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OCTY2210 Flashcards

1
Q

Information to gather when interviewing a patient with oedema

A 
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
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2
Q

Information to gather when completing a physical examination with patient with oedema

A 
Site of swelling 
Severity 
Skin condition
Function
Clinical oedema measurement (e.g. circumferential measurements)
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3
Q

Conservative Intervention options for patients with oedema

A 
Compression 
Massage
Positioning and elevation
Wound management
Skin care, hydration & protection
Functional patient focused goals 
Education
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4
Q

Key considerations in the reduction phase of compression in oedema management

A

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)
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5
Q

Key considerations in the maintenance phase of compression in oedema management

A 
Level of compression
Style of garment 
Material 
Cost
Application and removal
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6
Q

What is the glasgow coma scale?

A

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

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7
Q

TBI: Indices of severity

A

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)

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8
Q

PTA: Intervention approaches

A 
Orientation activities
Memory activities 
Basic cognitive skills 
Simple perceptual activities 
Engagement in basic ADL 
Physical rehabilitation 
Encourage engagement in meaningful activities 
Short sessions
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9
Q

TBI: Active inpatient rehabilitation OT role

A 
Goal setting 
Cognitive assessment/intervention
ADL/IADL 
UL assessment
Equipment perscription/training
Family education
Beginning aspect voc. rehab.
General Assessment post discharge needs
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10
Q

TBI:Discharge planning/transition phase: OT role

A 
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
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11
Q

TBI: Ongoing community rehab OT role

A 
Community living skills retraining
family support 
home programs 
involvement in community/social/recreational activities
Driving
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12
Q

Vocational rehabilitation

A 
Graded return 
Timing of return
Harness support (workplace) 
Familiar work?
Address self-awareness
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13
Q

Describe the Prevent, Manage, Review (PMR) Behaviour Model

A

Prevent: manage triggers; clear rules; communication; choice

Manage: Redirection; feedback; calming; defusing outbursts

Review/Recover: re-engage and problem solve, move on, self-care

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14
Q

Behaviour interventions

A

Management focuses around udnerstanding the person, the injury, the severity/range of impairment and the environment that the person is in.

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15
Q

Musculoskeletal effect of inactivity (4)

A

Loss of muscle tone/sarcomeres
Soft tissue shortening or lengthening
Joint changes
Changes to neural tissue

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16
Q

Information gathering and assessment: What to observe during task performance in a person with motor loss-weakness? (5)

A

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

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17
Q

What formal assessments could you use for a person with motor loss-weakness? (2)

A

ROM or Grip strength: performance components

UL Motor Assessment Scale (MAS)

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18
Q

Contemporary approaches to intervention for a person with motor loss-weakness (6)

A

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

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19
Q

Which factors increase the risk of shoulder subluxation? (4)

A

A fall risk
Incorrect handling
Incorrect positioning/poor UL support
Incorrect passive movement

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20
Q

Assessment of shoulder subluxation (3)

A

X-Ray measurement
Measure between acromion process & humeral head
Finger width

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21
Q

Prevention of shoulder subluxation (4)

A

Facilitate motor return
Have good structural stability around joint
Slings sometimes used for transfers, mobility, toileting or showering

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22
Q

Positioning & Handling fror shoulder subluxation

A

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

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23
Q

Intervention: hemiplegic shoulder pain

A

Strapping and botox injections may be effective for pain

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24
Q

Prevention: hemiplegic shoulder pain (3)

A

Shoulder strapping
Education - preventing trauma
Active motor training to improve function

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25
Information gathering: Hemianopia, neglect and inattention
Visual fields test | Observation of functional tasks
26
Information gathering: Inattention and neglect (visual) (5)
``` Extinction Visual extinction Line bisection Clock drawing Observation of functional tasks ```
27
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
28
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
29
Apraxia: Information gathering/assessment
Occupational/task analysis, AMPS & PRPP Performance components: ideomotor and Occupational Therapy Adult Perceptual Screening Test (OT-APST)
30
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
31
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 ```
32
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
33
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
34
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
35
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
36
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)
37
Aims of resting splints in UL hypertonicity management
Reduce tone Prevent organic contracture Maintain joint alignment at rest
38
Aims of functional splints in UL hypertonicity management
Position and stabilise joints for function | Promote mechanical advantage of weak muscles
39
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
40
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)
41
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
42
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?
43
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
44
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
45
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)
46
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) ```
47
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
48
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
49
Patterns of spinal cord injury: UMN above T12
Reflex arcs intact
50
Patterns of spinal cord injury: LMN below T12 & cauda equina, conus
Very different pattern affecting bowel, bladder and sexuality
51
Spinal cord syndrome - central cord
Occurs in neck and affects UL mobility
52
Spinal cord syndromes - Brown-Sequard syndrome
Results in impairment to one side of the spinal cord
53
Spinal cord syndromes - Anterior cord syndrome
Impairment to motor systems
54
Spinal cord syndromes - Cauda Equina Syndrome / Conus Medullaris
Result in partial loss of motor and sensation to bowel, bladder and sexual functions
55
Effects of SCI on musculoskeletal system
``` Paralysis (below level) Muscle weakness Spasticity or flaccidity Wasting Loss of ROM Balance Posture Pain ```
56
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
57
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
58
Effects of SCI on body temperature and control
Inablity to shiver or sweat below leison Assume the temperature of environ. Hypothermia / heat stroke
59
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 ```
60
Effects of SCI on bowel and bladder function
Management depends on level/completeness of injury - UMN is reflexic BUT LMN is flaccid
61
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
62
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)
63
Role of OT in driving cessation
``` Education responsibilities/ strategies Duty of care Future planning Assessment/education about community mobility Report unsafe drivers ```
64
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
65
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

OCTY2210 (1 decks)

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