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881 Physical Determinants > Exam > Flashcards

Exam Flashcards

1
Q

Physical Determinants hierarchy

A

person

  • -> impairment: Diabetes, COPD, Mobility, wound, care sensation
  • -> occupation: getting dressed, bathing, walking his dog, playing sports, gardening
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2
Q

Biomechanics:
Kinesiology:
Rehabilitation:
Anatomy:

A

Biomechanics: forces, mechanics
Kinesiology: movement
Rehabilitation: Enabling Function - Adaptation/compensation
Anatomy: underlying structures

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3
Q

Canadian Practice Process Framework (first four stages)

A

enter/initiate–> set the stage –> access and Evaluate

–> agree on Objectives, plan

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4
Q

Occupation-as-Means

A

the use of occupation as a treatment to improve clients impaired capacities and abilities to enable occupational functioning

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5
Q

Occupation-as-Ends

A

the client functional goal which is to be carried out within a given environment and within their own comprised goal

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6
Q

Activity –> steps –Activity Demands –> analysis for intervention
Explain in more detail

A

action verb, how the action takes place, objects, time amounts
“retrieve 1 shirt from the cupboard
Objects, environmental, social, contextual demands, timeing, safety. Biomechanical analysis
Grading and adaptation

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7
Q

Activity Analysis
Assessment:
Intervention:

A

Assessment: understand abilities, Analyze challenges
Intervention: grade activities to build capacity
compensate or adapt performance

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8
Q

Activity Analysis Steps ( 5 steps)

A
  1. Describe the activity
  2. Describe task demands
    Identify primary therapeutic aspects of activity
  3. Adapt activity demands to align with therapy goals
  4. Modify activity demands to adjust difficulty level
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9
Q

Performance Analysis steps (5 steps)

A
  1. Name the role
  2. List tasks the person identifies as important to the role
    List the activities the person identifies as part of key task
    -Describe environment and context in which person will be performing activity
    -Observe person performing activity in environment
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10
Q

If person is able to perform activity, observe another activity
when unable to do activity an OT could then: (3 points)

A
  • teach adaptive methods
  • modify/simplify environment
  • Remediate impaired abilities and capacities
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11
Q

Performance Analysis ( more points)

A

f remediating, analyze what ability limitations are interfering with performance

  • after identifying ability limitations, measure abilities to confirm limitations, analyze what deficit capacities are causing limitations
  • measure capacities and treat when verified
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12
Q

Bottom up

A

Biomechanical Approach

-person focused

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13
Q

Top Down

A

Rehabilitative approach

occupational focused

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14
Q

Biomechanical Approach

A
  • remediation or prevention of limitations in ROM, strength and endurance to fully engage in purposeful and occupational based activities
  • preventing or decreasing impairment through occupation
  • meaning created by the ultimate goal of establishing occupations
  • underlying pathology must be considered
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15
Q

Goals related to Biomechanical approach: (4)

A
  • maintain or prevent limitations in ROM
  • increase ROM
  • increase Strength or prevent limitations in strength
  • increase endurance or prevent limitation in endurance
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16
Q

Rehabilitation Approach ( 6 points)

A

achieve maximum function in the performance of his or her daily activities
-looks at overall client functioning and performance - al determinants considered
considers individual’s context - environment
-Emphasis on teaching individuals to compensate or adapt to optimize functioning when impairment cannot be remediated
-teaching and learning process
-collaboration with client

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17
Q

Goals related to Rehabilitative Approach:

A
  • compensation and adaption
  • teaching/education
  • when remediation will not restore function OR goal is to optimize functional independence while restoring abilities
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18
Q

Modifying activity to: (3 points)

A
  • enabling individuals to perform activities they would not otherwise be able to perform
  • prevent injuries i.e cumulative trauma/repetitive stress injuries
  • accomplish goal
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19
Q 
Discuss Bullet round 1 case loads: 
COPD acute 
Upper Extremity BE amputation (rehab) 
Burn 
Dupytrens Disease 
Shoulder impingement
A

DISCUSS

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20
Q

Myocardial Infarct facts and risk factors

A

70000 heart attacks in Canada - heart attack every 7 minutes
16000 Canadians die annually a result of MI
Risk Factors include: obesity, smoking, physical inactivity, BP, high cholesterol and diabetes

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21
Q

Congestive Heart Failure States

A

500 000 Canadians live with heart failure and 50 000 are diagnosed each year
-up to 40-50% of people with congestive heart failure die within 5 years of diagnosis

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22
Q

Signs and symptoms of CHF

A
  • Sudden Weight gain
  • inability to sleep lying down
  • dry hacking cough
  • SOB (short of breath) with normal Activity
  • swelling in ankles, feet or legs
  • fatigue with activity
  • lack of appetite
  • difficulty concentrating/attending
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23
Q

Signs of cardiac distress

A 
-Angina -chest pain 
dyspnea (shortness of breath)
palpation 
fatigue 
presyncope/syncope (dizzy, confusion, fainting) 
-diaphoresis - cold clammy skin
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24
Q

Lifestyle Issues: (cardiac problems)

A

-15% of adults acheive 150 min/week of moderate-vigorous physical activity
-52.5% of women (12 and over) are physically inactive
23% of Canadians report high degree of life stress

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25
Q

Medical interventions to consider ….. do we need to know this (cardiac)

A
  • coronary artery bypass graft (CABG)

- percutaneous coronary intervention (angioplasty)

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26
Q

Why use the biomechanical model for cardiac stuff

A

Endurance:
ability to sustain an activity over time
cardiac, biomechanical and neuromuscular function
-compromised by inactivity, immobilization, cardioresp or muscular deconditioning
-related to intensity, duration or frequency of activity
-% max HR, # of reps, length a contraction is held

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27
Q

Functional Implications
Decreased endurance - impact on:
Psycho-emotional:

A
  • ADL’s
  • Leisure Activities
  • work

Psycho-emotional:
high performance of depression and anxiety
-10-60% of depression; 11-45% anxiety

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28
Q

Top Down: Occupational-Participation

A

COPM
Barthel Index
Minnesota Living with heart failure Questionnaire
Health Promoting Activities

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29
Q

Bottom Up - Person -Impairment

A

-2 minute walk test
vital sign (BP, heart rate)
Borg Rate of Perceived Exertion

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30
Q

Barthel Index (4 points)

A
  • Longstanding ADL assessment - primarily for acute or rehabilitation contexts (stroke, neuro)
  • Used with older adults - fair- good inter-rater reliability
  • Excellent internal consistency
  • issues with ceiling effects in older adults
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31
Q

Minnesota Living with Heart Failure (3 points)

A

developed in 1984 - QOL measure
Validity
–> concurrent validity with a QOL measures function test (ie. 6 min walk test) and biological measures (O2 Consumption, chronic heart Failure score = 0.82)

Reliability - internal consistency

  • -> chronbachs alpha = 0.86
  • ->also reliable as telephone interview
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32
Q

Health Promoting Activity Scale (4 points)

A

-assesses participation in leisure that promote or maintain well-being
Developed to assess mothers of children with disabilities
-Psychometric properties - internal consistency, alpha .87, intra-rater =.9, minimal detectable change = 5 points, no ceiling or floor effect
-Recommended for use in broad populations

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33
Q

2 min Walk Test (6 points)

A
  • individual walks without assistance for 2 min and the distance is measured
  • start timing when the individual is instructed to “go”
  • stop timing at 2 minute mark
  • assistive devices can be used but should be kept consistent and documented from test to test
  • if physical assistance is required to walk, this should not be performed
  • should be performed at the fastest speed possible
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34
Q

Functional Movements of the shoulder (3 points)

A
  • Foundation for u/e movement
  • -> reach
  • -> precision movement
  • Wide ROM due to glenohumeral joint surfaces
  • ROM further increased by movement of scapula
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35
Q

Muscles moving the pectoral girdle
-Scapula contributes to wide ROM
what terms do we use to describe movement of scapula

A

elevation/depression

  • protraction/retraction
  • upward rotation/downward rotation
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36
Q

What muscles move the GH joint through its wide ROM

A
  • deltoid
  • Pectoralis Major
  • Latissimus Dorsi (teres major and coracobrachialis)
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37
Q

Anterior muscles of pectoral Girdle

A

subclavius
pectoralis minor
serratus anterior

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38
Q

Posterior muscles of pectoral Girdle

A
  • Trapezius
  • levator scapulae
  • rhomboid minor and major
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39
Q

Muscles that stabilize GH joint

A

subscapularis
supraspinatus
infraspinatus
teres minor

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40
Q

Adhesive Capsulitis (5 points)

A 
frozen shoulder 
-three phases: freezing, frozen and Thawing 
sudden or gradual onset 
40-60 years olds at greatest risk 
--> stroke, diabetes, RA 
--> 2-5% of population 
--> External rotation
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41
Q

Assessment Top Down: (UE)

A

-COPM
-Self-report
–>DASH
Job site visit - activity analysis
–> observation at work
–> RULA

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42
Q

Assessment Bottom Up (UE)

A

-ROM
-active and passive
Strength -MMT
Pain - VAS

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43
Q

VAS

A

Visual Analogue scale
Numerical Pain Rating
(0-10) 0-no distress
10 unbearable distress

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44
Q

ROM

End feels

A

soft - Soft tissue (ie knee flexion)
-Firm -jt capsule (MCP ligament (sup, pron)
Hard - bone (elbow extension)

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45
Q

Strength

Manual muscle testing

A

MMT
Valid and reliable
grade 1-5
NOTE Grade 4 - against gravity

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46
Q

DASH

A

No difficulty - 1
Unable - 5
Example: open a tight or new jar
There is also a work module that is optional

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47
Q

Rula

A

-weird pictures
-shoulder is raised
select only one of these

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48
Q

Osteoarthritis (OA)

5 points

A
  • most common form of arthritis
  • can be multifocal
  • leading cause of pain and disability worldwide
  • involves all joint tissue (cartilage, bone, synovial membrane, capsule, ligaments, and muscle)
  • Synovial membrane inflammation can occur due to irritation from osteophytes -bony formations (spurs) occur next to an OA joint causes pain and stiffness
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49
Q

Interventions of OA

A

self-management, condition education, muscle strengthening, exercise, ergonomic education

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50
Q

OA and occupation 3 points

A

-82% report difficulty with ADLs
–> shopping: 57%, housework: 43%, dressing 21 %
–> 1 in 5 have to leave work on retire early due to OA symptoms
4 out of 5 people report constant pain

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51
Q

Rheumatoid Arthritis (RA)

A
  • inflammatory disease that can affect multiple joints in the body
  • 1 out of every 100 Canadians have RA, affects women 2-3 x more
  • Autoimmune disease where the body’s immune system mistakenly attacks the linings of the joints
  • cause is unknown and no cure for RA but there are effective medications and treatments to control symptoms and inflammation
  • thickening of synovial membrane and increased synovial fluid
    (swelling)
  • prolonged swelling stretches and weakens ligaments and joint capsules resulting in joint instability and risk of deformity
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52
Q

symptoms of RA:

A

pain, fatigue, malaise, swelling

-inflammation can start to affect other organs, such as nerves, eyes, skin lungs or heart

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53
Q

Common Affected joints of RA

A 
wrist 85%
MCP 80%
Elbow 70% 
PIP 65% 
Shoulder 60%
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54
Q

Management for RA

A

methotrexate, self-management, condition education, ergonomic education, exercise, fatigue management, ADLs

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55
Q

Occupation and RA

A

60% issues completing ADLS, 28-40%, stop work and will likely not return

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56
Q

Activity Analysis (summary)

A

-an analysis of the typical demands of an activity
-How is an activity completed
–> what are the steps
–> What are the body mechanics required
–> what are the cognitive components required
–> what tools are required?
–> how is the environment set up?
What are the barriers to accomplishing the activity

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57
Q

Performance Analysis

A
  • An analysis of the level of physical effort, efficiency, safety, and independence a person demonstrates while doing an activity
  • Focuses on quality of performance of an activity
  • What are the barriers to accomplishing the activity
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58
Q 
Function Repertoire of the hand 
Personal Constraints: 
Hand Roles: 
Hand Actions: 
Task Parameters:
A

Personal Constraints:
Physical and Psychological
Hand Roles:
Unimanual, bimanual
Hand Actions: reach, grasp, manipulation
Task Parameters: object, movement patterns, performance demands

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59
Q

Colles Fracture

A

A Colles’ fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards. Symptoms may include pain, swelling, deformity, and bruising.
WHAT WOULD IT IMPACT

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60
Q

Lateral Epicondylitis

A 
Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.
WHAT WOULD IT IMPACT
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61
Q

CMC (basal) joint arthritis

A

Carpometacarpal joint (trapezium and first metacarpal of the thumb)

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62
Q

De Quervain’s Tenosynovitis

A

affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.

Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting your baby — can make it worse.

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63
Q

Carpal Tunnel syndrome

A

carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.

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64
Q

Colles Fracture

A
  • Foosh injury -falling on outstretched hand
  • Accounts for 14% of all fractures
  • Women over 65 are 50% more likely to have clinically important functional decline
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65
Q

Fracture Healing process ( 4 steps)

A

fracture, (between 1-2 weeks) inflammatory Phase, (between 1-7 weeks), Reparative Phase (5 weeks -++ months), remodeling phase
-not scar tissue, but new bone

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66
Q

Mary –> colles fracture case

Rehabilitative FOR

A 
observation
-in kitchen -cup for ta 
-dressing shoe/socks and UE
-bathing 
mobility: falls 
COMP: what were her issues
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67
Q

Mary –> colles fracture case

Biomechanical FOR

A

Edmena: circumferential measurement
Pain - visual analogue scale
Sensation - light touch

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68
Q

Volumeter assessment

A
  • used for edema

- hand is placed in water –> water is displaced and measured

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69
Q

Figure 8 method

A

must also used observation

-pitting edema, warm shiny skin

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70
Q

Understand Lateral Epicondylitis

-muscles affected

A 
Extensor carpi radialis longus 
Extensor carpi radialis brevis 
brachioradialis 
impacts extension and radial deviation 
extensor carpi ulnaris 
-extensor digitorum 
-extensor digiti minimi
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71
Q

understanding the Diagnosis: lateral Epicondylitis

A
  • repetitive movements
  • repetitive strain injury
  • account for 43% of loss claims and cost in ON
  • 50 % of individuals playing sports with frequent overhead arm movements will experience lateral epicondylitis
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72
Q

Assessment for Lateral Epicondylitis

Rehab FOR:

A

DASH

COPM

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73
Q

Assessment for Lateral Epicondylitis

Biomechanical FOR

A
  • Grip strength
  • MMT/ROM
  • Pain
  • Palpation/Observation
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74
Q

JAMAR Hydraulic Hand Dynamometer

A

Ideal for routine screening of grip strength and initial and ongoing evaluation of clients with hand trauma and dysfunction.

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75
Q

Arches of the hand (for the lols)

A

longitudinal arch
-distal transverse arch
proximal transverse arch

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76
Q

What is functional position of the wrist

A 
wrist- extension 20 degrees 
ulnar deviation 10 degrees 
Fingers
MCP = flexed 45 degrees 
PIP = flexed 30-45 degrees 
DIP flexed 10-20 degrees 
Thumb
Partially abducted and opposed 
MCP =flexed 10 degrees 
IP flexed 5 degrees
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77
Q

What . are the main functions of the hand:

A

-most complex movements found in the body
-combined action of intrinsic and extrinsic muscles
Grasp
–> tool use
-Manual Dexterity
-Sensation
-Communication

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78
Q

What is the biggest key play in pouring (2 things)

A

the thumb

wrist stability and position

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79
Q

Grasp is dependent on:

A
  • shape of the object
  • what will you do with the object after grasping
  • texture of the surface
  • location, orientation of workplace
  • No stereotypical pattern as seen in LE ie sit/stand
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80
Q

Type of Power grips

A

Cylinder
Ball
Hook

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81
Q

Type of Precision Grips

A 
Plate
Pinch 
Key 
Pincer 
Tripod (three-jaw chuck)
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82
Q

What is globally the most used Grasp Method

A

Pinch ,then cylinder or non P (non prehensile grasp)

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83
Q

RH only
Left Hand only
Both Simultaneously stats about hands

A

both is over 50 % just over a quarter for RH and left the remaining

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84
Q

Bilateral Activities

A

-playing the piano

cooking

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85
Q

In-hand Manipulation (4)

A 
Translation: 
-->finger to palm
-->palm to finger 
Rotation 
Shift 
Combination of movements
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86
Q

Understanding the Anatomy of DeQuervain’s:

A

Abductor Pollicis Longus (APL)
–>Abduction of carpometacarpal (joint 1)
–> slight extension
Extensor Pollicis Longus and Brevis (EPL and EPB)
F: Extension of CMC, MCP and IP joints of thumb (brevis does not extend IP joints
Flexor Pollicis Brevis
Adductor Pollicis Brevis
Opponens Pollicis

87
Q

Anatomical “snuffbox”

A

between EPL and EPB and APL radial artery and radial nerve

88
Q

Understand the Diagnosis

of De Quervain’s Tenosynovitis

A

-women 4X more likely than men
-pain weakness and swelling along the radial side of the wrist
29X increase in persons with highly repetitive or forceful jobs
–> opening jars, cutting with scissors, playing the piano, needlepoint

89
Q

New Assessments for De Quervain’s Tenosynovitis

A 
Grip strength, 
Pinch strength, Palpation/observation
edema... volumeter 
Provocative tests 
--> Finklestein
90
Q

Finklestein

A

put thumb in hand and and ulnar deviate

91
Q

Pinch testing

A

pad to pinch
lateral key pinch
tripod pinch

92
Q

New Tests added when we talked about arthritis Society Community OT
Bottom up and Top Down

A

TEMPA (top down )
Bottom-up
Dexterity - Purdue Pegboard
Minnesota Rate of Manipulation Test

93
Q

UE assessment - Dexterity - Purdue Pegboard

A

instructions
get thirty seconds
do right , then left then both

94
Q

Minnesota Rate of Manipulation Test/Minnesota Manual Dexterity Test

A 
simple but rapid hand eye coordination
muscle reaction time to visual stimuli 
-packing of components, filling containers, sorting cards 
instructions should be well understood 
and there should be a practice period 
placement test- hand movement 
turning test - finger manipulation 
only one handed
95
Q

TEMPA (what the fuck is this) ??

A 
4 unilateral and 5 bilateral tests 
examiner sits beside 
they test grip strength at end of test 
scoring : functional rating (independence 0 to -3 point scale) 0 is the best , task analysis (active range of motion, strength and precision (all also on a 4 point scale) , time to complete task 
-instructions and manual for scoring
96
Q

Understand the Diagnosis:

Carpal Tunnel Syndrome

A
  • Compression Injury
  • loss of light touch or vibration – initially mild, but may lead to loss of protective sensation
  • Electronic assembly work was found to be one of the top jobs at risk of CTS
  • -> other include meat and fish processing, forestry work with chain saws
  • -> Associated with hand force > 4 kg, repetition >50% of cycle time performing same movements
97
Q

Assessments for carpal tunnel new

A 
Sensory evaluation 
--> two point discrimination 
(moving and static) 
Touch threshold 
--> semesweinstien monofilaments 
--> mobera pick-up 
Palpation/observation 
Provacative tests 
--> tinnels 
--> Phalens
98
Q

Phalens Test

A

out your two palms together for 30-60 secs put hands together on dorsal surface
for 30 to 60 seconds

99
Q

Tinels test

A

Tapping on carpal tunnel produces positive sign (tingling/numbness in lateral 2.5 fingers)

100
Q

what are the 5 senses

A 
touch (somatic) 
sight (vison) 
smell 
auditory 
taste 
the sixth sense --> proprioception
101
Q

Cutaneous Sensory

A

-Pain, light touch, pressure, temperature

Dermis and epidermis

102
Q

Proprioceptors sensory system

A

-position, movement, vibration

joints, muscles, bones, tendons, ligaments

103
Q

Corical Sensations the sensory System

A

-stereognosis, graphesthesia, 2-pt. discrimination

Combined superficial and deep sensation

104
Q

Sense organs in the skin

A

thermo-receptor senses heat or cold
Meissner’s corpuscle –> sense touch
nociceptor –> sense pain
Pacinian corpuscle senses pressure

105
Q

three layers of the skin

A

epidermis
dermis
hypodermis

106
Q

RECAL LAB ONE FUUUCK \

ROOTS GANGLION GREY MATTER WHITE MATTER

A

in the dor(sal) out the Ven(tral)
sensory info in the dorsal
motor out ventral roots

107
Q

Purpose of sensory evaluation

Extent and type of loss

A
  • intact, impaired, absent

- exteroception; proprioception, cortical sensation

108
Q

Purpose of sensory evaluation

Document recovery

A

-Nerve regeneration

109
Q

Purpose of sensory evaluation

direction of intervention

A
  1. sensory retraining
  2. Compensation/ safety
  3. Desensitization
110
Q

Sensory Evaluation: general Principles (4 points)

A
  1. Client seated and comfortable in no-distracting
    - -> support body part being tested
    - -> occlude vision during testing
    - ->eliminate auditory cues
  2. Explain Procedure
  3. Test on unaffected side first
  4. Apply stimulus distal to proximal:
    in random order, at irregular intervals, maintaining stimulus
111
Q

Sensation

A

light touch
pain
temperature
vibration

112
Q

Two point discrimination

A

measures innervation denisty

113
Q

Stereognosis:
Graphesthesia:
Proprioreception:
Kinesthesia:

A

Stereognosis: the mental perception of depth or three-dimensionality by the senses, usually in reference to the ability to perceive the form of solid objects by touch.
Graphesthesia: Graphesthesia is the ability to recognize writing on the skin purely by the sensation of touch. Its name derives from Greek graphē (“writing”) and aisthēsis (“perception”).
Proprioreception
Kinesthesia:
Proprioception (or kinesthesia) is the sense though which we perceive the position and movement of our body, including our sense of equilibrium and balance, senses that depend on the notion of force

114
Q

Pattern of Sensory Recovery ( 3 points)

A

-crush injuries have a faster recovery than lacerations injuries
-sensation of temperature and pain recover first, followed by touch sensation
-moving touch recovers before light touch
–> pain fibre regrowth 1.08mmm/day
touch fibre regrowth .78 mm/day

115
Q

Sensation: touch threshold

Monofilaments-semmes-weinstein

A

-start with 2.83 smallest
-begin distally
-apply filament perpendicular to the skin
-record on a hand map
Location of light touch (protective sensation)
-smallest filament felt by client in previous test
-provide stimulus to an area
-record on hand map (differentiate location felt from location stimulated)

116
Q

Sensation: innervation Density

-two point discrimination

A

static: start with 5 mm
perpendicular to fingertip
-longitudinal or transverse direction

Moving ( always returns earlier)

  • start with 5mm to 8 mm
  • Perpendicular to fingertip
  • stimulate in a longitudinal direction
  • proximal to distal
117
Q

Why is it important to conduct functional tests

A
  • understand disability associated with sensory impairment (sterogenosis)
  • -> is the client sensibility sufficient to manipulate small objects
  • can the client use the hand for fine coordination without relying on visual feedback
118
Q

Moberg’s: pick up test

A

pick up small objects (safety pin, key, coin) and place them in a box
Score: total time client take with and without vision

119
Q

Stereognosis

A

a number of known objects

-identify objects without vision

120
Q

ZONE of FLEXOR LOL

A 
zone 1 distal end 
zone 2 rest of phalanges 
zone 3 metacarpals 
zone 4 carpals 
zone 5 radial and ulnar 
thumb has its own 
1, 2, 3 (three is the same as other zone 3 called T111
121
Q

What are the different types of mobility

A
  • bed mobility
  • mat/we/bed transfers
  • functional ambulation for ADL
  • toilet and tub transfer
  • car transfer
  • functional ambulation for community
  • community mobility and driving
122
Q

Functional Mobility

A

how a person walks a while achieving a goal

-adapting to their environment and task demands

123
Q

community mobility (4 factors )

A
  • distance
  • speed
  • navigation
  • fall safety
124
Q

Assessments for Hip replacement

A

FIM (functional independence measure)
-observation of task (formal/informal)
Ambulation Self-Confidence Measure

125
Q

FIM (functional Independence Measure)

A

no helper 7
minimal assistance 4
total assitance 1

126
Q

Functional mobility

Postural control

A

ambulation in home and community
transfers-bed mobility
sit to stand
stairs

127
Q

Key concepts of Balance

A

base of support and centre of gravity

128
Q

Types of Postural Control:

Anticipatory

A

postural adjustments required for reaching, leaning, lifting

129
Q

Static Posture control

A

-maintaining safe, idependentent sitting or standing

130
Q

Reactive

A

-balance response: recovery from loss of balance

131
Q

Postural Control Strategies

A 
stepping 
stiffening/fixation 
shifting weight 
visual regard 
extra input from environment
mobility aids (changing BOS 
-avoiding activity
132
Q

Assessments for
Bernadette – Aging, Balance
Frequent falls – in bedroom, bathroom and garden. Difficulty walking in home and community due to balance issues

A 
Gait 
balance 
balance confidence/falls efficacy 
-ROM/strength testing 
Sensory testing -proprioception and sensory
133
Q

Balance Test

A
  • timed up and GO
  • berg balance test
  • functional reach test
  • activities balance confidence scale (ABC)
134
Q

Task/activity assessment

A

-observation
–> sit to stand, transfers, transitional movements, functional mobility -walking in the community/home, taking a bath, climbing stairs
self-Report -Ambulation confidence
-ambulation Aids
-ENVIRONMENT

135
Q

Gait what are the two phases what are the percent

double and single support

A 
stance phase (60%) and swing (40%) 
double (20%) and single support (80%)
136
Q

The Gluteal Region:

adductors of the hip

A

gluteus minimus
–> medial rotation and abduction
gluteus medius
–> abduction

137
Q

Gluteus Maximus

Tensor Fascia Lata

A

Function: extends thigh at hip

adducts and medially rotates the thigh at the hip stabilizes pelvis while standing tenses IT band.

138
Q 
The knee (gait) 
Muscles that flex the hip and extend the knee
A

Quadriceps femoris
special: rectus femoris
action Hip flexion and knee extension

139
Q

Biceps Femoris

A

composed of long and short heads hip extension (long head only) and knee flexion

140
Q

Pes Anserinus

A

SGT

common insertion located on anteromedial tibia (proximal)

141
Q 
The ankle (gait) 
muscles that dorsiflex the foot
A

tibialis anterior
extensor Hallucis Longus
Extensor Digitorum longus

142
Q

Muscles that plantar flex the foot

A

gastrocnemius
popliteus
plantaris
soleus

143
Q

What to observe during gait

A

step and stride length
BOS
toe angle
Speed

144
Q

Common Acute weight bearing care restrictions

A 
NWB no weight bearing 
TDWB: Toe  Down or toe touch weight bearing 
PWB partial weight bearing 
WBAT: weight bearing as tolerated 
FWB : full weight bearing
145
Q

what side do you use

what foot do you lead with

A

Torque = force * distance
15 degree angle
affected foot

146
Q

Sit to Stand

A

move from large to small BOS
Lower limb flex and extend over a fixed pt
trunk muscles stabilize
hip/knee extensor and tibialis anterior

147
Q

Hip Replacement facts

A

55981 hip replacements in 2016-2017 up to 17.8% from five years ago
2 of every 3 individuals were aged 65 and older
almost all surgeries were performed in an inpatient setting
most common reason was OA and acute fracture

148
Q

Hip precautions

A

hip flexion
internal rotation
adduction

149
Q

Hip Fracture Stats

A

almost 30 000 people across Canada experience a hip fracture each year

  • direct health care systems costs approx 27 000 per patient
  • falls are leading cause of hip fracture
  • 20 % will die within a year of the fracture
  • 15% of total hip replacements are due to hip#’s - predominantly women (69%) and older mean age 82 vs 71
150
Q

Hip fractures

A

intertrochanteric Fracture

Femoral Neck

151
Q

wheel chair mobility

A

participation and engagement in meaningful occupations

152
Q

Wheelchair/seating Evaluation

A

–> person, technology/equipment, environment

153
Q

Seating Intervention

A

-postural control, pressure management, comfort function

154
Q

Seating intervention (4 points)

A
  1. seat for postural control and prevention of deformity
  2. seat for pressure management
  3. seat for comfort and postural accommodation
  4. seat to optimize occupational performance and interaction with the environment
155
Q

Basic guide to seating

A

Keep it simple and individualized (KISS)
-work proximal to distal (pelvis first )
promote function
-monitor impact of changes in components on comfort and function
Re-Assess seating - needs will change over time
i.e changes in physical status or function

156
Q

why use a wheelchair

A

fatigues when walking longer distances; difficulty with walking independently
needing full postural management and support; unable to sit independently

157
Q

Wheel chair assessment the person

A

seating goals occupations –> interview
Postural assessment –> MAT assessment
Skin –> pressure Risk assessment
Use –> wheelchair skill assessment

158
Q

Mechanical Assessment Tool (MAT)

A 
in supine and sitting (plinth is ideal) 
-posture/balance 
-tone 
-endurance 
-skin integrity 
-strength 
-ROM 
--> flexible 
-->tight 
--> Fixed e.g contracture 
ALWAYS START WITH THE PELVIS
159
Q

pelvis

A

key point of control -stable base - U/E freedom and movement
-iliac crests aligned

160
Q

Check for: (in the pelvis)

A
  • Pelvis obliquity
  • pelvis rotation
  • posterior tilt
  • windswept legs
161
Q

What can you palpate on the pelvis

A 
Ischial tuberosity 
-ASIS 
anterior superior iliac spine 
-PSIS
posterior superior iliac spine
162
Q

Pelvic rotation

A

one ASIS in front of the other

163
Q

Pelvic Obliquity

A

PSIS one in higher than other causes curving of the spine

can cause windswept deformity

164
Q

Pelvic Tilt

A

ASIS higher than PSIS bone titled back

-causes tilt of spine

165
Q

windswept Deformity

A

legs to one side

166
Q

Vertebral Column curvature

A

Cervical convex 2 degrees
Thoracic concave 1
lumbar convex 2
sacral concave 1

167
Q

Spine develop

A

primary: concave anteriorly
Secondary: convex anteriorly
secondary curves mature through early-life growth and development
-new born some convex lumbar
4 years -some convex lumbar and cervical
adult all four sections clearly defined

168
Q

Kyphosis

A

Kyphosis is a spinal disorder in which an excessive outward curve of the spine results in an abnormal rounding of the upper back. The condition is sometimes known as “roundback” or—in the case of a severe curve—as “hunchback.”

169
Q

Lordosis

A

Lordosis is the normal inward lordotic curvature of the lumbar and cervical regions of the human spine. The normal outward (convex) curvature in the thoracic and sacral regions is termed kyphosis or kyphotic

170
Q

Scoliosis

A

Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.

171
Q

Movements of the Vertebral Column

A

Flexion, extension (cervical and lumbar spine )
Lateral flexion –> lateral extension (cervical and lumbar spine )
Rotation of head and neck, rotation of upper truck
Cervical and thoracic spine

172
Q

Comfort and FIT Size measurements for a wheel chair

A

Seat width: measure across hips or thighs which ever is wider (add 2 inches)
Seat depth: measure from behind the cafe to back (subtract 2 inches)
Leg length Measure from heel to under thigh
Seat height: add 2 inches to leg length measurement
Arm height: measure from seat platform to just under the elbow Add 1 inch
Back height: measure from the seat platform to under the axilla, hihc the arms fully extended parallel to the ground

173
Q

Pressure Ulcers Stats

A

prevalence declining

  • significant impact on quality of life
  • -> pressure ulcers cause endless pain–> produce a restricted life–> coping with a pressure ucler
174
Q

Pressure Ulcers deff

A

-localized injury to the skin and/or underlying tissue usually over a bony prominence as a result of pressure or pressure in combination with shear and/or friction

175
Q

Intrinsic and extrinsic risk factors

A 
Sensation
Moisture 
Activity
Mobility
Nutrition
Friction and shear 
Grade 1 pressure ulcer
Cognitive level
Age
Other health conditions affecting circulation (ie diabetes)
Smoking
Incontinence
Spasticity
176
Q

Risk Assessment for pressure Ulcers

A
  • Braden scale for predicting pressure sore scale

- waterlow pressure ulcer risk management

177
Q

Pressure equation

A

F/A

-the amount of force applied perpendicular to a surface per unit area of application

178
Q

Pressure in terms of wheelchairs

A

tissue damage = duration of application and (intensity) amount of pressure applied.
when pressure is applied over a bony prominence the internal stresses are at highest in the soft tissues closest to the boney prominence
-patient at highest risk from pressure are those who are unable to move themselves or to ask to be moved
–> focus on removing or reducing pressure

179
Q

Sources of pressure

A

-bed
-wheelchair
-recliners and hard chairs
toilets
splints

180
Q

Friction

A
  • 2 surfaces moving across one another
  • involved in the development of shear stresses
  • consider skin moisture, surface wetness and humidity -all increase coefficient of friction
181
Q

shear

A

mechanical force that acts on an area of skin in a direction parallel to the body surface

182
Q

Stage 1

A

skin in not broken but read or discoloured

redness change in colour does not fade within 30 min

183
Q

Stage 2

A

thickness loss of dermis
skin is broken creating a shallow open sore
-drainage may or may not be present

184
Q

Stage 3

A

break in the skin extend through dermis (second skin layer
into subcutaneous and fat tissue
-tendon/bone not visible
-depth depends on location

185
Q

stage 4

A
  • ful thickness. breakdown extends into the muscle and can extend as the bone/muscle
  • usually lots of dead tissue and drainage are present
186
Q

Unstageable wound

A
  • ulcer covered by necrotic tissue or eschar and depth obscured
  • unable to accurately stage ulcer - but either stage 3 or 4
  • eschar should not be removed
187
Q

Suspected

A
  • Purple or maroon localized of discoloured, but intact skin
  • skin may feel firm, mushy, warmer or cooler than adjacent tissue
188
Q

types of seating
Manual
Independent
Power

A 
dependent (attendant propelled) 
--> manual 
--> transport 
--> other Broda 
Power 
-power add-on 
Power 
Scooter
189
Q

Standard Manual category 1

A
  • user is not consistently independently mobile
  • requires minimal adjustment for posture and mobility
  • limited options
  • tend to be more institutional type of chair
190
Q

Lightweight Manual -category II

A
  • user is independently mobile
  • requires some adjustments for posture and mobility
  • great number of options
  • frame height
  • wheel size
  • front hangers
  • rear axle adjustments
  • -> up/down
191
Q

Lightweight manual - Category iii

A

-user is very active
-requires altered wheel placement for optimal posture and mobility
-Adjustable axles
–>up/down, forward/backward
quick release
-key features
–>frame height
–>wheel size
–> front hangers

192
Q

Ultra lightweight Manual iV

A
  • ultra lightweight, rigid frame and optimal maneuverability user requires postural support and altered wheel placement
  • ->high performance
193
Q

Category V

A

manual Dynamic Tilt

  • user cannot maintain upright posture though use of seating components alone
  • tilt and recline
194
Q

Stability vs Maneuverability

A

Casters
rear wheel positions
camber
-squeeze

195
Q

Camber

A

decrease height increase base

increase lateral stability decrease turning radius

196
Q

squeeze

A

angle from back front to back

-decrease trunk-hip angle

197
Q

real wheel position

A

typically 60% of weight over rear wheels 40% over front

can change to up to 75%/25%

198
Q

Cushion Type

A

-planar
-contour
-custom
Foam and air

199
Q

Assistive Devices Program

A

Eligibility criteria
Ontario resident with valid health card
Physical disability with duration of 6 months or longer
Basic and essential
Individual not covered by WSIB or DVA Group A benefits
Accessing – certified authorizer / certified vendor

200
Q

Chronic Pain

A

pain only starts when signal reaches our brain

201
Q

Gait control

A

pain signal two arrows a-dulta nerve fiber C-fibers

laminae –>a-beta nerve fiber (inhibitory neuron not active during danger active ) spinal cord –> brain

202
Q

Classification of burns

A

superficial (epidermal)
partial thickness (affects deep layers)
Full thickness
-affects all layer of skin

203
Q

skin graphs

A

autographs are graphs that remove skin from unburnt parts of the body
skin from left thigh was used over the fulthickness burns on dorsal of hands

204
Q

special considerations of burns

A

psychosocial side effects

-newly grafted skin is incredibly sensitive

205
Q

Phantom Limb pain

A

Phantom limb pain (PLP) refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there. The limb is gone, but the pain is real. The onset of this pain most often occurs soon after surgery. … The length of time this pain lasts differs from person to person

206
Q

Residual limb pain

A

Residual limb pain is defined as a painful sensation or feeling from the remaining part of the leg. Aggressive bone edge, bone spur formation, neuroma, abscess or bursitis are common causes of residual limb pain. … The non-amputated limb was used as a control for the amputated side.

207
Q

Acute VS Chronic Pain

A

acute pain serves to alert after an injury or malfunction of the body
chronic pain begins as as acute but it continues beyond the usual time expected for resolution of the problem or persists or recurs for other reasons

208
Q

chronic pain

A

Pain without apparent biological value that has persisted beyond the normal tissue healing time (usually taken to be 3 months)
-multidimensional in nature
-subjective
Subjective nature of pain does NOT mean that pain is not real

209
Q

what is the impact of chronic pain

A

-fear and anxiety
sensitivity
-anticipation of future event

210
Q

Impact of chronic pain

A

triggers emotional distress

  • reveals strength or weakness of relationships
  • pain and occupation are reciprocally related forces
  • elicits innovative adaptive responses
211
Q

Pain related to disability

A

dependent on many psycho-social variables

  • fear of movement
  • perceived disability
  • depression -anxiety
212
Q

Pain assessment PQRST

A 
provoking factors 
quality 
region 
severity 
time 
Accept description as accurate
Ensure clients use their own words
Actively listen .. .
Pain diagram
Pain scales
Manage pain ASAP
213
Q

Occupational Therapy Lens

A

-empowerment is in an important concept
–> pain is all encompassing
-Takes over all aspects of daily life
OT help clients regain control by teaching the use of specific tools to enable occupational performance despite pain

214
Q

Important concepts to pain

A

therapeutic listening

  • compassion
  • innovativeness of individual with chronic pain
  • potential of occupation to invoke change

881 Physical Determinants (1 decks)

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