Exam 5: Hand Stuff Flashcards
Hand Therapy, Splinting, PAMs, PNS vs. CNS deficits, Theorists of Functional Movement
purpose of an orthosis
Protection
* Fractures, tendon repair, trauma
Positioning to relieve symptoms and promote
healing
* Nerve compression, arthritis
Awaiting functional return
* CVA, SCI, TBI
Increase motion/compensate for lost motion
* Stiffness, nerve compression injuries, SCI
static orthosis
- no moveable parts
- designed to protect, restrict motion, and provide proper positioning
static progressive orthosis
- uses inelastic parts to position a joint at the available end of ROM
- intent is to improve PROM
dynamic splint
- has moveable or elastic parts
- used to improve motion, provide controlled motion or compensate for loss of motion
static and static progressive orthosis principles
- 3/4 length of forearm
- 1/2 up sides of hand/ forearm
- fractures - one joint above/ below injury stabilized
- avoid pad/ bony prominences
- edges smooth
- strapping wide enough to distribute pressure (also at angle)
dynamic orthosis principles
- same as static/ static progressive +
- high/ low profile outriggers
- force should be enough to achieve goals while being tolerable
orthosis precautions and contraindications (5)
- poor skin integrity
- decreased cognitive status
- undiagnosed joint instability
- pain
- client unwillingness to accept responsibility
orthosis education and training (5)
- wearing schedule
- caring for the orthosis
- monitoring for skin irritation
- not stored near heat source
- picture of client wearing orthosis
thermoplastic properties (5)
- thickness
- drapability
- memory
- rigidity
- adherence
purpose of serial casting
to decrease tone
- botox often injected in muscle
to decrease joint stiffness
- casting motion to mobilize stiffness (CMMS)
precautions and contraindications to serial casting
- poor skin integrity
- decreased cognitive status
- bony restrictions
different types/ names of orthoses (7)
- resting hand
- volar wrist
- thumb spica
- ulnar gutter
- dorsal blocking
- metaphalangeal blocking
- finger gutter
different types of assessment of the hand (8)
- ROM
- Strength
- Sensation
- Inflammation/ Edema
- Integument
- Observation
- Functional Performance
- Provocative Testing
ganglion cysts
soft tissue mass
Dupuytren’s Contracture (disease)
- progressive contraction of fascia in palm
- can occur in any finger
de Quervain’s tendinopathy
tenosynovitis of first dorsal compartment
trigger finger
tenosynovitis at the A1 pulley
complex regional pain syndrome (CRPS)
- pain
- skin and temperature changes
- inflammation and waxy
swelling, stiffness, burning pain, hypersensitivity to cold, changes in skin color, hair/nail growth, loss of functional use
Type I vs Type II - diagnosed exam, x-ray, bone scan or diagnostic sympathetic block
THERAPEUTIC GOALS - minimize pain, decrease edema while improving functional ROM
- need encouragement to use extremity
‒ bilateral activities, ADLs, weight bearing
‒ graded motor imagery, sensory re-education, orthotic intervention, modalities
goals of traumatic hand injuries (5)
- wound, inflammation, scar and pain management
- client education
- fabrication of a custom positional orthosis
- ADL training
- discussion of the psychological effect of trauma
OT interventions for ROM vs. strengthening (6)
- arom vs. prom
- tendon glides
- blocking
- controlled motion
- early protected motion
- goal of early mobilization
OT interventions for rom vs. STRENGTHENING (4)
- isometric, isotonic, isokinetic
- ways to provide resistance
- contraindications
- use of functional movements
stage 1 orthosis fabrication and fitting
positioning and support
stages 2 & 3 orthosis fabrication and fitting
decrease joint stiffness and increase functional ROM
sensory re-education
- treatment similar for both hypo- and hypersensitivity
- sensory re-education
- mirror visual feedback
- protection/ injury prevention
- desensitization - immersion, textures, and vibration
- PAMs
- always use as an adjunt
- superficial heat/cold, fluidotherapy, ultrasound, NMES, TENS
general areas for education (5)
- ergonomics
- jp
- use of AE
- activity and lifestyle modification
- care and use of orthoses
