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OTA 233 > Midterm > Flashcards

Midterm Flashcards

1
Q

Four Phases of Bone Healing:

A
  • Inflammation- 0-4 weeks
  • Soft tissue- no mineralization, no strengthening, fragile -3-8 weeks
  • hard repair- start strengthening- 6-12 weeks
  • remodeling- reshaping mineralization- 8-12 weeks
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2
Q

Non-surgical Fx: Phases

A
  • protective phase: ROM of non-casted joint, edema management, light functional use
  • ROM phase: fabricate removable orthosis, PROM, AROM and or passive stretch
  • Strengthening Phase
  • Normal Use
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3
Q

Frozen Shoulder: Phaes

A
  • ideopathic condition: patient develops pain and contracture of glenohumeral joint
  • Phase 1: freeze phase: dull ache
  • Phase 2: frozen phase: shoulder is stiff and loss of ROM and Occ. perf.
  • Phase 3: Thaw phase: regains ROM
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4
Q
  • Median Nerve: Carpal Tunnel Syndrome
A
  • compressed at transverse carpal ligament
  • caused by decreased space in carpal tunnel
  • caused by extreme flexion and extension
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5
Q

CTS Symptoms

A
  • Symptoms:
  • numbness or tingling in volar thumb, index, middle and half ring finger
  • decreased fine motor
  • weak or atrophied thenar muscles
  • decreased pinch strength
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6
Q

CTS OT Rx

A
  • CT OT Rx:
  • Neutral wrist splint at night
  • patient education:
  • tool redesign
  • position of keyboard
  • Tendon Gliding Exercise
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7
Q
  • Ulnar Nerve: Cubital Tunnel Syndrome
A
  • nerve kinked around elbow
  • Symptoms:
  • numbness in 4th and 5th volar dorsal (ring and pinky)
  • flexor weakness
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8
Q
  • Radial Nerve: Posterior Interosseous Nerve (PIN)
A
  • High Radial Nerve Palsy:
  • weakness of supinator
  • all extrinsic extensors
  • wrist drop- need splint
  • Radial Tunnel Syndrome:
  • cause: compression of posterior interosseous nerve, supinator muscle or lateral epicondylitis
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9
Q

Symptoms of Radial Nerve Compression

A
  • Symptoms:
  • pain at forearm 3 fingers from lateral epicondyle
  • weakness of thumb, finger and ulnar wrist extensors
  • weakness of abductor pollicis longus
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10
Q

OT Rx: Radial Nerve Compression

A
  • deep tissue massage
    * ultrasound, ESTIM
    * extensor stretching
    * patient education
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11
Q

Brachial Plexus:

A
  • usually a traction injury
    * no surgery available
    OT Rx:
    * protection
    * compensation
    * regaining what you get
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12
Q
  • medial epicondylitis
A

golfers elbow

  * pain in grip
  * pain with resisted wrist flexion
  * pain at medial epicondyle with palpation
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13
Q
  • lateral epicondylitis
A
  • tennis elbow
    * pain with extended reach in pronation
    * pain with grip
    * pain at insertion of extensors tendons
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14
Q

OT Rx od epicondylitis

A
  • OT Rx:
  • ice massage
  • deep friction massage
  • ultrasound or heat
  • extensor and supinator stretch
  • extensor strengthening- lateral epicondyle
  • flexor stretch- medial epicondyle
  • isometric grip
  • progressive resistive exercise
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15
Q

RTC Phases

A
  • Phase 1 of injury
  • Rest- avoid above 90* elevation
  • ice
  • ultrasound
  • PROM- pendulums
  • Active
  • Phase 2 of injury
  • isometrics
  • theraband
  • postural re-education
  • Phase 3
  • PNF diagonals
  • with resistance
  • pulley, theraband for free weights
  • Scapular strength: PRONE TYI
  • Rotator cuff strengthening
  • abducted internal/external rotation
  • empty can
  • shoulder PRE or Tband
  • Work/sports conditioning
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16
Q
  • Rotator Cuff:
A
  • functions: abduction of arm- compresses glenohumeral joint in order to allow deltoid muscle to further elevate arm
  • prevent humeral head from coming out of glenoid fossa
  • efficiency of the deltoid muscle
  • stability to humeral head
  • SITS - supraspinatus, infraspinatus, teres minor and subscapularis
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17
Q
  • Symptoms of RC Injury
A
  • painful arc
    • aching in middle deltoid
    • functional limitations
    • positive hawkins test
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18
Q

OT Intervention after Hip Fracture:

A

-upper extremity strengthening as needed
-tub and toilet transfers
-lower extremity dressing and bathing
-home management
-reinforce weight bearing status during functional
modality and balanced

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19
Q

Hip Precautions Anterior Approach

A
  • avoid extension
    * avoid external rotation
    * avoid adduction
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20
Q

Hip Precautions: Posterior approach:

A
  • avoid hip flexion > 90*
    * avoid internal rotation
    * avoid adduction/crossing legs
21
Q

OT Treatment:

A
  • ADL retraining - adaptive equipment
    * UE strengthening
    * Precaution education
   * hip precautions
   * weight bearing precautions

* Functional mobility
   * balance
   * transporting items
   * endurance 
   * home modification
  • Transfer techniques
  • tub transfers
    * toilet transfers
    * getting OOB
    * bed> chair
22
Q
  • THR Adaptive Equipment
A
  • avoid internal or external rotation
       * leg lifter
   * abduction wedge

* Avoid hip flexion

   * commode
   * shower chair

* Facilitates functional mobility
   * pocketed apron or walker bag 
* To Avoid bending

   * dressing stick
   * long handled sponge
   * long handled shoehorn
   * reacher
   * sock aid
   * elastic shoelaces

* To avoid crossing legs

   * sock aid
   * elastic shoelaces
23
Q

Hip Transfers

A
  • Transfer
    * Sit > Stand
  • extend operated leg
  • slide to front of chair using posterior tilt
  • push from armrest
  • front legs can be lower than the legs for posterior lateral approach
    * Stand > Sit
  • high, firm seat with armrest
  • extend operated leg forward, reach back for armrest and lower while learning back
  • push seat back and recline for car transfers
24
Q
  • Total Knee Replacement
A
  • Goal
    * alleviate pain
    * restore motion- CPM machine if ordered
    * restore alignment
    * maintain stability of the knee
  • OT Treatment with TKA
  • don/doff knee immobilizer if ordered/protocol
  • adaptive equipment
  • as needed due to limitations in knee flexion
  • balance
  • UE strengthening
  • Functional mobility
  • avoid rotation of knee during toilet hygiene
25
Q
  • Lower Amputations Levels:
A
  • Hemipelvectomy: half of the pelvis and entire LE
    * Hip disarticulations at the hip joint
    * AKA: above knee amputation
    * BKA: below knee amputation
    * Transmetatarsal: at metatarsals
    * Toe: removal of toe
26
Q
  • OT Intervention: Amputations
A
  • positioning, prevention of knee contracture
    * ADL’s/home management
    * upper body strengthening
    * desensitization
    * scare and edema management, residual limb shaping
    * balance
    * driving
    * prevocational and vocational activities
    * community reintegration
27
Q
  • Care of Residual Limb
A
  • alcohol causes skin to become dry
    * wash residual limb in evening with warm water and mild soap.
    * bathing may cause the residual limb to swell which could affect the fit of the prosthesis
    * thoroughly clean skin folds using cotton swabs to avoid bacteria. Completely rinse and towel dry
    * inspect residual limb with long handled mirror
    * massage residual limb daily
    * avoid prolonged dependent positioning of residual limb
    * avoid prolonged pressure to stump sit to avoid skin breakdown
28
Q
  • Cerebrovascular Accident
A
  • sudden loss of blood supply resulting in loss of oxygen supply to the brain
  • damages kills brain cells
  • neurological deficits related to areas affected
  • affects opposite side of the body to the hemisphere of the brain affected
29
Q

Hemispheric Lateralization:

Left

A
  • Left cerebral hemisphere- Right hemipharesis
  • responsible for language, time concept, and analytic thinking
  • often have aphasia- partial or total loss of language communication and apraxia- motor planning problems
30
Q
  • Right cerebral hemisphere- left hemipharesis
A
  • controls visual-perceptual function and perception of the whole
  • neglect/inattention more common
  • may retain good verbal but poor functional performance- dysarthria
31
Q
  • Cerebellum Stroke:
A
  • abnormal reflexes of the head and torso
    * coordination and balance problems
    * ataxia
    * dizziness
    * problems with swallowing and articulation
    * cranial nerve deficits- vertigo, nausea, vomitting, headaches, nystagmus, slurred speech
32
Q
  • Brainstem Stroke
A
  • controls primary functions- breathing, heart rate, blood pressure and arousal
    * dizziness
    * problems with swallowing and articulation
    * cranial nerve deficits
    * paralysis
    * likely to be critically ill- to need mechanical ventilation
33
Q
  • MCA- Middle Cerebral Artery
A
  • most common
    * largest vessel branching off the internal carotid artery
    * most common cerebral occlusion site
    * feeds- femoral, temporal, parietal lobes of brain and basal ganglia and internal capsule
    * MCA- has main stem and several branches arising from it
34
Q
  • PCA- Posterior Cerebral Artery
A
  • feeds the medial occipital lobe and inferior and medial temporal lobes
  • vision- contralateral homonymous hemianopsia
  • larger strokes- aphasia and neglect
35
Q
  • ACA- Anterior Cerebral Artery
A
  • least common- frontal and parietal lobes
  • classic signs:
  • contralateral leg weakness and sensory loss
  • behavioral abnormalities
  • incontinence may occur
36
Q
  • Ideational Apraxia
A
  • inability to plan motor acts
  • functional manifestations:
  • pt does not know what to di in order to perform an activity
  • does the pt attempt to use items incorrectly
  • may perform task incorrectly
37
Q
  • Treatment for Apraxia:
A
  • verbal and tactile cues
    * positioning garmet in same position each time
    * bottom up to top
    * pull over clothes
    * hand over hand assistance
    * perform same way each time
38
Q
  • Cognitive Dysfunction:
A
  • initiation and motivation deficits
       * difficulty starting and finishing a task
   * decrease in intrinsic motivation

* Attention and concentration deficits

   * deficits in ability to attend and maintain focus
   * tx: adjust environment, remove distractions

* Disorientation and confusiong:

   * awareness of person, place, time and situation
   * retain personal information the longest
   * forget situational information first
   * Tx: provide visual cues for place, date, situation: reinforce orientation but be careful about making pt frustrated or belligerent

* Memory deficits:

   * CVA affects reception, integration, and retrieval of information
   * Tx: use external memory aides, repetition, and visual cues

* Sequencing and organization

   * affects understanding of time and space
   * may stop activity after each step of an activity
   * use familiar environment

* Insight deficits:

   * unable to recognize deficits
   * Tx: fréquence re-education into current status/stimulation occasionally may allow pt to fail at certain tasks to promote awareness of deficits

* Judgement and safety

   * impaired ability to understand the consequences of behavior
   * may be resistive to feedback
   * Tx: discuss consequences of actions, allow pt to fail at task and review why and what could have been done differently. 

* Generalization and learning deficits:
   * client should perform task in various context
* Cognitive fatigue
   * build rest periods into treatment sessions
39
Q
  • Aphasia:
A
  • acquired language disorder- range of deficits
    * broca- aphasia: expressive aphasia
    * wernicks aphasia: receptive aphasia
    * global aphasia: loss of expressive and receptive skills
    * anomia- word finding difficulty
    • Communication guidelines:
      • variety of compensatory methods are available
      • collaborative with speech language pathologist
40
Q
  • Multiple Sclerosis:
A
  • autoimmune disease that affects the CNS
  • immune system attacks myelin, causing demylelinations in multiple areas
  • leaves scars known as scleroses, plaques or lesions
  • impedes transmissions of nerve impulses to an from the brain
41
Q

epidemiology of MS

A
  • more common in women age 20-50
    * genetic aspect
    * more prevalent in higher latitudes
    * more common in caucasians
42
Q
  • Disease course:
A
  • Most Common: relapsing and remitting; acute attacks with full or partial recovery, 85% of initial diagnoses
  • Secondary progressive: starts with relapsing and remitting course followed by progression at a variation rate; 50% develop in 10 years and 90% develop within 25 years
  • Primary progressive: progressive without remission 10% of initial diagnoses
  • Progressive relapsing: progressive with acute relapses; 5% of initial diagnoses
43
Q
  • OT Interventions: MS
A
  • improving participation via fatigue management
       * fatigue is the most common symptom of MS
   * primary fatigue due to disease process
   * secondary fatigue due to reconditioning and respiratory muscle weakness and pain

      * eliminate secondary causes: treat coexisting condition, adjust medication, improve sleep patterns, teach energy conservation
      * interventions that reduce fatigue are used of cooling garment, energy conservation techniques, aerobic conditioning.
      * control of tremors and movement disorders
44
Q

Poliomyelitis:

A
  • contagious viral disease
  • affects spinal cord and brainstem
    * results in flaccid paralysis
    * primarily affects lower extremities, accessory muscles of respiration, and muscle for swallowing
  • Immunizations have eradicated the disease in the Western hemisphere
    * Medical treatment:
       * bedrest, positioning and warm packs
   * no cure, disease must run its course
45
Q
  • Post-polio syndrome
A
  • impairment occurring years after having polio with satisfactory function in the interim
    * characterized by increased weakness of muscle previously affected
    * fatigue is the most debilitating symptom
    * other symptoms:
       * slowly progression of weakness in knees, atrophy, joint pain, skeletal deformities
   * limitations in ADL’s ambulation, swallowing and bladder and bowel control
46
Q
  • Post Polio syndrome: OT Intervention
A
  • evaluate how strength, ROM, and endurance affect ADL’s occupational performance, and psychosocial status
  • muscles may function at lower levels that scored on MMT due to easy fatigue
  • Assessment of psychosocial status is needed
  • pt worked hard to initially overcome polio
  • confronted a second time with being disabled
  • denial, anger, frustration, and helplessness are common
  • Overwork of muscles should be avoided
  • strength may be maintained through ADL’s
  • encourage activity within safety and comfort
  • Manage pain with body mechanics, support weak muscles, and lifestyle modification
  • Lifestyle modification is most important
  • activities should be modified to reduce fatigue and muscle overuse
  • teach energy conservation and work simplification
  • use assistive devices as needed
47
Q
  • Guillain- Barre Syndrome:
A
  • Acute inflammatory condition of the spinal nerve roots, peripheral nerves and in some cases, selected cranial nerves
  • often follows a viral infection, an immunization, or after surgery
  • affects both sexes at any age
  • progressive motor weakness of the limbs, sensory loss, muscle atrophy and fatigue
  • may affect speaking, swallowing, and breathing
  • varied course, but majority will recover in weeks to months with few residual effects
48
Q

GBS: OT Interventions

A
  • Rehab is initiated when patient is stabilized
  • pt may be totally paralyzed
  • Initial focus on PROM, positioning, and splinting to prevent contracture
  • gentle PROM only to point of pain
  • Graded activities as the Pt progresses
  • start with non-resistive activities and gradually add resistance
  • vary between gross and fine motor and resistive and non resistive activities to prevent fatigue
  • Always guard against fatigue and irritation of the inflamed nerves
  • Use adaptive equipment and energy conservation techniques as needed
  • discontinued AE as function improves
  • Progress with upright position and activities
  • use handling techniques from CVA rehab for trunk control, weight bearing, and progression of activities
  • Provide psychological support
  • facilitate feeling of self-worth and positive attitude

OTA 233 (3 decks)

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