Exam 3 Flashcards
Burns, Amputations, Muscle Strength, MMT, Cardiac and Pulmonary Dysfunction, Ethics/Scope of PAMS, Prosthetic Devices and How They Work
causes of muscle weakness
- lower motor neuron diseases
- primary muscle disease
- neurological diseases
- disuse/ immobilization
- secondary symptom
MMT contraindications
- inflammation/ pain
- fracture/ dislocation
- myositis ossificans
- bone carcinoma
- other fragile bone disease
MMT limitations
- cannot measure muscle endurance, coordination, or task performance
- will not get accurate results with spasticity
MMT 3 and higher requires:
full ROM AGAINST gravity
MMT 2 and lower requires:
gravity ELIMINATED position
dynamometer assess:
grip strength
pinch meter assesses:
pinch strength
- three jaw chuck
- lateral pinch
- two-point pinch
factors to consider when planning intervention for muscle strength
- degree of weakness
- generalized or specific
- imbalance between agonist/ antagonist
- impact on occupations
- orthosis needed?
general purpose of therapeutic exercise (documentation purposes)
- develop awareness of normal movement patterns
- aid in overcoming ROM deficits
- develop strength/ endurance for function
types of exercises (5)
- active-assisted
- active
- resistive
- progressive resistive
- isometric
for STRENGTHENING:
INCREASE load, DECREASE reps
for ENDURANCE/TOLERANCE:
INCREASE reps, DECREASE load
cause of MI
- reduced blood flow to the heart for an extended period
- leads to damage, necrosis or death of cardiac tissues
- coronary artery disease - atherosclerosis
- spasm of coronary artery
symptoms of MI
- pain/pressure in chest that may radiate to teeth, jaw, ear, arm, or mid-back
- nausea/ vomiting
- SOB
- diaphoresis
- fatigue
risk factors of MI
modifiable vs. non-modifiable
medical management for MI
- medication
- balloon angioplasty
- atherectomy
- CABG
sternal precautions
- avoid completing asynchronous UE movements
- avoid activities that cause feelings of sternal clicking or shifting
- avoid shoulder flexion beyond 90 degrees/ other excessive shoulder movements
- no lifting 5-10 lbs+ (push/pull)
- use small pillow held against sternum when coughing or mobility transitions
cause of CHF
- chronic/ progressive condition in which the heart loses the ability to pump effectively
- causes: CAD, hypertension, MI
- results in: fluid in lungs, edema in LEs and abdomen, physiological changes
symptoms of CHF
- sudden weight gain
- SOB, wheezing/ coughing
- fatigue
- decreased appetite
- changes in sleep patterns
risk factors of CHF
modifiable vs. non-modifiable
medical management for CHF
- medication
- lifestyle change
- goals (maintain optimal cardiac function; reduce exacerbation)
surgeries - valve replacement
- defibrillator placement
- LVAD
physical impact of CHF
- fatigue/ decreased activity tolerance
- decreased strength
- decreased UE and LE ROM
- SOB/ difficulty breathing
psychosocial impact of CHF
- anxiety
- depression
- PTSD
- anger/ hostility
cardiovascular conditions +
- hypertension
- cardiomyopathy
- angina pectoris
- arrhythmia
phases of cardiac rehab
1: Inpatient
- mobilization, ADL retraining, education/ HEP
2: Outpatient
- supervised exercise, education
3: Community-Based
- maintenance program
cardiac rehab interventions +
- strength and endurance training
- stress management and coping techniques
- lifestyle modification education
- addressing edema
- addressing SOB
COPD includes:
- emphysema - “pink puffers”
- chronic bronchitis - “blue bloaters”
- peripheral airway disease
medical management for COPD
- medications
- supplemental O2
physical impact of COPD
- postural abnormalities
- decreased strength & activity tolerance
- fatigue/ SOB
- postural control
- cognitive changes
psychosocial impact of COPD
- anxiety/ depression
- altered body image
O2 safety tips!!
- avoid open flames
- store cylinders properly and safely
- turn off valves when not in use
- avoid products with petroleum; use water-based around the nose instead
- always follow instructions of the company for safe use
- tubing can become a falls risks!
pulmonary conditions +
- idiopathic pulmonary fibrosis (hardening of lungs)
- cystic fibrosis (thick mucus)
- kyphoscoliosis (restricts lung expansion)
general goals of pulmonary rehab
- increase ADLs, func. mob., other occs.
- increase strength, activity tol., balance, and use of breathing patterns
- increase QoL, and occ engagement
- improve coping skills to manage SOB
- decrease anxiety and symptoms
educate clients/ caregivers to support carryover of recommendations
pulmonary rehab interventions +
- strength and endurance training
- breathing techniques (PLB, DB, AE)
- coughing techniques
- EC, WS
- stress management/ coping techniques
breathing techniques
- pursed-lip breathing (PLB)
- active expiration
- diaphragmatic breathing
EC & WS tips:
- sit when possible
- rest breaks
- spread heavy/ light tasks throughout day
- keep items in easy reach, work at own pace
- use AE
- minimize movements
- support elbows
- push/pull items on counter rather than lifting
- allow time to prevent rushing
- prioritize what is most important
interdisciplinary teams
- PT
- SLP
- dietician
- psychologist, counselor, social worker, pastoral care
- RT
skilled OT interventions: vital signs
- create daily vital signs diary
- develop self-awareness strategies
- teach compensatory techniques
- teach self-advocacy
signs & symptoms of exercise and activity intolerance
- chest pain (angina)
- pain radiating to teeth, jaw, ear, or UE
- severe SOB
- extreme fatigue
- nausea/ vomiting
- weight gain of 3-5 lbs in short time
SUPERFICIAL BURN: skin layers affected; symptoms; healing; scarring
- epidermis only
- painful, no blisters, red, blanches to touch
- heals in 3-5 days
- no scar
SUPERFICIAL PARTIAL-THICKNESS BURN: skin layers affected; symptoms; healing; scarring
- epidermis and top of dermis
- painful, blisters, moist, red, blanches to touch with brisk capillary refill
- heals before 21 days
- risk of pigment change (color difference)
DEEP PARTIAL-THICKNESS BURN: skin layers affected; symptoms; healing; scarring
- epidermis and deeper into dermis
- less painful sloughed skin, dryer, pale red, may blanch with slow to no capillary refill
- heals in greater than 21 days, usually needs surgery via skin grafting to heal
- scarring, risk for hypertrophic scarring and contractures
FULL-THICKNESS BURN: skin layers affected; symptoms; healing; scarring
- epidermis and entire dermis
- no pain, pale, brown, white, red, leather-like, dry, no blanching, thrombosed vessels
- will not heal (unless small), requires surgical skin grafting to heal
- high risk for hypertrophic scarring and contracture
severity of burns (3)
- total surface area
- age
- premorbid health
burn complications
- capillary leak
- burn edema
- burn shock
- hypo/hyperthermia
- increased metabolic rate
- vascular compromise
- respiratory compromise
- compartment syndrome
burn infection protection
- wound excision/ debridement
burns: stages of wound healing
- hemostasis
- inflammation
- replication/ proliferation
- synthesis/ remodeling
burn wound healing factors
- age
- nutrition
- infection
- other illnesses
- medications
types of burn wound coverage
temp. skin substitutes
- xenograft
- homograft/ allograft
permanent coverage
- split thickness sheet skin grafts (STSG)
- full thickness sheet grafts (FTSG)
burn scar management overview
- scar contracture
- hypertrophic scarring
- interventions essential before scar matures
OTs role in burn and scar management
- orthoses
- ADLs
- family/ caregiver involvement
- functional mobility
- standard precautions
- proper wound/ skin care
burns: acute phase
- depends on burn severity
- goal - prevent deformity
burns: acute phase; OT interventions
manual therapy
- scar management/ massage
- AAROM
- edema reduction
- positioning
- composite stretching
therapeutic activity/ exercise
- ADL retraining
- functional mobility
- endurance activities
neuromuscular reeducation
orthosis fabrication
- preventative
- protective
- contraindications/ precautions
strengthening
positioning
burns: rehabilitation phase
- inpatient/ outpatient
- after burns heal
burns: rehabilitation phase; OT interventions
scar management
- scar massage
- gels/ gel sheets
- silicone products
corrective orthosis
premature rupture of membranes (PROM)/ AAROM/AROM
strengthening
HEP
nerve reeducation
desensitization
modalities
- compression therapy
- sun protection
- skin care
OTA role in burn scar management
- scar massage
- client and family education
- silicone products
- scar remodeling
- compression
psychological factors in burn rehabilitation (5)
- cognition
- pain
- anxiety
- depression
- self-image
common OT goals in first few week post burn
- Client/family will verbalize understanding of burn
rehabilitation process - Client will be independent in HEP for ROM
- Client will increase AROM/PROM of upper
extremities in order to be independent with ADLs
and reduce potential for burn scar contracture - Client will maintain proper positioning for edema
control to optimize wound healing
common OT goals after meeting functional ROM post burn
- ADLs
- IADLs
- rest/sleep
- leisure
- return to work
causes of amputations
- traumatic
- congenital
- disease process
psychosocial factors of amputations
- self awareness
- performance skills and patterns
- social interactions
- stages of grief
- depression and anxiety
phantom pain vs. phantom sensation: treatment
- medication
- TENS
- mirror therapy
- biofeedback/ behavioral treatment
- surgical intervention
changes in sensation
components of prosthesis (3)
- socket
- suspension
- terminal device
types of UE prostheses (5)
- passive
- body powered (voluntary opening; voluntary closing)
- myoelectric
- hybrid
- activity specific
prosthetic application
suspension
- liner
- pin
prosthetic socks
donning
- transtibial
- transfemoral
- UE
knee locking
Phase 1: early management and wound
healing (amputations)
- ROM
- limb care - shrinking and shaping (shrinker/ wrapping)
- wound management
- immediate postoperative prosthesis (IPOP)
- early postoperative prosthesis (EPOP)
- skin care
- limb shrinking and shaping
- desensitization
Phase 2: preprosthetic program, preparation, training (amputations)
- increasing general endurance and stamina
- limb strengthening and ROM
- participation in ADLs
- use of affected/ unaffected limbs
- AE
- education/ training
- one-handed/ cross-dominance training
- myosite training
Phase 3: prosthetic training (amputations)
- donning/ doffing prosthesis
- controls training for elbow, wrist, and terminal device
- body-powered
- myoelectric
- proportional control
- ADL activity using affected UE as an assist
- ADL activity with a LE prosthesis and mobility device
Phase 4: advanced prosthetic training (amputations)
- incorporating UE prosthesis use into ADLs, IADLs, health management, work, and leisure
- minimizing compensatory movements and biomechanical stress to uninvolved limb
- participation in ADLs, IADLs, work, and leisure activities with LE prosthesis
- bilateral high complexity prosthetics
reasons for limited prosthetic use
- age
- comorbidities/ medical history
- cardiovascular tolerance
- skin integrity/ circulation
- UE strength
- condition/ strength of intact LE
- fitness level
- body weight and type
8 parts of prosthesis
- terminal device
- wrist unit
- wrist flexion unit
- forearm
- elbow
- triceps cuff
- harness
- control cable
+ turntable
