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
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
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
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
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
6
Q
CTS OT Rx
A
- CT OT Rx:
- Neutral wrist splint at night
- patient education:
- tool redesign
- position of keyboard
- Tendon Gliding Exercise
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
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
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
10
Q
OT Rx: Radial Nerve Compression
A
- deep tissue massage
* ultrasound, ESTIM
* extensor stretching
* patient education
11
Q
Brachial Plexus:
A
- usually a traction injury
* no surgery available
OT Rx:
* protection
* compensation
* regaining what you get
12
Q
- medial epicondylitis
A
golfers elbow
* pain in grip * pain with resisted wrist flexion * pain at medial epicondyle with palpation
13
Q
- lateral epicondylitis
A
- tennis elbow
* pain with extended reach in pronation
* pain with grip
* pain at insertion of extensors tendons
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
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
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
17
Q
- Symptoms of RC Injury
A
- painful arc
- aching in middle deltoid
- functional limitations
- positive hawkins test
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
19
Q
Hip Precautions Anterior Approach
A
- avoid extension
* avoid external rotation
* avoid adduction
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
- Communication guidelines:
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
