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enabling occupational performance > hand therapy and burns > Flashcards

hand therapy and burns Flashcards

1
Q

what is the role of the hand therapist?

A
  • active engagement
  • knowledge in upper limb anatomy
  • skilled implementation of intervention
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2
Q

what is initial assessment in hand therapy?

A
  • history of condition
  • comorbidities
  • social history
  • ADLs
  • interests
  • goals
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3
Q

what should be assessed in physical testing in hand therapy?

A
  • pain
  • skin condition
  • wound
  • scar
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4
Q

what should be looked at in relation to pain in physical assessment?

A

visual analogue and verbal rating scale

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5
Q

what should be looked at in relation to skin condition in physical assessment?

A
  • sweating/hair
  • nail growth/texture
  • dry/flaking
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6
Q

what should be looked at in relation to wound in physical assessment?

A
  • open
  • infection
  • hyper granulating
  • epithelising
  • granulating
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7
Q

what should be looked at in relation to scar in physical assessment?

A
  • colour
  • height
  • size
  • pliability
  • blanching or puckering on motion
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8
Q

how is ROM assessed?

A

passive/active ROM using goniometry

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9
Q

how is strength assessed in hand therapy?

A

manual muscle testing and dynamometer

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10
Q

how is sensibility assessed?

A

tactile sensation and hot/cold 2 point discrimination

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11
Q

what are functional assessments undertaken during hand therapy?

A
  • subjective report
  • self-report functional outcome scale
  • test battery
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12
Q

what are provocative tests for hand therapy?

A
  • Phalen’s for carpal tunnel

- grind test for OA

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13
Q

what are some principles of hand management?

A
  • use clinical judgement
  • each injury treated according to anticipated rate of healing
  • acute different to chronic
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14
Q

what does acute treatment for the hand involve?

A
  • rest
  • ice
  • compression
  • elevation
  • protection
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15
Q

what does chronic treatment for the hand involve?

A

-rest, heat, stretch, pain control, and education

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16
Q

how long does the inflammatory phase following injury last?

A

up to 72hrs

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17
Q

what occurs in the inflammatory phase following injury?

A
  • vasoconstriction followed by dilation
  • platelets produce fibrin clot
  • increased permeability
  • WBC
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18
Q

what does increased permeability in the inflammatory give rise to?

A

tissue oedema

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19
Q

what are treatments that promote wound and oedema control?

A
  • wound management
  • rest and orthotics
  • elevation
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20
Q

when does the proliferative/fibroblastic phase commence and last?

A

commences at day 3 and lasts approx 3-4 weeks

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21
Q

what does the proliferative/fibroblastic phase involve?

A
  • infiltration of fibroblasts
  • collagen production
  • form new blood vessels
  • epithelialisation
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22
Q

what are some treatment options for scars?

A
  • massage
  • compression
  • silicone based products
  • sensory re-education
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23
Q

when does the maturation/remodelling phase following injury begin and last?

A

begins around 3-4 weeks and lasts months (up to two years)

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24
Q

what does the maturation/remodelling phase following injury include?

A
  • extracellular matrix reorganised
  • collagen synthesis and degradation
  • wound tensile strength increases
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25
Q

what treatment options are utilised during the maturation/remodelling phase?

A
  • exercise
  • strengthening (isometric, resistance with bands/putty)
  • sensory motor rehab (proprioception training)
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26
Q

what are some treatment focuses of acute hand therapy?

A
  • education
  • psychological support
  • activity mod
  • wound management
  • orthotics
  • oedema control
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27
Q

what are treatments for ongoing therapy?

A
  • education
  • psych
  • activity mod
  • sensory motor function
  • sensory retraining
  • motion
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28
Q

what are some focuses of chronic and therapy treatment?

A
  • education
  • psych
  • motion and gentle strengthening
  • activity assessment
  • orthotics
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29
Q

what are some mechanisms and causes of OA?

A
  • changes in cartilage and underlying bone
  • weight
  • joint damage
  • infection
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30
Q

what are some assessments of OA?

A
  • xray
  • pain/swelling
  • nodules
  • poor active range
  • decreased function
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31
Q

what are conservative treatment options for OA?

A
  • orthoses
  • steroid injection
  • oedema control
  • gentle heat
  • strengthening stabilising muscles
  • protetction techniques
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32
Q

what is carpal tunnel syndrome?

A

compression of median nerve at wrist

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33
Q

what are some signs and symptoms of carpal tunnel?

A
  • pain
  • worse at night
  • worse with repetitive forceful motion
  • weakness/clumsiness
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34
Q

what are some anatomical causes of carpal tunnel?

A
  • fractures
  • carpal dislocation
  • osteophytes
  • lesion tumour
  • cysts
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35
Q

what are some neuropathic or inflammatory disorders causes of carpal tunnel?

A
  • diabetes
  • alcoholism
  • changes in fluidbalance eg.pregnancy
36
Q

what are some mechanical forces causes of carpal tunnel?

A

changes in joint position caused by tendon load, external forces, vibration

37
Q

how does obesity cause carpal tunnel?

A

correlations between BMI and CTS

38
Q

how should the wrist be positioned in orthosis for carpal tunnel syndrome?

A

neutral

39
Q

what is involved in the clinical assessment of De Quervain’s Tenosynovitis syndrome?

A
  • CMC arthritis
  • trigger thumb EPB funger
  • wrist or digital tendonitis
  • intersection syndrome
40
Q

what is De Quervain’s?

A

an inflammatory condition

41
Q

how can inflammation be treated in management of De Quervain’s?

A
  • NSAIDS
  • oedema control
  • orthosis
  • controlled loading of tendon
42
Q

is De Quervain’s likely to go away completely?

A

no

43
Q

what can a paddle orthosis pattern by used for?

A
  • resting splint

- POSI splint

44
Q

what is a resting orthosis suitable for?

A

intermittent splinting

45
Q

what is the aim of a resting orthosis?

A

rest in comfortable position

46
Q

what position is the hand and wrist in in a resting orthosis?

A
  • wrist: 20-30 degrees extension
  • MCP: 45 flexion
  • PIP: 30 flexion
  • DIP: 10 flexion
  • thumb in palmar abduction
47
Q

what is a POSI orthosis suitable for?

A

acute stage of trauma, burns, post-operative, acute infection/inflammation

48
Q

what is the aim of a POSI orthosis?

A

prevent contractures

49
Q

what is the position of the wrist and hand in a POSI orthosis?

A
  • wrist: 30 degrees extension
  • MCP: 70-90 flexion
  • IP: full extension
  • thumb in abduction but lying lateral to index
50
Q

what is the position of the short opponens orthosis?

A

splint thumb in opposition to allow function and maintain sign of O

51
Q

what are some goals of orthoses?

A
  • relieve pain
  • stabilise
  • protect
  • promote healing
  • prevent/correct deformity
  • increase occupational performance
52
Q

what are some effective mechanical principles in orthoses constriction?

A

optimise. ..
- surface area
- lever arm
- straps
- arches

-conform to contour

52
Q

what are some effective mechanical principles in orthoses constriction?

A

optimise. ..
- surface area
- lever arm
- straps
- arches

-conform to contour

53
Q

what are five principles of fit of an orthosis?

A
  • mechanical and technical considerations
  • anatomic considerations
  • practical considerations
  • physical appearance
  • client education
54
Q

what are some functions of the skin?

A
  • protective
  • immunological
  • fluid balance
  • thermoregulation
  • neuro-sensory
  • social-interactive
  • metabolism
55
Q

what happens to the skin when there is a superficial dermal burn?

A
  • surface is dry
  • red (sunburn)
  • painful
56
Q

what happens to the skin when there is a superficial partial-thickness burn?

A
  • blistered surface, soft/wet texture
  • swollen
  • red/bright pink
  • intact sensation, painful
57
Q

how long does healing take to occur for a superficial dermal burn?

A

3-7 days with peeling

58
Q

how log does a superficial partial-thickness burn take to heal?

A

spontaneous re-epithelialisation will occur in 1 day or less

59
Q

what happens to the skin when there is a deep partial-thickness burn?

A
  • mottled red or waxy white
  • soft and wet looking, blanching
  • sensation is varied
60
Q

how does healing occur in a deep partial-thickness burn?

A

re-epithelialisation is possible but takes up to 3-6 weeks usually requires skin graft/substitute

61
Q

what happens to the skin when there is a full thickness burn?

A
  • surface is white, tan or waxy
  • looks dry and leathery, is rigid and non-elastic
  • initially painless
62
Q

how does healing occur in full thickness burns?

A

skin grafts required, hypertrophic scarring

63
Q

what layers of the skin are damaged in full thickness burns?

A

complete epidermis and dermis

64
Q

what layers of the skin are damaged in deep partial thickness burns?

A

epidermis and a greater portion of dermis

65
Q

what layers of the skin are damaged in superficial partial thickness burns?

A

epidermis and upper layer of dermis

66
Q

what layers of the skin are damaged in superficial burns?

A

epidermal layer only

67
Q

what does the severity of a chemical burn injury depend on?

A
  • concentration
  • quantity
  • duration of skin contact
  • surface area
  • mechanism
68
Q

how do burns effect the skin?

A
  • loss of protective epidermis
  • loss of thermo regulators
  • risks in function
69
Q

how do burns effect the CVS?

A
  • inflammatory response results in increased vascular permeability
  • hypovolemic shock
  • increased HR
70
Q

what is hypovolemic shock?

A

drop in blood volume and pressure

71
Q

how do burns effect the renal system?

A
  • acute renal failure can occur from reduced CO, mainly by fluid loss
  • reduced urine output
  • period of hlemodialysis
72
Q

how do burns effect the GI system?

A

reduced blood supply to intestine can result in…

  • gastric ulcers
  • paralysis of ileum or bowel obstruction
73
Q

how do burns effect the pulmonary system?

A

-burn to upper oropharynx and upper airway results in swelling and can block airway

74
Q

how do burns effect the metabolism?

A
  • increased rate of tissue breakdown
  • metabolic rate increases
  • weight loss
75
Q

what are the aims of treatment following burns?

A
  • prevent additional injury/infection
  • rapid wound closure
  • preservation of motion
  • early functional rehab
76
Q

what are some treatment principles with burns?

A
  • determine dimensions/depth
  • decompression
  • wound dressings
  • conservative or surgical treatment
77
Q

what is the OTs role with burns?

A
  • anti-deformity positioning/splinting
  • scar management
  • facilitating ADLs and functional use
  • increasing ROM, strength and endurance
78
Q

how are fluids replaced following burn?

A
  • maintain adequate material and venous pressures
  • adequate urine output
  • restore intravascular electrolytes
  • prevent hypovolemic
79
Q

what is intubation?

A

tube inserted to maintain airway

80
Q

what is tracheostomy?

A

surgically insert tube into trachea

81
Q

how can body temp be maintained by modifying the hospital enviro?

A
  • heated rooms

- ward set up to accomodate thermo regulators

82
Q

how are wounds managed with burns?

A
  • dressings absorb and prevent bacteria entering
  • wounds are clean
  • silver products
  • antibacterial cream, gauze and crepe bandages
83
Q

how does early excision and grafting allow early wound closure with burns?

A
  • decreases risk of infection
  • decreases metabolism and energy requirements
  • cosmetic outcome
  • decrease contracture risk
84
Q

what types of surgery can be undertaken for burns?

A
  • amputation
  • debridement
  • splint skin grafts
  • cadaverty/biobrane

enabling occupational performance (8 decks)

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