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