OCTA 226 Midterm (Physical Dysfunction) Flashcards
A practice model that focus on musculoskeletal capacities that underlie functional motion in everyday occupational performance
Biomechanical Practice Model
study of the motions of objects and the forces acting on them
kinetics
Evaluation and Treatment used in the Biomechanical Practice Model are:
Joint ROM Endurance Therapeutic activities Strength Orthotics
Goals of Biomechanical Practice Model
- evaluate specific limitations in ROM, strength, and endurance
- restore these functions
- prevent or reduce deformity
Biomechanical Practice Model patient population:
pt with intact CNS orthopedic conditions burns lower motor neuron disorders SCI primary muscle disease
A practice model that focus on neurophysiological mechanisms to normalize muscle tone and elicit more normal motor responses
Sensorimotor Practice Model
Evaluation and Treatment used in the Sensorimotor Practice Model are:
reflex integration
recapitulation of otogenic Development
Goals of Sensorimotor Practice Model:
providing controlled input to the NS which is meant to stimulate specific responses
Sensorimotor Practice Model patient population
pt with CNS dysfunction (cerebral palsy, stroke, head injury)
an approach associated with the sensorimotor approach that focuses on the acquisition of motor skills through practice and feedback
Motor Learning
this approach addresses the volition and habituation and performance capacity components of the MOHO
Motor Learning
A practice model that focuses on using measures that enable a person to live as independently as possible despite residual disability
Rehabilitation Practice Model
Evaluation and Treatment used in the rehabilitation practice model:
intrinsic worth and dignity of person
restoration of satisfying and purposeful life
Goals of the Rehabilitation Practice Model:
help patient to learn to work around or compensate for physical limitations
Rehabilitation Practice Model patient population:
any patient population: used along with the other 2 approaches
client requires no assistance or cueing in any situation and is trusted in all situations 100% of the time to do task safely
Independent (Ind.)
caregiver is not required to provide any hands-on guarding but may need to give verbal cues for safety
Supervision (Sup.)
caregiver must provide hands-on contact guard to be within arm’s length for client’s safety
Contact guard/standby (Con. Gd./Stby)
caregiver provides 25% physical and/or cueing assistance
Minimum assistance (Min.)
caregiver assists client with 50% of the task (physical assistance or cueing)
Moderate assistance (Mod.)
caregiver assists with 75% of the task (physical assistance or cueing)
Maximum assistance (Max.)
client is unable to assist in any part of the task (caregiver performs 100% of the task for client physically/cognitively)
Dependent (Dep.)
purpose of this chart is to learn about a patient prior to seeing them, looking for pertinent info on pt
chart review
this type of weight bearing indicates that pt should be able to put full 100% of their weight on affected leg w/o causing damage to fractured site
Full weight bearing (FWB)
this type of weight bearing indicates that patients are allowed to judge how much weight they can put on affected leg w/o causing too much pain
Weight bearing as tolerated (WBAT)
this type of weight bearing indicates that no weight at all can be placed on the extremity involved
Non weight bearing (NWB)
this type of weight bearing indicates that only 50% of the person’s body weight can be placed on the affected leg
Partial weight bearing (PWB)
this type of weight bearing “no weight on affected leg; can rest foot on ground w/o putting weight through leg; affected leg may rest on ground during transfers for balance”
Flat foot weight bearing (FFWB)
this type of weight bearing indicates that only the toe can be placed on the ground to provide balance while standing; 90% of weight is on unaffected leg
Toe touch weight bearing (TTWB)
this type of weight bearing “UE restriction; do not put any weight through hand or wrist, but may bear weight proximally through elbow or forearm; must use platform walker; may not use hand to pull on bed rails or trapeze for bed mobility; no w/c propulsion
Platform weight bearing
Hip Precautions Posterior Approach:
- no hip flexion greater than 90 degrees
- no internal rotation
- no adduction (crossing legs/feet)
Hip Precautions Anterior Approach:
- no external rotation
- no adduction (crossing legs/feet)
- no extention
Bed Mobility in preparation for Transfer
recommended- supine sleeping position with abduction wedge or pillow; side lying with pillows
-rolling transfers (body moves as a unit)
Chair Transfer
- recommended: firmly based chair with armrests
- to sit: extend affected leg forward, reach back for armrests, sit slowly
- to stand: extend affect leg forward, push off armrests, supports body weight with unaffected leg
Commode Chair Transfer
-recommended: 3 in 1 commode chair with armrests
-
Shower Stall Transfer
- recommended: non skid strips or stickers in all stalls/tubs
- enter: walker/crutches go first, affected leg next, followed by unaffected leg
Shower-Over-Tub Transfer
- recommended: tub bench
enter: sit on edge of bench, carefully swing legs over tub while observing flexion precautions, using leg lifter as needed
Car Transfer
- recommended: bench seats, avoid prolonged seating, pillow behind back may be needed
- To sit: push seat back/reclined position, back up to seat, hold on to stable part of car, lean back/extend affected leg, slide buttocks toward driver seats, UE & LE move as unit to turn face forward
first 30 days after amputation is referred to
Golden Period
what are the benefits for prosthetic?
- Decreased edema
- Decreased postoperative and phantom pain
- Accelerated wound healing
- Increased prosthetic use and acceptance
absence or loss of limb at birth, usually result of deficit
congenital amputation
loss of part of all of extremity due to trauma or by surgery
acquired amputation
bulbous benign tumor that may develop at the proximal end of a severed nerve
neuroma
when amputee feels sensation coming from amputated limb
phantom sensation
unpleasant sensation of burning and shooting pain as well as squeezing sensation in the part that was amputated
phantom limb pain
shortening of ligaments and muscles which would otherwise allow for good motion at joint
contracture
breathing that prevents air from being trapped in the lungs, helps regulate breathing pattern, reduce anxiety from feeling out of breath
Pursed-lip breathing (PLB)
breathing helps strengthen your diaphragm; decrease energy used for breathing
Diaphragmatic breathing
Pursed lip and diaphragmatic breathing is indicated:
- difficulty breathing
- COPD
- Emphysema
- shortness of breath
What are the benefits of pursed lip and diaphragmatic ?
- release trapped air
- relaxation
- keeps airways opened (ease breathing)
- relieves shortness of breath
- improves breathing patterns
- prolongs exhalation to slow breathing rate
Energy Conservation
- environmental considerations
- elimination of unnecessary effort
- plan ahead
- prioritize
lower extremity amputee main focus
balance
acute care focus
treating edema
Energy Conservation:
- prioritize: spend time wisely
- plan:
- pacing: spend time wisely (taking your time)
- posture: better posture better use or muscle, less energy used
Initial precautions/contraindications for individuals with pulmonary disease:
- watch for dyspnea (painful breathing)
- watch for cyanosis (bluish skin)
- avoid chills & drafts
- avoid exposure to fumes, smoke, or other irritants
- avoid excessive fatigue
- administer oxygen as prescribed
- be aware of drug side effects
Cardiac risk factors:
- heredity, male gender, age (unchangeable factors)
- cholesterol levels, smoking, high BP, inactive lifestyle (changeable factors)
- diabetes, stress, obesity (contributing factors)
the amount of energy used doing a physical activity is referred to as
Metabolic Equivalent Task (MET) level
permanent destruction of tissue caused by release of energy from external agent
burn
skin taken from the same species (cadaver)
allograft
skin from another species
xenograft
the membrane from an amniotic sac
amniograft
a person skin from an unburned area
autograft
- 1-5 days to heal
- not going to seek care
1st degree burn
-14 days to heal
2nd degree burn (superficial partial-thickness burn)
-21 days to heal
2nd degree burn (deep partial thickness burn)
- variable healing time
- graft needed
- large burn
3rd degree burn (full thickness burn)
- variable healing time
- amputation or reconstructive surgery
4th degree burn
Edema Assessment:
- burn etiology
- medical history
- secondary diagnoses
- precautions from medical chart
- extent/depth of injury
- notes critical areas involved
- hand dominence
- previous functional limitations
- sensory limitations
- daily activities before injury
- psychological status
- spiritual and cultural values
Edema management:
- ace wrapping (most common to control swelling)
- shrinker (compression to reduce edema)
- removable rigid dressing (provide protection to residual limb)
largest organ of body
skin
pressure the blood exerts against the artery walls as the heart beats
blood pressure
moving
isometric
standing still (static)
isotonic
Goal Setting:
- let the reader know what you hope pt will achieve during therapy sessions
- cover specific things you want to address during therapy
- LTG by OTR during evaluation
- STG written by OTA
SMART stands for:
- specific
- measurable
- attainable
- realistic
- timely
Example of goal:
Current Status: Min assist toilet transfer
LTG: Pt will be mod I to complete toilet transfer with crutches to BSC
STG: Pt. will complete toilet transfers to BSC using crutches with CGA within one week
patient need assistance to prepare for task
Setup
patient uses adaptive equipment or staregies
Modified Independent
occur when the bones ability to absorb tension, compression, or shearing forces is exceeded
fracture
what causes lower extremity joint replacement
osteoarthritis and degenerative joint diseases
When patient transfers on to toilet, what side should they use to get on and off?
weak side to get on toilet and strong side to get off toilet so when they have no energy left- they have their strong side left.
what are the ROM terms?
within normal limits
within functional limits
impaired
R
resistance
GE
gravity eliminated
0 on strength scale
no palpable muscle contraction
1 on strength scale
feel palpation but pt cant move arm
2 on strength scale
gravity eliminated through full ROM
3 on strength scale
full ROM against gravity, no resistance
4 on strength scale
against gravity, mod resistance
5 on strength scale
against gravity, max resistance
a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.
contracture
AG
against gravity
Assistance Levels:
Dependent- total assistance
Max Assist- 75% assistance
Mod Assist- 50% assistance
Min Assist- 25% assistance
Contact Guard Assist- physical contact for balance & safety
Supervision- verbal cues for safety & technique
Setup- need assistance to prepare for task
Modified Independent- uses AE or strategies
Independent- no assistance
When completing lower body dressing after a hip replacement with AE and hip precautions which leg do you dress first?
affected leg followed by the unaffected leg
When completing lower body undressing after a hip replacement with AE and hip precautions which leg do you undress first?
unaffected leg followed by the affected leg
