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OTB 513 > Final Exam Wk 5 to 13 > Flashcards

Final Exam Wk 5 to 13 Flashcards

1
Q

Topic Functional Mobility:

What part of the OTPF is included in the evaluation?

A

Evaluation includes client factors and performance skills

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2
Q

Define the following weight bearing status

  • NWB
  • TTWB
  • PWB
  • FWB
A

NWB-Non weight bearing-Affected foot not touching floor

TTWB-Toe touch weight bearing-May lightly touch the floor for balance, not to weight bear through the leg (10%)

PWB-Partial weight bearing-30-50% of body weight on affected side

FWB-Full weight bearing-Full body weight allowed

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3
Q

What are the transfer levels?

  • IND
  • MOD I
  • Contact Guard
  • Min Assist
  • Mod Assist
  • Max Assist
  • Dependent
A

Independent-Pt completes transfer I, safely with no assistance

Mod (I)-Pt completes transfer I with use of AE

Contact Guard-Pt requires close supervision

Min Assist-Pt performs 75% or greater of the transfer

Mod Assist-Pt performs between 50% -74 % of the transfer

Max Assist-Pt performs between 25-49% of the transfer

Dependent-Pt assists less than 25 %, performed entirely by 1 or two other people or mechanical lift

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4
Q

Public Transportation:

What’s fixed route?

A

Fixed route-defined routes with predetermined stops

OT interventions include: Inform, educate and encourage to use the system. Identifying barriers and providing remediation of compensation for skills.

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5
Q

Public Transportation:

What’s paratransit?

A

Paratransit-demand/response with geographic area for qualified riders

OT interventions include: Orientation to system, training in making reservation and education of service limitations

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6
Q

Ramps:

For every 1 inch of rise you need _____ foot of run

A

1 foot of run

1 in to 12 in

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7
Q

Pain is….

A

Pain is subjective
Pain is multifaceted
Pain is affected by mood, attention, prior pain experiences, familial factors, cultural factors

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8
Q

What’s the causation of acute pain?

A

Caused by tissue irritation or damage due to injury, disease or disability

Has a defined onset
Serves a biological purpose
Predictable
Responds to medication or treatment

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9
Q

What’s chronic pain?

A

Does not serve biologic purpose

Unpredictable

Does not respond to routine interventions

Often causes changes in personality, lifestyle and functional ability

Associated with depression and anxiety

Lasting longer than 6 months

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10
Q

Define the following:

  • Allodynia

- Analgesia

A

Allodynia- Pain associated with a stimulus that is not normally painful (light touch)

Analgesia- Absence of pain response to a stimulus that should be painful (burn)

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11
Q

Define the following:

  • Hyperalgesia
  • Hyperesthesia
  • Hyperpathia
A

Hyperalgesia- Increased sensitivity to stimuli (includes allodynia and hyperesthesia)

Hyperesthesia- Increased sensitivity to noxious stimuli

Hyperpathia-Abnormal painful reaction to stimuli (especially repetitive) often includes extended duration of pain, frequently with a delay

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12
Q

Define the following:

-Hyopesthesia

A

Hyopesthesia- decreased sensitivity to stimuli

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13
Q

Define the following:

  • Nociception
  • Sympathetic pain
  • Neuropathic pain
A

-Nociception- Response to a noxious stimuli that produces pain under normal circumstances

Sympathetic pain- Pain associated with an over-action of sympathetic pain fibers (CRPS)

Neuropathic pain- Pain from nerves

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14
Q

What’s Bipsychosocial model of pain?

A

Focuses on the interaction between body, mind, and environment

Conceptualizes the multilayered nature of pain

Pain behaviors can exist in the absence of nociception

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15
Q

What’s the 4 distinct domains of the Bipsychosocial model of pain?

A

Four distinct domains:

Nociception- detection of tissue damage transmitted to A-delta and C fibers in the peripheral nerves. Tells the body to react to pain (pull hand away from hot stove)

Pain- Perceived noxious input to the nervous system

Suffering- The negative affective response to pain

Pain Behavior- What an individual says/does or does not say or do leading others to believe they are in pain. Pain behaviors are influenced by culture, family, experiences and environment

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16
Q

What are common pain syndromes?

A 
Headache Pain
Low Back Pain
Arthritis
Complex Regional Pain Syndrome
Myofascial Pain Syndrome
Fibromyalgia
Cancer Pain
Disability-Related Pain
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17
Q

CRPS…what is is and what are the 2 types?

A 
Complex Regional Pain Syndrome
Previously known as Reflex Sympathetic Dystrophy (RSD)
No clear cause
No precise way to diagnose
No gold standard treatment

Two Types
CRPS I- No known cause
CRPS II- Same s/s of I but directly related to a nerve injury

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18
Q

What are the signs and symptoms of crps?

A 
Severe pain- Out of proportion (often refuse to be touched)
Swelling
Stiffness
Discoloration
Decreased function

Vasomotor changes- Changes in color and temperature
Sudomotor changes- Changes in sweat
Trophic changes- Changes in nails, finger pad and skin appearance, bone health
Pilomotor changes- Changes in goosebump response

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19
Q

What are medical management for CRPS?

A 
-Medications:
Corticosteroids, NSAIDs
Antidepressants
Anticonvulsants
Topical agents
Opiates
  • Nerve Blocks
  • Neuromodulation (i.e. spinal cord stim)
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20
Q

What are signs and symptoms present in Myofascial Pain Syndrome?

A 
 Muscle pain
 Presence of trigger points
 Pressure on trigger points causes pain to well-defined distal area (predictable pain
referral pattern)
 Usually constant dull ache
 Commonly found in the UT
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21
Q

What are interventions for myofascial pain?

A

 Needling
 Manual therapy
 Modalities

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22
Q

What are the 5 different pain assessments

A

 Numeric analog scales- Line with markings from 0-5, 10 or 20 is used to indicate
pain level

 Visual analog scale- Patient uses a 10 cm line to indicate pain level

 Verbal rating scale- Patient describes pain in 4/5 words

 Graphic representations- marking pain on a body chart

 Pain Questionnaire-Written standardized Questionnaire (McGill’s)

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23
Q

What are the mechanism of nerve injury?

A 
Compression or Entrapment
¡ Internal sources
¡ External sources
 Traction
 Avulsion
 Laceration
 Burn (Thermal/Electrical)
 Chemical
 Ischemic
 Radiation
 Injection injuries
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24
Q

Symptoms of nerve injury for motor/sensory/autonomic

A 
Motor
¡ Weakness
¡ Venous/lymphatic issues
¡ Atrophy
¡ Muscle/joint fibrosis
 Sensory
¡ Paresthesia
¡ Altered vibratory
perception
¡ Abnormal discrimination
¡ Decreased functional use
¡ Increased risk of burn
Autonomic
¡ Vasomotor
÷ Skin temp, edema, color
¡ Sudomotor
÷ Sweat patterns
¡ Pilomotor
÷ Absence of goosebumps
¡ Trophic
÷ Nail and hair changes,
slowed skin healing and
slow bone growth in kids
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25
Q

Where is motor screen at C5, C6, C7, C8, T1?

A 
C5- Shoulder abd
 C6- Elbow flexion, wrist ext
 C7- Elbow ext, wrist flexion
 C8- Digital flexion
 T1- Digital abd/add
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26
Q

Where is sensory screen at C5, C6, C7, C8, T1?

A 
C5- Skin over deltoid
 C6- Tip of thumb, radial wrist
 C7- Tip of middle finger
 C8- Tip of SF, Ulnar wrist
 T1- Medial elbow
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27
Q

Define incomplete injury

What are the different types of incomplete injuries (7)

A

Incomplete- External tissue remains to some degree
attached. Prognosis varies by damage

  1. Mononeuropathy- damage to single nerve
  2. Multiple mononeuropathy- muti-focal, asymmetrical
    involvement of multiple nerves (ie. MN and UN)
  3. Double crush syndrome- One nerve, multiple sites of
    pathology
  4. Polyneuropathy- B/l extremity damage to two or
    more PN due to metabolic changes
  5. Peripheral polyneuropathy- Often hands and feet, in
    smokers, alcoholism, autoimmune diseases.
  6. Neuropraxia- Compression and loss of blood flow to
    a nerve = sensory and motor loss. Recovery weeks to
    months (Saturday night palsy) (Sutterlands type 1)
7. Axonotmesis-Severe compression, axons distal to
compression degenerate. Endoneurial tubes remain,
good recovery (Sunderland type 2)
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28
Q

Define complete injury

What are the different types of complete injuries (5)

A

Complete- Poorest prognosis, need surgical
intervention

  1. Sunderland type 3- Destruction of endoneurial tubes
  2. Sunderland type 4- Destruction of perineurium
    (significant internal scarring which impairs functional
    recovery) Nerve graft probably required
  3. Sunderland type 5 and 6- Physiologic disruption of entire
    nerve or section of nerve. Requires surgery.
  4. With complete severed PN will see loss of sensation, motor control,
    reflexes.
  5. Wallerian degeneration- Breakdown of the axon distal to
    site of injury. Starts 48-96 hrs after injury and concludes
    3 wks after injury. During this process there is
    deterioration of myelin and distal axons become
    disorganized. (Surgery best performed before this starts)
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29
Q

What are different medical management techniques for Peripheral nerve damage ?

A

Primary nerve repair- within first wk of injury

— Secondary nerve repair- week or more after injury

— Nerve grafting- when primary repair on the cut ends
can not occur due to tension on the nerve
¡ Autograft-harvested from sensory nerves
¡ Allograft- cadavers
¡ Conduits- commercially available tubes to bridge gap

— Neurolysis- free nerve from surrounding tissue

— Nerve decompression- remove nerve from
impingement by moving nerve or cutting tissue

— Tendon transfers

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30
Q

Define Neuropraxia

A

Neuropraxia- A conduction block, no anatomical

disruption- all components attached

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31
Q

Define Axonotmesis

A

Axonotmesis- Disruption of axons and myelin

sheaths, but endoneurial tubes are intact

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32
Q

Define Neurotmesis

A

— Neurotmesis- Complete severance or serious

disorganization- No spontaneous recovery

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33
Q

What factors influence regeneration?

How long does it take?

A 
Factors that influence regeneration
¡ Age
¡ Amount of scar tissue
¡ How high the injury (proximal worse prognosis)
¡ Delayed reconstruction
¡ Severity of injury
¡ Inaccurate alignment of fascicles during surgery
¡ Neuroma development

-Regeneration: 1-4mm per day (after 3 wks of
Wallerian degeneration) (about 1 in per month)

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34
Q

What’s the pattern of sensory recovery?

A 
— Pain perception
— Vibration of 30 cps
— Moving touch
— Constant touch
— Vibration 256 cps
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35
Q

How does high radial nerve injury looks like?

A

— Presentation
¡ Tricep spared (can ext elbow)
¡ Weakness- wrist ext, supination, thumb ext, MP ext
¡ Paresthesia- dorsum of the hand

High Radial Nerve Injury
¡ Crutch palsy- compression at axilla, motor and sensory
involvement
¡ Saturday night palsy (High RN injury)- compression of the RN
at midhumerus, motor and sensory involvement (tricep
spared)
¡ Humeral shaft fx

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36
Q

What 3 syndromes is caused by compression of the median nerve?

A

— Pronator syndrome:
— Anterior interosseous syndrome:
— Carpal tunnel syndrome:

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37
Q

Sensory Re-education is divided into 2 stages, what are they?

A

— Divided into two stages
1. Protective sensory reeducation

  1. Discriminative sensory reeducation
38
Q

What are the 2 phases of Discriminative sensory reeducation?

A

— Two phases

  1. Early phase- Starts when protective sensation,
    ÷ Use of visual/auditory cues
    ÷ Imagining a movement and the feel of touch
    ÷ Mirror therapy
  2. Late phase-When moving/constant touch of 256 cps is
    perceived at fingertips with good localization
    ÷ Functional tasks
    ÷ Desensitization
    ÷ Sensory localization
39
Q

What’s the ASIA impairment Scale?

A

§ A= Complete. No sensory or motor function is preserved below the level of injury.
Includes sacral segments S4-5

§ B = Sensory Incomplete. Some sensation is preserved, but no motor function is
preserved below the level of injury. Includes sacral segments S4-5

§ C = Motor Incomplete. Motor function is preserved below the neurological level of
injury and the muscles have a muscle grade less than 3.

§ D = Motor Incomplete. Motor function is preserved below the level of injury and at
least half of the key muscle functions below the level of injury have a muscle grade
greater than or equal to 3.

§ E = Normal. Motor and sensory function are normal in all segments.

40
Q

Define clinical syndromes

A

§ After SCI spinal shock occurs from 24 hrs to 6 wks. Reflex activity ceases below the
level of injury.

§ Bowel/Bladder – above T12 (Upper motor neuron)spastic, L1 and below (lower motor
neuron) bowel/bladder flaccid

§ Deep tendon reflexes are decreased, sympathetic functions disturbed due to low BP,
constriction of blood vessels, slower HR, no perspiration below level of injury
§ Muscles below the level of SCI usually develop spasticity

§ Sympathetic functions become hyperactive

41
Q

What does a median nerve orthosis do?

A

Prevent thumb add contracture (web space

contracture)

42
Q

What are the compression Sites of the UN ?

A

— Cubital tunnel

— Guyon’s canal (ulnar tunnel)

43
Q

Guyons Canal

A 
— Pain, sensory symptoms and/or motor weakness
(depends on area of compression)
— AKA -handle bar palsy
— Test- Compression to canal
— TX- padded glove, injection, surgery
44
Q

Ulnar Nerve Orthosis
Prevents…?
And puts MPS in… (flexion or extension) ?

A

— Prevent RF/SF from clawing

— Put MPs in flexion

45
Q

What are the 4 functions of skin

A
  1. Protection: Environmental barrier, moisture barrier
  2. Thermoregulation- temp regulation, prevents heat loss, allow for rapid
    cooling
  3. Neurosensory- processing environmental stimuli (pressure, pain, temp)
  4. Cosmesis- Body image
46
Q

Name the 3 parts of the skin anatomy

A
  1. Epidermis-
    § Non-vascular
    § Rapid regeneration
    § Protects from sun
  2. Dermis-
    § Vascular
    § Fiberous connective tissue made up of collagen and elastin,
    § lymph spaces, sweat glands, hair follicles
  3. Subcutaneous tissue
    § Fatty tissue
    § Fibrous CT
47
Q

Burn Depth

A

§ Burn wounds are now classified by depth:

§ Superficial (1st degree)

§ Superficial partial thickness (superficial 2nd degree)

§ Deep partial thickness (deep 2nd degree)

§ Full thickness (3rd degree)

§ Subdermal (4th degree)

48
Q

What are the phases of wound healing?

A

Stages are overlapping
§ Inflammatory Phase
3-10 days after injury

§ Proliferation Phase
Day 3 till wound heals

Maturation Phase
§ Week 3- 2 years

49
Q
  1. Describe a Hypertropic scar. How long for wound closure?
  2. How long does hypertrophic scars mature?
  3. Does it lead to loss of motion/joint contracture?
  4. Can scar formation be influenced by proper positioning, exercise, splinting, and
    compression?
A
  1. Scar development varies by: amount of time for wound closure, age, race,
    burn depth, infections
    Hypertrophic scars: are thick, rigid, red scars (6-8 wks after wound closure)
    Deeper wounds that take over 2 wks to heal have an increased wrist of
    hypertrophic scaring
  2. Hypertrophic scars mature btwn 12-24 months (keloids take up to 3 yrs)
  3. Can lead to loss of motion and joint contracture
  4. Can influence scar formation by proper positioning, exercise, splinting, and
    compression
50
Q

Medical Management:

Fluid resuscitation:

A

Fluid resuscitation:

§ With IV fluids such as Ringer solution. Monitor vitals, hematocrit and urinary output

51
Q

Medical Management:

Edema

A

Edema:
§ Can cause compartment syndrome- interstitial pressure get high enough to
compress blood vessels, tendons and nerves which can lead to tissue death
§ Escharotomy or Fasciotomy are performed

52
Q

Medical Management:

§ Respiratory management

A

Smoke inhalation, burns to face

§ Tracheostomy, ventilator (over oral intubation)

53
Q

Medical Management:

Wound care and Infection control

A

-Surgical – graft

§ Non surgical- dressings

54
Q

What are the 8 methods to wound care?

A
  1. Topical agents
    - Used to control microbial colonization and prevent infection
  2. Biologic Dressings
    - Temporary coverings to close wound (prevent infection, reduce fluid loss, decrease pain)
    - Allograft (cadaver skin), Xenografts (pig skin)
  3. Biosynthetic Products
    - Used to close wounds, may lead to less pain, faster skin regrowth and less scarring
  4. Hydrotherapy
    -Removes debris and left of topical antibiotic. Use of shower trolley (nonsubmersive). Pain
    medications.
    -Therapist usually performs ROM at this time
  5. Sepsis
    -Can result due to infection (s/s ischemia, tachycardia, hypotension, hypothermia, disorientation,
    decrease urinary output, coma)
  6. Surgical Intervention
    - When wound will take more than 2 wks to heal (Debridement, skin grafts)
  7. Vacuum-Assisted Closure
    - A sealed dressing and controlled negative pressure
  8. Nutrition
55
Q

Skin Grafts

A

-Split thickness skin graft- Upper layers of skin (epidermis, part of dermis)
§ Can cover large areas

-Full thickness skin graft- Epidermis and dermis
§ Need for deep burns where bone, tendon are at risk

-Microvascular skin flap
§ Provides vascularization
§ Can include skin, fat, muscle, bone

56
Q

What are the 3 Complications of Burns

A

-Stress
§ Reliving the event, avoidance, hypervigilance
§ PTSD

-Pain
§ Pharmacologic tx (opiates, anti-inflammatory drugs, antidepressants,
anticonvulsants, benzodiazepine, ketamine)
§ Nonpharmacological tx (CBT, hypnosis, relaxation techniques, breathing
exercises, guided imagery, music therapy, aromatherapy etc)

-Psychosocial Factors
§ Depression
§ Severe grief
§ Denial/isolation, Anger, Bargaining, Depression, Acceptance

57
Q

Burn rehab STG/LTG?

A

§ Multidisciplinary team

§ Goals
-STG
§ Providing support
§ Preparing for self-care tasks
§ AROM
§ Education
  • LTG
    § Established with patient, family and rehab team
58
Q

What are the 3 phases of recovery for burn pts?

A
  1. Acute care phase
    § Psychosocial support, edema, prevent contractures and loss of ROM, strength and
    activity tolerance, Promote occupational performance and I with self-care,
    education
  2. Postop phase
    § Protect/preserve graft and donor sites (splints, positioning), Prevent atrophy and
    DVT (exercises as appropriate), I with self-care, AE, Educate
  3. Rehab phase
    § Begins when wound closes
    § All above goals including:
    § Scar mgt program, compression therapy, improve jt mobility and prevent contractures
    § Restore ROM, MMT, coordination and endurance
    § ADL, IADL retraining, post dc planning (school, work)
59
Q

When is OT eval done for pts? What does it include?

A

§ Eval done btwn 24-48 hrs after admission

§ Gather PMH, secondary dx, burn etiology
§ Assess wounds
§ Occupational profile (both pt and family)
§ Joint mobility
§ Strength
§ Sensation
§ Functional use
§ Education
60
Q

OT interventions for burns

A 
§ Preventive positioning
§ Splinting
§ ADLs
§ Therapeutic exercise
§ Scar management
§ Compression therapy
§ Edema management
61
Q

Preventive positioning for burn pts

A

§ Goals
§ Reduce Edema
§ Maintain antideformity position***
§ Pedretti pg 1128
§ Position of comfort is usually position of contracture
§ Position of contracture includes
§ UE- shoulder add and flexion
§ LE-flexion of the hip, knees with plantar flexion of the ankles, toes pulled dorsally
§ Hand- MP ext, IP flexion, Thumb add (claw hand)

62
Q

Splinting for burn pts

A 
§ Splint in antideformity position
§ Acute phase- static splint
§ Volar hand splint-
§ Wrist ext 15-30*, MP flex 50-70*, IP ext, Th abd/ext
§ Elbows and knees
§ 5* of flexion
§ Ear protection splint
§ Check for pressure
§ Assessment daily
§ Secure with figure of 8 wrap
63
Q

Immobilization after surgery

A

§ Split thickness skin grafts (STSG) 3-5 days
§ Epithelial grafts 7-10 days
§ Avoid shearing after graft placement
§ Assess surrounding tissue for graft integrity
§ Donor sites are treated similar to burn sites

64
Q

ADLS acute phase for burn pts

A

§ Can be very limited during acute phase
§ Self suctioning of oral cavity if not facial burns have occurred
§ After extubation oral care is attempted
§ Self feeding when cleared by MD
§ AE for ADLs
§ Select tasks with high probability of success

65
Q

What does scar massage/skin conditioning do for burn pts?

A

§ Help improve scar integrity and durability
§ Used on any burned area taking over 2 wks to heal
§ Lubrication and massage with water based cream performed 3-4 x per day
§ Help desensitize, soften scar bands
§ Massage in circular motion (pressure increases gradually over time)
§ Scar maturation takes 12-18 mo after injury

66
Q

Compression therapy for burn pts

A 
§ Initiated early usually 5-7 days after removal of dressings
§ Decrease hypersensitivity, edema control and scar compression
§ Considerations
§ Shearing force
§ Pressure gradient
§ Ease of application
§ Consistency of pressure
§ Skin tolerance
67
Q

Edema management for burn pts

A

§ Chronic edema can lead to fibrosis
§ Elevation, progressive compression and activity are recommended
§ Coban used for digits, hands and feet (tips of finger left open to monitor
color)
§ Elastic wrap for remainder of limb
§ Elevate above heart
§ LE’s double wrapped when ambulating, elevation when resting
§ Compression pump therapy used for distal extremities
§ Custom made compression garments (OT measures, orders and fits)
§ Worn 23 hrs/day
§ Must apply equal pressure over entire burned area

68
Q

Burn complications

A 
§ Heterotopic ossification
§ Neuromuscular complications (burn of PNS)
§ Electrical burns
§ Infection
§ Metabolic abnormalities
§ Neurotoxicity
§ Facial disfigurement
§ Rigid facial orthosis for scar mgt
69
Q

PSYCHOSOCIAL ADJUSTMENT TO AMPUTATION:

Grieving process?

A

•Grieving process (denial, anger, depression, coping and acceptance)

Note*
•Hostility and anger are common. It is important to react with positive reinforcement with use of the rehab process and provide interactions with other amputees

70
Q

AMPUTATION:

•Skin-most common postsurgical problem and treatments

A
  • Delayed healing, extensive grafting, wounds, infection, allergic reaction
  • Can occur during any stage of rehab process
Treatments include
•Daily massage
•Compression wrapping
•Skin checks
•Gradual wearing schedule
71
Q

AMPUTATION: Define hyperesthesia

How can you desensitize the limb?

A
  • Hyperesthesia-Overly sensitive limb

* Desensitization of residual limb includes texture stimulation, tapping and massage

72
Q

AMPUTATION: Whats Neuroma? What does treatment include?

A

Neuroma-
•Small ball of nerve tissue caused by axons attempting to re-grow toward the distal limb. Can cause pain with pressure. Most occur 1-2 in from end of the residual limb.

Treatment includes injection, US, massage, stretching.
•Surgical interventions.
•Adjustment to socket

73
Q

AMPUTATION:Phantom limb

A
  • Sensation of the limb that has been amputated
  • Normal sensation, may reduce over time or may remain
  • TX: Education and counseling and use of residual limb
74
Q

AMPUTATION: •

Phantom Sensation

A
  • Phantom Sensation
  • Cramping, pain, squeezing, numb/tingling, stuck, cold, moving, hot, achy
  • Constant or intermittent
  • TX: Isometric exercises, AROM of residual limb, mirror therapy, biofeedback, TENS, US, relaxation exercises, controlled breathing
  • Tapping, massage, pressure
75
Q

AMPUTATION: Bone spurs-

A 
Excess bone usually at the end of the residual limb
•DX by X-ray
•Pain, continued drainage
•TX-surgery
•
Can grow back
76
Q

AMPUTATION: Factors that affect wound healing include:

A

Smoking, DM, renal disease, cardiac disease and infection

  • Infection from contaminated wounds including foot ulcers or traumatic open injuries
  • Wound must be closed for prosthetic wearing
  • Monitor for wounds, blisters, redness during prosthetic training/wearing
77
Q

AMPUTATION: CONSIDERATIONS FOR PROSTHESIS includes?

A
  • Age
  • Health status
  • Amputation level
  • Skin condition
  • Cognitive status
  • Pt’s preference
78
Q

AMPUTATION: PREPROSTHETIC TRAININGPREPARING RESIDUAL LIMB

A
  • Desensitization-tapping, massage, vibration, pressure, textures
  • Scar management/skin grafts-massage
  • Shaping the limb-wrapping, figure of 8 method (video)
  • Circumference measurements
  • ROM
  • Endurance
  • Education-Hygiene, wrapping, desensitization program, insensate skin, SKIN INSPECTION
79
Q

AMPUTATION: PROSTHETIC PROGRAM

A
  • Begins after final fitting with prosthetist
  • Team program-prosthetist, client and therapist work closely. Numerous adjustments are usually required
  • Functional training using meaningful activities
  • Prosthetic is used as ”helper” will not mimic lost limb
  • If the ptwas R handed and had a R UE amp, they are now L handed
  • Training-hygiene, donning/doffing (coat and sweater methods)
  • Wearing schedule (15-30 min, 3 x per day, increasing 30 min daily) SKIN INSPECTION!
80
Q

AMPUTATION: WHAT ARE 5 BODY POWERED DEVICE COMPONENTS

A
  1. Prosthetic sock-absorbs perspiration and protects skin from irritation. Used for volume change in socket
  2. Socket-Cast molding of residual limb is used to make socket. All other components are attached. Fits over the residual limb.
  3. Harness and Control System
    •Figure of 8 harness commonly used
    •Action of the UB creates tension when operates the prosthesis
  4. Terminal Device-to grasp and maintain an object
    •Hook-functional
    •Voluntary opening (VO)-opens when wearer exerts tension on cable
    •Voluntary closing-(VC)-closes when wearer exerts tension on cable
  5. Hand
    •Cosmetic-min function
81
Q

AMPUTATION: ELECTRIC POWERED PROSTHESIS

A

Myoelectric prosthesis-“Uses muscle surface electricity to control the prosthetic hand function”

82
Q

AMPUTATION: PREPROSTHETIC THERAPY

A
  • Can be a frustrating process
  • Id potential muscle sites
  • Improve muscle control and strength
  • Use of a myotesterto help train muscles with both auditory and visual feedback
  • Preparatory socket and prosthetic fitting-used to find optimal mm sites and fit
  • Financial consideration
83
Q

AMPUTATION: PROSTHETIC PROGRAM FOR MYOELECTRIC LIMB

A
  • Orientation of prosthesis
  • Education-don/doffing, skin checks, charging procedure, residual limb care
  • Wearing schedule-15-30 min to start, with increases of 30 min increments 2-3x per day. Check for redness *if redness does not subside within 20 min after removal of prosthesis, prosthesis should be returned to prosthetist for adjustments
84
Q 
AMPUTATION:
Terminology
AKA
BKA
Ankle disarticulation
A

•95% of all LL amps in US due to PVD with 25-50% due to DM complications

  • Terminology
  • AKA (Above-knee amputation/transfemoral)
  • BKA (Below-knee amputation/transtibial)
  • Ankle disarticulation/Syme’samputation)
85
Q

AMPUTATION: POSTSURGICAL CARE

A 
Skin care
•Positioning
•Wrapping
•Shrinking and shaping can take up to 3 moor longer
•Scar mgt
•Psychosocial issues
86
Q

AMPUTATION: OT INTERVENTION

A
  • Education
  • ADLs
  • Adaptive equipment for ADLs, repositioning
  • Wheelchair fitting-
  • IADLs
  • Sleep-phantom symptoms
87
Q

CONDITIONS AFFECTING SEXUAL FUNCTIONING

A
  • Amputations
  • Arthritis
  • Burns
  • Cardiac disease
  • Cerebral palsy
  • CVA
  • Diabetes
  • Hand injury
  • Head Injury
  • Musculoskeletal injuries
  • Spinal cord injury
88
Q

OCCUPATIONAL THERAPY ROLE in intimacy

A
  • Goals that facilitate an increased self-esteem
  • Foster feelings of self-worth and positive body image
  • Encourage trust and communication
  • Be prepared with information and resources
  • Approaches to intervention can include individual, partner or group sessions
  • Role may depend on your practice setting
89
Q

OCCUPATIONAL THERAPY INTERVENTIONS MACRAE (2016)

  • Health promotion:
  • Remediation:
  • Modification:
A
  • Health promotion: This approach consists of support groups, educational programs, and stress-relieving activities.
  • Remediation: This approach consists of restoring skills, such as range of motion, strength, endurance, effective communication, and social engagement, as part of meeting sexual needs.
  • Modification: This approach consists of changing the environment or routine to allow for sexual activity.
90
Q

What’s PLISSIT

A
  • Approach to guide the therapist in helping the client deal with sexual information
  • Permission-Allowing the client to to feel new feelings and experiment with new thoughts or ideas regarding sexual functioning
  • Limited information-Explaining what effect the disability can have on sexuality. Facts are shared, myths dispelled
  • Specific suggestions-for specific problems that relate to disability such as positioning. (Highest level of input the average OT should attempt without advanced training)
  • Intensive Therapy-Advanced training
91
Q

Intimacy resources

A 
•Healthcare Providers
–Primary Care Physicians
–Urologists, Gynecologists,
–Behavioral Health (Psychologists/Psychiatrists)
–OT/PT
–Nurses
–Social Workers
–Fertility specialists
–Certified Sex Counselors or Therapists
  • Peer connections or support groups
  • Internet

OTB 513 (3 decks)

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