EXAM 2 Flashcards
RA
Systemic in nature; can develop in the heart, lungs, blood vessels or eyes
Characterized by remissions and exacerbations
Chronic systemic inflammatory disease of the synovium.
bilateral/symmetrical
morning stiffness less than 1 hr
etiology unknown, (monocyclic, polycyclic, or progressive)
OA
Chronic disease involving the joints especially weight bearing joints (i.e. DIP, PIP, Thumb CMC, MTP, Knee, Hip)
Characterized by destruction of articular cartilage, overgrowth of bone, spur formation, and impaired function
Occurs as a result of aging – affects 10% of the older population
Typically asymmetrical and does not present with nodules
genetic from defect in collagen production, trauma, wear and tear, progressive
common arthritic joint deformities
Nodules/synovial thickening, trigger finger
Tendon rupture
Ulnar drift
Palmar subluxation Intrinsic plus hand Thumb deformities (Nalebuff Classification) Gamekeeper Zig zag deformity
Boutonniere - DIP extension, PIP flexion, lateral band volar
Swan Neck Deformity - DIP flexion, PIP extension, lateral band dorsal
rheumatic disease evaluation procedures
ROM, Soft tissue, Pain, Sensation, UE strength, Dexterity, ADLs, Endurance, Treatment plan, Living situation
classifications for Global Functional Status in RA
Class 1: Completely able to perform usual activities of daily living
Class 2: Able to perform usual self-care and vocational activities but limited avocational activities
Class 3: Able to perform usual self-care activities, but limited in vocational and avocational activities
Class 4: Limited in ability to perform usual self-care, vocational and avocational activities
Vocational: Work, school, homemaking
Avocational: recreation or leisure
Systemic Lupus Erythematosus (SLE)
No uniform pattern of symptoms
Fever, weakness, fatigue, weight loss, skin rash on face or neck or arms
Raynaud’s
Joint pain in the hands, wrists, elbows, knees, or ankles
Muscle aches, swollen glands, lack of appetite, low grade fever, hair loss and nausea and vomiting
Depression or inability to concentrate
Photosensitivity
scleroderma (localized and generalized - CREST)
cause unknown
- localized: Morphea, hard, localized, oval patches on the skin
Linear, a line of thickened skin on the arms, legs or forehead. It can extended deep into the skin and affect the bones and muscles underneath
- generalized: Limited (CREST) – calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia
Diffuse, occurs throughout the entire body
s/s scleroderma
Skin – hardening and thickening, ulcers on the fingers, decrease in hair over affected area, change in skin color
Swelling – fingers and toes look and feel swollen, shiny skin, tight skin, lack of skin creases, numbness and tingling
Sclerodactyly – skin of fingers and toes becomes hard and shiny, difficulty bending fingers leading to contractures
Raynaud’s phenomenon
Telangiectasia
Calcitosis – white lumps under the skin that can break through and leak a chalky white fluid
Arthritis and muscle weakness – painful and swollen joints, general fatigue, weak muscles in shoulder or hip
Sjogren’s Syndrome – deceased secretions of mucosal surfaces
Digestive, heart, lung, kidney problems
psoriatic arthritis (5 types)
- Symmetric Psoriatic arthritis – progressive and destructive. Resembles RA, but generally milder. Affects matching pairs of joints on both sides of the body
- Asymmetric Psoriatic Arthritis – involves 1-3 joints large or small.
- Distal Interphalangeal Predominant (DIP)
- Spondylitis – inflammation and stiffness in the neck, lower back, spine
- Arthritis Mutilans – severe, deforming, and destructive. Primarily affects small joints in the fingers and toes closest to the nail, but also is associated with lower back and neck pain. Uncommon.
psoriatic arthritis s/s
Gray scaly spots on the scalp
Pitting or detachment of fingernails or toenails
Pain in one or more joints
Skin problems occur months or years before swelling and pain
Swelling of fingers and/or toes that gives them a sausage like appearance
Ankylosing Spondylitis
More common in males than females, onset 16-35
Presentation: inflammation causes pain and stiffness progressively up the back. The whole spine begins to fuse together. Can also affect the hips, knees, and ankles, and some patients have eye inflammation (25%)
It is very important that patients keep their back in good position to avoid fusing in an undesirable position. Leaning back against a wall is a good way to ensure good posture.
Surgery is rarely done
Fibromyalgia
90% moderate to severe fatigue
Decreased exercise endurance
Numbness and tingling in the hands, arms, feet, legs and sometimes face
Tenderness of at least 11 of the 18 areas identified.
sternal precautions
No weight-bearing on UE No pushing, pulling or lifting for 12 weeks-- 5 Ibs x8 weeks; 10 Ibsx 8-12 Use pillow when coughing DO AROM exercises Log roll
phases of sternectomy rehab
Phase 1: Inpatient phase (3-7 days) – review sternal precautions, initiate physical activity and provide home exercise/activity guidelines.
Phase 2: Acute outpatient (up to 12 weeks) – comprehensive program including individually prescribed and monitored exercise, and individual and group educational sessions aimed at reducing risk factors and secondary events.
Phase 3: Follows phase 2 (6 months or more) – a continuation of phase 2 but patients no longer receive continuous telemetry monitoring during exercise and are more independent.
Understand the concept of a joint only being a small percentage of the whole body
Take a single joint measurement of a finger, look up the impairment of finger percentage, look up the relationship of impairment of the finger to impairment of the hand, look up the relationship of impairment of hand to impairment of upper extremity, look up the relationship of the upper extremity to impairment of the whole person.
Recognize the process that is carried out to obtain a percentage disability
Not done until pt has maxed out all treatment that would improve their condition
Functional history, clinical tests, and medical history all considered
Needs of pt, physician, lawyer, and insurance companies all considered
OT completes eval, which is reviewed by independent medical examiner
Recognize tools that could be used to assess the functional status of a client.
AMA evaluation of permanent impairment= main test
Evaluation tests: RIM, QuickDash, COPM, grip strength, sensation testing, etc
causes of COPD
Emphysema- Progressive and irreversible destruction of alveoli walls
Chronic Bronchitis- Excessive sputum production and cough of at least 3 months in duration occurring 2 years in a row
Increase risk of COPD: smoking, exposure to lung risk environment, allergens
Identify signs of COPD and stages in which they occur including expected survival rates based on Forced Expiration Volume (FEV)
FEV1 is the volume of air that can be forcefully expelled in 1 second. In COPD the FEV1 is directly related to severity and thus prognosis of the disease.
FEV > 1.5 is considered mild with a prognosis of 10-20 years.
FEV from 1-1.25 is considered moderate with a prognosis of 6-10 years.
FEV < 0.75 is considered severe with a prognosis of 2-6 years.
treatment methods for COPD
Bronchodilators: Adrenergic agents, anti-cholinergic agents, methylxanthines, corticosteroids, mucolytics, diuretics
*Know what kind of medications they may be on
Other treatments: weigh daily (excess weight could mean fluid retention), eat a low salt diet (to prevent fluid build up), be as active as possible without over exertion, vitamin D
Rancho Los Amigos Dyspnea Scale
0: pt unaware of need to breathe 1+: slight awareness 2+: aware, breathes mid-sentence 3+: breathing rapid and deep 4+: can’t carry conversation
Facilitate all aspects of the treatment process for COPD patients
Encourage as much moderate exercise as possible without over-exertion→ increase functional endurance
Work on UE function
Work simplification and energy conservation
Education about energy conservation, relaxation techniques
Evaluate breathing patterns (what muscles are they using?). Teach breathing techniques
Stop treatment is they have chest pain, fever, or nausea
burn depths
1st deg: epidermis
2nd deg: dermis
3rd deg: subcutaneous tissue
4th deg: mx or bone
Demonstrate understanding of percentage burn chart
TBSA: total body surface area. Percentage of skin around body that’s affected
types of burn treatment /management
Burn Dressing – now done with a needle patch that mimics a parasitic worm. The patch is three times stronger than the materials currently used for burn patients. It is a super-grip plaster covered with microscopic needles to heal surgical wounds.
Brown Air Dermatome – a razor that removes skin from one area of the body to graft it onto the burn.
Mesher – a machine that prepares a skin graft for it’s final location
Analyze necessary positioning and OT treatment for a burn victim
Positioning for orthosis:
Dorsal Hand Burn: Intrinsic Plus
Volar Hand Burn: Resting Pan– Digit extension, Full thumb aBduction
Circumferential Hand Burn: Alternate intrinsic plus and pan orthoses– Modify Pan for slight MCP flexion to prevent clawing
burn rehab phases
Evaluation: wound assessment, look at what joints are involved, DON’T DO FULL FLEXION OF HAND (FIST)
Emergent phase: positioning to reduce edema, promote tendon gliding, AROM
Acute phase: AROM, tendon gliding, muscle activity, minimize scarring, compression gloves, orthosis to prevent contracture, ADL
Rehabilitation phase: scar management, fine motor/dexterity, desensitization, compression gloves, analyzing skin integrity
Define work hardening and analyze the S and O components of a work assessment evaluation
S: Current symptoms– what hurts, where and when
Pain scale 0-10
Does pain resolve, what helps pain resolve and aggravate
ADL review (tolerance level)
Additional info and ask specific questions
O:
AROM review of all related areas
Try to get them to go further than they initially attempt
PROM, muscle strength, sensation, functional assessment, tolerance of sitting, standing, walking, carrying, push/pull, balance, kneeling, crawling, climbing, stairs, grip strength, static pull (dynamometer), repetitive foot motion, squatting, pulse rates (in response to activity)
Developmental Stage Model of Work Hardening
Stage I
Looking for a cure
Symptoms control productivity/environment
Stage II
Experiencing a need to work
Understanding activity control of symptoms
Stage III
Has a vocational goal
Develops and maintains an active control of symptoms
work conditioning
rehab to restore functional work tasks (2-4 days/wkly)
work hardening
multidisciplinary approach to progress client to return to work activities (5 days/wkly)
importance of re-assessment in work assessment
This motivates patients who are doing well as they can demonstrate improvement. Unmotivated patients tend to under achieve when reassessed, reinforcing what they feel they cannot do.
Early motion programs
early PROM:
Kleinert –
Dorsal blocking splint with rubber bands pulling fingers down to wrist.
Patients are encouraged to extend the fingers against the resistance of the rubber bands to the dorsal block.
think: rubber bands
Modified Duran –
Primarily repaired flexor tendon delayed mobilization therapy
think: hourly exercises
early AROM: belfast and sheffield, strickland and cannon - tenodesis
Tenolysis and the flexor tendon grafting process
Tenolysis: surgery to release a tendon affected by adhesions/remove the adhesions
Flexor tendon grafting: using a flexor tendon from another part of the body to repair another tendon
goals of flexor tendon healing
Main goal: tendon gliding without gapping or adhesions. “Least amount of force needed for the greatest amount of gliding.”
Other goals: improve tensile strength, improve tendon excursion, improve repair site cellularity, enhance nutrition and intrinsic healing via synovial fluid, and reorganization of extrinsic scar
ADA acceptable wheelchair ramp incline ratios
Standard Adult Wheelchair size: 16” x 18” x 20”
Turning 360: need 5x5 turning radius
Ramps: 1” of vertical rise needs 12” ramp, 1”:12” ratio
Door width 36”, 42” is better; counter height no lower than 30” (34” is standard)
Make recommendations for medication management
Keep a list of all current meds w/ dosages and who prescribed
Bring all meds to each MD visit
Include vitamins, minerals, herbal, natural, and OTC products on your list of meds and bring them all with you
Never share or borrow meds
Store in a dry place unless otherwise instructed
Do not put more than one mediation in the same bottle or container
Ask pharm to recommend a compliance aid to help you take your meds correctly
Know the names of meds and what they treat
Ask pharm if meds should be taken with or without food and if they can be taken along with other meds and dietary supplements
Obtain all meds at single pharmacy
common deaths in homes
falls (#1 cause), poisoning, fires and burns
reasons for adaptive equipment
As an enabler to increase a patient’s level of independence
As a prevention method of further problems
As a treatment tool that will be initially used as an enabler, but later discarded
types of orthoses
Static/casting: support/stabilize/protect/immobilize
serial static: apply with tissue near max end range to wear for long periods of time to accommodate soft tissue elongation
Static progressive: low load force via non elastic component to hold end range until tissue accommodates
dynamic: to restore mobility, has movement
safe positioning orthosis
PIP/DIP extension 0
MCP flexion 70
wrist ext 20-30
thumb in palmar abduction
BTE
interactive rehabilitative system that is able to replicate specific tasks and objectively track progress to show improvement with each therapy session
across the lifespan
pre employment screening/counseling
rehab services, vocational rehab
uses: work conditioning and ergonomic analysis of body mechanics/tool effectiveness
Diagnoses: Musculoskeletal, Cumulative Trauma/Repetitive strain, Neurological conditions/injury
5 main causes of back pain
Bulging Disc: Asymptomatic patient– involves outer layer of the cartilage
Disc Herniation: Involves rubbery cushioning provided
Spinal Stenosis: Abnormal narrowing of spaces within the spine
Spondylosis: Crack or stress fracture of vertebrae. Common cause of back pain in young people.
Spondylolisthesis: Vertebrae start to shift due to the stress fracture
diagnostic tests and medical procedures for lower back pain
Spinal infection or tumor, Neurological deficit, x-rays, bone scans, discograms, electromyography, myelogram, CT scan and MRI
conservative tx methods back pain
Alleviate pain early to prevent psychological changes
Prevent chronic back pain
Return patient back to work and resume daily activities as soon as possible
Teach flexibility program
Bed mobility, Functional transfers, Home rearrangement, BODY MECHANICS
tx chronic back pain
Discectomy: Removal of abnormal disc material– Typically go home day of surgery
Spinal Fusion: Joins two or more vertebrae
kaltenborn joint mobilization techniques and 3 grades
When a convex joint surface is moving, the roll and glide transpire in the opposite direction. When a concave joint surface is moving the roll and the glide takes place in the same direction.
Grade I: loosen
Grade II: tighten or take up slack
Grade III: stretch
functional capacity eval
Systematic process designed to assess a clients physical capacities and functional abilities
Can be used to match the individuals residual capacities with the demands of a specific job as a basis for establishing modifications
Evidence in the determination of disability or compensation status
Baseline for noting the physical capabilities of new employees
true statements about FCE’s
Job specific
Physical and cognitive abilities
Most difficult and important functions of the job are identified and a treatment plan is developed using the task components
There are more than 55 FCE available
facts about grab bars and safety rails
Must be able to support the persons weight
Horizontal are for pushing up and vertical are for pulling up
Optimum diameter is 1.25-1.5 inches and width from wall 1.5 inches (bigger is dangerous because the arm could get stuck
One vertical outside the tub and one horizontal/diagonal along the length of the tub is recommended
goals for work hardening
Includes all aspects required for the client to return to full employment function (psychosocial, communication, physical, and vocational needs)
Aim at particular job or classification of jobs (involve work simulation)
Work hardening is different from work conditioning: use of real work activities in graded fashion, building to work over periods comparable with those in actual work settings, the full spectrum of work related intervention, and multidisciplinary approach)
harnesses for UE prosthetics
Figure of eight, figure of nine, and chest strap (cutaneous anchor is new)
types of terminal devices
TD prehensors can be classified as voluntary opening mechanism or voluntary closing mechanism
VO – fingers remain closed by springs for a mechanical hand or by rubber band for a hood. Force/pinch on the hood can be increased by adding rubber bands (1 pound for each band)
VC – amount of pinch force is decreased or increase by the amount of tension the patient applies on the cable of close the TD. Appealing for people who are active in sports, heavy physical work, or recreational activities
Electric prehensors are heavy but provide stronger pinch force
controllable factors of heart disease
Smoking – damages the endothelial lining making them more susceptible to plaque formation and causes vasoconstriction of the arteries and increase the heart rate
Hyperlipidemia – high lipid level, can be lowered by a low fat diet, aerobic exercise, weight loss
Hypertension
Sedentary lifestyle
Obesity – second leading preventable cause of death. Central/abdominal obesity is linked to increased risk of CAD
Diabetes – women who have diabetes lose the protective effect of their hormones against heart disease and risk is significantly higher.
Psychological stress
different types of activities with METS
Going up the stairs causes the biggest increase
1-2.5 METS
2.6-4
4-6
6-10 – carrying heavy things (especially upstairs)
important in emergent care of burns
Initial injury to about 72 hours
Attempts to stabilize the patient (fluid resuscitation, establishment of adequate tissue perfusion by ventilation, achievement of cardiopulmonary stability
Important consideration is the possibility of inhalation injury (because you can damage the upper airway))
Full OT evaluation is deferred until after the emergent phase (but in the stage screen for distribution and which joints are involved) begin collecting information
Focus on the prevention of early contracture formation through splinting and positioning
Ideal to start within 24-48 hours
joint protection principles
Respect pain
Distribute load over several joints
Reduce the force and effort required in activities
Use correct patterns of movement
Use good body positioning, posture and moving, and handling techniques
Use the strongest, largest joint available for the job
Avoid staying in one position for too long
Use ergonomic equipment, assistive device, and labor saving gadgets
Pace activities: balance rest and activity, alternate heavy and light tasks, take microbreaks
Use work simplification: plan, prioritize, and problem solve
Modify the environment and equipment location and be ergonomically efficient
Maintain muscle strength and rom
NOT cumulative trauma
pain from acute sprain
tendinitis
vascular disruption and small micro tears to the otherwise healthy tendon
nutrition to flexor tendon
both synovial diffusion and vascular supply
NOT a physiological response to tendon gliding in repaired flexor tendon
improved adhesions
true regarding flexor tendon repair immobilization
tendon could weaken
