OCTY2210 Flashcards
Information to gather when interviewing a patient with oedema
Onset of swelling Time of swellling Distribution Percipitating factors (e.g. heat) Reducing factors (e.g. elevation) Symptoms (e.g. heaviness/pain) Effect on Function (i.e. ADL) Psychosocial issues
Information to gather when completing a physical examination with patient with oedema
Site of swelling Severity Skin condition Function Clinical oedema measurement (e.g. circumferential measurements)
Conservative Intervention options for patients with oedema
Compression Massage Positioning and elevation Wound management Skin care, hydration & protection Functional patient focused goals Education
Key considerations in the reduction phase of compression in oedema management
Degree of compression applied by a bandage will depend on:
- a high or low stretch bandage
- Size/shape of lumb
- Figure 8 (higher pressure) or Spiral (lower pressure) application
- Amount of bandage overlap (max 50% in a high stretch bandages)
Key considerations in the maintenance phase of compression in oedema management
Level of compression Style of garment Material Cost Application and removal
What is the glasgow coma scale?
Neurological scale that measures the degree of responsiveness (level of coma) on a 15 point scale (3-15) - repeatedly over the first 24 hours until they reach consciousness.
3 dimensions: Eye opening, best motor response and best verbal response
TBI: Indices of severity
Depth of coma (lowest GCS in first 24hrs)
Length of coma (rate of change of GCS)
Length of post traumatic Amnesia (more than 7 days severe)
PTA: Intervention approaches
Orientation activities Memory activities Basic cognitive skills Simple perceptual activities Engagement in basic ADL Physical rehabilitation Encourage engagement in meaningful activities Short sessions
TBI: Active inpatient rehabilitation OT role
Goal setting Cognitive assessment/intervention ADL/IADL UL assessment Equipment perscription/training Family education Beginning aspect voc. rehab. General Assessment post discharge needs
TBI:Discharge planning/transition phase: OT role
Reassess/give feedback on progress involve family - lvl care/supervision Home visit (modifications) Medical advice about driving/alcohol educate - community resources Arrange referral/follow up
TBI: Ongoing community rehab OT role
Community living skills retraining family support home programs involvement in community/social/recreational activities Driving
Vocational rehabilitation
Graded return Timing of return Harness support (workplace) Familiar work? Address self-awareness
Describe the Prevent, Manage, Review (PMR) Behaviour Model
Prevent: manage triggers; clear rules; communication; choice
Manage: Redirection; feedback; calming; defusing outbursts
Review/Recover: re-engage and problem solve, move on, self-care
Behaviour interventions
Management focuses around udnerstanding the person, the injury, the severity/range of impairment and the environment that the person is in.
Musculoskeletal effect of inactivity (4)
Loss of muscle tone/sarcomeres
Soft tissue shortening or lengthening
Joint changes
Changes to neural tissue
Information gathering and assessment: What to observe during task performance in a person with motor loss-weakness? (5)
Evidence of mobility impairments at specific joints
Missing or limited components
incorrect timing of components
Evidence of weakness or paralysis of specific myscles
Compensatory motor behaviour
What formal assessments could you use for a person with motor loss-weakness? (2)
ROM or Grip strength: performance components
UL Motor Assessment Scale (MAS)
Contemporary approaches to intervention for a person with motor loss-weakness (6)
1) Task specific training: patient’s lvl of motion; progressed for motivation, challenge and engagement.
2) Simple repetitive exercises
3) Bimanual training & practice
4) CIMT
5) Supplementary methods: mental practice, mirror box, Electrical stim or robot assisted training
6) Sensory retraining
Which factors increase the risk of shoulder subluxation? (4)
A fall risk
Incorrect handling
Incorrect positioning/poor UL support
Incorrect passive movement
Assessment of shoulder subluxation (3)
X-Ray measurement
Measure between acromion process & humeral head
Finger width
Prevention of shoulder subluxation (4)
Facilitate motor return
Have good structural stability around joint
Slings sometimes used for transfers, mobility, toileting or showering
Positioning & Handling fror shoulder subluxation
Shoulder integrity maintained at all times
This can be done through devices like a lapboard, table or arm trough
Optimum position: nornal alignment, mid-rotation, good posture and symmetry
Intervention: hemiplegic shoulder pain
Strapping and botox injections may be effective for pain
Prevention: hemiplegic shoulder pain (3)
Shoulder strapping
Education - preventing trauma
Active motor training to improve function
Information gathering: Hemianopia, neglect and inattention
Visual fields test
Observation of functional tasks
Information gathering: Inattention and neglect (visual) (5)
Extinction Visual extinction Line bisection Clock drawing Observation of functional tasks
What might you observe as the impact on occupational performance for inattention and neglect (3)
Personal or body neglect
Near peripersonal spatial neglect
Far extrapersonal spatial neglect
Neglect, inattention and hemianopia intervention
STEP 1: Education & awareness raising
STEP 2: Address the question of recovery
STEP 3: Identify the specific functional goals
STEP 4: Explain the intervention options
STEP 5: Commence compensatory visual scanning training
Apraxia: Information gathering/assessment
Occupational/task analysis, AMPS & PRPP
Performance components: ideomotor and Occupational Therapy Adult Perceptual Screening Test (OT-APST)
Impact of Apraxia on occupational performance
Negative impact engagement in meaningful activity
Increases dependency in basic self-care tasks
More severe apraxia = higher burden of care
General principles of apraxia interventions
Practice functional tasks w/ graded instructions, assistance and feedback Goal-based practice patient/carer Keep commands simple Cues (external) Ecnourage mental practice cues Guided practice w/ manual contact Compensation strategies Natural context/environment Errorless learning
What are positive symptoms (4)? (hypertonicity management)
Excessive or exaggerations of mvmnt due to hypertonicity, hyperactive reflexes, clonus (imbalance in contraction) and synergistic movement patterns
What are negative symptoms (3)? (hypertonicity management)
Losses or deficits in mvmnt due to: Changes in motor unit number, type & recruitment
Mechanical restraint
Muscular imbalance
What kind of symptoms do we want to support and which ones do we want to block?
We aim to support NEGATIVE symptoms and block POSITIVE symptoms
Implications of UL hypertonicity (6)
Varying degrees of hypertonicity occuring at rest & activity
Poor coordination & quality of mvmnt
Joint changes (possible)
Organic contractures (possible)
Gross arm movement and grasp cha
llenge
Some patients even start to have absent or limited voluntary movement
General interventions for managing UL hypertonicity
UL function Retraining
Functional Splints
Resting Splints
Casting and/or Boulinum Toxin and/or surgery (along with splints to maintain)
Aims of resting splints in UL hypertonicity management
Reduce tone
Prevent organic contracture
Maintain joint alignment at rest
Aims of functional splints in UL hypertonicity management
Position and stabilise joints for function
Promote mechanical advantage of weak muscles
When is splinting appropriate in UL hypertonicity management ?
When retraining activities alone do not prevent the hand/arm from moving into positions of deformity at rest OR less optimal positions for mechanical advantage during activity
When is splinting not enough in UL hypertonicity management?
When there is an organic contracture (serial casting)
When hypertonicity is high that a well-fitting splint cannot be made
When joint changes are present (?surgery)
Observational assessment of wrist and finger patterns: UL hypertonicity management
Stretch wrist back - stretching wrist flexors
Evaluate effect of wrist position on grasp
o Extend wrist with fingers flexed: (contracture at the rest); Extend wrist with fingers extended: (determines if contracture at the finger flexors)
o Adjust wrist position to the point where active finger extension possible (if person has active movement) or where a relaxed hand position can be maintained (using natural biomechanics of the hand to hold things
This is the wrist position you will make your functional or resting splint in
Key processes in intervention for patients with UL hypertonicity (4)
1) Observation of Client
2) Identify goal
3) What challenges may they have?
4) How can we address these challenges?
What is the processs of facilitation in UL hypertonicity management
1) restore “normal” allignments (best mech advantage)
2) Assist the mvmnt using handling
3) feel for response - reduce handling as client actively assists
4) lighten messages of your hands so the client has to work harder (verbal fdbck!)
5) Withdraw your assist until voluntary action of client
Which goals/tasks could you use to facilitate participation for a person with no functional use of their arm?
Attention to affected UL (washing, positioning UL)
Preventional goals: learn shoulder protection, self-ROM and positioning
Which goals/tasks could you use to facilitate participation for a person with minimal movement return in their arm?
Postural support & weight-bearing
Bed mobility assist
UL for assistance during transitions (e.g. reach back when sitting)
Postural support in sitting/standing (e.g. grab rail in shower)
Which goals/tasks could you use to facilitate participation for a person with some movement return in their arm but limited hand function?
Supported reach (hand does not leave support surface) Wiping table, push shopping trolley, apply body lotion Lock wheelchair breaks Anti-gravity shoulder mvmnts (e.g. arm into sleeve)
Which goals/tasks could you use to facilitate participation for a person with increasing movement return in their arm?
Grasp: static grasp e.g. stabilise food while cutting, hold wash cloth
Reach: grade activities by height/distance reached, weight of object, speed and accuracy
How does the letter and number system work in terms of spinal cord injuries?
This system is a way of classifying the etent of injury. The number is the last fully functional level and teh letter refers to increasing levels of impairment
Patterns of spinal cord injury: UMN above T12
Reflex arcs intact
Patterns of spinal cord injury: LMN below T12 & cauda equina, conus
Very different pattern affecting bowel, bladder and sexuality
Spinal cord syndrome - central cord
Occurs in neck and affects UL mobility
Spinal cord syndromes - Brown-Sequard syndrome
Results in impairment to one side of the spinal cord
Spinal cord syndromes - Anterior cord syndrome
Impairment to motor systems
Spinal cord syndromes - Cauda Equina Syndrome / Conus Medullaris
Result in partial loss of motor and sensation to bowel, bladder and sexual functions
Effects of SCI on musculoskeletal system
Paralysis (below level) Muscle weakness Spasticity or flaccidity Wasting Loss of ROM Balance Posture Pain
Effects of SCI on respiratory system
Paralysis of respiratory muscles
May require assistance to cough
Higher risk of chest infections & aspirations (as unable to clear secretions)
Fatigue
How can an OT manage the effects of SCI on the respiratory system
Through postural considerations e.g. a powerchair or sitting more upright in bed
Effects of SCI on body temperature and control
Inablity to shiver or sweat below leison
Assume the temperature of environ.
Hypothermia / heat stroke
How can an OT manage the effects of SCI on body temperature & control
Education about: Adequate ventilation & hydration Reverse cycle air conditioning Sufficient clothing/bed clothing Avoiding being in sun
Effects of SCI on bowel and bladder function
Management depends on level/completeness of injury - UMN is reflexic BUT LMN is flaccid
SCI and autonomic dysreflexia
Occurs SCI T6 or above
Caused by painful sesnsation below cord damage (e.g. full bladder)
This starts an ANS reflex which raises BP BUT the cord damage stops the body controlling this reflex, further raising BP –> if the cause is not fixed, BP goes very high and may cause stroke
Occpational therapy role in SCI rehabilitation
1) Functional strengthening
2) Splinting/passive ranging exercise
3) Odema management
4) Education for sensory impairment
5) Pressure area prevention
6) ADL retraining
7) Sexuality & parenting
8) WC prescription
9) AT; access (environmental controls, adapting task/environment)
Role of OT in driving cessation
Education responsibilities/ strategies Duty of care Future planning Assessment/education about community mobility Report unsafe drivers
Factors promoting good outcomes when discussing driving assessment/ cessation
Clear communication
Clear verbal/written info with client & family
Clear communication w/ primary HC provider
Discuss alternate options
Education in how to use alternate methods
Fair/reasonable plan
PLISSIT Model
PERMISSION they can discuss this issue (all OTs)
LIMITED INFO giving info/education about sexuality (some OTs)
SPECIFIC SUGGESTIONS aimed at problem solving/goals
INTENSIVE THERAPY: requires sex therapist
