Exam 2 Flashcards
Goniometry, Joint Replacement, Teaching and Learning Techniques, ROM Interventions, Pelvic Floor and Incontinence Management
AROM
active range of motion
- movement produced by one’s own muscles
AAROM
active assisted range of motion
- movement produced by one’s own muscles and assisted by an external force
PROM
passive range of motion
- movement produced by an external force
functional ROM
ROM needed to perform functional movements
- ex. reach top of head or small of back
WNL ROM
within normal limits range of motion
- indicates that the arc of AROM is within normal acceptable limits
limitations, contraindications, and precautions to ROM
- bone metastasis
- unhealed fracture or recent dislocation
- infection
- post surgery
- myositis ossificans
- subluxed or unstable joints
- skin grafts
- other as identified by the physician
hard end-feel normal/abnormal
normal: bony block - olecranon process in olecranon fossa
abnormal: client has an external fixator bone in grown
firm end-feel normal/abnormal
normal: soft tissue, tight but a bit resilient
abnormal: client has frozen shoulder
soft end-feel normal/abnormal
normal: flexing elbow with excess adipose tissue
abnormal: flexing elbow with edema
always round to the nearest ___ when using a goni
5 degree
rotator cuff muscles (4)
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
shoulder condition: shoulder instability
- causes: joint laxity, trauma, rotator cuff disease
- unidirectional - multidirectional
- subluxation - dislocation
- surgery - arthroscopy to tighten GH capsule
shoulder condition: impingement and tears
shoulder impingement: tendonitis, bursitis, tendinopathy
- causes: tendons/ bursa trapped/ compressed by shoulder movements
rotator cuff tears: acute vs. chronic
- causes: acute - trauma/ chronic extension of shoulder impingement
shoulder condition: adhesive capsulitis
adhesions
- synovitis
- fibrosis
- primary vs. secondary
4 stages of adhesive capsulitis & treatment
- mimic other rotator cuff diseases
- freezing
- primarily pain management - frozen
- thawing
- ROM
shoulder condition: fractures
cause: FOOSH
- rehab depends on stability
- complex immobilized 4-6 weeks
- minimally displaced 1-3 weeks
* must consider different questions
- non-operative management
- stable, non-displaced
- surgical management
shoulder condition: brachial plexus
- C1-T1
- dysfunction, intervention, and prognosis relate to mechanism and severity of injury
- neuropraxia - avulsion
- traumatic vs. non-traumatic causes
shoulder condition: cervical radiculopathy
- arm pain radiating from cervical nerve root condition
- other complaints may require referral to other discipline
- limited ROM (shoulder, arm, head/neck)
- postural difficulties
medical and surgical management: factors in decision making
- status of injury
- key neurovascular structures involvement
- potential for anatomical/ functional recovery
- client’s factors
medical and surgical management: conservative treatment
when is it the best option
- education
- HEP
- strategies for balancing rest & modified activities
when for a poor surgical candidate
- prevention of further injury
- caregiver education
immobilization, pain/edema control/modalities
medical and surgical management: different types of surgery/ surgical management
- arthroscopy
- arthroplasty
- open repair
- thermal capsulorrhaphy
OT evaluation of the shoulder
- history and intake
- clinical observation
- physical examination
- outcome measures
- occupational profile
OT assessment - shoulder
- symptoms
- activities - pain
- routine before/after symptoms
- interventions tried?
- clinical observations/ physical exam
- posture
- ortho screening tests
outcome measures - shoulder
- disabilities of the arm, shoulder & hand (DASH)
- shoulder pain & disability index (SPADI)
- analysis of occupational profile
immobilization phase: ___ weeks
- 4-6
- education & training
- don/doff sling/shoulder immobilizer
- cryotherapy
- pendulum/modified pendulum exercises
- modify ADLs
mobilization phase: ___ weeks
- 4-10
- exercises
- modalities
- superficial heat
- aerobic exercise
- occupation
- rest
- activity
reintegration phase: ___ weeks; goals
- 8-10
- increase strength
- increase power
- increase endurance
- progress to advanced functional activities
- progress to optimal weight bearing
reintegration phase: ___ weeks; exercises
- 8-10
- rotator cuff strengthening
- scapular stabilization
- core strengthening/ postural education
OTAs role - shoulder
- psychological impact of shoulder issues
- compensatory strategies or AE
- collaboration with PT
what is arthritis?
- inflammatory, infectious, metabolic, or autoimmune
- progressive, static, or have periods of remission and exacerbation
arthritis and goals of OT intervention
- improve/ prevent decline in function
- reduce/ manage pain management
- preserve joint integrity
- improve QoL
OA/DJD vs. RA
OA: articular cartilage wears away
RA: systemic, autoimmune; affects eyes & internal organs; exacerbations/ remission
OA signs & symptoms
- joint pain
- joint stiffness
- decrease ROM
- inflammation
- difficulty performing daily activities
- visible joint changes
- muscle weakness
RA signs & symptoms
- tender, warm, swollen joints
- morning stiffness
- rheumatoid nodules
- fatigue, fever, and weight loss
diagnosing OA
- detailed health history
- history of symptoms
- physical examination
- x-ray/ MRI
- ruling out other arthritic conditions (blood tests, joint aspiration)
diagnosing RA
- extensive history
- physical examination
- blood tests
- imaging studies
OA treatment/ OT intervention
- pain management
- improve function
- reduced potential for long-term (LT) disability
- variable medical treatment
OT
- body mechanics
- lifestyle changes
-AE
- environmental modifications
RA treatment/ OT intervention
- non-steroidal anti inflammatory drugs (NSAIDs)
- disease-modifying antirheumatic drugs (DMARDs)
- pain medication
OT
(exacerbation)
- jp
- orthoses
- pain/ inflammation management
- AE
(remission)
- gentle progressive exercise
fibromyalgia signs & symptoms
- pain
- fatigue
- cognitive impairment
- other
diagnosing fibromyalgia
- no lab test
- American College of Radiology (ACR) criteria
fibromyalgia treatment
- pain management
- symptomatic relief
- exercise
- acupuncture
- massage therapy
- biofeedback
- meditation
- dietary supplements
causes of fibromyalgia
- genetics
- infections
- physical/ emotional trauma
lupus signs & symptoms
- painful, swollen joints
- extreme fatigue and unexplained fever
- butterfly-shaped rash
- photosensitivity
- blood-related anemia/ ABN clotting
- headache, confusion, and/or memory loss
- Raynaud’s phenomenon
- chest pain
- edema
- affects body systems
diagnosing lupus
- blood tests
- urinalysis (UA)
- other
causes of lupus
- genetic predisposition & environmental factors
- medication induced
lupus treatment
- medication for symptoms
- alternative treatments
- orthosis for arthritic changes
gout signs & symptoms
- intense pain
- swelling
- redness
- heat/ warm joint
- joint stiffness
- joint deformity
- tophi
diagnosing gout
- blood test for uric acid levels
- x-rays - bony changes
- joint fluid testing - uric crystals
- family history
- use of certain drugs & vitamins
causes of gout
- family history
- male gender/ obesity
- alcohol abuse
- intake of foods rich in purines
- enzyme defect
- organ transplants
- exposure to lead
gout treatment
- dietary modification
- medication
- lifestyle changes
- education
pharmacological treatment of arthritis
- corticosteroids
- OTC analgesics
- opioids
- DMARDs/ biologics
- antidepressants
- low dose seizure
- antimalarial
- immunosuppressant
- drugs that affect uric acid
arthrodesis
JOINT FUSION
- decrease pain and increase stability
- ankle, wrist, thumb, or fingers
arthroplasty
JOINT REPLACEMENT
- hips, knees, shoulder, ankle, wrist, elbow, MCP joints
osteotomy (OA)
OSTEOARTHRITIS
- bony defect corrected by cutting and repositioning
- correct curvature & improve WB (LE long bones)
resection
- removal of all/ part of a bone
- decrease pain and improve function
synovectomy (RA)
RHEUMATOID ARTHRITIS
- diseased synovium is removed
- decreases pain and swelling
joints: OT interventions
- decreasing pain
- improving function
- environmental and lifestyle modifications
- decreasing risk of deformity or disability
- client education, AE, orthoses, edema management and modalities, therapeutic exercises and activities
common shoulder conditions (6)
- shoulder instability
- impingement and tears
- adhesive capsulitis (frozen shoulder)
- fractures
- brachial plexus
- cervical radiculopathy
common joint conditions (5)
- fibromyalgia
- gout
- lupus
- osteoarthritis (OA)
- rheumatoid arthritis (RA)
what is incontinence
“involuntary urination or defecation”
- NOT part of normal aging process
- bladder capacity and ability to delay urination and defecation decreases as we age
etiology of incontinence
common causes
- delirium, infection, psychological factors such as depression
- excessive urine production, hypercalcemia
- hyperglycemia, diabetes, CHF, edema
drug-induced causes
- sedatives, diuretics, calcium channel blockers, antihistamines, etc.
anatomic
- sphincter dysfunction, fecal impaction, hemorrhoids, neuromuscular disorders, psychiatric disorders
urge incontinence
inability to hold urine for a time long enough to reach a bathroom; uncontrolled bladder contraction
stress incontinence
loss of urine when coughing, laughing, sneezing, exercising, or lifting
overflow incontinence
frequent or constant dribbling of urine caused by the bladder always being full
mixed incontinence
combination of urge and stress incontinence
functional incontinence
impaired cognition and mobility
all about urinary retention
- issue in men or women
- the bladder does not completely empty, so the person always feels they need to urinate
- significantly increases the incidence of UTIs
** double voiding
all about fecal incontinence (3 types)
results from problems with GI tract and colon
- diarrhea: frequent passage of loose, watery stools
- constipation: infrequent, hard, dry stools
- bowel obstruction: hard, lodged stool that creates actual obstruction to defecation; can cause temporary diarrhea, but then nausea and vomiting as it progresses
incontinence: interdisciplinary team strategies
- promote comfort with elders discussing their bowel and bladder habits
- involve the collaboration of other health care providers to determine the cause and options for treatment of incontinence
- begins with medical history and lab tests
- surgical repair is possible for men and women with less than 100% success
- medications can often help or revision of medication regimen helps
bladder training: timed voiding and habit training
elders void on fixed schedule, usually every 2 hours
bladder training: double voiding for nocturia
urinate, lay down for 30 mins, and then urinate again
bladder training: prompted voiding
ask elders if they need to void every 2 hours
bladder training: bladder training exercises
- kegel exercises: not always effective for post menopausal women
- can be difficult to assess whether contractions are being completed accurately
beyond kegels: nocturia
one good suggestion is to complete double voiding prior to falling asleep
beyond kegels: physiologic quietening
using relaxation techniques, breathing techniques
beyond kegels: keep a bladder diary
look for trends
beyond kegels: avoid bladder irritants
coffee, caffeine
beyond kegels: keep urine diluted
drink frequently throughout the day, limit liquids after 7pm
pelvic floor exercises
- understand pelvic floor structure and relationship to core strength and diaphragm
- pelvic floor fitness/ alignment
- HIP ABDUCTION: theraband
- HIP ADDUCTION: pillow or ball
- pay attention to posture, try to have the client engage the core
- ROLL FOR CONTROL
- have client do exercises in different positions: standing, sitting, lying down
incontinence: use of breathing techniques
- assists with physiologic quietening to decrease irritable bladder
- allows client to breathe through the height of the urge cycle (and bladder contraction)
- trains and utilizes the pelvic/ diaphragm piston action
incontinence: environmental adaptations
- provide grab bars
- encourage functional independence in all environments
- avoid restraints
- clear the path to the bathroom
- always leave the client with the call light so they may call for assistance
- adjust clothing so the elder and caregivers can easily toilet the person
- provide bedside commodes
skin integrity
braden scale
- risk factors for skin breakdown
- incontinence and immobility are two major risks for skin breakdown
- high score > low score
prevention of skin erosion
prevention measures
- bowel and bladder program
- repositioning (turning) schedule
- proper wound care
- good nutrition
- hydration
- frequent skin inspections by staff, physician, RNs
environmental hygiene CONSIDERATIONS with incontinence in community settings
- ADLs: can client change their brief?
- washable mats where they sit
- throw away briefs in single bag to decrease odor
- clean carpets/ floors if incontinent
- can clients clean up bathroom after an incontinence episode?
spinal precautions
- no twisting, bending, or lifting
- TLSO (thoracolumbosacral orthosis)
cervical collars for cervical spine surgery or trauma
- used to immobilize the neck
- you will see following surgeries or trauma for wear of 4-6 weeks
- watch pressure areas around the ears
** we DO NOT mess with
hip - medical management
- THA surgery designed to alleviate pain and restore joint motion
- socket fitted into acetabulum; femoral head and neck
hip - OTA interventions
- education!!!
- AE
- precaution management
- safety techniques
- compensatory techniques
- fall prevention
- safe transport of items
- ADL/ IADL retraining
OTA interventions for movement restrictions
- movement during ADLs and functional mobility
- ADL/IADL education
- AE
- car transfers
- education
- fall prevention
s/p considerations
- safety
- any additional comorbidities
- mental health stability
- environmental modification
- pain management during function
- caregiver support
sexual activity post surgery
- QoL/ ADL
Role of OTA: - open mindfulness
- normalize
- allow for client to be open; can refuse
- educate on safe positions
- ensure there is clearance from surgeon
- pain management recs per surgeons recs
- safe environment
why is improving incontinence important?
- reduce skin breakdown, UTIs, urosepsis, and falls
- improves well being, dignity, independence, and participation in activities
- reduces cost to patient/ facility
causes of incontinence
- overweight
- constipation
- nerve damage
- surgery
- medication
- caffeine
- infection
this issues of incontinence
- physical and emotional well being is compromised
- increased risk of falls
- embarrassment
- reduced socialization
- depression
- increased burden of care
- skin integrity
incontinence - patient identification
- observe for wetness
- incontinence products in room?
- ask to toilet frequently
- catheter in
- recent childbirth
- cancer related complications
- decreased ability to manage pericare
remediation approaches to incontinence
- exercises
- bladder diary
- retraining bladder with toilet schedule
- fluid intake/ times
- e-stim/ biofeedback
Codman’s exercise (pendulum exercises) are a common form of PROM use for: ___
postsurgical shoulder patients
AROM should be performed when ___ is greater than ___
PROM; AROM
