Competency Exam 3 Flashcards
1
Q
What are the 3 options for intervention when diminished or lost protective sensation is present?
A
- Compensatory strategies to prvent injury
- Findings of discomfort associated with touch (hypersensitivity) suggest a need for desensitzation
- Sensory reeducation is provided for patients who have some sensation adn potential for better sensation or better interpreation of sensory information
2
Q
What are the learning principles for sensory retraining strategies?
A
- Each patient should practice within the natural context of activites.
- Tailor training and training materials to teh interest and ability of the patient.
- Grade the activity so that the patient can meet the expectations for improved performance
- The patient must attend to the stimuli and information provided and perceive them as important and relevant
3
Q
What are the five mechanisms of damage to insensitive limbs?
A
- continuous low pressure
- Concentrated high pressure
- Excessive heat or cold
- Repetitive mechanical stress
- Pressure on infected tissue
4
Q
What are the principles of Compensatory Strategies for upper extremities?
A
- diminished or lost protective sensation
- goal = avoid injury; don’t have pain as a warning mechanism
- avoid continuous low pressure, concentrated high pressure, hot/cold extremes, repetitive motions/shearing, pressure on unhealthy tissue
- rely on other senses, good skin care
5
Q
What are the mecahnisms of damage secondary to loss of protective sensation?
A
- Continuous low pressure: with sustained pressure as light as 1 lb per square inch, capillary flow is blocked; this can cause tissue necrosis, leading to pressure sores (decubitus ulcers)
- Concentrated high pressure: Sudden high force that is accidental and/or a high force applied over a very small area, so that the force is inadequately distributed. This may result in tearing of skin and/or soft tissue or tissue necrosis as a result of insufficient blood supply.
- Excessive heat or cold: temperature extreemes that lead to burn or frostbite injuries
- Repetitive mechancial stress: repetitive motions or shearing of skin against clothing or objects that causes inflammation of the tndons or skin. Blistering of skin can also occur.
- Pressure on infected tissue: Continued use and pressure on infected tissue can hinder or prevent the natural healing process
6
Q
What is an important principle of skin care?
A
If the time for the skin to recover its normal color exceeds 20 minutes, it is absolutely essential to discover the cause of teh skin irritation and correct it. Modification of position, schedule, procedure, equiment, or orthocis is necessary
7
Q
What are the principles of desensitization?
A
- Hypersensitivity; includes allodynia & hyperesthesia
- allodynia - the perception of pain as result of a non-painful stimulus
- hyperesthesia - a heightened sensitivity to tactile stimuli
- Goal = decrease comfort associated with touch in hypersensitve area
- Intervention = desensitization program of repetitie stimulation of hypersenstive area with variety of sensory expereinces (e.g., textures, vibration); hopeful that progressive exposure to stimulation will allow progressive tolerance
8
Q
What does a program of desensitization usually include?
A
- repetitive stimulation of the hypersenstiive skin with items that provide a variety of sensory experiences, such as textures ranging from soft to coarse.
9
Q
What does the hierarch of desensitization material described by Hardy, Moran, and merritt include?
A
- Level 1: tuning fork, paraffin, massage
- Level 2: Battery-operated vibrator, deep massage, touch pressure with pencil eraser
- Level 3: Electric vibrator, texture identification
- Level 4: Electric vibrator, object ID
- Level 5: Work and daily activities
Patients advance to teh next level after they demonstrate tolerance of the current level without signs of irritation.
10
Q
Describe the hierarchy of desensitization described by the Downey Hand Center?
A
Dowel Textures
- Moleskin
- Felt
- Quickstick
- Velvet
- Semirough cloth
- Velcro loop
- hard foam
- burlap
- rug back
- velcro hook
Immersion Textures
- Cotton
- Terry cloth peices
- dry rice
- popcorn
- pinto beans
- macaroni
- plastic wire insulation pieces
- small bbs, buckshot
- large bbs, buckshot
- plastic squares
Vibration (cps
- 83 cps near area
- 83 cps near area, 23 cps near area
- 83 cps enar area, 23 cps intermittent
- 83 cps intermittent, 23 cps intermittent
- 83 cps intermittent, 23 cps continuous
- 83 cps continuous, 53 cps intermittent
- 100 cps intermittent, 53 cps intermittent
- 100 cps intermittent, 53 cps continous
- 100 cps continuous, 53 cps continuous
- No problem with vibration
11
Q
What are desensitization techniques used in therapy?
A
- Can use items based on a hierarchy or a series of levels
- Dowel textures, particle immersion, vibration are some examples
- Others include: weight bearing, massage, use of TENS unit, fluidotherapy and theraputty
- Goal = to incorporatre use of affected part in everday functional occupations
12
Q
What is sensory reeducation?
A
A combination of techniques that helps the patient with a sesnory impairment learn to reinterpret sensation.
13
Q
What are the principles of sensory reeducation?
A
- Learning to reinterpret sensation after sensory impairment
- Goal= regain use of sensation of teh affected part (e.g. hand)
- Clients with CVA, periperial nerve injury (PNI)
14
Q
What is the most important information when interacting with external environment?
A
In daily activites, cutaneous information fromt eh fingers, palm, and toes is most important because it is generally these skin surfaces that interact with teh external environment.
15
Q
What is the focus of sensory reeducation?
A
To regain the use of sensation of the hand.
16
Q
What is the purpose of sensory reeducation in patines with peripheral injuries?
A
To help them learn to recognize the distored cortical impression (cognitive reorientation)
17
Q
What are the sensory reeducation techniques used in therapy?
A
- Based on levels or a heirarchy
- With PNI, use of vision in imprtant in introduction of tasks; graphesthesia
- With CVA, may use cobination of utilizing vision in fucntional tasks, occlude vision with object ID; neural plasticity
18
Q
When can sensory reeducation occur?
A
When the patient first can appreciate deep, moving touch. In the early phase of interention, the patient concentrates on learning to match the sesnory perception of stimuli with teh visual perception.
19
Q
What are the five stages of reeducation used int the Nakada Uchida program?
A
- Stage 1: Object recognition using feature detection strategies. Obejcts that varied greatly in shape, material, and weight were used. The patient was encouraged to handle each object and identify teh object characteristics.
- Stage 2: Prehension of various objects with refinement of prehension patterns. In this stage, grasping obejcts that varied in size and shape and emphasized. The patient needed to maximize the contact between the object and th ehand to develop the ability of the hand to closely contour to obejcts, which is seen in normal grasp
- Stage 3: Control of prehension force while holding obejcts. Feedback regarding excessive force that was used to maintain grasp was provided throught eh use of a strain gauge and thearpy putty
- Stage 4: Maintenance of prehension force during transport of obejcts. Whild holding an object, the patient moved the shoulder, elbow, and wrist into varyign positions of flexsion and extension.
- Stage 5: Object manipulation. The patient practiced grasp and release of objects adn moved objects in teh hand into various positions.
Appropriate grading of sensory reeducation activities is important to optimize patient motivation and progress
20
Q
PROCEDURES FOR PRACTICE
What are the principles for sensory reeducation?
A
* Choose a quiet environment that will maximize concentration
- Sessions should be brief, approximately 5-15 minutes
- Three or four practice or homework sessions per day are recommended
- Instruct teh patient and/or family in techniques to be used during practice
- Monitor patient’s home program and progress during therapy sessions
Prerequisties for Early-PHase Sensory Reducation
- Patient must be able to perceive 30 cycles per second vibration and moving touch in the area
- Patient must be motivated and ablet o follow thorugh with the program
Techniques for Early-Phase Sesnory Reeducation
- Use the eraser end of a pencil
- Apply moving storkes to the area
- Use enough pressure for the patient to perceive the stimulus but not so much that it causes pain
- Ask teh patient to observe what is happening first and then to close the eyes and concentrate on what is being felt
- Instruct the patient to put into words (silently) what is being felt
- Instruct the patient to observe the stimulus again to confirm the sensory expereince with teh perception
- When perception of constant touch returns to the area, use a similar process for constant touch stimuli
- Test the patient by requiring localization of moving and constant touch wihtout seeing the stimulus
Prerequisites for Late-Phase Sensory Reeducation
- Patient must be able to percieve constant and moving touch at teh fignertips
- Patient must demonstrate good localization of touch
Techniques for late-Phase Sensory Reeducation
- Use a collection of common objects taht differe in size and shape
- Instuct teh patient to grasp and manipulate each item with eyes open, then with eyes closed, and then with eyes open for reinforcement
- The patinet shoudl concentrate on the tactile perception
- Test the patient by timing correct identifcation of each object without vision
- Grade the practice by intoducing objects of similar size but different texture and then small objects that vary in size and shape but are similar in texture.
21
Q
What is Complex Regional Pain Syndrome (CRPS)?
A
- AKA: causalgia (major or minor), shoulder hand syndrome, Reflex Sympathetic Dystrophy (RSD)
- Vasomotor sympathetic nervous system response that is not in proportion to injury (abnormal)
- Can be entrie limb or 1 finger
- Can radiate
- Dysfunction of SNS
- pain abnormalities, sensation, blood flow, thermoregulation, motor control, anatomy and physiology of limb
22
Q
What are the causes of CRPS (complex regional pain syndrome)?
A
- Disruption to sympathetic nervous system
- Often occurs after acute injury
- can be very minor (sprained ankle)
- surgery
- cumulative trauma
- trauma
- Why this happens is not clearly understood
- SNS loops –> reactivates response rather than shuts it down
23
Q
Describe the SNS’s role in CRPS.
A
SNS normally will shut down after injury
- In CRPS, it continues with an abnormal heightened activity
Abnormal feedback loop of a normal response to injury:
- Cycle of pain, swelling, decreased movement
- pain described as burning, sharp, stabbing or searing - 25% of cases have no pain
- Allodenia - pain from non-painful stimulus - i.e. air
- Hyperpathia - prolonged pain after removal of stimulus
- Edema progreses beyond intial injury - piting browning edema
- stiffness occurs because of chronic edema –> decreased ROM <– protective posture
24
Q
What are the different types of CRPS?
A
Continuity type
- the symptoms may migrate from the initial site of the pain
- For example, from your hand to shoulder, trunk and face, affecting a quadrant of the body
Mirror-image type
- The symptoms may spread from one limb to the opposite limb
Independent type
- Symptoms may leap to a distant part of the body
- example: hand to foot
25
Q
What are the trophic symptoms of CRPS?
A
- Skin may change color with activity or while at rest. Colors can range from blue, purple, red, white, and mottled combinations of all the colors
- Brawny skin
- Skin can be dull or shiny
- Hair is sparse and coarse
- Nails may be rigid
26
Q
What are the vasomotor symptoms of CRPS?
A
- Temperature of extremity may vary widely adn suddenly from very cold (usually skin is blue) to very hot (usually skin is red)
- Poor tolerance of cold temperature (especially water)
27
Q
What are the motor symptoms of CRPS?
A
- Muscle atrophy and shortening – may note contractures in advanced cases
- may have dystonia
- weakness
- tremors
- resting position – usually guarded with fingers flexed or in a lumbrical ro half-flexed position with elbow flexed
28
Q
What are the symptoms of pain and edema in CRPS?
A
Pain
- Unrelenting, severe pain that is out of proportion in relation to injury
- Avoids moving, protects extremitiy, hypersenstive to touch
Edema
- initially thick, pitting, and significant
29
Q
What is the medical intervention for CRPS?
A
Treating Physicians
- Neurologists
- pain specialists
- Orthopedists
Medication
- Cymbalta
- Neurontin
- NSAIDS & cortiocsteroids for pain and inflamation
- Bone-loss medications
- Sympathetic nerve-blocking medication (injection of anesthetic)
Surgical interventions
- ablative sympathectomy
- Sympathetic nerve blocks either at the brachial plexus (for UE) or the lumbar plexus (for LE)
- Intrathecal pain pumps
Spinal cord stimulation
- insertion of tiny electrodes along spinal cord. A small electrical current delivered to the spinal cord sometimes results in pain relief
- Electrical impulses applied to nerve endings to decrease pain
Transcutaneous electrical nerve stimulation
- electrical impulses applied to nerve endings to decrease pain
Biofeedback
- learning to become more aware of body to relieve pain
30
Q
What is the therapeutic intervention for CRPS?
A
Psychosocial
- Be gentle with physical examinations because they may be very painful
- Patients may be leery and fearful of medical professionals if the symptoms have been undiagnosed for a long time. Many patients have already been referred to psychaiatry for drug-seeking behaviros and for symptoms being “only in their head”
- Patients expect the therapists to minimize teh pain and force unrealistic activities
Therapy that sets the stage for future intervention
- Weight bearing – may only include placing the hand flat on a smooth warm surface such as his or her own leg or a wooden tabletop
- Functional use – most patients cannot tolerate using the limb for long periods. Performance of tasks with the affected limb is also what causes the most pain. Helping the patient to understand this conundrum will prove helpful to the rehabilitation process
- Sensory reeducation – using normal desensitization strategies (e.g. rubbing with different textures, contrast baths, putting hand in dry beans)
Contraindications
- Immobilization is contraindicated and contributes to teh disease process. Splinting is contraindicated; however, it may be indicated in some instances (e.g., unstable fractures when patient is not a candidate for surgical intervention) and immobilization is unavoidable
- Manual therapy is very painful adn should not be attemtped in the early stages of intervention
- icing
- heat modalities may decrease pain; however, they must be used with caution becasue of decreased sensation
Discharge recommendations
- Outpatient therapy with therapist experienced in treating CRPS
- Outpatient workup with physician experienced in treating complex regional pain syndrome
- Aquatic therapy in a warm pool may reduce pain
31
Q
What happens in Stage 1 (Acute) of CRPS?
A
Acute (1-3 months)
- usually can repsond to treatment if diagnosed early
- pain is only at site of injury
- swellign and increased sensitivity to touch
- skin is warm and red
- osteoporosis begins at 3 to 4 weeks
Description
- pain (burning, irritating light touch)
- redness of joints
- pain due to movement
- early stage hand may be pale
- sweat may drip from digit
32
Q
What happens in Stage 2 (sub-actue) of CRPS?
A
Sub-acute (within 1 year)
- pain becomes more diffuse, swelling becomes more thick and hard
- Skin becomes dry, nails brittle, grooved, stiffness is pronounced around joints
- May see atrophy of finger tips (pencil pointing appearance)
- Osteoporosis will now be pronounced
Description
- pain
- edema (brawny and hard)
- doesn’t respond anymore
- decreased sweating
33
Q
What happens in Stage 3 (chonic) of CRPS?
A
Chronic (can last longer than 2 years)
- Several months to many years
- pain may diminish
- deformities are now more fixed (clawing, etc)
- Atrophy of muslces is very pronounced
- Skin loses creases and becomes dry and cool
- extreme osteoporosis
Description
- fibrosis with joint contracture, thickening of structures of joints
- “dead hand” - pale, blue, atrophy, skeletal profound osteoporosis –> very difficult to reverse
- Men more likely than women
- UE more than LE
- diathesis = person is labile, dependent, low pain tolerance NOT MALINGERING
34
Q
What is the role of OT intervention in CRPS?
A
- Diagnose early
- contact MD immediately
- edema reduction
- AROM
Encourage functional use - Sensory desensitization/re-education
- Patient education
- WEIGHT BEARING: scrubbing on all fours; carrying a heavy bag
- Education
- Psychosocial
- Coping skills training
- significantly affects patient’s life and family
- Anxiety, loss of job, frustration because of misdiagnosis or missed diagnosis
- Reduce pain: TENS or desnesitization –> working in different particles
- Massages (retrograde)
- elevation
- compression wrap
- Contrast bath
- Splint, continual passive range of motion machine
- biofeedback
- ultrasound
- usually don’t sling because it encourages protective posturing
- gentle stretch
- decrease caffine
35
Q
What is fluidotherapy and why is it used?
A
- dry superficial thermal phsycial agent that transfers heat to soft tissues by agitation of heated air in cellux particles
- contains fine particles of cellus (ground up corn cobs that are about the size of grains of sand)
- the benefit is that patients can perform AROM while undergoing treatment (a good prepartory activity before occupation-based activity)
Contraindication
- tissue healing
- severe circulatory obstruction
- systemic infectious diseases (overheat body - fever)
- open wound or sutures
- severely impaired sensation
- malignancy
36
Q
What comprises the clinical examination of the hand?
A
- Occupational Profile
- Accurate medical history
- Hand dominance
- Mechanism of injury (neurological or orthopedic)
- General Inspection
- Can the hand be placed in functional position?
- What is the U/E posture?
- What is the hand posture?
- White towel on table –> place injured hand on towel and non-injured hand to compare
- Observe and compare to contralateral side
- Color -bruising, change in vasculation, inflammation – pale, red, blue
- Shape - arches of hand - flattened (weakness, atrophic, deinnervation
- skin creases - swelling
- atrophy - thenar and hypothenar (if flat then hadn is deinnervated)
- edema
- vascularity - cool (loss of vascularity) hot (inflammation)
- skin texture - waxy, scaly, calloused, chapped
- deformities - joint sublux or misalignment, look for nail bed to be parallel
- lesions - scars, abrasions, burns, wounds - is there any drainage from wound? color? amount? odor? measure wound and location, classify by color (black, yellow, red)
37
Q
What are the common deformities of the hand?
A
- Boutoniere - an imbalanced digital position of PIP flexion and DIP hyperextnsion. The deformity is due to volar displacement of the central slip
- Swan neck - presents as MP flexion, PIP hyperextension, and DIP flexion.
- Mallet deformity - disruption of the terminal extensor tendon and manifests itself as DIP extensor lag.
- Intrinsic minus - position of MP hyperextension and PIP flexion associated with muscle imbalance in ulnar-innervated structures.
38
Q
What structures and characteristics do you palpate in a hand exam?
A
- muscle bulk
- muscle tone
- skin temperature
- nodes
Approach the hand gently, palpate every area client complains of symptoms and looks suspicious
wear gloves - keep everything clean
39
Q
What are the hand assessments used in a hand exam?
A
- pain - visual analog scale
- Sensory - sterognosis, proprioception, vibration, kinesthesia, tactile location, light touch
- Goniometric measurement (AROM, PROM, TAM & TPM)
- TAM - total active motion - sum of composite digital flexion and extension of AROM
- TPM - total passive motion - sum of composite digital flexion and extension of PROM
- Normal TAM & TPM are 270 degrees
- To calculate add the measurements for flexion of the MP, PIP, and DIP joints. Then subtract the combined deficits in extension for those joints.
- Observe for tenodesis, digit alignment
- MMT, Grip and Pinch
- Coordination (Minnesota Rate of Manipulation Test, Box and Block test, purdue pegboard test, nine-hole peg test, jebsen test of hand function, TEMPA)
- Edema (circumferential and volumeter)
40
Q
What special hand tests are used in a hand exam?
A
- Finkelstein’s test: pain in the 1st dorsal compartment is positive for tenosynovitis
- make a fist with thumb tucked into fist. ulnarly deviate fist.
- if positive teach patient to avoid wrist deviation, especially in conjunction with pincihign. Provide built-up handles. If splinting, use a forearm-based thumb spica
- Median N compression tests
- Phalen’s test - maintaining the wrist in flexion for 60 seconds. done with extended elbows to avoid confusing these findings with a positive elbow flexion test. Positive if numbness and tingling in median distribusion
- Tinel’s test - tap/percussion over median nerve - positive if tingling or electric shock occurs
- Both of these test indicate median n compression and are accompanied by thenar atrophy and night pain
- Grind Test - test of CMC degenerative joint change - grind CMC into trapezium with rotation
- Allen’s test - test for arterial blood flow
- occlude radial and median nerve and have patient pump fist. Release one and watch it flush. If hand doesn’t flush the artery is occluded
- if they have arterial insufficiency it leaves the hand pale adn cool
- if they have venus insufficiency it leaves the hand blue (cyanotic)
- Don’t elevate hand with vascular occlusions.
41
Q
What are the biomechanical principles of strengthening the hand/UE?
A
Strength increases when muscle is stressed to the extent that additinoal motor units are recruited
muscles must be stressed to the point of fatigue
muscle will only gain strength within the ROM exercised
Isometric, isotonic assistive, isotonic active, isotonic active resistived exercises
- isometric - exercise in which a weak muscle is isometrically contracted to its maximal force 10 times with rest periods between each contraction
- muscle grade: trace (0) the force of contraction is not sufficient to move teh part
- Procedures: provide a stimulating environment; explain procedures; instruct the patient to contract the weak muscle (“hold”). External resistance appplied by teh therapist may help the patient isolate teh contraction ot the weak muscle or muscle group; patient holds contraction at maximum effort as long as possible while breathing normally; repeat 10 times with a rest between each contraction; increase duration of maximal contraction as patient improves; maximal isometric contraction is contraindicated for patietns with cardiac disease
- Isotonic Assistive (Active Assistive ROM) - Exercise in which a weak muscle is concentrically or eccentrically contracted through as much ROM as patient can achieve; therapist adn/or external device provides assitance to complete motion
- Muscle Grade: Poor minus (2-), fair minus (3 - ); though muscle can move only through partial available range in either a gravity-eliminated or against-gravity plane
- Procedures: Provide a stimulating environment; explain procedures; for a 2- muscle, position limb to move in a gravity-eliminated plane; for a 3- muscle, position the limb to move against gravity; patient moves weak muscle through as much range as possible; therapist provides external force to complete motion; although this seems similar to PROM, it differs because patient actively attempts to contract weak muscle
- Isotonic Active (AROM) - patient contracts muscle to move part though full ROM
- Muscle grade: Poor (2), Fair (3), Muscle can move through full available range in either gravity-elminated
- Procedures: Provide a stimulating environment; explain procedures; for a 2 muscle, position the limb to move in a gravity-eliminated plane; for a 3 muscle, position the limb to move against gravity; patient moves weak muscle through full available ROM; patient repeats motion for 3 sets of 10 repetitions with rest break between sets
- Isotonic Active Resistive (Active Resistive ROM) - Patient contracts muscle to move part through full available ROM against resistance
- Muscle grade: Poor plus (2+), Fair (3), Fair plus (3+), Good (4), Good plus (4+)
- Procedures: provide a stimulating environment; explain procedures; for a 2+ or 3 muscle, position limb to move in gravity-eliminated plan; for a 3+ or above muscle, position limb to mvoe against gravity; therapsits determines appropriate amount of resistance depending on the strengthening used, teh 10-RM is established, which is teh maximum weight a person can lift through 10 repetitions with smooth controlled movement. If teh simplified protocol is used, the 1 - RM is established, which is the maximal amount of weight the patient can lift one time in a smooth controlled movement; Patient moves weak muscle through full available ROM against resistance; If the DeLorme protocol is used, the patient does 3 sets of 10 reps with varying resistance and rest breaks between sets. If teh simplified protocol is used, the patient does 4 sets of 10 reps at a set weight with rest breaks between sets.
42
Q
What are the biomechancial principles to increase ROM?
A
- Passive stretching: Slow and gentle stretch to the point of maximal stretch in direction of teh line of pull; a few degrees beyond point of discomfort and hold for 15-30 seconds
- Safety precautions: (1) Inflammation weakens the structure of collagen tissues; therefore, those tissues must be stretched cautiously with slow, gentle motion; (2) Sensory loss prevents the patietn from monitoring pain; thus, the therapist must pay particular attention to the tension of the tissues beign stretched; (3) Overstretching must be avoided becasue it causes internal bleeding and subsequent scar formation that may eventually ossify. Overstretching can lead to heterotopic ossification; (4) Resistance can be provided by weights either held in patient’s hand or strapped around the moving part. Resistance can also be provided by tools and materials of activity. The greater the resistance taht is provided, the more aggressive teh stretch will be, so the therapist must take care that the stretch is slow and gentle
- Manual Stretching Methods
- Provide a relaxing environment for the patient
- Describe manual stretching, noting that it involves tolerable pain
- Use motions identical to motions used in ROM evaluation
- Stabilize the bone proximal and distal to the joint that is to be moved to avoid any compensatory movement
- Move the bone smoothly, slowly, and gently to teh point of maximal stretch (mild discomfort indicated verbally or facially by the patient)
- Make sure the movement is in the line of pull of the muscle
- Encourage the patient to assist in moving the limb if possible
- Hold the limb at the point of maximal stretch for 15-30 seconds
- Relief of discomfort should immediately follow the release of stretch
- If the patient complains of residual pain, future stretches should be performed more slowly and with less force
- Active stretching - place client in actiivty that encourages the desired motion. Use contract-relax technique of isometric contraction of the tight muscle for 3 to 10 seconds followed by passive stretch
- Contract-relax involves a maximal isometric contraction of the tight muscle, usually performed at teh point of limiation. The muscle is contracted maximally for approx. 3-10 seconds against resistance provided by the therapists and then relaxed. During the relaxation phase, the therapist moves the part in the direction opposite to the contraction and holds it.
43
Q
What are the biomechancial princliples to increase muscular endurance?
A
- Use moderately fatiguing activity for increasingly longer periods with intervals of rest
- Increase the number of repetitions of a specific motion or time on task for this to be effective
44
Q
What basic hand interventions do you use to address edema?
A
- Contrast baths: 2 basins of water (100 degree H20 & 50 degree H20) place hand in warm water for 3 mins followed by 1 min in cold water for 4 or 5 cycles
- Compression:
- Coban wrap distal to proximal - wear during activity
- Isotoner glove for short term. replace every 4 days
- Position in elevation
- hold extremity above heart and perform overheat fist 10 minutes on the hour - if they have good vascularity
- retrograde massage - massage gently but firmlyfrom finger tips to heart
45
Q
What basic hand interventions do you use to address scar managment?
A
- Compression
- coban wrap
- isotoner glove
- Scar massage
- use soft pencil eraser followed by massage cream
- Remodel scar tissue usign elastomer and gel pad under pressure
- contraindication: open wound
46
Q
What basic hand intervention do you use to prevent tendon adhesion?
A
Digital Tendon Gliding
- Individual tendon glides are specific active exercises to promote independent function of structures
- Purpose is to reduce soft tissue adhesions
- Three types
- Differential flexor tendon gliding exercies at the wrist
- Median nerve gliding exercises
- ulnar nerve gliding exercises
- go to start position between each movement 10x several times a day
Blocking Exercise
- Stablization is provided to adjacent joints to facilitate tendon excursion at a specific joint
- Blocking is applied by either the therapist, patient or blocking tool or splint
- exercise comfortably into the end range to remodel the tissue. Teach them to do the exercises frequently adn slowly, holding at the comfortable end range for 3-5 seconds
Place and Hold
- Place the hand by passive or active assisted motion to end range followed by contraction to hold the position
- Release teh assisting hadn while the patient tries to sustain teh position in a pain-free way
- Use when PROM exceeds AROM
- Purpose is to promote passive glide with less stress on the tissue
- can be effective in combo with blocking exercises
47
Q
What intervention do you use to address stiff hand?
A
- Prevent stiff hand by simultaneously managing edema and inflammation
- Full, gentle arcs of motion
- Gentle passive motion
- buddy straps
- static splic during acute, inflammatory stage
Avoid aggressive PROM. It is okay to coax tissues to lengthen within their available comfortable range, but always respect teh feeling of tissue resistance, and do not exceed it.
48
Q
What intervention do you use for tendinosis?
A
- If indicated, splint to rest the injury
- Active pain free motion in conjunction with splint
- Redesign workspace and modify activities
- Lateral epicondylitis: Velcro elbow cuff with gel insert below extensor wad. Support wrist at neutral during the night [resting splint]
- Medial epicondylitis: eliminate resisted flexion and pronation. Velcro elbow cuff with gel insert below the flexor wad. Support wrist at neutral during the night.
- use good ergonomics must change activity that caused it
- after teh inflammation subsides, upgrade intervention to restore normal function through gradual mobilization balanced with rest.
- Pain must be avoided
- Instruct in tendon gliding exercises in a pain-free range appropriate to teh particular strutures involved.
- Progress from isometric exercises with gentle contractions of involved structures to isotonic exercises
- Gradually introduce low-load, high-rep strengthening in short arcs of motion.
- Increase teh arc of motion and modify proximal positions to be more challenging if appropriate for work simulation.
- Instruct in gentle flexibility exercises in a pain-free range.
- Aerobic exercises and proximal conditioning are essential
- How to evaluate
- start with a cervical screening to look for proximal causes of distal symptoms
- compare both extremities
- asses for pain that may be local or diffuse, swelling, sensory changes, and loss of function.
- identify the activity causing the pain
- ergonomic risk factors for tendinitis include forceful, rapid, repetitive movement
49
Q
What is De Quervains’s disease and how is it treated in OT?
A
- Tendinosis involving abductor pollicis longus and extensor pollicis brevis at the first dorsal compartment
- use teh comfort cool thumb splint or long thumb spica with teh IP free
- Avoid wrist deviation and pinch motions
- modifiy work tasks and use built up handles
- rest the hand and prevent excess thumb motion
Can be tested by finkelstein’s test (hand in fist and ulnar deviate the wrist - positive if there is exquisite pain with passive wrist ulnar devation while flexing thumb)
50
Q
What interventions are provided for nerve compressions?
A
Median nerve compression/Capal Tunnel Syndrome (CTS)
- Neutral splinting at the wrist
- Median nerve glide exercise 10x several times a day
- Modify activity demands to prevent extreemes of forearm rotation, wrist flexion, sustained pinch and grip
- change person’s pattern of hadn use - ergonomic recommendation
Ulnar Nerve Compression/Cubital Tunnel Syndrome
- Ulnar nerve glide exercises 10 x several times a day
- Modify activty demands to prevent pressure on elbow
- Pad or cushion the elbow in bed at night
51
Q
What Intervention is provided for nerve laceration?
A
- Desensitization for hypersensitivity - unresolved n laceration for neuroma treatment
- Splint to protect a surgical repair of nerve - after surgery repair
- Teach client to compensate for lost protective sensation
- Identify the splint for
- Median nerve: low median (laceration at the wrist) - hand-based thumb abduction splint to maintain balance, to substitute for lost thumb opposition, and to rpevent overstretching of denervated muscles; high median (laceration near or at the elbow) - hand-based thumb abduction splint
- Ulnar Nerve: low ulnar nerve (laceration at the wrist level) - aims to prevent overstretching of the denervated ring and small finger intrinsics. An MP blocking splint that maintains slight MP flexion and prevents MP extension is recommended; high unlar never (laceration at or proximal to the elbow) - same as low ulnar nerve
- Radial Nerve: low radial nerve (laceration at deep motor branch) - splinting to promote tenodesis for functional pinch, grip and release; high radial nerve (laceration caused by humeral fractures) - restores tensodesis and may be useful for many months during teh wait for reinnervation which occurs at approx 1 inch per month. Wrist extention splint (wrist cock-up)
52
Q
What types of deformities are associated with each nerve laceration?
A
Median nerve - ape hand
ulnar nerve - claw hand
radial nerve - wrist drop
53
Q
What intervention is used to address extensor tendon injury?
A
- Injury can be minor or superficial
- Mallet finger (Zones I and II) and Boutonnier (Zones III & IV)
- Surgical repair of extensor tendon
- splint to protect repair by limiting flexion
- do NOT flex, maintain extension
- Splint must be worn 24/7 until complete healing is achieved
54
Q
What intervention is used to address flexor tendon injury?
A
- Postoperative splinting to protect repaired structures
- minimize formation of adhesions through controlloed motion of passive flexion - active extension within protective dorsal splint
- At night strap fingers to the dorsal hood
- DON’T put hand in extension keep flexed
- Fabricated splint with dorsal splint
- move so they don’t have adhesion but not so much they pop are repair
55
Q
How many flexor tendon zones are there?
A
3 Thumb
5 Hand
(Carpal tunnel is at zone IV)
56
Q
How many extensor tendon zones are there?
A
7 Hand
5 Thumb
(Carpal Tunnel is Zone 7)
(injuries at zones I and II leads to a mallet deformity)
(injuries at zones III and IV of hand lead to a boutoniere deformity)
(injuries at zones V and VI of hand may be treated with immobilization or by controlled early motion)
(injury in zone VII is likely to resutl in restrictions due to development of adhesions)
57
Q
What occupations can be used to facilitate recovery for flexor or extensor tendon injuries?
A
- Moderate temperatures
- Gentle active motion through full arc of motion
- evaluation rather than dependent posture
- avoid forceful pinch
- avoid abrasive materials
- repetitions without strain
- intervals of rest
- short duration, repeated throughout the day
- meaningful and contextually relevant
- Avoid: ironing, scrubbing, sewing, needle point, knitting, sawaing
- Good exercises: wiping a counter, dusting with dust mitt, card games (holding or card holder), brushing teeth/ADLs, flower arranging, sponge or finger paint, finger weaving, washing windows
58
Q
What muscles make up the rotator cuff?
A
S - Supraspinatus
I - Infraspinatus
T - Teres minor
S- Subscapularis
59
Q
What tests are used to evaluate rotator cuff injuries?
A
Neer Impingement - Forced forward flexion witht eh shoulder internally rotated. If teh patient expresses pain, teh sign is positive, indicating compression and/or inflammation of teh supraspinatus and/or long head of the biceps
Hawkins Test - Shoulder and elbow are flexed to 90 follwed by forced internal rotation. If teh patient expresses pain, the test is positve, indicating compression and/or inflammation of the supraspinatus and long head of the biceps
Empty can test: Shoulder elvation to 45 and internal rotation (thumb facing down). Therapist applies resistance to abduction (downward force). Positive sign is weakness or pain. This test indicates a tear of teh supraspinatus tendon. Repeat the same test at 90. If pain is only experienced at 90 position, suspect bursitis
Drop arm test : Patient’s arm is postiioned in 90 degrees of abduction. The patietn slowly lowers his or her arm to the side. The test is positive if the patient drops the arm to teh side, indicating a supraspinatus tear
Biceps speed’s test: Shoulder flexed to 90, forearm supinated, and elbow extended. Resistance is applied to flexion (downward force using a long lever arm). Positive sign is pain over bicipital grove
60
Q
What intervention should you implement if the patient tests positive for a rotator cuff injury?
A
Rotator cuff injury
- Post-operative therapy
- regaining full ROM, scapula and rotator cuff strengthening, practicing activies of daily living, and occuaptional tasks
- immediately begin with PROM/AAROM for the next 4-6 wks
- pendulum exercises, passive shoulder elevation, adn internal/external rotation int eh adducted of slightly abducted position
- ice pack should be used befoe, during,a nd after exercise to decrease paina dn swelling
- During this time, the patient should be instructed in one-handed techniqeus to perform activites of daily living.
- At 4-6 wks the patient progresses to AROM. Begin in gravity-lessened positons and progess to against gravity movements
- Engage the patient in light ADLs
- Avoid compensatory movments such as hikign the scapula or lateral bending of the trunk
- When performing against gravity ADLs, progress from waist level to above shoulder level
- Strengthenign cna be initiated at 6 wks to prepare for functional activities
- begin with isometric exercises for the rotator cuff adn scapula stabilization exercises
- Eight wks post surgery, the patient progresses to isotonic exercises usign theraband and free weights
- ADLs above shoulder level should be emphasized, includign cooking and laundry.
- At 12 wks, the patient can begin resistive occupational tasks.
- Pain-free occuaptional functioning
- Non-surgical treatment
- educating the patient on activity modification.
- Patient should be instructed to avoid above shoulder level activities until pain subsides
- Sleeping postures should also be addressed.
- avoid sleepign with the arm above teh shoulder level or in an adducted and internally rotated position
- combined adduction adn internal rotation for long periods of time can future compromise blood supply of the supraspinatus
- exercise shoudl fous on pain-free ROM
- Begin with PROM and as pain decreases progress ot AROM
- Strengthing should include isometric exercises for the rotator cuff and scapula musculature
61
Q
What are the different types of heart disease?
A
- Myocardial infarction
- Congestive heart failure
- Coronary artery disease (CAD)
- Cardiomyopathies (disease of caridac muscle)
- Angina
- Valvular heart disease
- Aortic aneurysm
- Arrhythmias
62
Q
What are the risk factors associated with heart disease?
A
Prventable or modifiable
- high cholesterol
- cigarette smoking
- diet high in saturated fat and calories
- excess alcohol consumption
- high blood pressure or hypertension
- throbogenic risk factors (e.g., elvated plasma fibrinogen)
- diabetes mellitus or hyperglycemia
- beign overweight, obsity
- left ventricular hypertrophy
- physical inactivity and sendentary lifestyle
- psychosocial factors and emotinoal stress (ie., anxiety, depression, personality traits and disorders)
Not Correctable
- heredity – gamily history of heart disease before age 55 in men adn age 65 in women
- Age – older than 60
- Gender – men have a higher incidence of heart disease
- AFter menopause in women
- Personal history of coronary artery disease (e.g., stroke or peripheral vascular disease)
63
Q
What are the contraindications for cardiac OT treatment?
A
- Active signs and symptoms of MI (e.g., nausea, shortness of breath, light-headedness, chest pain)
- Acut MI (<1 day or 2 days after MI)
- Active infection
- Acute mycarditis or pericarditis
- Digoxin toxicity
- uncontrolled arrhythmias
- uncontrolled diabetes,
- severe CHF
- Recent pulmonary embolism
- Abnormal vital signs and blood counts (O2 saturation < 85 %, respiration rate > 45 breaths per minute, hemobglobin < 8 g/dL or hematocrit <26%)
64
Q
What are the signs and symptoms of Congestive Heart Failure?
A
- Increase in weight of 2-5 pounds or more over several days
- inability to sleep
- persistent dry hacking cough
- shortness of breath with normal activity
- swelling in ankles or feet
- fatigue
65
Q
What types of medical and surgical managements are provided for cardiac disease?
A
- cornoary artery bypass graft (CABG)
- Angioplasty
- Ablation
- pacemakers
- Cardioversion
- Medications:
- beta blockers, ACE inhibitors, platelet inhibitors, anticoagulant therapy
66
Q
What are some of the concerns for activity post CABG?
A
Patients are discouraged from engaging in activities that expand the chest or pull the sternum apart. Generally, patients are restricted to lifting no more than 5-10 lbs. Patients are discouraged from using their upper extremities and ecnouraged to use the stronger muscles of their lower extremities when going from a sitting to a standing psotion. Patients are also encouraged to splint or brace their chest when coughing
67
Q
What are some the precautions mentioned for cardiac disease?
A
Sternal precautions
- General
- any movements that require asynchronous movement between the two sides of the chest, any excessive shoulder flexion, rotation, abduction, or lifting more than 5-10 pounds are discouraged for the first 5-6 weeks. Consult the phsyican or facility policy for specific precautions and restrictions.
- Bed Mobility and ambulation precautions
- scooting up in bed: bend knees with feet flat on the bed adn push off the bed with legs extended to scoot up. Do not push or pull with arms on bed rails
- Rolling side to side: Bend hips and knees and roll to teh side, with the trunk following
- Supine to sitting: Roll onto side, drop legs off the bed, and then push up using elbow. The other hand holds onto the bedrail for support only. Patients may be assisted by supporting their upper back adn moving the hips toward the edge of the bed.
- Do no pull on patients’ arms when assiting them into an upright postion
- Use the bed controls to raise the head of the bed to assist the patient into an upright position. However, once the patient is sitting on the edge of the bed, flatten the bed back to provide a level seat surface
- Transferring to a low seat surface should be avoided because of tendency to push with the arms when coming to a stand
- Hand-held assitance may be preferable to the ptaient when an assistive device for ambulation because some patients cannot control the amount of pressure exerted through a walker or other ambuation device
- Activities of Daily living
- Engage in normal ADLs but minimize excessive shoulder movemnts (e.g., shoulder retraction, shoulder abduction)
- Avoid holding arms above teh head for sustained periods (e.g., washing hair)
- Avoid excessive chest expansion movemnts with U/B dressing (e.g., when donnign or doffing a shirt or fastening a back-closing bra)
- Avoid U/B twisting. When reaching for an object (e.g., the telephone), the patient should turn teh dirction of the obect instead of twisting an arm back behind himself or herself to reach for it
- Minimaize shoulder extnsion and rotation movements when engaging in toileting hygiene
- Avoid bending over to don lower-body clothing to minimize inadvertent breath holding when bendign forward. Cross one leg over teh other to access feet for L/B ADLs, or consider the use of assitive devices (e.g., readcher, dressing stick)
- Do not lift more than 10 lbs, including grocery bags, children, pets, or trash bags
- Avoid one-sided pusing, pulling, or lfiting (e.g., opending heavy doors, vaccuming)
- AVoid heavy pushign or pulling wtih both arms (e.g., moving furniture)
- Avoid driving or riding in the front seat of a car. An accidnet may resutl in forceful movemnt or pressure on teh sternotomy site
- Avoid straining, for example, openign tight jras, straining during bowel movements, or activities that may cause breath holding (e.g., valsalva effect)
- Exercise
- Patients may partiicpate in full active range of motion exercise but should not exceed 90 degrees of shoulder flexion with presence of a muscle flap
- Patricipants should not participate in resistive exercise, includign use of a thera-band or light weights, until cleared by physician (usually contrainidcated the first 4-6 weeks)
- Avoid pushing and pulling activities
- Sternal clicking is a feeling of shifting or snapping of the sternum and indicates instability. Any arm motion that causes clicking, expecially shoulder abduction, should be avoided.
Signs and symptoms of exercise intolerance
- chest pain or pain reffered to the teeth, jaw, ear, or arm
- excessive fatigue
- shortness of breath
- lightheadedness or dizziness
- nausea or vomiting
- unusal weight gain of 3-5 lbs in a 1 - 3 day period
General precautions
- monitor vital signs before, during, and after therapy
- Be aware of any signs of exercise intolerance or cardiac distress, including complaints of
- dizziness
- light-headedness
- SOB
- heart palpitations
- chest pain described as pressure, burning, or heaviness
- indigestion, nausea, or vomiting
- sweating
- confusion
- anixiety or fear
- changes in blood pressure (BP; > 20 mm HG) or heart rate (HR: > 20 bpm over resting heart rate)
- Early activity helps prevent cardiopulmonary complications
- Avoid valsalva maneuvers or effects. Holding teh breath casues an incrase in intrathoracic pressure, which decreases venous return, slows heart rate, and increases BP
- Modify activity requirements per patient tolerance. Gradually grade activities, slowly progressing the patient
- Durign teh first few weeks after a MI, HRs should not exceed 20-30 beats per minute over teh RHR
- If the patinet’s HR is more than 125 bpm with minimal effort, contact the physican
- Heart transplant patients ahve a higher-than-normal RHR (e.g., 90-110 bpm) and require a longer warm-up and cool-down period than patients who have had other cardiac surgeries.
- Patients on betablockers ahve lower HR and BP responses; therefore, therapsits must be attentive to otehr symptoms of distres (e.g., shortness of breath, fatigue, complaints of chest pain)
- U/E exercises tend to increase HR and BP at a faster rate than do L/E exercises
- Patients with a hsitory of hypertension may have an exaggerated response to exercise, even if is more than 180 over 90, notify the physican
- If you are treating a ptient with a percutaneous transluminal cornoary angioplasty and angina begins, notify medical staff immediately
- Patients are usually on bedrest precautions for several hours after a cardiac catheterization or angioplasty procedure
68
Q
Describe Cardiac Rehab
A
Cardiac rehab is often divided into phases that involve monitored exercise, nutritional counseling, support and edducation about lefestyle changes to reduce risks of heart problems
The goals of cardiac rehab are to regain strength, to prevent condition from worsening adn to reduce risk of future heart problems
69
Q
What is included in the formal education that a OT provides a cardiac patient?
A
- Anatomy of the heart and circulatory system
- Mechanisms of damage to the heart; for example, narrowing of teh coronary arteries
- Medical terminology so clients understand technical information regarding their recovery
- Signs of disease and when to seek emergency care
- Safe levels of exercise
- How to prevent further disease by controlloing risk factors
- Stress management
- Medications
- Energy Conservation and Work simplification
70
Q
What are some general tips for Energy Conservation?
A
- Sit for as many activities as possible
- Allow yourself more tiem for each activity
- Consider the best time of day for each activity
- Eliminate unnecessary tasks (e.g., air dryign teh dishes instead of hand drying)
- Take frequent rests. Rest before getting too tired or overfatigued
- Balance rest and activty
- Prepalan activities: Try daily schedules, weekly schedules, or both so activities can be evenly spread out
- Store things that are used often at a level comfortable to reach to avoid excessive reaching, bending, or stretching
- Avoid lifting and carrying heavy objects
- When engaging in activities, use both arms (hands) in smooth, flowing motions. Avoid jerky movements
- Remember to use pursed-lip breathing during activities that may increase your shortness of breath. Pursed-lip breathing is breathing in through the nose and out thought gently pursed lips (i.e., smell the roses and blow out the birthday candles)
71
Q
What strategies can you use to avoid unnecessary motions in EC/WS?
A
- Minimize steps in a task. Consider waht you are going to do next
- Use labor-saving equipment that is easy to handle and operate
- Avoid overreaching and bending by arranging equipment and materials in your work area within easy reach
- Slide objects, do not lift and carry
- Use carts with wheels to substitute for carrying or lifting
- use good posture and body mechanics
- Use proper breathing techniques when performing any task
- Perform a task in teh proper sequence. Repeating the same methods will increase skill and make movments more efficient and ecnoomical. For example, if you normally put on a shirt before you pants, keep that sequence consistent. Do not don pants before you shirt, deviating from your normal routine
- Combine steps when possible (e.g., don underwear and slacks over feet at the same time before pulling both up over hips)
- Minimize trips between points. Gather all necessary items before moving between different rooms or locations
- If available, use store scooters or wheelchairs for shopping instead of walking the aisles
- Consider hiring someone to assist with certain activities, such as lawn care, maintenance, cooking, or cleaning
72
Q
What strategies can you use to avoid rushing in EC/WS?
A
- Plan your schedule to allow time to engage in the task and also take rest periods
- Work at a slowed, rhythmic, relaxed speed; work to music if necessary
- Pace yourself
- Spread heavy adn light tasks throughout the day or week, doing heavy tasks when you have the most energy
- Set priorities
- Eliminate unnecessary tasks
- Delegate jobs when appropriate
- Plan frequent periods for rest and relaxation (both mentally and physically)
73
Q
What strategies can you use to set up proper working conditions in EC/WS?
A
- Sit when able and at a proper work height. A good work height is when you do not have to reach or bend excessively
- Avoid clutter in work areas
- Optimally position needed materials and equipment closer together
- Organize all work areas by keepign all supplies for an activity or task stored together. use organizing equipment (e.g., lazy susan, stacking shelves, bins)
- Ensure work areas have good lighting and ventilation
74
Q
What strategies can you use in grooming and hygiene to implement EC/WS?
A
- Sit when possible
- Have one designated area where all supplies are organized (e.g., razor, toothbrush, makeup, other toiletries)
- Consider a short, easier-to-care-for haircut
- Wash hair while in the shower
- Have hair done by a professional, or ask family members to help out
- Support elbows on a counter or table top when tasks take 5 minutes or longer
- Never force, bear down, or hold your breath when having a bowel movement. Take deep breaths in through your nose and push gently as you blow out thorugh pursed lips
75
Q
What strategies do you use in bathing and showering to implement EC/WS?
A
- Sit on a shower or tub chair or stool when showering or bathing
- Sit to dress, undress, bathe, adn dry
- Use a long-handled bath sponge or hand towel to wash back and feet
- Use lukewarm water to reduce steam if you have difficulty with shortness of breath, or decrease the amount of steam by turning on the cold water first and then adding hot water slowly.
- Use a shower hose extension (i.e., hand-held shower) to increase control over direction of spray
- Install grab bars and nonslip strips to prevent falls
- Organize shampoo, conditioner, and soap in an easy-to-reach place in the shower or bathtub
- Have a towel and robe easily accessible. Use a towel or terry-cloth robe to pat yourself dry (or wear a terry-cloth robe until dry) instead of vigorously drying yourself off with a towel
- If oxygen is prescribed, it should be worn while in the shower or bath
- Avoid overexertion by taking rest breaks
76
Q
What strategies can you use in dressing to implement EC/WS?
A
- Designate a dressing area where all cothes can be reached easily
- Before starting, gather all clothes and shoes together
- Remeber breathign techniques–exhale while bending over or raising arms up
- Wear loose-fitting, lightweight, comfortable clothing. Use suspenders if belts are too restrsicting
- sit to dress
- compelte lower-body dressing before upper-body dressing
- eliminate bending as much as possible to minimize SOB. Consider using adaptive equipment to minimize bending
- bring feet up toward body (e.g., can prop on stool) rather than bending down
- minimize bending by crossing one leg over teh otehr while sitting ot put on socks, underwear, pants, or shoes
- pull underwear and pants to knees while sitting, then stand one time to pull both items of clothing up over the hips
- Put on slip-on shoes using a long-handled shoehorn
- Try to use clothing that opens in the front, preferably with zippers, hook-and-loop fasteners, or buttons. Shirts that open from the front do not require neck flexion, which can constrict the lungs, making breathing slightly more labored, similaryly, use a front-closing bra
77
Q
What strategies can you use in kitchen organization and meal planning to implement EC/WS?
A
- use a cart with wheels to move items from the fridge to the sink or counter
- use the coutner space for sliding heavy objects rather than carryign them
- keep frequently used itms and ingredients within easy reach; store items where they will be used. For example, keep canned goods near the electric can opener, and keep pots and pans near the stove
- Keep heavier items where they can be slid back and forth rather than lifting and carrying. Store lighter items higher up
- Use electric appliances to make the work easier and quicker. For example, use a blender, electric can opener, electric knife or microwave oven
- Stabilize or set objects down on teh counter or table rather than holdign them
- Use lightweightt utensils and cookware
- Distribute the weight of heavy pots or trays over tow hands rather than using one. Use oven mitts for handling hot items
- Angle a mirror over the stove to see into the pots from a seated position
- use dishes that can go from preparation to oven to dinner table
- Eat on paper plates or reuse dishes directly from the dishwasher
- Inquire whether the grocery store delivers or whether Meals on Wheels is available in your area
78
Q
What strategies can you use in cooking to implement EC/WS?
A
- cook large quantities, and freeze individual protions for later
- prepare part of the meal ahead of time
- use recipes taht require short preparation time and little effort
- Gather all necessary items before beginning meal preparation
- Sit to prepare items and mix ingredients
- make one-pot meals
- use ready-made foods to eliminate preparation time
- Avoid peelign and other preparations. use packaged fresh vegetables or frozen products
- serve food directly from baking dish
79
Q
What strategies can be used in after-meal cleanup to implement EC/WS?
A
- Rest after emals before starting to clean up
- have everyone clear their own place setting
- use a utility cart to transport items
- let dishes soak to eliminate scrubbing
- sit to wash dishes or use a dishwasher
- let dishes air dry
- use lightweight cloths or sponges rather than heavy terry cloth rags
80
Q
What strategies can be used in housecleaning to implement EC/WS?
A
- Clean a different room each day
- Use a lightweight vacuum or power broom
- Use long-handled dusters and cleaning attachments
- sit to dust
- use a mop or a dustpan with an extended handle to clean up spills on the floor
- Use a dust mitt rather than gripping a dust rag
- Break up chores over the whole week, doing a little each day
- Keep cleaning supplies in the room in which you use them
- Allow cleaning agents (foamy spray) time to do their work so that less scrubbing is required
81
Q
What strategies can be used for bed making to implement EC/WS?
A
- store bed linen near the bedroom
- use fitted sheets
- make as much of the bed as possilbe while still lying in it, or sit on the edge of teh bed and scoot up as the covers are straightened
- use the clock method. start at one end of the bed, and slowly make the bed as you move around it to the other side
- Use a lightweight spread or comforter
- consider changing the sheets less often to conserve energy
- Share the taks with another person to reduce reaching
82
Q
what strategies can be used for laundry that can implement EC/WS?
A
- If laundry area is downstairs or at teh opposite end of the home, put soiled clothes in a large laundry bag and throw it downstairs or drag it to the washer
- Use a scoop for a dry detergent rather than lifting the whole box. put liquid in a pump container
- use a wheeled cart to move clothes
- make more frequent trips with lighter baskets of laundry rather than carrying heavy but less frequent loads
- sit to iron, sort clothes, pretreat stains, or fold laundry
- Transfer wet clothes into the dryer a few items at a time
- Use a long-handled reacher to remove clothes from the back of teh washing machine
- remove clothes from the dryer immediately after cycle to avoid wrinkles
- Get help to fold large items such as sheets
- Buy clothes that are easy to wash and require little to no ironing
- If you need to iron, try a travel iron, which weighs less than 2 pounds
- When ironing, slide the iron rather than lifting it
- Do not do all the laundry chores in 1 day. Spread the tasks out over several days
83
Q
What are the phases of cardiac rehab?
A
- Phase 1: inpatient - cardiovascular risk factors and signs and symptoms of MI
- Home Program Phase: HEP, focus on surgical incision care, increased activity, exercised program would be low intensity
- Phase 2: Outpatient - cardiac telimetry (holter monitor - measures cardiovascular activityadn vital signs, increase rsistance and time spent in exercise, continued education concerning risk factors,
- goals: increase aerobic activity, increase strength and endurance, monitor own HR and activity level, learn stretch and strengthening exercises (tied to occupation)
- Phase 3: Maintenance - (ongoing community exercise program) - Long term lifestyle changes, generally community facilities, heart healthy habits, decreased future cardiac events
84
Q
What is the purpose of pulmonary rehab?
A
an individualized program of education and exercise classes that teaches a client about his/her lungs, how to exercise with less shortness of breath, and how to “live and breathe” with lung disease
