Musculoskeletal Impairments Flashcards
Amputations: What does the OT eval include?
1) evaluate self-care activities WITH and WITHOUT prosthesis
2) look at client factors: sensation, phantom sensations, pain, self-concept, strength of residual limb, skin integrity
3) performance skills of uninvolved hand
4) functional mobility
5) driving eval
6) vocational and recreational interests
7) environmental eval: home, school, work, etc
Amputations: What does the OT intervention during the preprosthetic phase look like?
1) training in limb hygiene
2) wound healing
3) limb shrinkage and shaping: reduce edema
4) desensitization of residual limb through WB on surfaces
5) maintenance of flexibility and strength of residual limb
6) maintenance of strength and flexibility of remaining limbs
7) wheelchairs: need residual limb support; large rear wheels placed further back to counterbalance missing limbs; wheelchairs should have antitippers
Amputations: What does the OT intervention during the prosthetic prescription phase look like?
1) considering different factors for upper limb prosthesis: performance of residual limb, cosmetic preferences, hand dominance, activities used with prosthesis (home, school), attitude, finances, cognition
2) Prosthesis Components
a) terminal devices
- can be passive or active (passive is for cosmetics, active does functional stuff through EMG signals… wowsers)
- clients with myoelectric devices need two superficial muscle sites that can fit within prosthsis socket with sufficient EMG signals
b) socket
c) positioning components
d) harness
e) control system to control TD in upper body
f) pylon to connect TD to socket in LB
g) prosthetic sock or gel liner
Amputations: What does the OT intervention during the postprosthetic phase look like?
1) Education, education, education (We OTs… we educate)
2) Donning/Doffing prosthesis
3) Create a wearing schedule (start with 15-30 mins, increase by 15-30 increments until it’s a full day if client tolerates or talk to prosthetist to fix sh** up)
4) limb hygiene
5) care of prosthesis
6) upper limb prosthesis training (control, use, prepositioning, prehension, functional)
7) adaptive equipment if needed
8) work with client to develop skills for ADLs and IADLs
What is a contracture? How do you treat a soft tissue or bony block contracture?
- fixed posture because of shortening of skin, ligaments, muscles, etc
- soft tissue: responds to therapy
- boney block: requires surgery (sorry, OTs can’t do this)
How does OT evaluate a contracture?
PROM and AROM
What are OT interventions for contractures? 3 steps
1) Superficial and deep heat to increase tissue extensibility (think of tight muscles and how hot yoga helps loosen your muscles)
2) slow stretch (just like you do in yoga when you try to touch your toes)
3) static splinting (when you use a strap to help stretch)
What are the types of splints to reduce soft-tissue contractures?
1) antideformity burn splint
2) elbow/knee extension splint
3) wrist extension splint
4) thumb abd splint
5) lumbrical bar splint
6) resting hand, ball, cone antispasticity splint
7) soft neoprene splints
8) splint to prevent foot drop
9) serial casting: fiberglas, plaster of paris
10) dynamic splinting: think 90 angle of pull
What is fibromyalgia?
A syndrome consisting of widespread pain affecting entire musculoskeletal system. Symptoms include: widespread soft tissue pain, nonrestful sleep, fatigue, foggy thinking, pins and needles, depression (Think of patient from NWOMC when shadowing with Jen)
What is the OT eval for fibromyalgia?
1) Daily activity log: record baseline activities
2) COPM
3) Pain assessments
YO. Do you remember entering all of these for two years? You better know this one. -_-
What is the OT intervention for fibromyalgia?
1) client education (We OTs, we educate)
2) gentle regular aerobic exercise
3) sleep hygiene
4) myofascial release, trigger point treatment (NWOMC trigger point injections)
5) fatigue management, pacing, energy conservation
6) memory aids
7) modification of activity or environment
What is a significant risk factor for hip fractures in the older population?
1) osteoporosis (decreased bone density in the head of the femur usually) & being a women -____- (bc osteo affects more women than men… BOOOOOO)
What are the different weight-bearing restrictions for and open reduction and internal fixation of the hip?
1) non-weight bearing: NADA
2) toe-touch: touch of toe
3) partial: 50%
4) weight bearing at tolerance: dependent on patient
5) full weight bearing: 100%
Precautions of posterolateral hip replacement?
No bending more than 90 degrees, no internal rotation, and no adduction
Precautions of anterolateral hip replacement?
No external rotation, no extension, no adduction
What is the role of OT in hip replacements?
1) complete occupational profile
2) provide home safety recommendations
3) EDUCATION, REEDUCATION of hip precautions (teach transfer techniques, home modifications, etc)
4) emphasizing maintaining joint motion
5) increase strength of other muscles
6) emphasize increasing independence in ADLs and IADLs
7) adaptive equipment
8) PAMS as licensed
What does an OT evaluation for lower back pain usually look like?
1) ALWAYS complete an occupational profile during initial eval… (think intake interview at NWOMC)
2) Questionnaires are sometimes used to ID performance areas (think spinal sort)
3) Determining occupational performance is best done by OBSERVING performance in clinic (Lifting eval… BLEGH)
What do intervention plans for LBP look like?
1) EDUCATION… back anatomy and movements
2) use of neutral spine back stabilization techniques
3) Body mechanics!
4) adaptive equipment, modified tasks
5) task analysis, ergonomic design
6) energy conservation
7) occupation to increase strength and endurance
8) more education or pain management, stress reduction, and coping (remember Buzz lightyear!)
