracture and/or cupping of hand *Positioning: -Palmar contracture: Palm extension splint -Cupping of the hand: Myofascial pain syndrome (MPS) in slight hyperextension

Anticontracture Positioning by Location of Burn *Location: Hand volar *Tendency: (2) *Positioning: (2)

Anticontracture Positioning by Location of Burn *Location: Hip- anterior *Tendency: Hip flexion *Positioning: Prone positioning; weights on thigh in supine; knee immobilizers

Anticontracture Positioning by Location of Burn *Location: Hip-anterior *Tendency: *Positioning:

Anticontracture Positioning by Location of Burn *Location: Knee *Tendency: Knee flexion *Positioning: Knee extension positioning and/or splints; prevent external rotation, which may cause peroneal nerve compression.

Anticontracture Positioning by Location of Burn *Location: Knee *Tendency: *Positioning:

Anticontracture Positioning by Location of Burn *Location: Volar wrist *Tendency: Wrist flexion *Positioning: Wrist cockup splint in 5-10 degrees flexion

Anticontracture Positioning by Location of Burn *Location: Volar wrist *Tendency: *Positioning:

Arthritis Rheumatoid Arthritis: systemic, symmetrical, and affects many joints. 1. Most commonly attacks the small joints of the hand. 2. Characterized by remissions and exacerbations. 3. Begins in the acute phase as an inflammatory process of the synovial lining.

Arthritis Rheumatoid Arthritis: _______, ________, and affects _____ joints. 1. Most commonly attacks the small/large joints of the _____. 2. Characterized by ______ and _______. 3. Begins in the ______ phase as an inflammatory process of the synovial lining.

Assessment of Pain 1. Determine location of pain -localized or diffuse 2. Evaluate intensity of pain -Most commonly used is the pain scale 1- 10 -Identify the time of day pain is most intense. 3. Determine the onset and duration of pain. -Gradual vs. sudden onset -The length of time pain has been experienced. 4. Description of pain. -Common descriptors are sharp, throbbing, tender, burning, shooting. 5. Functional assessment of pain. -McGill Pain Questionnaire. -Pain Disability Index -Functional Interference Estimate

Assessment of Pain 1. Determine ______ of pain -______ or _______ 2. Evaluate ______ of pain -Most commonly used? -Identify the _________ pain is most intense. 3. Determine the _____ and _____ of pain. -______ vs. ______ onset -The ____________ pain has been experienced. 4. ________ of pain. -Common " are sharp, throbbing, tender, burning, shooting. 5. ________ assessment of pain. -Name three scales.

Burns to the Hand *If burns to the volar surface of the hand causing flexion contractures: Palmar extension splint -Wrist in 0 - 30 degrees extension. -MCP joints in neutral to slight extension and abduction (monitor collateral ligaments). -IP joints in full extension -Thumb abducted and extended *If web space burn: c- splint

Burns to the Hand *If burns to the volar surface of the hand causing flexion contractures: _______ _____ splint -Wrist in __-__ degrees flexion/extension. -MCP joints in _______ to slight ________ and _______ (monitor collateral ligaments). -IP joints in full ________ -Thumb ______ and _______ *If web space burn: _______ - splint

Burns to the Hand a. Wrist in 20 - 30 degrees extension b. MCP joints in 70 degrees flexion c. Thumb abducted and extended.

Burns to the Hand a. Wrist in ___-___ degrees flexion/extension b. MCP joints in ___ degrees flexion/extension c. Thumb _____ and _______

Burns: Classification 1. Superficial burn (aka first degree burn) involves the epidermis only. a. minimal pain and edema, but no blisters. b. healing time: 3-7 days.

Burns: Classification 1. Superficial burn (aka ___ degree burn) involves what area of skin? a. minimal ____ and ____, but no _____. b. healing time: _______

Burns: Classification 2. Superficial partial thickness burn (aka second degree burn) involves the epidermis and upper portion of the dermis. a. Example: sunburn b. Appearance: red, blistering, and wet c. Painful, no grafting necessary, heals on it's own. d. Healing time: 7 - 21 days.

Burns: Classification 2. Superficial partial thickness burn (aka _____ degree burn) involves what areas of skin? a. Example: ________ b. Appearance: 3 c. Painful, no ______ necessary, heals ________. d. Healing time?

Burns: Classification 3. Deep partial thickness burn involves epidermis and deep portion of dermis; hair follicles and sweat glands a. Appearance: red, white, and elastic b. Sensation may be impaired c. Potential to convert to full thickness burn d/t infection. d. Healing time: 21-35 days

Burns: Classification 3. Deep partial thickness burn involves what areas of skin? Be specific. a. Appearance: 3 b. ______ may be impaired c. Potential to convert to ______________ d/t ________. d. Healing time?

Burns: Classifications 4. Full thickness burn involves the epidermis and dermis; hair follicles, sweat glands, and nerve endings. a. aka third degree burn b. Appearance: white, waxy, leathery, and non-elastic c. Sensation is absent, requires skin graft d. Hypertrophic scar e. Healing time can take months

Burns: Classifications 4. Full thickness burn involves what areas of skin? Be specific. a. aka? b. Appearance: 4 c. _____ is absent, requires ________ d. ___________ e. Healing time?

Burns: Classifications 5. Fourth degree burn a. involves: fat, muscle, and bone b. Electrical burn: destruction of nerve along pathway. *Rule of nines is a method of assessing burn wound size. -Head and each arm:9% -Each leg: 18% -Trunk: 36% -Peri-area: 1%

Burns: Classifications 5. Fourth degree burn a. involves: 3 b. Electrical burn: *What is the Rule of Nines? Give percentages.

Don't memorize, but read over this info.

Classification, Dx, and Medical Management *Know that there are several different types: -Type 1 is the most mild -The other 7 types range between moderate and severe sx *Diagnosis -Family and medical hx and results from a physical examination and medical exam including xrays collagen and blood tests. *Medical Management 1. Care for brittle bones (OT's largest medical involvement) 2. Dental care for brittle teeth. 3. Medication for pain. 4. Surgery. a. fix bone malformations b. Prevent bone malformations c. "Rodding" in which metal rods are put inside the long bones.

Complications 1. Neuromas: nerve endings adhered to scar tissue. a. these can be very painful and hypersensitive. 2. Skin breakdown. 3. Phantom limb syndrome: sensation of the presence of the amputated limb. 4. Phantom limb pain: sensation of the presence of the amputated limb but is also painful. 5. Infection. 6. Knee flexion contractures in transtibial amputation. 7. Psychological impairments due to shock/grief.

Complications Name 7 *One is specific to transtibial amputation.

Following nerve injury repair surgery, an individual is evaluated for sensory return. Which measurement tool is best for the occupational therapist to use to assess for the return of vibration? A. A tuning fork. B. Nylon filament. C. A disk-criminator. D. the ninhydrin test

Correct Answer: A Rationale: Tuning forks are used to test for the sense of vibration. Nylon filaments are used to assess for cutaneous pressure thresholds. A disk-criminator or caliper is used to test for two pint discrimination. A ninhydrin test of the ability to sweat.

An individual recovering from hepatitis, type C has decreased upper and lower extremity muscle strength and hypertension. Six months ago the client had an angioplasty and is very fearful of having a heart attack. Which should the OT instruct the client to perform to increase muscle strength? A. isotonic exercises. B. Isometric exercises. C. Contract-relax exercise. D. Muscle contractions and holds.

Correct Answer: A Rationale: Isotonics are the only exercises listed that are not contraindicated for a person with hypertension or heart disease. The other choices describe isometric exercises or activities which include isometric elements and are contraindicated in this case.

A person with arthrogyrposis undergoes serial casting with weekly cast changes of the R wrist. Upon cast removal during the fourth week, the therapist notes a small open area 1/4 cm by 1/4 cm and a red rash over the ulnar styloid. Which is the therapist's best response to these observations? A. Pad the area and apply another cast B. Refer the individual to a team of wound care specialist C. Fabricate a static splint that does not impede on the ulnar styloid. D. Contact the physician and describe the observation

Correct Answer: D Rationale: The physician needs to be informed of the therapist's observations. The physician can then make a decision whether to recast, dress the open area, refer to the would care team, fabricate a new splint or employ other action. Arthrogyrposis is a condition in which the individual is born with two or more joint contractures that are very severe. The condition is known for this as well as muscle weakness.

The occupational therapist wishes to compare the results of an evaluation of lateral pinch to the norms. Which is the best positioning for the therapist to place the individual in when using the pinch meter? A. Forearm in neutral and the pinch meter placed on the DIP joint. B. Forearm in neutral and the pinch meter placed on the middle phalanx. C. Forearm in pronation and the pinch meter placed on the middle phalanx. D. Forearm in pronation and the pinch meter placed on the DIP joint.

Correct answer: B Rationale: Norms for lateral pinch have been established with the forearm in neutral and the pinch meter placed on the middle phalanx.

A client is now seven weeks post-op from a flexor tendon repair surgery. The physician prescribed the Kleinert protocol for the OT to follow. Which are the most appropriate intervention activities for the OT to use with this client? A. Home management activities such as doing laundry. B. Light ADLs such as grooming. C. Strengthening exercises using high resistance theraband. D. Passive exercises using a dynamic splint.

Correct answer: B. Rationale: According to the Kleinert protocol, light ADLs are introduced 6 - 8 weeks post-op. Strengthening activities and heavier work activities (such as doing laundry) are introduced 8 - 12 weeks post-op. The use of a dynamic splint is indicated immediately and up to 4 weeks post-op.

A house painter is referred to OT after a re-occurrence of rotator cuff tendonitis. The physician prescribes a conservative approach. Which recommendation is best for the OT to make to the individual? A. Continue performing above shoulder activities to build rotator cuff strength. B. Use an extension handle in the pain roller when painting ceilings. C. Sleep with the shoulder extended and adducted. D. Sleep with the shoulder fully flexed and adducted.

Correct answer: C. Rationale: Sleeping with the shoulder extended and adducted is an acceptable position for this condition. Above shoulder activities and positions are contraindicated for persons with rotator cuff injuries. Even with an extended roller handle the individual would still be performing above shoulder activities while painting.

Greifer (External Power) *Cosmesis: Unfavorable *Pinch Force: Strong pinch, 32 lb. *Prehension pattern: Precise pinch and cylindrical grasp *Weight: Heavy, 19 oz *Durability: Durable and rugged *Reliability: Very good *Feedback: Same as externall powered hand *Ease of use: Same as EP hand *Use in various planes: Same as EP hand *Visibility of items grasped: Poor for small items *Cost: About the same as EP hand

Greifer (External Power) *Cosmesis: Favorable/Unfavorable *Pinch Force: *Prehension pattern: *Weight: *Durability: *Reliability: *Feedback: *Ease of use: *Use in various planes: *Visibility of items grasped: *Cost:

Hands (External Power) *Cosmesis: Favorable *Pinch Force: Strong grip, 22 lb; may have proportional control *Prehension pattern: cylindrical grasp, 3 - point pinch, configuration is the same as BP hand *Weight: Heavy; 16.2 oz *Durability: Not durable; delicate inner electronics and glove *Reliability: Good if not used for rugged activities *Feedback: Some feedback through intensity of muscle contraction, particularly for proportional control *Ease of use: Low effort to activate *Use in various planes: Very good for transradial amputation *Visibility of items grasped: Poor for small items *Cost: Highest cost

Hands (External Power) *Cosmesis: Favorable/Unfavorable *Pinch Force: *Prehension pattern: *Weight: *Durability: *Reliability: *Feedback: *Ease of use: *Use in various planes: *Visibility of items grasped: *Cost:

Hands VO (Body Power) *Cosmesis: Favorable *Pinch Force: Pinch stronger than VO hook but weaker than externally powered TD; relies on internal springs, adjustable *Prehension pattern: Cylindrical grasp, three point pinch; configuration same as EP hand *Weight: Heavy; 10.5 - 14 oz *Durability: Not durable; delicate inner spring mechanism and glove *Reliability: Good if not used for rugged activites. *Feedback: Feedback similar to VO hook *Ease of use: More effort to open; can relax for grasp *Use in various planes: Similar to VO hook/ hand because of harness *Visibility of items grasped: Poor for small items *Cost: Higher than hooks, but lower than EP hand

Hands VO (Body Power) *Cosmesis: Favorable/Unfavorable *Pinch Force: *Prehension pattern: *Weight: *Durability: *Reliability: *Feedback: *Ease of use: *Use in various planes: *Visibility of items grasped: *Cost:

Heterotopic Ossification Definition: This is a calcium deposit that may occur in or near a joint after burns. -Circumferential burns are the most susceptible to this condition. -Symptoms include decreased joint excursion, a stiff endpoint, and increased pain. -The best action is to call the physician. -Aggressive passive ROM, especially to increase range, is contraindicated in treatment of this condition. Heat may be contraindicated at this time. Splinting may be contraindicated at this time. -The physician must determine the intervention.

Heterotopic Ossification -Definition: This is a calcium deposit that may occur in or near a joint after burns. -________ burns are the most susceptible to this condition. -Symptoms include: Name 3 -The best action is to _______________. . -Aggressive _______, especially to increase range, is contraindicated in treatment of this condition. _____ may be contraindicated at this time. ______ may be contraindicated at this time. -The physician must determine the intervention.

Hip Fractures Occupational Therapy Evaluation 1. Review precautions and weight bearing status before initiating evaluation. 2. Occupational role requirements and expectations. 3. ADL: focus on dressing, bathing, and transfers. 4. ROM and strength of UE. 5. Conduct other assessments as needed (e.g. cognitive).

Hip Fractures Occupational Therapy Evaluation 1. Review _________ and ____________________ before initiating evaluation. 2. _________ ____ requirements and expectations. 3. ADL: focus on ______, ______, and _______. 4. ________________. 5. Conduct other assessments as needed (e.g. ______).

Hip Fx: OT Intervention 1. Bed mobility and bedside ADL. 2. UE strengthening. 3. Functional ambulation and transfers with appropriate SB status and appropriate ambulation device (i.e. walker, crutches). 4. Instruct in and practice use of AD for use in the home (e.g. shower chair, elevated commode seat). 5. Practice occupation-based activities (e.g. small meal prep) using proper WB status and amb. device.

Hip Fx: OT Intervention 1. ________ and ______ ____. 2. ____ strengthening. 3. _______ _______ and _______ with appropriate ___________and appropriate ____________ (i.e. ______, _____). 4. Instruct in and practice use of _______ for use in the _____(e.g.________, __________). 5. Practice _____________ activities (e.g. small meal prep) using proper WB status and amb. device.

Hypertrophic Scar *Most common with deep second and third degree burns. *Appears 6 - 8 weeks after wound closure. *One to two years to mature. *Compression garments wearing schedule: 24 hours daily. a. Applied when wounds are healed. b. Recommendation is to wear 24 hours a day for 1-2 years until scar is matured. *Additional interventions include: ROM, skin care, ADL, role activities, and patient/family education.

Hypertrophic Scar *Most common with deep ____ and _____ degree burns. *Appears ___-___ weeks after wound closure. *___ to ___ years to mature. *Compression garments wearing schedule? a. When are these applied? b. What is the recommended long term wearing schedule? *Additional interventions include: Name 5

Correct Answer: B. Reasoning: A and C puts the child at risk for spinal and pelvic fractures. D would A the parents with bonding with the child, however they will not want to depend on this everytime the child needs to sit.

OI Study Guide Practice Question: *A four-month old child with OI has poor trunk control and is unable to maintain herself in a seated position. What would be an appropriate intervention? A. Propping the child up with pillows to maintain a seated positioning. B. Placing the child in a supportive reclining seat to watch a colorful mobile. C. Placing the child in a high chair with a back rest without head rest or lateral supports. D. Teaching the parents how to hold their child safely during feeding.

Correct Answer: D. A video game with his brother. Reasoning: This is an age-appropriate activity that maintains the relationship between the child and his sibling. Soccer and basketball put the child at risk for fractures so they are contraindicated. Video games alone would be inappropriate because he's not spending time with family/caregivers.

OI Study Guide Practice Question: *What is an appropriate activity for a pre-teen with OI? A. Soccer with his brother. B. Basketball with his friends. C. A video game of his choice. D. A video game with his brother.

OI Study Guide Tips: *Understand that prevention of fx and deformities is the priority. AROM is emphasized. *Analyze all activities I.D. in exam item answer choices to ensure that they do not put undue stress on bones. * Be certain to consider the developmental age in your analysis. *Know the guidelines for the evaluation and treatment of fractures should be followed. *Recognize that family and caregiver education would be an important consideration in exam items.

OI Study Guide Tips: *Understand that prevention of _____ and _______is the priority. ______ is emphasized. *Analyze all activities I.D. in exam item answer choices to ensure that they do not ___________________. * Be certain to consider the ______ _____ in your analysis. *Know the guidelines for the evaluation and treatment of ________ should be followed. *Recognize that ______ and _______ education would be an important consideration in exam items.

OT Eval: Full Thickness Burn 1. ROM (5-7 days post-op) - following grafting surgery. 2. All else is same as superficial and deep partial thickness burns.

OT Eval: Full Thickness Burn *Name 2

OT Eval: Superficial and Deep Partial-Thickness Burns 1. Occupational profile 2. ROM, 72 hours post-op 3. Sensation, wen wounds are healed 4, Strength, when wounds are healed 5. ADL and meaningful role activities, asap.

OT Eval: Superficial and Deep Partial-Thickness Burns *Name 5

OT Intervention 6. Strengthening. a. avoid during inflammatory phase. b. gentle strengthening while avoiding positions of deformity. 7. Purposeful and occupation-based activities. a. joint protection and energy conservation techniques should be incorporated. b. Adaptive equipment should be provided to prevent deformity, decrease stress on small joints, and extend reach.

OT Intervention 6. Strengthening. a. avoid during ___________ ________. b. gentle strengthening while avoiding ______________. 7. Purposeful and occupation-based activities. a. ____ ________ and _____ _______techniques should be incorporated. b. Adaptive equipment should be provided. Provide 3 reasons.

OT Intervention: Full Thickness Burn 1. 72 hours: dressing changes, splint at all times. 2. Five to seven days: begin AROM, light ADL and meaningful activities, sterile whirlpool. 3. Over seven days: PROM as tolerated, ADL and meaningful activities. 4. When wounds are healed, use massage. 5. Order compression garments. 6. Provide otoform/elastomer inserts. 7. Strengthening.

OT Intervention: Full Thickness Burn *Name 7

OT Intervention: Superficial and Deep Partial Thickness Burns 1. Wound care and debridement, sterile whirlpool, and dressing changes. 2. Gentle AROM and PROM to individual's tolerance 3. Edema control 4. Splinting, if necessary 5. ADL and role activities 6. Strengthening (more appropriate for deep partial thickness burns.

OT Intervention: Superficial and Deep Partial Thickness Burns *Name 6

Occupational Therapy Evaluation 1. Activity interests that can be safely pursued. 2. Environmental risk factors. 3. Evaluation for fractures (note back to fracture eval). 4. Assessment of pain.

Occupational Therapy Evaluation *Four components

Occupational Therapy Evaluation 1. Occupational Profile 2. ROM: focus on AROM a. PROM should be avoided, especially in the inflammatory stage b. Note deformities and nodules 3. Muscle strength a. Avoid muscle testing unless requested by the physician b. Document strength in relation to function 4. Grip strength: use sphygmomanometer 5. ADL and role activities: note if ADL and role activity deficits are related to pain, limitation in motion, deformity, weakness or fatigue. 6. Pain: use pain scales. 7. Edema: volumeter or tape measure.

Occupational Therapy Evaluation 1. __________ ________ 2. ROM: focus on ______ a. ______ should be avoided, especially _____________________. b. Note ______ and ______ 3. Muscle strength a. Avoid _________________________________________ b. Document strength __________________________ 4. Grip strength: _________________________________ 5. ADL and role activities: note if ________________________ 6. Pain: ___________________ 7. Edema: ______________________.

Occupational Therapy Intervention a. Resting hand splints b. Wrist splint c. Ulnar drift splint d. Silver ring splints e. Dynamic MCP extension splint with radial pull f. hand base thumb splint.

Occupational Therapy Intervention 1. Splinting a. ________ _______ splint in the acute stage. b. ______ splint only if arthritis is specific to the wrist. c. ______ _______ splint to prevent deformity. d. _______ ______ splints to prevent boutonniere and swan neck deformities. e. _____ _____ _______ splint with _____ ____ for post-operative MCP arthroplasties. f. _____ _____ _____ splint for CMC arthritis.

Occupational Therapy Intervention 2. Joint Protection techniques. 3. Energy conservation techniques. 4. ROM: focus on AROM. a. Gentle PROM if person unable to perform AROM. b. All exercises should be pain free. 5. Heat Modalities. a. Hot packs can be used before exercises but avoid during the inflammatory phase. b. Paraffin is recommended for the hands.

Occupational Therapy Intervention 2. ____ ________ techniques. 3. ______ _______ techniques. 4. ROM: focus on ______. a. _____ ______ if person unable to perform AROM. b. All exercises should be ____ ____. 5. _____ Modalities. a. _____________________________________________. b. ______ is recommended for the hands.

Occupational Therapy Intervention 1. Utilize physical agent modalities and massage in preparation for functional activities. 2. Teach proper positioning techniques. 3. Splint in the resting position. 4. Gentle ROM 5. Teach relaxation exercises. 6. Utilize proper body mechanics during self-care, leisure, and work activities. 7. Correct environmental factors. 8. Correct standing and seated posture. 9. Modify activities and provide ADL training and AE, as needed. 10. Provide alternative exercise programs (e.g. aquatic therapy, ai chi, tai chi).

Occupational Therapy Intervention 1. Utilize physical agent modalities and massage in preparation for functional activities. 2. Teach proper positioning techniques. 3. Splint in the resting position. 4. Gentle ROM 5. Teach relaxation exercises. 6. Utilize proper body mechanics during self-care, leisure, and work activities. 7. Correct environmental factors. 8. Correct standing and seated posture. 9. Modify activities and provide ADL training and AE, as needed. 10. Provide alternative exercise programs (e.g. aquatic therapy, ai chi, tai chi).

Occupational Therapy Intervention 1. Activity adaptation and assistive device prescription and fabrication to facilitate safe participation in daily occupations. 2. Environmental modifications to maintain safety. 3. Preventative positioning and protective splinting/padding. 4. Activities to increase muscle strength. 5. Weightbearing activities to facilitate bone growth.

Occupational Therapy Intervention 1. _______________ and _____________________ to facilitate safe participation in daily occupations. 2. ____________ __________________ to maintain safety. 3. Preventative _____________ and ________________________________. 4. Activities to increase ____ ______. 5. ____________________________________________.

Occupational Therapy Intervention 6. Health education to promote a healthy lifestyle. a. healthy diet and weight control. b. avoid smoking, caffeine, alcohol, steriods. c. Exercise: swimming, water therapy, walking. 7. Family, caregiver and teacher education about proper handling, positioning, activity adaptations, environmental modifications, and the need to observe all safety precautions. 8. Interventions for fractures and musculoskeletal pain.

Occupational Therapy Intervention 6. ______ ________ to promote a healthy lifestyle. a. healthy diet and weight control. b. avoid smoking, caffeine, alcohol, steriods. c. Exercise: ________, __________, and _______. 7. Family, caregiver and teacher education about: Name 5. 8. Interventions for ________ and _____________________.

Osteoarthritis *Degenerative joint disease 1. Not systemic but wear and tear 2. Commonly affects large weight bearing joints 3. Attacks hyaline cartilage

Osteoarthritis *_________ joint disease 1. Not systemic but ____ and ____ 2. Commonly affects small/large _____ ______joints 3. Attacks _____ cartilage

Osteogenesis Imperfecta Signs and Sx 1. Malformed bones. a. short, small body b. triangular face c. barrel-shaped rib cage d. brittle bones that fracture easily e. multiple fx as the child grows f. developmental growth problems. 2. Loose joints 3. Sclera of the whites of the eyes look blue or purple 4. Brittle teeth 5. Hearing loss (often starting in 20s or 30s) 6. Respiratory problems 7. Insufficient collagen.

Osteogenesis Imperfecta *Signs and Sx: Name 7

Pain *Fibromyalgia Syndrome (FMS): a musculoskeletal pain and fatigue disorder that can vary in intensity. Appears to be nonarticular rhematic disease of unknown origin. -Characteristics: widespread pain accompanied by tenderness of muscles and adjacent soft tissues.

Pain *Define Fibromyalgia Syndrome (FMS). -Name two characteristics

Pain *Low Back Pain a. Most common work-related injury. b. Location: Lumbar lordosis c. Etiology: -Poor posture: seated and standing -Repetitive bending using poor body mechanics. -Heavy lifting -Sleeping with poor posture d. Symptoms: -Pain -Difficulty with self-care activities and other role activities (especially lower extremity activities). -Difficulty sleeping.

Pain *Low Back Pain a. Most common _____-related injury. b. Location: _______ ______ c. Etiology: Name four d. Symptoms: Name 3

Pain *Myofascial Pain: specific to muscles, tendons, and fascia. *Myofascial Pain Syndrome (MPS): -persistent, deep aching pains in muscle, nonarticular in origin. -Well-defined, highly sensitive tender spots (trigger points).

Pain *Define myofascial pain. *Define Myofascial Pain Syndrome (MPS): 2 characteristics

Precautions 1. WB status and the amount of ROM allowed at the hip will be determined by the surgeon. 2. Time frames for beginning OT intervention are also determined by the surgeon.

Precautions *Name three considerations.

Preprosthetic Treatment 1. Change of dominance activities, if needed. 2. ROM of uninvolved joints. 3. Prepare limb for a prosthesis 4. Desensitivization. 5. Wrapping to shape and shrink the residual limb. a. Wrap distal to proximal. b. Tension should decrease with proximal wrapping. 6. ADL training, including education in skin care. 7. Supportive counseling to facilitate adjustment. 8. Individualize treatment to enhance physical and psychological adjustment.

Preprosthetic Treatment 1. Change of ________ activities, if needed. 2. _____ of _______ ____. 3. Prepare __________________ 4. ________________. 5. _______to _____ and _____ the residual limb. a. Wrap ____ to ______ . b. ______ should decrease with proximal wrapping. 6. ADL training, including ____________________. 7. Supportive _________ to facilitate adjustment. 8. Individualize treatment to enhance physical and psychological adjustment.

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Elbow Turntable *The purpose of the elbow turntable is to substitute for IR and ER of the shoulder. *Using sound hand. *Push or pull against stationary object to rotate. *Treatment: Teach patient to analyze task to determine need to use this component for more efficiency.

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Elbow Turntable *What is the purpose of this device? *How would someone with a unilateral UE amputee rotate the elbow away or towards the body? *Someone with bilateral UE amputations? *Treatment: ______________________________________

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Elbow unit *Movement needed to flex the elbow: humeral flexion *Movements needed to lock or unlock elbow mechanism: Depress arm while extending and abducting humerus.

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Elbow unit *Movement needed to flex the elbow: *Movements needed to lock or unlock elbow mechanism:

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Elbow unit Treatment: *Begin by practicing flexing and locking the elbow in several planes: -Manually guide the patient through each motion. -Begin with elbow unlocked. -Patient should listen for click as the lock activates. -Have the pt. exaggerate movements initially. -Use a mirror. *Use humeral flexion to flex the elbow -go beyond the desired height, since the arm will drop with gravity pull as patient is in process of locking the elbow unit.

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Elbow unit Treatment: *Begin by ______ and _______ the elbow in several ______: -Manually guide the patient through each motion. -Begin with elbow _______. -Patient should ______ for _____ as the lock activates. -Have the pt. _________ movements initially. -Use a _______. *Use ______ ______ to flex the elbow -go beyond the desired height. why?

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Terminal Device *Humeral flexion with scapular protraction (abduction) * Bilateral scapular protraction (abduction) * Bilateral scapular protraction (abduction) Treatment: 1.Manually guide patient through motions 2. Keep elbow unit locked in 90 degrees flexion in order to teach use of the TD control first.

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Terminal Device *Movements needed to activate opening or closing of the hand or hook? *Movements needed to activate opening or closing of the hand or hook when strength is limited? *Movements needed for midline use of the TD? Treatment: 1.__________________________________________ 2. For transhumeral prosthesis?

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Wrist Unit *Unilateral amp: have them rotate the TD using their sound hand. Fingers up - Supination; Fingers towards midline; Fingers down - pronation *Bilateral amp: Rotate TD against stationary object, between knees, or with contralateral TD. Treatment: 1. Have the patient analyze the task and determine the most efficient approach for grasp, avoiding excessive or awkward movements. Ex: TD in midpositon for carrying a tray, in pronation for grasping small box from a table.

Procedures for Practice Controls Training for Body Powered Prosthesis Component: Wrist Unit *For someone with a unilateral amputation how do they control the wrist unit to supinate? pronate? midposition? *What about for someone with bilateral amputation? Treatment: 1. ____________________________________________________

Prosthetic Treatment 1. Functional training with prosthesis. a. Practice engagement in activities of interest and occupational role activities. b. Know table 6.2 c. Donning and doffing the prosthesis. 3. Increase prosthetic wearing tolerance. 4. Individualize treatment to enhance physical and psychological adjustment.

Prosthetic Treatment 1. ________________________. a. Practice engagement in activities of interest and occupational role activities. b. Know table 6.2 c. _______________ & _____________ the prosthesis. 3. Increase prosthetic wearing ___________. 4. Individualize treatment to enhance physical and psychological adjustment.

RA -Activities that use AROM are indicated for the tx of RA both in its acute and chronic phases. -PROM is generally contraindicated for persons with RA. If a person is unable to perform AROM, gentle PROM may be used with caution. -Progressive resistance is also contraindicated in the treatment of RA. -The use of isotonic exercises for individuals with RA is somewhat controversial. If isotonics are considered for an intervention, the OT must establish that the individual's joints are stable and would benefit from isotonic exercises without jeopardizing other joints. The individual's responses to these exercises must be monitored; therefore, isotonics are not appropriate for an unmonitored home care programs.

RA -Activities that use ______ are indicated for the tx of RA both in its acute and chronic phases. -______ is generally contraindicated for persons with RA. If a person is unable to perform AROM, _____ _____ may be used with caution. -______ ______ is also contraindicated in the treatment of RA. -The use of ______ exercises for individuals with RA is somewhat controversial. If " are considered for an intervention, the OT must establish that the individual's joints are ______ and would ______ from " exercises without jeopardizing other joints. The individual's responses to these exercises must be _______; therefore, " are not appropriate for an unmonitored ____ ______programs.

Correct answer: B. Reasoning: review the protocol for gamekeepers thumb (aka skier's thumb).

Specific hand and UE disorders practice question *A person incurred a rupture of the ulnar collateral ligament of the MCP joint of the thumb seven weeks ago. Which intervention approach should the occupational therapist use with this client? A. Splinting B. AROM C. PROM D. Strengthening

Symptoms 1. Pain 2. Stiffness 3. Limited ROM 4. Bone spurs Types of Bone spurs: 1. Heberden's nodes at the DIP joint 2. Bouchard's nodes at the PIP joint

Symptoms *Name four *Types of Bone spurs: Name 2

Symptoms of RA 1. Pain 2. Stiffness 3. Limited ROM 4. Fatigue 5. Weight Loss 6. Limited ADL status, diminished ability to perform role activities. 7. Swelling 8. Deformities.

Symptoms of RA *Name 8

THA OT Intervention 1. Educate the individual in hip precautions. a. Posterolateral 1. Do not flex beyond 90 degrees 2. Do not adduct or cross legs. 3. Do not pivot at hip 4. Sit only on raised chair and raised toilet seat. 5. Transfer sit to stand by keeping operated hip slight abduction and extended out in front.

THA OT Intervention 1. Educate the individual in ____ ________. a. Posterolateral: Name 5

THA OT Intervention 1. Educate the individual in hip precautions. b. Anterolateral 1. Do not ER 2. Do not extend hip 3. Precautions vary for anterior THR. Some surgeons follow a no restriction protocol.

THA OT Intervention 1. Educate the individual in hip precautions. b. Anterolateral -Name 2 -Name one consideration

THA OT Intervention 2. Instruct in and practice use of long handled equipment. 3. Provide transfer training. a. Practice with tub bench, raised toilet seat. b. Practice car transfers. c. Practice bed to chair transfers. 4. Practice occupation-based activities (e.g. small meal prep) using proper WB status and amb. device.

THA OT Intervention 2. Instruct in and practice use of___________________. 3. Provide _____ training. Name four necessary. 4. Practice ___________________ (e.g. small meal prep) using proper ______ and __________.

Terminal Devices (TDs) 1. Function to grasp and maintain hold on an object. 2. The two main types of TDs are the hook and the hand. a. Voluntary opening (VO): hook remains closed until tension is placed on cable and then it opens. b. Voluntary closing (VC): hook remains opened until tension is placed on cable and then it closes. c. Cosmetic device: minimal function. 3. Know table 6.1 in Study Guide. 4. Determination of the most appropriate TD is based upon the person's interest, roles, and preferences. a. TDs can be interchangeably used with a prosthesis if the shaft size is the same.

Terminal Devices (TDs) 1. Function? 2. The two main types of TDs are the _____ and the ____. a. Voluntary opening (VO): _____________________________. b. Voluntary closing (VC): ________________________________. c. Cosmetic device: ______ function. 3. Know table 6.1 in Study Guide. 4. Determination of the most appropriate TD is based upon the person's _________________________________. a. TDs can be interchangeably used with a prosthesis if the _________________.

Total Hip Replacement/THA Surgical Procedures 1. Cemented or uncemented 2. Anterolateral or posterolateral (more common) OT Eval *Same as hip fracture

Total Hip Replacement/THA Surgical Procedures 1. Cemented or uncemented 2. ________or _________(more ________) OT Eval *Same as hip fracture

Treatment for LE Amputations 1. Wrapping to shape residual limb and decrease swelling. 2. Desensitization. 3. Strengthening (UE) with the focus on triceps. 4. Transfer training, stand pivot. 5. ADL training, LE dressing is the most difficult. 6. Standing tolerance. 7. W/c mobility.

Treatment for LE Amputations *Name 7

Types of deformities common with RA. 1. Ulnar deviation and subluxatin of the wrists and MCP joints. 2. Boutonniere deformity: flexion of PIP joint and hyperextension of DIP joint. 3. Swan neck deformity: hyperextension of PIP joint and flexion of DIP joint.

Types of deformities common with RA. *Name three specific deformities.