Management of RA Flashcards
what is RA?
chronic inflammatory disease with many jts affected
what does RA affect?
jts, blood vessels, heart, lungs, eyes
what is the goal of RA therapy?
slow down rate of deformity
what are the types of RA?
- self limited (resolves)
- persistent
- progressive
what are the fxnl classifications for RA?
- independent
- independent in ADL, no avocation
- self care, limited work
- limited in all activity
role of OT in drug therapy?
reinforce benefits of tx
early vs late stage RA?
early: diffuse swelling
late: skeletal collapse, need surgery
OT role in RA?
splints education assistive devices sy management exercise instruction balance activity + rest
acute goals for RA?
rest splint cold modality gentle arom positioning
chronic active stage goals for RA?
jt protections
assistive tech
gentle ROM NOT stretching capsule
energy conservation
chronic inactive stage goals for RA?
reduce stiffness with heat modalities
preserve mobility + strength
fatigue management
when is splinting important?
post surgery
provides safe motion, alignment, prevents rigidity
how do you tx ulnar drift?
dynamic splint that drops down at diff angle (not 90)
what do cold PAM’s achieve?
reduce acute swelling, spasm
what do heat PAM’s achieve?
decrease stiffness, spasm, pain
only use once inflammation is controlled
what are PAM contraindications?
ultrasound and diathermy can cause stiffness
what are exercises done in acute phase?
gentle active assistive
PROM
what are exercises done in chronic active stage?
AROM
isometrics
short arc isotonics
low impact endurance
what are exercises done in chronic inactive stage?
AROM/PROM
isometrics
isotonic arc with light resistance
low impact cardio
how to do muscle strengthening with RA?
adapt exercise to stage of disease
reduce flare up
isometric –> isotonic
do warm up + cool down
what does low impact aerobics provide?
reduced pain
self effectiveness
physical performance
what is a possible problem with wrist involvement?
wrist drop could cause impingement
what are characteristics of wrist RA?
synovitis + tenosynovitis
sublux
carpal tunnel
what are characteristics of MCP RA?
synovitis
sublux
ulnar deviation
intrinsic muscle tightness
how do you tx MCP RA?
intrinsic strengthening going radially
i.e. hook fisting, radial walking
what is ulnar drift?
extensor tendons slip over + into ulnar gutter
can eventually cause MCP sublux
when is a total jt arthroplasty considered?
unremitting pain
limited motion
severely impaired fx
how do you tx while respecting pain?
maintain ROM + MS use jts in stable fxnl plane avoid positions of deformity use strongest/largest jts for the job assistive devices
how do you use correct pattern of movement in tx?
avoid static for too long
avoid unstoppable activity
balance rest and activity
reduce the force
