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PHYS REHAB > Exam 2 > Flashcards

Exam 2 Flashcards

Goniometry, Joint Replacement, Teaching and Learning Techniques, ROM Interventions, Pelvic Floor and Incontinence Management

1
Q

AROM

A

active range of motion
- movement produced by one’s own muscles

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2
Q

AAROM

A

active assisted range of motion
- movement produced by one’s own muscles and assisted by an external force

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3
Q

PROM

A

passive range of motion
- movement produced by an external force

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4
Q

functional ROM

A

ROM needed to perform functional movements
- ex. reach top of head or small of back

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5
Q

WNL ROM

A

within normal limits range of motion
- indicates that the arc of AROM is within normal acceptable limits

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6
Q

limitations, contraindications, and precautions to ROM

A
  • bone metastasis
  • unhealed fracture or recent dislocation
  • infection
  • post surgery
  • myositis ossificans
  • subluxed or unstable joints
  • skin grafts
  • other as identified by the physician
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7
Q

hard end-feel normal/abnormal

A

normal: bony block - olecranon process in olecranon fossa
abnormal: client has an external fixator bone in grown

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8
Q

firm end-feel normal/abnormal

A

normal: soft tissue, tight but a bit resilient
abnormal: client has frozen shoulder

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9
Q

soft end-feel normal/abnormal

A

normal: flexing elbow with excess adipose tissue
abnormal: flexing elbow with edema

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10
Q

always round to the nearest ___ when using a goni

A

5 degree

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11
Q

rotator cuff muscles (4)

A
  • supraspinatus
  • infraspinatus
  • teres minor
  • subscapularis
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12
Q

shoulder condition: shoulder instability

A
  • causes: joint laxity, trauma, rotator cuff disease
  • unidirectional - multidirectional
  • subluxation - dislocation
  • surgery - arthroscopy to tighten GH capsule
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13
Q

shoulder condition: impingement and tears

A

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

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14
Q

shoulder condition: adhesive capsulitis

A

adhesions
- synovitis
- fibrosis
- primary vs. secondary

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15
Q

4 stages of adhesive capsulitis & treatment

A
  1. mimic other rotator cuff diseases
  2. freezing
    - primarily pain management
  3. frozen
  4. thawing
    - ROM
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16
Q

shoulder condition: fractures

A

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

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17
Q

shoulder condition: brachial plexus

A
  • C1-T1
  • dysfunction, intervention, and prognosis relate to mechanism and severity of injury
    • neuropraxia - avulsion
    • traumatic vs. non-traumatic causes
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18
Q

shoulder condition: cervical radiculopathy

A
  • arm pain radiating from cervical nerve root condition
  • other complaints may require referral to other discipline
  • limited ROM (shoulder, arm, head/neck)
  • postural difficulties
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19
Q

medical and surgical management: factors in decision making

A
  • status of injury
  • key neurovascular structures involvement
  • potential for anatomical/ functional recovery
  • client’s factors
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20
Q

medical and surgical management: conservative treatment

A

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

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21
Q

medical and surgical management: different types of surgery/ surgical management

A
  • arthroscopy
  • arthroplasty
  • open repair
  • thermal capsulorrhaphy
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22
Q

OT evaluation of the shoulder

A
  • history and intake
  • clinical observation
  • physical examination
  • outcome measures
  • occupational profile
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23
Q

OT assessment - shoulder

A
  • symptoms
  • activities - pain
  • routine before/after symptoms
  • interventions tried?
  • clinical observations/ physical exam
    • posture
    • ortho screening tests
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24
Q

outcome measures - shoulder

A
  • disabilities of the arm, shoulder & hand (DASH)
  • shoulder pain & disability index (SPADI)
  • analysis of occupational profile
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25
Q

immobilization phase: ___ weeks

A
  • 4-6
  • education & training
  • don/doff sling/shoulder immobilizer
  • cryotherapy
  • pendulum/modified pendulum exercises
  • modify ADLs
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26
Q

mobilization phase: ___ weeks

A
  • 4-10
  • exercises
  • modalities
  • superficial heat
  • aerobic exercise
  • occupation
  • rest
  • activity
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27
Q

reintegration phase: ___ weeks; goals

A
  • 8-10
  • increase strength
  • increase power
  • increase endurance
  • progress to advanced functional activities
  • progress to optimal weight bearing
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28
Q

reintegration phase: ___ weeks; exercises

A
  • 8-10
  • rotator cuff strengthening
  • scapular stabilization
  • core strengthening/ postural education
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29
Q

OTAs role - shoulder

A
  • psychological impact of shoulder issues
  • compensatory strategies or AE
  • collaboration with PT
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30
Q

what is arthritis?

A
  • inflammatory, infectious, metabolic, or autoimmune
  • progressive, static, or have periods of remission and exacerbation
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31
Q

arthritis and goals of OT intervention

A
  • improve/ prevent decline in function
  • reduce/ manage pain management
  • preserve joint integrity
  • improve QoL
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32
Q

OA/DJD vs. RA

A

OA: articular cartilage wears away
RA: systemic, autoimmune; affects eyes & internal organs; exacerbations/ remission

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33
Q

OA signs & symptoms

A
  • joint pain
  • joint stiffness
  • decrease ROM
  • inflammation
  • difficulty performing daily activities
  • visible joint changes
  • muscle weakness
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34
Q

RA signs & symptoms

A
  • tender, warm, swollen joints
  • morning stiffness
  • rheumatoid nodules
  • fatigue, fever, and weight loss
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35
Q

diagnosing OA

A
  • detailed health history
  • history of symptoms
  • physical examination
  • x-ray/ MRI
  • ruling out other arthritic conditions (blood tests, joint aspiration)
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36
Q

diagnosing RA

A
  • extensive history
  • physical examination
  • blood tests
  • imaging studies
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37
Q

OA treatment/ OT intervention

A
  • pain management
  • improve function
  • reduced potential for long-term (LT) disability
  • variable medical treatment

OT
- body mechanics
- lifestyle changes
-AE
- environmental modifications

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38
Q

RA treatment/ OT intervention

A
  • 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

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39
Q

fibromyalgia signs & symptoms

A
  • pain
  • fatigue
  • cognitive impairment
  • other
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40
Q

diagnosing fibromyalgia

A
  • no lab test
  • American College of Radiology (ACR) criteria
41
Q

fibromyalgia treatment

A
  • pain management
  • symptomatic relief
  • exercise
  • acupuncture
  • massage therapy
  • biofeedback
  • meditation
  • dietary supplements
42
Q

causes of fibromyalgia

A
  • genetics
  • infections
  • physical/ emotional trauma
43
Q

lupus signs & symptoms

A
  • 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
44
Q

diagnosing lupus

A
  • blood tests
  • urinalysis (UA)
  • other
45
Q

causes of lupus

A
  • genetic predisposition & environmental factors
  • medication induced
46
Q

lupus treatment

A
  • medication for symptoms
  • alternative treatments
  • orthosis for arthritic changes
47
Q

gout signs & symptoms

A
  • intense pain
  • swelling
  • redness
  • heat/ warm joint
  • joint stiffness
  • joint deformity
  • tophi
48
Q

diagnosing gout

A
  • blood test for uric acid levels
  • x-rays - bony changes
  • joint fluid testing - uric crystals
  • family history
  • use of certain drugs & vitamins
49
Q

causes of gout

A
  • family history
  • male gender/ obesity
  • alcohol abuse
  • intake of foods rich in purines
  • enzyme defect
  • organ transplants
  • exposure to lead
50
Q

gout treatment

A
  • dietary modification
  • medication
  • lifestyle changes
  • education
51
Q

pharmacological treatment of arthritis

A
  • corticosteroids
  • OTC analgesics
  • opioids
  • DMARDs/ biologics
  • antidepressants
  • low dose seizure
  • antimalarial
  • immunosuppressant
  • drugs that affect uric acid
52
Q

arthrodesis

A

JOINT FUSION
- decrease pain and increase stability
- ankle, wrist, thumb, or fingers

53
Q

arthroplasty

A

JOINT REPLACEMENT
- hips, knees, shoulder, ankle, wrist, elbow, MCP joints

54
Q

osteotomy (OA)

A

OSTEOARTHRITIS
- bony defect corrected by cutting and repositioning
- correct curvature & improve WB (LE long bones)

55
Q

resection

A
  • removal of all/ part of a bone
  • decrease pain and improve function
56
Q

synovectomy (RA)

A

RHEUMATOID ARTHRITIS
- diseased synovium is removed
- decreases pain and swelling

57
Q

joints: OT interventions

A
  • 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
58
Q

common shoulder conditions (6)

A
  • shoulder instability
  • impingement and tears
  • adhesive capsulitis (frozen shoulder)
  • fractures
  • brachial plexus
  • cervical radiculopathy
59
Q

common joint conditions (5)

A
  • fibromyalgia
  • gout
  • lupus
  • osteoarthritis (OA)
  • rheumatoid arthritis (RA)
60
Q

what is incontinence

A

“involuntary urination or defecation”
- NOT part of normal aging process
- bladder capacity and ability to delay urination and defecation decreases as we age

61
Q

etiology of incontinence

A

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

62
Q

urge incontinence

A

inability to hold urine for a time long enough to reach a bathroom; uncontrolled bladder contraction

63
Q

stress incontinence

A

loss of urine when coughing, laughing, sneezing, exercising, or lifting

64
Q

overflow incontinence

A

frequent or constant dribbling of urine caused by the bladder always being full

65
Q

mixed incontinence

A

combination of urge and stress incontinence

66
Q

functional incontinence

A

impaired cognition and mobility

67
Q

all about urinary retention

A
  • 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
68
Q

all about fecal incontinence (3 types)

A

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

69
Q

incontinence: interdisciplinary team strategies

A
  • 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
70
Q

bladder training: timed voiding and habit training

A

elders void on fixed schedule, usually every 2 hours

71
Q

bladder training: double voiding for nocturia

A

urinate, lay down for 30 mins, and then urinate again

72
Q

bladder training: prompted voiding

A

ask elders if they need to void every 2 hours

73
Q

bladder training: bladder training exercises

A
  • kegel exercises: not always effective for post menopausal women
  • can be difficult to assess whether contractions are being completed accurately
74
Q

beyond kegels: nocturia

A

one good suggestion is to complete double voiding prior to falling asleep

75
Q

beyond kegels: physiologic quietening

A

using relaxation techniques, breathing techniques

76
Q

beyond kegels: keep a bladder diary

A

look for trends

77
Q

beyond kegels: avoid bladder irritants

A

coffee, caffeine

78
Q

beyond kegels: keep urine diluted

A

drink frequently throughout the day, limit liquids after 7pm

79
Q

pelvic floor exercises

A
  • 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
80
Q

incontinence: use of breathing techniques

A
  • 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
81
Q

incontinence: environmental adaptations

A
  • 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
82
Q

skin integrity

A

braden scale
- risk factors for skin breakdown
- incontinence and immobility are two major risks for skin breakdown
- high score > low score

83
Q

prevention of skin erosion

A

prevention measures
- bowel and bladder program
- repositioning (turning) schedule
- proper wound care
- good nutrition
- hydration
- frequent skin inspections by staff, physician, RNs

84
Q

environmental hygiene CONSIDERATIONS with incontinence in community settings

A
  • 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?
85
Q

spinal precautions

A
  • no twisting, bending, or lifting
  • TLSO (thoracolumbosacral orthosis)
86
Q

cervical collars for cervical spine surgery or trauma

A
  • 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
87
Q

hip - medical management

A
  • THA surgery designed to alleviate pain and restore joint motion
    • socket fitted into acetabulum; femoral head and neck
88
Q

hip - OTA interventions

A
  • education!!!
  • AE
  • precaution management
  • safety techniques
  • compensatory techniques
  • fall prevention
  • safe transport of items
  • ADL/ IADL retraining
89
Q

OTA interventions for movement restrictions

A
  • movement during ADLs and functional mobility
  • ADL/IADL education
  • AE
  • car transfers
  • education
  • fall prevention
90
Q

s/p considerations

A
  • safety
  • any additional comorbidities
  • mental health stability
  • environmental modification
  • pain management during function
  • caregiver support
91
Q

sexual activity post surgery

A
  • 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
92
Q

why is improving incontinence important?

A
  • reduce skin breakdown, UTIs, urosepsis, and falls
  • improves well being, dignity, independence, and participation in activities
  • reduces cost to patient/ facility
93
Q

causes of incontinence

A
  • overweight
  • constipation
  • nerve damage
  • surgery
  • medication
  • caffeine
  • infection
94
Q

this issues of incontinence

A
  • physical and emotional well being is compromised
  • increased risk of falls
  • embarrassment
  • reduced socialization
  • depression
  • increased burden of care
  • skin integrity
95
Q

incontinence - patient identification

A
  • observe for wetness
  • incontinence products in room?
  • ask to toilet frequently
  • catheter in
  • recent childbirth
  • cancer related complications
  • decreased ability to manage pericare
96
Q

remediation approaches to incontinence

A
  • exercises
  • bladder diary
  • retraining bladder with toilet schedule
  • fluid intake/ times
  • e-stim/ biofeedback
97
Q

Codman’s exercise (pendulum exercises) are a common form of PROM use for: ___

A

postsurgical shoulder patients

98
Q

AROM should be performed when ___ is greater than ___

A

PROM; AROM

PHYS REHAB (5 decks)

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