Domain 3 Flashcards
Sensory modulation problem
inability of CNS to regulate responses to sensory input from common daily stimuli resulting in: hyper-responsive, hypo-responsive, sensory-seeking
Sensory processing
Ability of the CNS to interpret and regulate responses to sensory input
Hypo- responsiveness
A form of sensory modulation in which the central nervous system is slow to register or process sensory input Behavioral characteristics include but are not limited to lack of response to:
socially-relevant signals
painful stimuli
alarms and flashing lights
Tactile defensiveness
Inability of the central nervous system to regulate tactile input resulting in overreaction to ordinary touch sensations on the skin or in the mouth Behavioral manifestations may include: extreme discomfort emotional outbursts aggression anxiety
Gravitational insecurity
Inability of the central nervous system to regulate vestibular input resulting in overreaction to changes in head position and movement during ordinary activities Behavioral manifestations may include intense fear or avoidance of:
riding on toys
heights
gross motor activities
Emotional regulation development: Neurophysiologic modulation phase
Phase of emotion regulation development, occurring between birth and 2-3 months of age Characterized by ability to:
regulate arousal (e.g., self-soothe, respond to parental soothing)
activate organized patterns of behavior (e.g., routine sleep-wake cycles)
Emotional regulation development: Sensorimotor modulation phase
Phase of emotion regulation development, occurring between 3-9 months of age Characterized by:
enjoyment of sensorimotor play
sensory exploration
possible sensory modulation challenges
Emotional regulation development: Control phase
Phase of emotion regulation development, occurring between 12-18 months of age Characterized by:
emerging awareness of social demands
varying levels of inhibition and compliance
self-initiated monitoring related to an understanding of consequences
Emotional regulation development: Self-control phase
Phase of emotion regulation development, occurring between 24-48 months of age Characterized by:
emerging sense of identity
demonstrated knowledge of social rules
minimal flexibility and adaptation to change
Emotional regulation development: Self-regulation phase
Phase of emotion regulation development, occurring between 36 months of age and older Characterized by emerging:
flexibility to adapt to unexpected change
self-awareness
capacity to evaluate own behavior
Stage of motor learning: Perceptual learning
Stage of motor learning development, occurring between 3-6 months of age where the infant uses perceptual skills developed through exploration Characterized by:
more accurate and direct reach
consistency of movement patterns
engagement in trial-and-error learning
Stage of motor learning: Skill achievement
Stage of motor learning development, occurring between 6–9 months of age Characterized by:
high adaptability
both perceptual learning and increased self-organization
using action patterns that are orderly and efficient
Autism spectrum disorder
Neurodevelopmental disorder commonly referred to as a pervasive developmental disorder May be characterized by a wide range of: social dysfunction stereotypical behavior patterns perseverative thoughts or interests sensory processing deficits executive dysfunction
Attention deficit / hyperactivity disorder
Neurobehavioral disorder characterized by inappropriate or excessive display of one or more of the following behaviors: inattention restlessness impulsivity emotional dysregulation sensory processing social immaturity
Fetal alcohol spectrum disorder
Congenital birth defect secondary to gestational exposure to alcohol resulting in mild to severe impairment in one or more of the following areas of development: physical cognitive social behavior
Righting reactions (3)
Postural reflex present from approximately 3 months to 6 months of age that functions to orient the body in response to visual and vestibular input Examples include:
neck on body
body on body
body on head
Protective extension
Postural response present at approximately 6 months of age and continues throughout life, characterized by reflexive straightening of the upper extremities in response to a loss of balance
Equilibrium reaction
Postural reflex present at approximately 6 months of age and continues throughout the life span Reflexive response to help maintain or recover balance, includes shifting the body to reorient to midline
Developmental dyspraxia
Neurodevelopmental disorder (also called developmental coordination disorder) Characterized by: clumsiness and poor coordination motor planning deficits learning difficulties perceptual deficits (visual and motor)
Sensory-seeking behavior
Actions characterized by craving input from a variety of senses and experiences, typically associated with:
altered sensory processing ability
challenges with regulation of arousal level
atypical praxis
hyper- or hypo-responsivity
Protective factor
Factors in the social environment that support health, wellness, and preparedness for adverse or stressful events, including:
access to supportive relationships and nurturing
awareness of resources
insight and capacity to use coping strategies
Self-verbalization strategies
Cognitive strategy where an individual learns to talk out loud to regulate or control behaviors
Video modeling
Intervention technique frequently used to teach a specific motor or social skill by having a client/child watch a video of the skill being performed then attempting to imitate the task
Social script
Narrative used to promote social participation or a skill to children, written from the perspective of the child, and practiced for use in a variety of contexts Typical narratives relate to:
giving or receiving compliments
asking for or giving help
self-introductions
Social story
Narrative used to promote social participation or a skill to children, written to prepare children how to act and respond in a variety of contexts Consists of four types of sentences: descriptive directive perspective control/affirmative
Applied Behavior Analysis (ABA)
Therapeutic approach used to enhance school function, positive behaviors, and socialization through intensive therapy consisting of reinforcement and daily structure
Stress thermometer
Visual feedback scale used for assisting children identify and quantify emotions, moods, or perceptions of their behaviors
Therapeutic sensory diet
Customized program designed to help regulate responses to a variety of sensory input Typically used as an adjunct intervention for children with: autism spectrum disorder sensory modulation disorder sensory seeking behaviors attention deficit hyperactivity disorder
Least restrictive environment
Academic context allowing students with disabilities to receive their education and all academic and related services in the same setting as children who do not have disabilities
Temperament
Behavioral attributes of a personality that influence social interactions in nine areas: activity level Intensity of response rhythmicity approach or withdrawal attention span threshold of response distractibility quality of mood adaptability
In-hand manipulation
Skill requiring control of the palmar arches of the hand to grasp and control objects Five patterns include: finger-to-palm translation palm-to-finger translation shift simple rotation complex rotation
Joint protection strategies
Techniques used to minimize stress or prevent excessive forces on a joint during daily tasks Principles include:
using the largest joint possible for the task
sliding items and performing tasks bilaterally
modifying the environment
considering adaptive equipment
Energy conservation techniques
Strategies to minimize fatigue by reducing task demands or amount of effort exerted during daily routines Includes:
pacing
planning
prioritizing
Activity modifications
Adaptations to activities or tools to:
promote a lifestyle change
facilitate independence
reduce injury or health-related risk
Desensitization
Intervention to reduce hypersensitivity by exposing the sensitive body part to graded sensory stimuli
*Commonly used following a nerve injury
Sensory re-education
Active training strategies used in the presence of a peripheral nerve injury or after a brain injury to enhance sensory awareness or compensate for lack of sensation, distinct categories include:
protective sensory re-education
discriminative sensory re-education
Mirror therapy
Motor re-training method that includes using the reflection of the unaffected limb, typically used as an adjunct intervention for:
complex regional pain syndrome
phantom limb pain
hemiparesis
Active exercise
Voluntary contraction and relaxation of muscles to move a body part through the available range of motion, used to: preserve joint mobility minimize atrophy increase strength increase endurance
Active-assistive exercise
Voluntary contraction and relaxation of muscles aided by an external force used with presence of severe muscle weakness to:
restore range of motion
regain muscle strength
Finger blocking exercise
Active exercise that involves isolating a specific joint of the hand by supporting the digit just proximal to the joint being moved, used to: target a specific joint restore strength prevent adhesions enhance tendon glide
Social skills group
Group intervention approach with focus on interactive activities that may address:
empathy development
relationships with others
nonverbal and verbal communication skills
social interactions
Sensorimotor group
Intervention used in primarily in pediatric and geriatric settings, includes the provision of sensory experiences through movement or play in a therapeutically structured group
Group leader
Role in a therapeutic group that includes:
facilitating participation and process
defining expectations and norms
teaching needed skills
guiding actions toward achieving desired outcomes
Group norms
Implicit and explicit rules that govern accepted behaviors and processes in a group Can be established by the group leader or by the members themselves
Group roles
Actions performed by group participants based on the type of group Examples include: initiator elaborator information seeker recorder
Group dynamics
Internal and external factors that influence functioning of a group and its outcomes
Life skills group
Group intervention approach to address acquisition of or barriers to specific skills that promote participation in occupation, may include practical exercises related to: daily living tasks conflict resolution anger management communication skills time management responsibility clarification of values
Mechanical switch
Type of single-switch interface activated by applying pressure to a button, pad, or lever, used to operate assistive devices, types include: paddle plate button lever membrane
Electromagnetic switch
Type of single-switch interface activated through energy such as radio waves or light used to operate assistive devices, types include: fiber-optic sensor infrared sound touch
Proximity switch
Type of single-switch interface activated by close proximity to a detector, used to operate assistive devices and operate light fixtures
Membrane keyboard
Alternative keyboard for computer access made up of pressure pads requiring limited hand and arm strength and mobility
Phonation switch
Type of single-switch interface activated by speech or sound, used to operate assistive devices such as computers and environmental control units
Joystick
Input device consisting of a handle that pivots on a base allowing multi-directional control, often used to operate a power wheelchair, computer, or remote-controlled toys Types include:
proportional (continuous)
switched (discrete)
Feeder chair
Positioning aid that provides trunk support for feeding or other short term activity Adjustability allows for upright or reclined position
Trunk support ring
Device used in the bathtub to provide external stability of the torso for children seated upright during bathing, typically used in the presence of mild hypotonicity
Hammock chair
Device used in the bathtub to safely position a child in supine for bathing, typically used in the presence of poor trunk and head control
Adaptive tools for handwriting
Instruments used during interventions in the classroom to enhance proprioceptive feedback during handwriting, examples include:
felt-tip pens
vibratory pens
crayons (scented, glittered, glow-in-the-dark)
weighted pens/pencils
chalk
Adaptive writing surfaces for the classroom
Modification made during handwriting interventions often involving a slant-board, upright easel, or white board to enhance upper extremity control for:
manipulation of a writing instrument
promoting upright posture
tracking of the hand’s movement during writing
Trunk stability
Ability of the core musculature to maintain posture and stability, influences the quality of movement of the extremities during activities
Tummy time
Placement of infant in prone position during periods of wakefulness to facilitate development of oral, fine, and gross motor skills
Adaptive positioning
Modifications made to the position of a client during an activity to optimize trunk stability and postural alignment, intended to improve: upper extremity control range of vision swallowing ability interactions within the environment
Transition planning for students with an IEP
Legal requirement for students enrolled in special education, includes collaboration among student, and relevant others involved in supporting the student to meet post-high school goals, may include:
recommendations for post school environment
establishment of goals for attaining a life skill
services options for supporting the students in adult life
Transition team
Persons involved in progressing a student to meet post-high school goals, includes the student and relevant others such as: family OT caregiver PT special ed team speech vocational counselor supported employment rep
Vocational rehabilitation
State-supported program that provides educational and employment services to eligible recipients Services include: guidance and counseling job-skills training job placement transition services supported employment
Transition target
Occupation-based service outcomes and goals used as part of the IEP to assist a student transition from high school to adult life Focus may include: academic achievement employment integration community integration independent living
Social competence
Mastery of a complex interaction of social, cognitive, emotional, and behavioral skills needed for social adaptation, includes demonstration of effective:
interpersonal communication
social communication
social skills
Mobile stander
Type of mobility device that enables a client with limited lower extremity function to bear weight through the legs in a standing position, includes large wheels for manual propulsion of the device
Prone scooter mobility device
Type of mobility device that enables a child with limited lower extremity function engage in floor play while lying on a flat padded board with casters, must have adequate upper extremity strength and head control
Caster cart
Type of wheeled seated mobility device that enables a child with limited lower extremity function navigate on flat surfaces, can be self-propelled, with option for battery operated joystick, may be difficult to maintain upright sitting for children with tight hamstrings or LE contractures
Myoelectric prosthesis
Type of prosthesis used for a person following amputation that uses electrical signals from existing muscles to control the movement of the artificial limb
Body-powered terminal device
Component attached to the distal end of a prosthesis that is operated by forces generated by the body and enables a person to hold and stabilize objects, types include hand and hook designs with voluntary opening or voluntary closing features
Body-powered prosthesis
Type of upper limb prosthetic device that is operated using a harness and the movement of the body to generate forces through a cable control system
Reality orientation
Intervention method used for persons with cognitive impairment that includes routine and consistent reminder of: time, date, and weather current location familiar names roles of people in their support network
Adaptive stroller
Type of wheeled, non-motorized transit device that provides supported positioning for children with moderate to severe disabilities; design requires others to push the device and does not enable self-initiated exploration
Walker
Type of mobility device in which the hands maneuver the device in the desired direction, may be wheeled or non-wheeled, used by persons who require external support and stability during ambulation, frame types include: anterior posterior hemi (one-handed) platform reciprocal
Sit-to-stand wheelchair feature
Power-assist mechanism attached to a seating system that elevates the user to an upright position and allows for:
peer height navigation and interaction
easier transfers from wheelchair to bed
Power-assist units
Battery-operated device attached to a seating and mobility system for enhancing independent mobility, types include:
joysticks
sit-to-stand lifters
head controls
Sports wheelchair
Wheeled mobility device specifically designed to enhance maneuverability and speed during athletic and leisure activities, features may include: light-weight frame specially designed wheels all-terrain options overall stability
Rear-wheel drive wheelchair
Feature of a powered wheelchair in which the casters are located at the front of the chair and the drive wheels located toward at the rear of the chair, designed to enhance maneuverability when using hand-operated controls Good option for use over rough terrain
Mid-wheel drive wheelchair
Feature of a powered wheelchair that requires a third set of stabilizing caster wheels, designed with smaller turning radius which increases overall maneuverability
Front-wheel drive wheelchair
Feature of a powered wheelchair in which the casters are located toward the rear of the chair and the drive wheels located at the front of the chair, designed to enhance maneuverability up and down sloped terrain May be more difficult to maneuver at higher speeds
Drive wheel position
Feature of a powered wheelchair that influences the maneuverability, stability, traction, and performance of the chair on a variety of terrains/surfaces, types include:
rear-wheel
mid-wheel
front-wheel
Play space
Designated social or physical environment designed for children to foster:
exploration
development
socialization
Environmental factors of healthy adolescent development
Social, cultural and socioeconomic factors that influence self-development and acquisition of occupational performance skills for individuals between 12-18 years of age
Mealtime environment
Contextual setting specifically designated for eating based on temporal, physical, cultural and social factors Important consideration when planning feeding interventions with clients
Teacher consultation
Conference with educators to support a student’s participation in curriculum-based activities related to: classroom performance barriers and facilitators in the school adaptive teaching/learning strategies educational goals
Teacher coaching
Collaborative process in which the OT practitioner assists the educator to assimilate curriculum-based learning or behavioral strategies in the least restrictive environment for supporting students’ participation in occupation
Caregiver education
Collaborative client-centered teaching approach used to advise family and relevant others on:
plan of care and goals
resources
discharge planning
home programs
Includes assessing the ability to carry out health care recommendations
Inclusion outcome
Intended objective for providing students with disabilities least restrictive and fair access to education, includes:
full participation in school activities
supporting peer interactions
options for general educational curriculum
establishing an environment of respect and tolerance
supporting interaction within the community
Generalization of skills
Ability to transfer a newly learned skill across a variety of contexts and activities, facilitated by:
maintaining client motivation
contextually relevant practice
direct exposure to a task
Ideational apraxia
Neurobehavioral deficit characterized by the inability to correctly use an everyday tool or object for its intended purpose (e.g., using a comb to brush teeth)
Motor apraxia
Neurobehavioral deficit characterized by difficulty planning and sequencing the motor movements needed to complete a task (e.g., attempting to reposition the bristles of a toothbrush to brush teeth when moving it from one side of the mouth to the other)
Protective sensation
Ability to accurately perceive sensory input necessary to prevent personal injury or harm (e.g., pain and temperature)
Diplopia
Visual impairment secondary to a neurological event, also referred to as double vision, may cause loss of depth perception and increase risk of falls. Interventions for managing symptoms may include:
prism correction
full occlusion eye-patching
partial visual occlusion
Oculomotor dysfunction
Visual impairment characterized by lack of efficient eye movements and eye-tracking skills due to a cranial nerve lesion or neural disruption of the extraocular muscles, functional deficits may include difficulties with:
reading speed
copying skills
writing skills
Unilateral spatial neglect
Neurobehavioral deficit characterized by the inability to interact with stimuli on the contralateral side to a brain lesion (e.g., bumps into walls with the affected side of body) Interventions may include: awareness training limb activation lighthouse strategy partial visual occlusion scanning techniques videotaped feedback environmental adaptation
Hemianopsia
Visual impairment secondary to a brain lesion that results in loss of vision to half the visual field Compensatory strategies may include:
visual anchoring
scanning training
environmental modification
Bariatrics
Term used to describe the area of medicine that evaluates, treats, and engages in clinical studies related to persons with morbid obesity (i.e., body mass index of 40 or more)
Aphasia
Receptive and/or expressive language impairment secondary to a brain lesion Typically sub-categorized as: global anomic Broca’s conduction Wernicke’s transcortical
Shoulder subluxation
Partial displacement or dislocation of the glenohumeral joint, may occur secondary to the effects of weakness, muscle imbalance, and gravity Conservative interventions may include:
slings, positioning devices, and taping
strengthening exercises
functional electrical stimulation
Tenodesis grasp
Kinsesiological effect that will cause the fingers to flex when the wrist is moved from neutral to extension, and the fingers to extend when the wrist is moved from a neutral position to flexion Used as a functional advantage for clients with:
spinal cord injury at the C6-C7 level
radial nerve palsy
Incremental gradation of occupation
Gradual increase or decrease in activity and/or environmental demands to optimize a client’s performance, typically started from where the client will be successful
Tactile cue
Graded somatosensory prompt to facilitate a performance outcome through use of touch
Gesture training
Compensatory intervention for neurobehavioral deficits that includes providing graded levels of task demands in two phases:
transitive gesture training (client demonstrates use of common objects)
intransitive gesture training (client performs pantomime gestures based on cues)
Desensitization
Systematic intervention for decreasing hyper-responsiveness to aversive stimuli, may be used in:
mental health interventions for anxiety disorders
hand therapy for nerve hypersensitivity
Visual skills training
Interventions for impairment of the peripheral or central visual field (e.g., visual strategies and visual scanning training) and for central visual field defects (e.g., eccentric viewing training)
Magnification
The process of enlarging an object’s appearance using an optical device or lens, commonly used in low vision therapy to enhance vision Categories include: low power (e.g., hand-held magnifier, reading glasses) high power (e.g., closed-circuit television)
Anchoring technique
Strategy used in visual scanning training where a visual cue (e.g., a solid line or a bright colored, thin strip) is placed in the impaired field of view and the client is encouraged to scan to the visual cue
Constraint-Induced Movement Therapy
Evidenced-based intervention approach in stroke rehabilitation where the unaffected limb is restrained to facilitate functional use of affected limb
Mental practice / motor imagery
Intervention approach used in rehabilitation where the client creates a mental image of a desired movement and imagines performing the motion without actually moving the body part
Activity pacing
Energy conservation technique that includes:
integrating regular rest breaks into daily activities
establishing daily habits and routines
maintaining adequate sleep hygiene
Activity planning
Energy conservation technique that involves looking ahead days, weeks or months to develop a strategy for organizing and scheduling tasks based on occupational roles, priorities, task demands and expected energy expenditure levels and includes time for rest and recovery
Self-management education
Therapeutic approach that involves:
enabling and empowering the client to independently identify issues
problem solving meaningful and realistic solutions/actions plans
Metabolic equivalent of task (MET)
Measurement system commonly used in cardiac rehabilitation that indicates the energy expenditure required during a physical activity or daily task, examples include:
- 0-2.5 MET’s = sweeping floors
- 6-4.0 MET’s = walking downstairs
- 0-6.0 MET’s = weeding
- 0-10.0 MET’s = jump rope
Medication compliance program
Strategy used to support a client’s participation in their prescription medication regimen, includes the use of assistive aids such as:
pill storage boxes (e.g., 7-day dosage box)
electronic reminders (e.g., pre-programmed alarm)
diary (e.g., calendar)
pill splitter or crusher
insulin holders
Cardiac rehabilitation
Structured interprofessional team approach used to assist individuals recover from myocardial infarction, heart surgery, percutaneous coronary intervention procedures (e.g., angioplasty), phases include:
phase 1: inpatient
phase 2: outpatient
phase 3: community-based
Just right challenge
Top-down task analysis approach that involves identifying client-centered activities that:
are meaningful and contextually relevant
provide the greatest opportunity for success
maintain motivation and arousal
Scar management
Technique best used six to 12 weeks after wound closure to minimize the risk of adhesions, contracture, hypertrophy or hypersensitivity. Interventions include:
mobilization orthoses (e.g., applying sub-maximal stretch)
massage (e.g., graded vibration, manual)
compression (e.g., gloves, tubular gauze)
desensitization (e.g., graded touching, textures)
ROM (e.g., active exercise and passive stretch)
thermal modalities (e.g., ultrasound, moist heat)
Edema management
Methods used to reduce interstitial accumulation of fluid in the extremities secondary to surgery, trauma or a disease process, may include: limb elevation cryotherapy compression retrograde massage manual edema mobilization purposeful activity/movement
Isometric exercise
Type of exercise in which a muscle or muscle group and the joint angle do not move when the muscle(s) acting on the joint are contracted
Work simulator
Electromechanical isotonic and isometric strengthening device used for work evaluation and intervention to improve upper extremity functional abilities [e.g., Baltimore Therapeutic Equipment (BTE™)]
Work conditioning
Program focusing on returning a client to work, may:
include restoring ability and capacity associated with work related tasks
precede work hardening program
Work hardening
Structured rehabilitation program aimed at maximizing a client’s physical ability to return to a specific job function after an injury, may include:
job simulation activities
work conditioning exercises
Return-to-work program
Work rehabilitation continuum that promotes cost-effective steps for job-related goal attainment
Prosthetic functional use training
Intervention program for clients who have an upper limb deficiency or amputation, includes education on the use of harness and cable controls or myoelectric components and terminal device, emphasizes activities for: bilateral and unilateral use of limbs automatic movement patterns spontaneous movements performance in daily activities
Pursed lip breathing
Technique used to control dyspnea/shortness of breath by inhaling through the nose, with mouth closed, followed by slow exhale through pursed lips
Serial casting
Specialized intervention technique used to increase range of motion ROM of a joint, involves applying a series of well-padded casts to the limb to hold the target joint in a sub-maximal stretch Requires changing the cast at scheduled intervals to progressively increase ROM
Codman’s pendulum exercises
Therapeutic exercise for the shoulder joint in which the client bends forward at the waist with the arm perpendicular to the floor, then rocks the body side-to-side allowing the relaxed arm to freely move in a clockwise and counterclockwise direction
Handling
Therapeutic technique that involves providing physical support and cueing to manually guide the torso or limbs into functional movement patterns Support is graded based on the amount of assistance the client needs
Conduction
Transfer of energy between two connected surfaces of contrasting temperatures, examples include:
paraffin wax
cryotherapy
hot pack
Convection
Transfer of energy from a circulating source in contact with a body part, examples include:
Fluidotherapy®
whirlpool
Evaporation
Physiological response resulting from the topical application of a vapocoolant, examples include:
cold spray
cooling cream
Electrotherapeutic physical agent modalities
Physical agent modalities (PAM) that require essential knowledge of electrical principles, electrode selection and placement, indications, and contraindications, examples include:
neuromuscular electrical stimulation (NMES)
functional electrical stimulation (FES)
transcutaneous electrical nerve stimulation (TENS)
Functional electrical stimulation (FES)
Form of electrotherapy to: maintain muscle mass gain range of motion facilitate voluntary movement manage spasticity Recommended for use as an adjunct to other occupation-based interventions
Transcutaneous electrical nerve stimulation (TENS)
Form of electrotherapy used as a component of a comprehensive pain management program Techniques of application include:
sub sensory
sensory
motor
Recommended for use as an adjunct to other occupation-based interventions
Ultrasound (US)
Mechanical acoustic modality that uses energy conversion to influence:
tissue length
pain
inflammation
tissue healing
Recommended for use as an adjunct to other occupation-based interventions
Hot pack
Superficial, moist heat, conduction modality Requires taking precautions to prevent:
overheating of the client
localized burns to the body part being treated
discomfort from the weight of the pack
Recommended for use as an adjunct to other occupation-based interventions
Fluidotherapy
Superficial, dry heat, convection modality that involves inserting a distal extremity into a thermostatically-controlled machine of circulating particles, typically used for:
desensitization
edema and pain reduction
improving range of motion
Recommended for use as an adjunct to other occupation-based interventions
Paraffin therapy
Superficial, conduction, heat modality that involves use of thermostatically controlled, warmed wax and mineral oil, methods include:
immersion
dip immersion
pouring
Recommended for use as an adjunct to other occupation-based interventions
Cryotherapy
Superficial, conduction, cold modality that may be used to address:
spasticity
pain
edema
Recommended for use as an adjunct to other occupation-based interventions
Orthosis
Custom-made or prefabricated device used to immobilize, mobilize, or restrict one or more joints, typically used to: maintain alignment promote healing improve function restrict motion prevent contractures correct deformities
Restriction orthosis
Classification of an orthosis intended to limit partial mobility of one or more joints while allowing free movement through the remaining arc of motion, typically used to: allow controlled motion decrease risk of scar adhesions minimized risk of contracture improve functional use
Immobilization orthotic
Classification of a custom-made or prefabricated orthosis intended to prevent movement of one or more joints, typically used to:
maintain tissue length
preserve joint alignment
maintain/protect a fracture reduction
protect a healing/repaired nerve or tendon
Mobilization orthosis
Classification of a custom-made or prefabricated orthosis intended to move one or more joints using applied, controlled tension, typically used to: promote tissue remodeling elongate/stretch adhesions substitute for weak or absent motion provide resistance for strengthening
Handling characteristic of thermoplastic material: Memory
Capacity of thermoplastic material to retain its original properties when reheated, recommended when frequent re-molding may be necessary
Handling characteristic of thermoplastic material: Drapability
Property of thermoplastic material that indicates its ability to conform, contour and shape to the underlying structures, material effective for:
small orthoses
experienced orthotic makers
Handling characteristic of thermoplastic material: Bonding
Capacity of thermoplastic material for it to adhere to itself, beneficial characteristic when attaching dynamic orthotic components to an orthotic base
Performance characteristic of thermoplastic material: Rigidity
Capacity of thermoplastic material to maintain its strength and to prevent a change in the integrity of the custom fit against force and repetitive stress, material effective to stabilize a large joint
Performance characteristic of thermoplastic material: Perforations
Small holes distributed throughout thermoplastic material that allow for air flow to minimize risk of skin rash, sweating, and maceration
Angle of application
Force or torque applied to a joint using the dynamic component of a mobilization orthosis, ideally 90o to body segment being moved
Mechanical advantage
Application of a three-class lever system to achieve efficiency and promote effectiveness of an orthosis Typically described in terms of the length of the effort arm and the length of the resistance arm
Elastic force
Used as part of a mobilization orthosis to influence tissue response Common devices used for this purpose include:
rubber bands
wrapped elastic cord
spring coils
Friction force
Term used in orthotic fabrication that describes the amount of force generated by the orthotic materials and the amount of contact force, typically lessened by using: smooth thermoplastics proper-fitting straps rounded edges foam-lining or gel padding stockinette
Orthotic pattern
Necessary first step of orthotic fabrication to ensure custom fit and design that includes:
tracing the shape/size of extremity on paper prior to cutting the material
using anatomical landmarks
Orthotic Nomenclature: Design descriptors
Terms traditionally used to describe characteristics of orthotic devices that may be included as part of an orthotic prescription to help identify an orthosis using non-modified orthosis classification system nomenclature, examples include: digit-based forearm-based hand-based arm-based thumb-based digit-based digit-based
Orthotic Nomenclature: Modified Orthosis Classification System
System used to describe an orthosis for outpatient billing and reimbursement purposes based on the Healthcare Common Procedure Coding System (HCPCS), typically corresponds to a specific “L-code” Replaces the traditional term “splints” with “orthotics”
Orthotic Nomenclature: Anatomical descriptors
Naming convention used to describe the anatomical location of an orthosis for outpatient billing and reimbursement purposes, based on the Healthcare Common Procedure Coding System (HCPCS) Examples include:
elbow wrist hand finger orthosis (EWHFO)
wrist hand finger orthosis (WHFO)
hand finger orthosis (HFO)
Mobile arm support
Low tech adaptive typically attached to a wheelchair frame or floor stand device that supports the weight of the arm and has swivel components, used to provide assistance to weak muscles of the arm during a functional activity
Swivel utensil
Adaptive spoon or fork with a moving component designed to minimize food spillage, may be beneficial for persons with decreased forearm supination or intention tremors
Rocker knife
Adaptive eating utensil designed to enable one-handed cutting, may be beneficial for persons with hemiplegia, peripheral nerve injury or other condition resulting in a non-functional grasp of one hand
Universal cuff
Adaptive device for persons with limited or no grip, designed to be secured with an elastic strap around the hand and contains a fixed pocket in which the handle of an eating utensil, toothbrush or other ADL device can be inserted for use
Built-up handles
Adaptive devices for persons with weak grip or decreased active ROM of the digits, designed to enlarge the handles of commonly used small-handled ADL devices such as pens, toothbrushes, eating utensils
Bath mitt
Adaptive device made of sponge or terry-cloth material to hold a bar of soap and worn on the hand during bathing, designed for persons with weak or no grip, intention tremors, incoordination
Long-handled sponge
Adaptive bathing device comprised of a 23-29-inch (58-74 cm) long plastic handle with a sponge or brush attached to the end, enables an individual with decreased reach to wash the back and lower extremities, options include a variety of handle types and sponge features
Suction denture brush
Adaptive grooming device consisting of a small brush with bristles on both sides secured to a base with suction feet to hold the brush upright, beneficial for persons with weak grip or decreased active ROM of the digits, tremors or hemiplegia
3-in-1 commode
Type of durable medical equipment that is portable and designed to increase safety and independence, designed to be used as a/an:
bedside commode
shower seat
elevated toilet seat
Drop-arm commode
Type of durable medical equipment used for toileting that is portable and designed with adjustable legs and an easy to release arm rest feature to facilitate lateral and sliding board transfers
Raised toilet seat
Type of durable medical equipment designed to increase the seat height of a standard bathroom toilet, makes sitting down or standing up from the toilet easier
Grab bar
Type of durable medical equipment designed to mount to a bathroom wall or to be secured to the side of the bathtub, used to provide a safe, stable surface to hold onto during BADL in the bathroom
Transfer tub bench
Type of durable medical equipment that is portable and designed to be positioned in a standard bathtub to increase safety and independence for getting in and out of the tub, optional features include: adjustable legs padded seat cut-out seat back and armrest suction feet drainage holes
Dressing stick
Adaptive device comprised of a 19-26-inch (48-66 cm) long dowel with a reinforced hook on the end, designed to aid in putting on or taking off clothing, for individuals with limited reach or decreased mobility of the lower extremities
Sock aid
Adaptive device used to help an individual put on hosiery without having to bend forward, beneficial for individuals who must follow post-surgical hip precautions, those who have osteoarthritis of the hips or poor dynamic sitting balance
Long-handled reacher
Adaptive device that allows a person to pick up items from the floor or from overhead areas, designed for individuals with limited trunk, hip, or knee mobility, decreased balance, or decreased shoulder mobility, options include a variety of handle types and grabbing features
Rehabilitative technology
The application of technology in the intervention of persons with disabilities with a focus on compensation, facilitation, or restoration of functional skills to support participation in occupation
Assistive technology
The term used to describe devices for persons with disabilities to:
compensate for loss of function
facilitate independence
restore functional skills
Universal design
The term used to describe feature considerations for products and spaces that are intended to benefit users of most sizes and abilities without special adaptation or modification
Low-tech communication board
Type of inexpensive augmentative communication device that does not require electronic or computer assistance Consists of letters, selected words, or pictures to assist individuals with verbal deficits express basic needs and emotions
High-tech communication board
Type of electronic or computerized augmentative communication device that produces a synthesized voice Allows a user with verbal deficits to express thoughts, needs, emotions, and to converse with others
AT: Input controls
Devices used to enter data and perform control functions on computers or other electronic devices, examples include:
joy stick
trackballs
touch screens
AT: Output
Devices that communicate the outcome of data processing from an information processing system, examples include:
braille
voice
Environmental control unit
Computerized or mechanized systems that enable a person with physical limitations to independently control or interact within their environment, may be activated by:
voice
eye gaze
switch
AT: Control Enhancer
Equipment used to improve the control an individual has for using direct selection assistive technology Types include: postural supports (e.g., laptray, lateral supports) hand/arm devices (e.g., orthotic, strap, pointer) head-mounted devices (e.g., stick, pointer, headrest)
Leg lifter
Assistive device used to move the LE into bed or raise the leg when in bed, constructed of a sturdy fabric with loops on both ends; smaller loop is used as a handle and the larger loop is placed around the foot for lifting
Over head trapeze
Type of durable medical equipment with an overhead hoist attached to a bedframe or portable stand, used to facilitate bed mobility or transition from supine to sitting by pulling up on a handle affixed to the base
Alternative and augumentative communication (ACC): Pointing device
Physical input device used to point at the desired location on a standard or graphic keyboard, beneficial for persons with decreased manual dexterity
Alternative and augumentative communication (ACC)
Type of high or low technology device designed to assist or replace verbal/gestural communication, assist individuals with verbal deficits express basic needs, emotions, thoughts, and/or converse with others
Phase of swallowing: Pre-oral phase
Phase of swallowing that involves:
smell and visual appreciation of food
stimulation of saliva
mouth and upper extremity motor movements to initiate the process of eating
Phase of swallowing: Oral preparatory phase
Phase of swallowing that involves: voluntary intake of food into mouth bolus formation with saliva chewing with molars and activation of buccal muscles to prevent pocketing bolus movement to the center of tongue
Phase of swallowing: Oral phase
Phase of swallowing that involves:
use of cheek and tongue muscles to retain bolus centrally
posterior migration of bolus
Phase of swallowing: Pharyngeal phase
Phase of swallowing that involves:
soft palate elevation
larynx and hyoid elevation and protraction
cessation of airflow to prevent aspiration
vocal cord closure when whole bolus is moved through the pharynx
Phase of swallowing: Esophageal phase
Phase of swallowing that is highly influenced by client’s position, and involves:
return of upper esophageal sphincter to tonic state
passage of food through the esophagus to the stomach
Feeding trial
Completed by a dysphagia specialist to determine clinically appropriate food (purees to solid/regular diet) and liquid (water/thin to honey-thick) Requires careful monitoring for effectiveness of swallow and signs of aspiration through:
auscultation
palpation
Auscultation
Listening to internal sounds of the body typically with the use of a stethoscope
Dysphagia diet
Guidelines published by the American Dietetic Association to establish standard terminology for dietary texture modification of food for dysphagia management, levels include:
Level 1: Pureed Foods
Level 2: Mechanical altered
Level 3: Dysphagia-advanced
Diet recommendations
Information in plan of care following dysphagia assessment that includes a prescribed diet of specific food and liquid textures and consistency, taking into consideration: diagnosis oral motor function aspiration risk cognitive function
Dysphagia diet liquid progression: Thin
Liquid consistency that requires an intact swallow, includes: water ice chips broth coffee gelatin
Dysphagia diet liquid progression
Dietary liquid modification that involves altering the viscosity of drinking liquids to decrease aspiration risk, includes the following levels (from most difficult to swallow to easiest to swallow):
thin
nectar-like
honey-like
Dysphagia diet liquid progression: Nectar-thick
Thickened liquid consistency for safer swallowing that is a progression from thin liquid May be natural or thin liquids prepared with thickening gel or powder, such as:
tomato juice
fruit nectars
egg nog
Dysphagia diet liquid progression: Honey-thick
Thickened liquid consistency so that it drips from a spoon for safer swallowing, progression from nectar-thick that may be prepared with thickening gel or powder
Dysphagia diet level: Pureed
Dietary food texture modification described as smooth, uniform consistency for safer swallowing that requires very little chewing ability, examples include:
pudding and plain yogurt
smooth apple sauce
whipped potatoes
Dysphagia diet level: Mechanically altered
Dietary food texture modification described as moist, semi-solid consistency for safer swallowing that requires some chewing ability, examples include: cottage cheese ripe banana moist meat loaf scrambled eggs
Dysphagia diet level: Advanced
Dietary food texture modification described as soft consistency for safer swallowing that requires more advanced chewing ability, examples include:
baked potato with skin
moist pancakes
thin sliced meat
Compensatory swallowing maneuvers
Techniques recommended to facilitate safe swallow during the pharyngeal phase (only considered with clients who are alert, attentive, and able to follow directions), examples include: chin tuck Mendelsohn maneuver supraglottic swallow super-supraglottic swallow
Chin tuck
Compensatory swallowing maneuver that involves moving the chin towards the chest while swallowing, protects the airway and reduces the risk of aspiration
Supraglottic swallow
Compensatory swallowing technique used to close the vocal cords before and during swallow, involves the following steps:
Taking a deep breath
Holding the breath while swallowing
Coughing to clear saliva or food that may have passed beyond the vocal cords
Super supraglottic swallow
Compensatory swallowing technique used to close the airway entrance above the vocal cords, involves the following steps:
Taking a deep breath
Holding the breath and bearing down (as in a bowel movement) while swallowing
Coughing to clear saliva or food that may have passed beyond the vocal cords
Mendelsohn maneuver
Technique used to prolong the opening of the upper esophageal sphincter during a swallow, involves pushing the tongue into the upper palette while manually maintaining the Adam’s apple in an elevated position
Sliding board transfer
Technique for moving from one seating surface to another used by individuals who have adequate UE and trunk strength but minimal to no functional use of the LE to move Involves using a specially designed device positioned under the thighs and on the transfer surface
Stand-pivot transfer
Technique for moving a client from one seating surface to another using the following procedures:
properly positioning the client for the move
assisting the client to standing
having the client shuffle both feet toward the transfer surface
slowly lowering the client onto the transfer surface
Dependent transfer
Moving a client who requires physical assistance of one or two caregivers to move from one seating surface to another without mechanical assistance If completed incorrectly, poses a high risk for client and caregiver injury
Mechanical lift transfer
Use of a hydraulic or powered frame in conjunction with a hammock-like seat to move a client requiring maximum physical assistance from one surface to another
Gait belt
Device typically made of cotton webbing with a buckle that adjusts and locks around a client’s waist, used by caregivers to provide external support to the client during transfers and ambulation
Ergonomic feature: Lumbar support
Feature considered in the ergonomic design of a chair or seat to maintain natural curvature of the lower back; especially beneficial when sitting for prolonged periods of time
Ergonomic feature: Seat backrest
Feature considered in the ergonomic design of a chair to ensure best possible postural support, that:
provides sufficient width for the back
is adjustable for height and angle
supports the natural curvature of the spine
Planar foam wheelchair seat cushion
Type of wheelchair seat cushion with the following characteristics:
composed of viscoelastic material
lightweight and inexpensive
absorbs moisture
multiple density and thickness options
least effective option for pressure distribution
Gel-filled wheelchair seat cushion
Type of wheelchair seat cushion with the following characteristics:
composed of viscoelastic material
lightweight and inexpensive
absorbs moisture
multiple density and thickness options
least effective option for pressure distribution
Air-filled wheelchair seat cushion
Type of wheelchair seat cushion with the following characteristics:
bladder design with adjustable inflation level
provides even distribution of pressure relief
lightweight design feature
potential for air pressure variability inherent in overall design
Wheelchair measurement: Seat width
Measurement used as part of a comprehensive wheelchair prescription, determined by measuring the widest point across the hips when client is in sitting then adding 2 inches (5 cm)
Wheelchair measurement: Seat depth
Measurement used as part of a comprehensive wheelchair prescription, determined by measuring from the base of the posterior aspect of the buttocks to the popliteal fossa, then subtracting 1-2 inches (2.5 – 5 cm) Recommended to measure each leg individually
Wheelchair measurement: Mid height back
Measurement used as part of a comprehensive wheelchair prescription, determined by measuring from the seat surface to the inferior angle of the scapula
Wheelchair measurement: Seat height
Measurement used as part of a comprehensive wheelchair prescription, determined by measuring from popliteal fossa to the bottom of the heel
Wheelchair measurement: Armrest height
Measurement used as part of a comprehensive wheelchair prescription, determined by measuring from the seat surface to the olecranon process with elbows flexed at 90 deg
Hydraulic standing frame
Piece of durable medical equipment designed with a hydraulic lifting mechanism intended to facilitate transfers and upright positioning for individuals who have minimal use of the lower extremities
Accessibility Standards: Ramp slope
Rise to run gradient recommended as an alternative to stairs for facilitating accessible entry into homes or buildings (e.g., 1 inch (2.54 cm) of rise should have 12 inches (30.5 cm) of length)
Barrier free design
Environmental plan that eliminates physical obstructions, allows for optimal performance and access for individuals with disabilities
Home modification process
Process of identifying and eliminating structural barriers in the living environment to improve accessibility and support engagement in occupation
Light meter
Assessment tool used for measuring ambient and natural lighting levels in context to determine areas of poor illumination that may hinder optimal occupational performance
Force measure
Environmental assessment tool for measuring push or pull force required to manage:
doors
drawers
windows
Clinometer
Environmental assessment tool used to measure lateral slope of a ramp, floor, or pathway
Built environment
Architectural and design features of buildings, dwellings, or homes
Universal Design Principle: Equitable use
One of the seven guiding principles for universal design whereby the design of products and environments is useful and marketable to potential users of varying abilities
Universal Design Principle: Flexibility in use
One of the seven guiding principles for universal design whereby the design of products and environments accommodates for a wide range of individual preferences and abilities
Universal Design Principle: Simple and intuitive use
One of the seven guiding principles for universal design whereby the design of products and environments is easily understood by all potential users
Universal Design Principle: Perceptible information
One of the seven guiding principles for universal design whereby the design of products and environments communicates necessary information effectively to the users, regardless of the ambient conditions and the user’s sensory abilities
Universal Design Principle: Tolerance for error
One of the seven guiding principles for universal design whereby the design of products and environments minimizes risk of injury or unexpected circumstances
Universal Design Principle: Low physical effort
One of the seven guiding principles for universal design whereby the design of products and environments allows for efficient expenditure of physical energy
Universal Design Principle: Size and space for approach and use
One of the seven guiding principles for universal design whereby the design of products and environments provides for sufficient size and space for approach, reach and manipulation for users of varying sizes, abilities, and levels of mobility
Body mechanics
Application of kinesiology to promote proper alignment, position, and efficient use of the body during physical task activities, principles include:
plan movements
load close to body and bend knees when lifting
ensure solid base of support and use inertia when appropriate
ensure solid base of support and use inertia when appropriate
Ergonomics
Science involving analysis and recommendations to ensure an optimal fit between the environment, equipment, and the user Facilitates optimal performance with the least risk of injury
Client education
Collaborative client-centered teaching approach used to advise a client on:
plan of care and goals
resources
discharge planning
home programs
Includes assessing the ability to carry out health care recommendations
Community resources
Public and private services available in a client’s community aimed to:
enable participation in meaningful occupations
provide ongoing social support
provide outreach based on needs
Automaticity
Ability to perform activities using an automatic response or habit, involves less attention to details of the procedural steps Intervention strategies may include:
linking a new activity with an existing one
ensuring consistency in instruction, steps, and environment
Home program
Set of recommended activities provided to support carryover of skills learned in a therapeutic setting to the natural environment
Attention
Cognitive process of being able to focus on specific stimuli, task, and/or task component while disregarding irrelevant distractors, types include: selective sustained alternating divided
Awareness deficit
Lack of insight into a person’s own functional deficits
Memory
Cognitive process of retaining information, types include: working, short term, and long term procedural, declarative, and episodic semantic, explicit, and implicit prospective and metamemory
Distractibility
Disruption in the cognitive process of attention that manifests itself with inability to maintain focus on desired performance due to distractions caused by external stimuli
Metacognition
Self-awareness of one’s own cognitive performance ability and capacities and the need for strategy use Frequently impaired in clients with executive dysfunction
Executive function
High level cognitive process that includes:
planning and organizing
regulatory control
problem solving and working memory
Errorless learning
Cognitive intervention method in which the task or activity is set up so that the client does not make an error, may be useful:
for clients with severe memory impairment
during skill training
Multicontext approach
Expectation that task modifications/cognitive strategies should be applicable and be practiced in multiple contexts where the client has performance demands Based on the Dynamic Interactional Model of Cognition
Spaced retrieval
Cognitive intervention method in which the client is asked to recall information at expanding intervals (e.g., client will be asked to immediately recall names of people then recall 5 minutes later, then 10 minutes later)
Graded cues
Cognitive intervention approach in which the therapist provides only the necessary cues for expected task performance, includes:
general cue
specific cue
explicit instruction
Cognitive compensatory strategies
Internal or external methods to maximize cognitive performance where strategy training may be a 3 phase process:
acquisition
application
adaptation
Internal memory strategies
Group of techniques to aid in mentally organizing cognitive information for retrieval at a later time Therapeutically used in conjunction with external strategies, examples include:
visual imagery
grouping similar information mnemonically
External memory strategies
Therapeutic method used in neurorehabilitation to support ability to retrieve cognitive information at a later time, examples include:
checklists
day planner
posted signs
Metacognitive strategies
Self-management method that includes the ability to identify cognitive challenges during day-to-day activities and to create strategies that can be duplicated over time
Sleep hygiene
Establishing physical and environmental conditions for effective rest and sleep, interventions may focus on:
activities performed prior to sleep
sleep schedules and routines
ambient conditions of the bedroom
Lifestyle Redesign
Preventive intervention model approach for older adults with a focus on establishing methods for continued participation in meaningful activities and healthy habits, and to identify solutions for self-identified barriers
Scanning training
Intervention for visual field deficits to structure a visual search and increase awareness of blind spots, may include:
progression of clinic activities to contextual task performance
visual anchoring
change in head and body position
Stress managment
Strategies to promote relaxation and reduce symptoms of stress and anxiety, techniques include:
deep breathing
muscular relaxation
visualization
Enhanced lighting
Environmental solution for low vision that may include lighting customization:
consistent with a person’s visual abilities
in context according to ambient conditions
based on results of an analysis of the desired occupation
Environmental adaptation: Contrast
Solution to enhance safety and performance for client’s with low vision, that includes a distinct color gradient, may be used for:
visual presentations/educational materials
placemat during meal time
edge of stairs
Memory aid: Calendar
External memory strategy involving a time-limited planner used to promote effective schedule management, typically placed in a commonly viewed location
Memory aid: Wall chart
External memory strategy that includes posting written instructions, steps or illustrations of routine tasks, or daily activities Typically placed in close proximity to where performance is expected
Electronic memory aids
Technology solutions (e.g., Smartphone, mobile apps) to aid in the retrieval of information during daily activities, considerations for selection include:
matching current abilities to device
simplicity of use
Graded cues
Varying levels of guidance to support activity performance and participation with modification and adjustments to allow for progression towards independence, cues can be:
visual
verbal
tactile
General cue
Visual or verbal guidance to prompt self-monitoring and modification to performance (e.g., “After bathing, dry your feet before getting out of the tub”)
Specific cue
Level of graded cueing that includes visual, verbal, or tactile prompt as a reminder to change behavior or action; used when general cue is ineffective, (e.g., “Now that you are done bathing, what do you do next?”)
Explicit instruction
Most direct level of graded cueing that includes instruction in the next step required for a given activity (e.g., “Now that you’ve finished bathing, it’s time to dry your feet”)
Task simplification
Method of grading activity to allow the capacity of the client to match activity demands, may involve:
breaking an activity into smaller parts
eliminating steps of an activity
modifying objects used during the activity
Coping strategies
Method of dealing with a challenging psychological situation, strategies may be:
adaptive (e.g., humor, positive thinking)
maladaptive (e.g., substance use, avoidance)
Chaining
Intervention technique that includes completion of one step of the task at a time and sequentially adding additional steps once performance is achieved, includes:
forward chaining
backward chaining
Common names of restriction orthoses
Names commonly used to describe this category of orthotic device include:
buttonhole PIP extension orthosis
anticlaw buckle orthosis
MCP joint ulnar deviation orthosis
Meunster orthosis
May be included as part of an orthotic prescription to help identify an orthosis using non-modified orthosis classification system nomenclature
Common names of mobilization orthoses
Names commonly used to describe this category of orthotic device include:
tenodesis orthosis
radial nerve palsy orthosis
palmar abduction orthosis
dynamic flexion assist orthosis
interphalangeal flexion orthosis
May be included as part of an orthotic prescription to help identify an orthosis using non-modified orthosis classification system nomenclature
Common names of immobilization orthoses
Names commonly used to describe this category of orthotic device include: volar wrist orthosis thumb spica orthosis dorsal blocking orthosis resting hand orthosis short opponens orthosis metacarpal fracture brace May be included as part of an orthotic prescription to help identify an orthosis using non-modified orthosis classification system nomenclature
Intrinsic-plus position
Term used in orthotic positioning, commonly referred to as the “anti-deformity” or “safe position” of the hand, intended to place the MCP joint collateral ligaments in an elongated position to reduce contracture risk Consists of: wrist in neutral or slight extension finger MCP joints in 75-90o of flexion finger IP joints in complete extension thumb in abduction and opposition
Neural gliding exercises
Series of structured UE exercises intended to prevent nerve adhesion and preserve neural mobility often used as an adjunct intervention for compression neuropathies or nerve entrapment syndromes
Tendon gliding exercises
Series of hand exercises intended to prevent tendon adhesion and preserve tendon excursion, includes the following:
straight fist: Composite MCP and IP joint extension
hook fist: MCP joint extension with IP joint flexion
intrinsic-plus: MCP joint flexion with IP joint extension
straight IPs: MCP and PIP joint flexion with DIP joint extension
full fist: Composite MCP and IP joint flexion
