AOTA Musculoskeletal Impairments Flashcards
what are the different levels of amputation
ATK: transfermoral BTK: transtibial BTA: transmetatarsal ATE: transhumeral BTE: transradial BTW: transmetacarpal disarticulation - across a joint
describe the pre-prostethic training goals
assist client in coping with psychological aspects of limb loss
optimize wound healingmaximize residual limb shrinkage
denensitize residual limb
maintain or increase ROM/strength
facilitate indepednence in basic ADLs
explore prosthetic options
describe prosthetic training goals
teach client to independently don and doff prosthesis
train client in care of prosthesis
increase client’s wearing timne to fully day
encourage client in independent use
how do you evaluate for amputations
limitated may be seen in all areas of occupation
self care should be evaled with and without prosthesis
watch for client factors that are limited
performance skills realted to motor skills of uninvolved hand in prep for training in one-handed techniques
functional mobility andbalance inLE amputation
vocationl and recreational interested
driving eval
environmental analsys of commnuity, home and school
describe pre-prosthetic interventions
training in limb hygiene
wound healing
limb shrinkage and shaping - used to reduce edema dndevelop tapered shape.
desensization of residual limb
maintenance of or increasing flxexbility and strength of residual limb to prevent contractures
maintenance of or increasing strength and flexibilty of remaining limbs
describe prosthetic considerations
legnth, strength, flexibilty adns kin integrity
patient reference for cosmesis and fucntion
hand dominance
typical activities to be performed
motivation and attidue
financial coverage
coignition
describe post-prosthetic interventions
client education
training to don/doff prosthesis
wearing schedule - start at 15 mins and increase by 15 with no visual redness
limb hygiene
care
training in use - control, prepositioning, prehension, functional
define contractures
fixed position because of shortening of skin, ligaments, joint capsule, tendons and muscles resulting from conditions
how do you eval contractures
arom/prom
what are the interventions used with contractures
superficial and deep heat to increase tissue extensibility
slow stretch
static splinting
describe fibromyalgia with symptoms
syndrome consisting of widespread pain affecting entire musculoskeletal system
symptoms - soft tissue pain, nonrestorative sleep, fatigue, inability to think clearl,y paresthesias, joint swelling, depression and anxieyt.
how do you eval fibromyaglia
daily activity log, COPM and pain assessment
what are some interventions used with fibromyalgia
client education to avoid pain triggers
gentle regular aerobic exercise, stretching/strengthening activities
sleep hygiene
myofasicla release and trigger point tratment
fatigue management
memory aids
activity/environmental modifications
describe the different types of hip fractures
femoral neck fx - caused by slight rauma or rotational force
intertrochanteric fx - direct blow to the area between greater and lesser trochanter
subtrochanteric fx - direct blow to lesser trochanter
what is the medical management for hip fractures
goals are to relieve pain, maintain good bone position, allow fx healing, and restore optimal function of client
name the weight bearing restrictions
nonweightbearing - no weight toe touch - 10% of bodyweight on leg partial - 50% BW weight bearing as toerated - as much as can be toerated full - 100% bw
what are the two approaches to hip replacements and their precautions
posteriolateral approach - no hip flexion, no adduction and no internal rotation
anterolateral approach - no adduction, no external rotation, no extension
what is the medical management of hip replacements
joint replacements are no considered if client will not comply wiht rhab or if client will not experience sifgnificant fucntional improvement
dependent on type of surgery
get patients up and walking 1-3 days after surgery
what is the role of the OT in hip replacements?
Complete occupational profile
Provide home safety recommendations
Offer education and reeducation regarding hip precautions, including transfers, home mods, ROM restrictions, and positioning.
Emphasize maintaining or increasing joint motion
Increase strength of surrounding musculature
Emphasize increasing independence in ADLs/IADLs using precautions, safety techniques and compensatory strategies.
Prescribe and instruct client in useful adaptive equipment.
Use PAMs as appropriate.
what are the different types of structural changes for LBP
sciatic pain, spinal stenosis, facet joint pain
spondylosis - stress fx of forsal transverse process
spondylolisthesi - slippage of a vertebra out of position
herniated nucleus pulposus - stress tearing of fibers of a disc, causing outward bulge pressing on spinal nerves.
what are the interventions for LBP
education neutral spine positioning body mechanic education adaptive equipment task analysis and ergonomic designs training in energy conservation pain management
what should rehab aim when dealing with injuries
reduction of pain
stabilization techniques
use of adaptive euqipment
incoropation of body mechanics and ergoniomic techniques
adbility to adapt learnig to future applications.
what are some interventions uesd with oncology
training in energy conservation, fatigue management, adn activity adn exercise tolerance to manage the side effects of medical tratments independence and safety in ADLs/IADLs adaptive equipment and assitive tech psychosocial support, caregiver training and support sensory education and denensitization scar management wheelchair seating and positioniong fall prevention lymphedema treatment PAMs end of life care
what are signs and symptoms of osteoarthrisis
most affected jointsa re DIPs, PIPs and first CMC, firs MTP, cervical and lumbar apophyseal joints and knee and hips.
symptoms - joint pain, stiffness, limted ROM, local inflammation and creputis of joints.
bouchard nodes on PIP, heberdens on DIP
what do you eval for osteoarthritis
ADLs, rest and sleep, work, swallowing evals, fall risk, pain
what are some OT interventions for osteoarthritis
occupation based retraining, low impact weight bearing activities
good positioning and posture
enviuronmental modifications
education in body mechanics, energy conservation and joint protection
what are the signs and symptoms of RA
symmetric polyarticular presentation - PIP, MCP joints, all thumb joints, wrist, elbowm, ankle, metatarsophalangeal joints, TMJ, hips, knees, shoulder and cervical spine.
symptoms - pain, redness, warmth, tenderness, morning stiffness, ROM lmiitations, muscle weakness, weight loss, malaise, fatigue, and depression
what are some common deformities seen with RA
boutonniere deformity, swanneck, mallet finger, ulnar drfit, subluxation of wrist, MCP joints, anklyosis of joint fusion, extensor tendon rupture, trigger finger
mutilans deformity - floppy joints with shortned bones and redundant skin
subcutaneous nodules
claw toe
hammer toe
cock up toe
bunions
how can you diagnose RA
need four of the following: morning stiffness three or more swollen joints in 14 possible areas swollen joints of hands symmetric swoollen joints RA serum rheumatoid factor radiogrpahic changes on posterioanterior hand and wrist radiographs
what are the stages of RA
acute
subacute
chronic-active
chronic-inactive
what are the classifications for the progression of RA
stage 1 - no changes on xray
stage 2 - evidence of osteoporsis; no joint deformity
stage 3 - joint deformity, muscle atrophy
stage 4 - terminal + all of stage 3
what are some ot evaluations used for RA
biomechanical factors cognitive function factors psycholigcal factors loss of social relationships performance affected by time of day and medkication use fatigue
what are some OT interventions used for RA
lmite activities during acute flare ups assistve devices PAMs therapeutic exercise splinting during acute flair ups education on disease process, sypmtoms management, joint protetion, and fatigue managment
