Midterm Flashcards
TREATMENT FOR IMPAIRED ROM COMPENSATION
•The use of assistive devices and environmental adaption can help compensate for lack of ROM and strength
- Dressing sticks
- Sock aides
- Button hooks
- Reacher
- Built-up handles, Universal cuff
- Tub bench, Shower chair, Grab bars, Handheld shower
OA Surgical Treatment
Joint replacements
Hip (THR)
Knee (TKR)
Shoulder (Total shoulder, Reverse Total shoulder)
CMC jt-Ligament Reconstruction Tendon Interposition (LRTI)
Gold standard treatment
Trapezium removed, tendon “anchovied”
Which Models of practice in physical disabilities is described below:
After WWII
Aligned with the medical model
Rehabilitation of disability
Patient is a passive participant
Rehabilitation model
Which Models of practice in physical disabilities is described below:
Disability rights movement
Self-advocacy-Client is at the center of the model = expert
Disability due to environment not function
Social model
Bridging medical and social model
Client-centered (collaborative)
Evidenced-based (use of the current best evidence)
Occupation-focused (meaningful occupations selected by the patient)
Culturally relevant (to the patient)
Occupational Functioning Model (OFM)
Participating in life roles brings a sense of self-efficacy and self-esteem
Goal of OFM is engagement in life roles
The assumption that ones ability to perform in life roles (areas of occupation) is based upon basic abilities and capacities (performance skills)
What FOR is described below?
Return to the fullest function possible
Modification strategies
Use of adaptive devices, equipment, technology etc.
Rehabilitation
What’s described below
1) Occupation as Therapy?
2) Occupation as Ends?
3) Occupation as Means?
■”Refers to engaging your client in occupations that constitute the end product of therapy” (W&S, 326)
- One handed shoe tying after CVA
- Teaching handwriting skills to UE amputee who lost their dominate arm
- Recommending adaptive equipment for a person with a brachial plexus avulsion to perform meal prep independently
- Recommending/training a patient with a spinal cord injuries to use hand controls for driving
Occupation as Ends
What’s described below
1) Occupation as Therapy?
2) Occupation as Ends?
3) Occupation as Means?
■”Occupation acting as the change agent to remediate impaired abilities” (W&S, 326)
- Engagement in putting together a Lego kit to develop reach and coordination skills that may transfer to ADL tasks for a patient using a UE myoelectric limb
- Rolling out dough to increase UE strength so they can increase independence in home making tasks
- Putting together a puzzle with all pieces placed on the left side to promote scanning techniques so a patient may be able to locate utensil placed on their left side
Occupation as Means
What’s Intervention Approach OTPF-2 is described below?
-Maintain upper extremity strength in wheelchair bound adults by providing a exercise program at a senior center
Maintain
What OT process is described below?
■Intervention Plan
■Intervention Implementation
■Intervention Review
Intervention Process
What are the 3 ways you can measure edema?
- Volumetry: Use of volumeter, beaker and 500 ml graduated cylinder
- Figure-of-eight method:Use of a tape measure
- Circumferential measurement: Use of a tape measure of circumferential measurement device
ICF Conceptual model includes
1) health condition (disorder/disease)
2) body functions and structures (impairment)
3) activities (limitation)
4) participation (restriction)
5) environmental factors
6) personal factors
OT domain includes
- performance in areas of occupation
- performance skills
- performance patterns
- context
- activity demands
- client factors
What OT domain is described below:
Cultural Physical Social Personal Spiritual Temporal Virtual
context
What FOR is described below?
CNS insult
Interventions to help reorganization of sensory and motor cortices of the brain
Proprioceptive neuromuscular facilitation (PNF)
Neurodevelopmental treatment (NDT)
Sensorimotor
What OT setting is described below?
Acute care hospital setting (days to 1-2 weeks)
Acute rehabilitation (weeks)
Subacute rehabilitation (weeks to months)
Skilled nursing facility (months to years (consultation)
Inpatient settings
What OT setting is described below?
Residential care (months to years) Assistive living setting (months to years (consultation)) Home health (weeks to months
Community-based settings
What OT process is described below?
■Brief process to determine need for skilled OT evaluation
■Identify need for other services
■Contains a brief occupational profile
■Assessments to determine if further therapy is needed
-Sensitive enough to identify performance problems
■Recommendations about the appropriateness for an evaluation
Screening
What step of intervention plan is describe below?
■What is the desired results?
■Select intervention approach
-Remediate, Modify
■Consider discharge needs -depending on your place in the continuum of care your interventions and goals may vary
-Is the patient going to a SNF, home, outpatient therapy
■Monitor program
-objectives, goals, outcomes
1st step Intervention Plan
What’s Intervention Approach OTPF-2 is described below?
■Enhances client factors (ROM, MMT, endurance, processing) to improve performance
■Must link changes in abilities to changes in occupational performance
■Increased strength and ROM should show improved occupational performance (if not is this the right intervention?)
■Sensory integration
■Constraint induced movement therapy
■Therapeutic exercises
Remediate/Restore
What’s Intervention Approach OTPF-2 is described below?
-Promote a health lifestyle in staff by starting a biking club
Health Promotion
Which ADL/IADL assessment is described below? (FIM/Barthel Index, COPM, AMPS, Patient Specific Functional Scale, PASS)?
26 ADL and IADL tasks Performance based Client centered 4 point ordinal scale 3 scores (Independence, Safety and Adequacy) Different protocols for home and clinic Reliable and valid
PASS
What are some exercise that can be used for edema?
Diaphragmatic Breathing § Should start at the trunk § Low level aerobic exercises § Followed by shoulder/elbow ROM § Followed by wrist/hand (fisting overhead)
What are contraindications of manual edema mobilization?
*Contraindications include:
§ Infection
§ Areas of inflammation
§ Hematoma or clot
§ Active cancer
§ CHF, severe cardiac or pulmonary problem
§ Renal failure
§ Primary lymphedema or lymphedema from mastectomy
What are the Three main types of intervention strategies can be utilized for compensation for strength limitation?
1.Activity method is altered
One handed techniques
2.Object can be adapted
Built up utensils
3.Environment is modified
Wheelchair ramp
Dressing: Which method (alter method/alter task object/modify the task environment) is described below:
Learn to dress the affected side first to compensate for hemiplegia
Alter Method
Measuring Cardiovascular Endurance
Metabolic equivalent level (MET)
One MET = basal metabolic rate (amt of O2 consumption necessary to maintain metabolic process of the body at rest (3.5mL of O2 per kilogram of body weight/min))
Rate of perceived exertion (PRE) (Borg Scale)
Patient rated, 15 point scale from 6-20 (20 max exertion)
Standardized instructions
Talk Test
Patient should be able to talk comfortably in full sentences during task
Max Heart Rate
Age - 220 = MHR or 206.9 – (.67 x Age)= MHR
Describe the different weight bearing status: NWM TTWB PWB FWB
NWB-Non weight bearing-Affected foot not touching floor
TTWB-Toe touch weight bearing-May lightly touch the floor for balance, not to weight bear through the leg (10%)
PWB-Partial weight bearing-30-50% of body weight on affected side
FWB-Full weight bearing-Full body weight allowed
What are OT Treatment for OA?
Patient Education Weight management Joint protection techniques Adaptive equipment Environmental modifications Energy conservation
rheumatoid arthritis (RA)
chronic systemic disease characterized by autoimmune inflammatory changes in the connective tissue throughout the body
Onset can be any age with a prevalence increasing with age with peak being between 40-60 yo
Rate is 2-3 times higher in females
Joint involvement is often symmetrical and bilateral throughout the body
Characterized by remissions and exacerbations
What joint deformities is described below: (choices: Ulnar drift/swan neck/boutonniere)
Extensor tendons slip to the ulnar aspect of the metacarpal head
Ulnar deviation of digits at MP joints (Ulnar drift):
What joint deformities is described below: (choices: Ulnar drift/swan neck/boutonniere)
PIP flexion contracture with DIP hyperextension (caused by rupture or lengthening of the central slip of the EDC)
Boutonniere deformity
Lymph is made up of…
protein, water, cellular components and particles, and fat
What method is described below…how interstitial fluid get out of the circulatory system, cells, and tissue and into the lymphatic system?
(choices: diffusion/osmosis/filtration/re-absorption)
- inward forces outweigh outward force
re-absorption
What are the Two Layers of Lymphatic Vessels: and what are they responsible for?
- superficial layer: is responsible for draining lymph from the skin and subcutaneous tissue.
- deep layer: drains lymph from muscle tissue, tendon sheaths, nervous tissues, the periosteum, and joint structures.
Lymphatic Dysfunction 3 Types (Dynamic /Combined/Mechanical Insufficiency)
Which 1 is described below?
- Most common insufficiency
- Caused by lymphatic load exceeding capacity of the anatomical and functionally intact lymphatic system
- May occur as a result of insufficient cardiac or kidney function
Dynamic Insufficiency
Lymphatic Dysfunction 3 Types (Dynamic /Combined/Mechanical Insufficiency)
Which 1 is described below?
- This is when both dynamic and mechanical insufficiencies are present
- Both the transport capacity is reduced and the lymphatic load is increased.
Combined Insufficiency
What OT domain is described below:
Activities of daily living (ADLs) Instrumental activities of daily living (IADLs) Education Work Play Leisure Social participation
Performance in Areas of Occupation
What OT domain is described below:
Motor skills- reaching, manipulating, pacing, rolling, standing sitting
Process skills-sequencing steps, staying on task, modifying performance when there is a problem
Communication/interaction skills- conversations, gestures, inhibiting behaviors, displaying emotions
Performance Skills
What OT domain is described below:
Habits
Routines
Roles
Performance patterns
What OT domain is described below:
Objects used and their properties
Space
Social
Sequencing and timing
Required actions
Required body functions (for specific activity)
Required body structures (for specific activity)
Activity demands
Body functions
Body structures
Values, beliefs and
spirituality-
“refer to the way that an individual views what is important in life. This includes their understanding of what makes an activity worthwhile and what makes a human life have purpose”. (Giles, 2019)
Client factors
What’s the Top down approach (observation of performance)
- Evaluation (activity analysis)
- Intervention
- Adaptive therapy- balance between goals and abilities
- Optimize abilities and -capacities
- Occupational activities and adjunct therapies are used
- Environment can promote or hinder functioning
What FOR is described below?
Rehabilitation Improvement of occupational performance
Restore function
Strengthening, exercises, splinting etc.
Biomechanical
What OT setting is described below?
Outpatient clinics (weeks to months) Day treatment (months to years) Work site (weeks to months (consultation))
Outpatient settings
What OT process is described below?
■Comprehensive and detailed assessment
■Contains occupational profile
■Identifies specific areas of occupation to be assessed
■Assessments
■Analysis of occupational performance
■Identifies treatment plan and outcomes
■Provides summary and recommendations
Evaluation
What OT process is described below?
■Documented in the evaluation (can be template of free form)
■Includes specific txinterventions you are planning
■Frequency of treatment
■Goals
■Length of OT treatment
-Pt will be seen 2 x per week x 4 weeks
Treatment Plan
What step of intervention plan is describe below?
■Therapeutic use of self ■Preparatory methods (PAMs, splinting, sensory stim, exercises) -Techniques that prepare the patient for occupational activities ■Therapeutic use of Occupations -Purposeful and meaningful -Occupation as ends -Occupation as means ■Consultation and Education
2nd step Intervention Implementation
What’s described below
1) Occupation as Therapy?
2) Occupation as Ends?
3) Occupation as Means?
■Selecting therapeutic occupations that are both Meaningful and Purposeful
- Meaningful occupations-the task is motivating and significant
- Purposeful occupations-help to enhance patients performance
■The therapist can then grade the task to provide the “just right challenge”
■”Occupation has the power to enable people to perform the actions they need and want to perform so that they can engage in and do the familiar, ordinary, goal directed activities of every day in a manner that brings meaning and personal satisfaction” Fisher (1998)
Occupation As Therapy
What’s Intervention Approach OTPF-2 is described below?
■When disability is considered permanent
■Client factors are not expected to improve
■Limited access to therapy prevents remediation approach
■Client prefers this approach
■Environmental adaptions are often utilized
■Focus is on modifying the tasks and use of adaptive equipment to maximize function and independence
Adapt/Modify
What’s Intervention Approach OTPF-2 is described below?
Prevent low back injuries by instructing employees in proper lifting techniques
Prevent
What part of the 3rd step for intervention review is described below?
- Formal-Re-evaluation, outcome measures, assess goals
- Informal Done at every visit, considering how your treatment is progressing, is this working
Monitor Progress
What part of the 3rd step for intervention review is described below?
- Have the goals been met?
- Has the patient plateaued?
- Insurance has maxed out
- Client requests discharge
- Should be a collaborative decision
Discharge
What are the 3rd step for intervention review?
Re-eval->Modify-> Continue/Discontinue services
Which ADL/IADL is described below? (FIM/Barthel Index, COPM, AMPS, Patient Specific Funcational Scale, PASS)?
Measure of disability in performing BADLs
18 items scored on a 7-point scale (13 motor, 5 cognitive)
Subscales for motor and cognitive function
Performance areas include self-care, continence, mobility, locomotion, cognition, and socialization
Certification required
FIM
Which ADL/IADL is described below? (FIM/Barthel Index, COPM, AMPS, Patient Specific Functional Scale, PASS)?
Measure of disability in performing BADLs
10 activities: bowel, bladder, feeding, grooming, dressing, transfer, toileting, mobility, stairs and bathing
Ordinal scale
0-20 or 0-100
Items are weighted
Measure of independence
Use of aides is allowed
Barthel Index
Which ADL/IADL is described below? (FIM/Barthel Index, COPM, AMPS, Patient Specific Functional Scale, PASS)?
Client centered Interview Outcome measure/satisfaction survey Patient identifies and prioritizes occupational performance areas Self-care, productivity, leisure skills Need to purchase
COPM
Which ADL/IADL is described below? (FIM/Barthel Index, COPM, AMPS, Patient Specific Functional Scale, PASS)?
16 motor skills, 20 process skills and task performance
Client selected
Selected from a list of 50 standardized IADL tasks
Observation
Ordinal Scale
Purchase
AMPS
Which ADL/IADL is described below? (FIM/Barthel Index, COPM, AMPS, Patient Specific Functional Scale, PASS)?
Patients identifies 3-5 functional activities
0-unable
10-PLOF
Patient Specific Functional Scale
What are some contraindications for ROM?
- Motion will cause damage or interrupt the healing process (measuring active fisting after flexor tendon repair)
- You suspect fracture, subluxation or dislocation
- Myositis ossificans/Ectopic ossification/Heterotopic ossification
What are some precautions for ROM?
Pain •Inflammation •Osteoporosis •Hypermobility •Hemophilia •Hematoma •Recently healed fx •Prolonged immobilization •Bony ankylosis •Disruption of soft tissue •Prolonged immobilization
Described all of the end feels (hard or bony/ soft/firm/capsular)
- Hard/ Bony-Painless, hard stop to motion. Bone meets bone (PROM elbow ext)
- Soft-When two body surfaces come together a soft compression of tissue is felt-PROM elbow flexion
- Firm-Firm/springy sensation-MCP extension
- Capsular-hard/firm stretch (stretching leather) (PROM shoulder ER)
Describe all of the abnormal end feel
hard, soft, firm, empty, springy block, spasm
- Hard-Abrupt hard stop to motion or a grating sensation (loose bodies in a joint, fracture)
- Soft-Boggy sensation (Soft tissue edema, synovitis)
- Firm-Springy sensation or hard arrest (ligament/muscular or capsular shortening)
- Empty-Unable to get to end range (usually due to pain)
- Springy Block -Bouncy -indicates loose body (knee with torn meniscus)
- Spasm-Hard sudden stop to PROM (no pain = tone, pain = arthritis, fx)
GONIOMETER RELIABILITY AND VALIDITY
Whats described below: (RELIABILITY or VALIDITY)
the extent to which the instrument yields the same repeated measure”
Reliability
Whats the difference between the following:
- Intrarater reliability-
- Interrater reliability-
- Intrarater reliability-Same rater
- Interrater reliability-Different raters
- Varies by joint, more reliable than visual estimation
•Intrarater is higher than interrater (use a standard protocol guidelines within your facility)
GONIOMETER RELIABILITY AND VALIDITY
Whats described below: (RELIABILITY or VALIDITY)
the degree to which an instrument measures what it is supposed to measure.”
VALIDITY
Can be invalid if proper protocol is not followed
How to measure ROM measurements?
- Total Active Motion (TAM) and Total Passive Motion (TPM)
- For single digit-add flexion from MP/PIP/DIP, then add total maximum ext from all 3 joints. Subtract extension from flexion
- IF MP 0/50, PIP -5/90, DIP -10/20= total flexion 50+90+20= 160, total extension 0-5-1-= -15 Total active motion (160-15 =145)
- TAM for IF = 145
What are some edema treatments?
§ Low stretch bandages § Self-Adherent Wrap (Coban) § Kinesotaping § Chip bag § Exercise § Edema gloves § Manual Edema Mobilization
What type of MEM is decribed below?
(U hand movement pattern; clearing U’s skin tractioning pattern; flowing U’s lymph movement pattern; pump point stimulation)
§ Pattern of hand on skin, Very light pressure (10 mm Hg or less)
§ Pulls skin lightly distal then circles back up and around
U hand movement pattern
What type of MEM is described below?
(U hand movement pattern; clearing U’s skin tractioning pattern; flowing U’s lymph movement pattern; pump point stimulation)
§ Starts proximally and moves to the distal part of the limb (upper arm, forearm hand)
§ Minimum of 5 U’s are done in 3 sections to create interstitial pressure changes
clearing U’s skin tractioning pattern
What type of MEM is decribed below?
(U hand movement pattern; clearing U’s skin tractioning pattern; flowing U’s lymph movement pattern; pump point stimulation)
§ Starts distal moves proximal
§ Moving one U after another from distal to proximal is repeated 5 times
§ The flowing U pattern is performed all the way to the contralateral upper quadrant
§ Followed by active muscle contraction in each segment (if not contraindicated)
flowing U’s lymph movement pattern
What type of MEM is decribed below?
(U hand movement pattern; clearing U’s skin tractioning pattern; flowing U’s lymph movement pattern; pump point stimulation)
§ Simultaneous, synchronous movement of therapists two hands in a U pattern over
areas of lymph bundles
§ Lymph bundles (groups of initial and collector lymphatics), watershed area or lymph
nodes
§ Therapist does 20-30 U’s in one area before proceeding to the next area of pump
points.
pump point stimulation
Dressing: Which method (alter method/alter task object/modify the task environment) is described below:
Lower clothing racks to increase access to clothes
Modify the Task Environment
Measuring Muscular Endurance
Measured by the amount of lactic acid build up in the blood
Dynamic assessment= reps /unit of time (Box and Block Test)(Functional
Capacity Evaluation, BTE work simulation)
Static assessment= time contraction is held
Intensity, duration and frequency
Primary OA
- Is it localized or generalized?
- What joints are most often involved?
- when does incidence increase?
Primary OA- No know caused may be localized or generalized
DIP and first CMC joints most often involved
Incidence increases with age
Secondary OA
- what causes it?
- what age?
Has identifiable cause such as trauma
Any age
What are the stages of Disease process?
Stage 1, Early Phase (Acute) : Joint swelling and inflammation, no destructive changes, possible presence of osteoporosis on X-ray “flare”
Stage 2, Moderate Phase (Proliferative) : synovium begins to invade the soft tissues producing tenosynovitis and limiting joint movement (no joint deformities yet), adjacent muscle atrophy
Stage 3, Severe Phase (Destructive): synovial erosion causes irreversible changes including joint deformities, loosening of ligamentous insertions, impairment of tendon function, muscle atrophy and joint disorganization. X-ray evidence of cartilage and bone destruction and osteoporosis
Stage 4, Terminal phase (Chronic): synovial activity “burnt out” fibrosis or bony ankylosis
What joint deformities is described below: (choices: Ulnar drift/swan neck/boutonniere)
PIP hyperextension with DIP extension lag, due to erosion of the PIP volar plate, rupture of lateral band or FDS rupture
Swan-neck deformity:
What does the lymphatic system do?
- removes excess fluids and waste products from the body’s tissues
- helps the immune system fight infection
- absorbs fats and fat-soluble vitamins from the digestive system and delivers these nutrients to the cells of the body
- system transports lymph fluid throughout the body.
What is interstitial fluid?
Fluid BETWEEN the cells or in the tissues
When does the lymphatic system develop?
during the fifth week of gestation.
-develops from the mesoderm
What method is described below…how interstitial fluid get out of the circulatory system, cells, and tissue and into the lymphatic system?
(choices: diffusion/osmosis/filtration/re-absorption)
- the movement of particles in a solution from an area of higher concentration to an area of lower concentration.
diffusion
What method is described below…how interstitial fluid get out of the circulatory system, cells, and tissue and into the lymphatic system?
(choices: diffusion/osmosis/filtration/re-absorption)
- movement of water molecules from a place of higher water concentration to a place of lower concentration through a permeable membrane.
osmosis
What method is described below…how interstitial fluid get out of the circulatory system, cells, and tissue and into the lymphatic system?
(choices: diffusion/osmosis/filtration/re-absorption)
- outward forces are greater than inward forces.
Filtration
Lymph nodes are responsible for…?
production on antigen-stimulated white blood cells called lymphocytes
Lymphatic Dysfunction 3 Types (Dynamic /Combined/Mechanical Insufficiency)
Which 1 is described below?
-Is a reduction in transport capacity due to functional or organic causes
- May occur as a result of tissue removal or damage.
- Tissues may be removed due to medical intervention for cancerous tissues. Damage may occur to tissues during cancer treatment such as radiation, burns to skin, or the presence of toxins such as medicines or parasites.
Mechanical Insufficiency
Level of Edemas
1) Acute Phase: Edema that begins immediately as a result of trauma or infection. Generally lasts up to 5 days and then begins to subside.
2) Subacute Edema: Is the edema that continues beyond the acute phase and becomes chronic if still present longer then 3 months.
3) Chronic edema is hard, indurated, and resistant to pitting
Treatment for Edema: Entry Level OT interventions for Subacute and Chronic Phase
- Start proximally with diaphragmatic breathing, trunk stretches, trunk exercises, easy yoga trunk stretches
- Active and passive exercise
- Loose elastic glove, loose stockinette, cotton finger wrap bandages and Coban
- Elastic taping
PRECAUTIONS!!!!!!!
For Treatment of edema…
In the presence of congestive heart failure (CHF), kidney failure, blood clots (DVT), infection, and undiagnosed cancer
**DO NOT apply interventions for edema. Medical clearance needs to be secured prior to treatment.
