Joint Replacements

Question 1

Posterior hip precautions

Answer 1

no hip flexion greater than 90°; no internal rotation; no adduction of affected hip joint

Question 2

Anterior hip precautions

Answer 2

No external rotation; no extension; no adduction of affected hip joint

Question 3

Joint replacements are generally not considered if the client ________

Answer 3

will not comply with rehabilitation or if

the client will not experience significant functional improvement (e.g., is immobile or bedridden).

Question 4

Out-of-bed activity should occur early with both anterior and posterior hip replacement approaches, traditionally ___ days postoperation.

Answer 4

1–3

Question 5

Role of the OT in hip replacement surgery

Answer 5

1. Complete an occupational profile with the client and family or caregiver.
2. Provide home safety recommendations.
3. Offer education and reeducation regarding hip precautions, including proper transfer techniques,
   home modification recommendations, ROM restrictions, and positioning to perform ADLs.
4. Emphasize maintaining or increasing joint motion.
5. Increase strength of surrounding musculature.
6. Emphasize increasing independence in ADLs and IADLs using prescribed precautions, safety tech-
   niques, and compensatory strategies.
7. Prescribe and instruct the client (and family or caregiver, as necessary) in use of adaptive equipment
8. Use physical agent modalities (PAMs) as appropriate to the practitioner’s level of training and in

compliance with specific state regulations (e.g., some states require occupational therapists to ob-
tain a PAM certification).

Question 6

Facts about low back pain

Answer 6

A. LBP generally resolves within 6 weeks for 90% of clients and 12 weeks for 5% of clients.
B. LBP is rarely the result of serious spinal diseases, and less than 5% is true nerve root
pain.

Question 7

1. Sciatic pain is cause when ________

Answer 7

when the nerve is trapped by a herniated disc

Question 8

Spinal stenosis is the narrowing of the

Answer 8

intervertebral foramen

Question 9

Facet joint pain: inflammation or changes of the

Answer 9

spinal joints

Question 10

Spondylosis is a stress fracture of the

Answer 10

dorsal to transverse process

Question 11

Spondylolisthesis: slippage of

Answer 11

a vertebra out of position

Question 12

Herniated nucleus pulposus: stress tearing of

Answer 12

the fibers of a disc, causing an outward bulge pressing

on spinal nerves

Question 13

OT guidelines for LBP

Answer 13

A. An occupational profile should always be completed in the initial evaluation.
B. Questionnaires are sometimes used to identify performance areas currently affected by
LBP.
C. Determining occupational performance is best done by observing actual performance
on tasks in the clinic or elsewhere simulating ADLs, IADLs, and skills highlighted in the
client’s occupational profile.

Question 14

OT interventions for LBP

Answer 14

Education regarding back anatomy and movements related to the client’s occupational performance

2. Use of neutral spine back stabilization techniques to promote decreased pain
3. Body mechanics education
4. Training in adaptive equipment and modified tasks
5. Task analysis and introduction of ergonomic design
6. Training in energy conservation
7. Use of occupation to increase strength and endurance
8. Education for pain management, stress reduction, and coping

Question 15

What type of lift is the safest for the back; ideal for heavy loads (e.g., clients)

Answer 15

Semisquat

Question 16

The stoop lift should be used only for

Answer 16

light loads (<20 lb)

Question 17

What lift is an alternative to the semisquat when space is limited?

Answer 17

Squat

Question 18

Guidelines for LBP with Bathing

Answer 18

a. A shower is generally better than a bath because neutral spine can be maintained.
b. All items should be kept within reach using a shower caddy or alternative device.
c. A handheld shower reduces unnecessary movements and twisting.
d. A bath mat should be used to decrease chance of slipping.

Question 19

Guidelines for LBP with dressing

Answer 19

2. Dressing
   a. Emphasis is placed on minimizing bending.
   b. The client should sit while dressing.
   c. The client should lie flat on the bed when pulling clothing up.
   d. Socks are applied and removed by bringing foot to the knee.
   e. Slip-on shoes are encouraged if possible.
   f. Belts are threaded through the loops before donning pants to decrease twisting.

Question 20

Guidelines for LBP with functional mobility

Answer 20

a. Logrolling, a technique for rolling the body as a whole unit without twisting, is recommended
for bed mobility.
b. To sit up, the client bends the knees and pushes up with the arms.
c. To lie down, the client brings the legs up and uses the arms to lower the body to the bedside.
d. For toilet mobility, the client lowers the body while maintaining a straight back and neutral
spine.

e. Firm-armed chairs are encouraged to ensure that the client is not too low, which increases vul-
nerability to back stress.

f. The client is advised not to sit for longer than 15 to 20 minutes.

Question 21

Guidelines for LBP with grooming

Answer 21

a. Bathroom sink activities are discouraged because of the low height of these sinks. Activities may
often be adapted to kitchen sinks.
b. The client places the foot inside the base cabinet while bending the hips and keeping the back
straight to reduce stress on the lower back.